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Views And Reviews Wounded Healer

Clare Gerada: Doctors and their defences

BMJ 2019; 364 doi: (Published 04 March 2019) Cite this as: BMJ 2019;364:l871

Re: Clare Gerada: Doctors and their defences

I was in Nairobi in November giving a series of talks to Strathmore University medical staff about mental health and burnout - the College where Theresa May did the famous dance. There is one psychologist for 6500 students - not counting staff - so I think if she wasn't burnt out to a cinder she should have been. Defence mechanisms were discussed and empathy, friendship, peer support, humour and altruism or doing things for a higher purpose eg helping those in need.

The students have much the same type of issues as any third level group. Smart phone addiction and screen times are as widespread there as anywhere and contribute to isolation, loss of friends and mental health issues. I used "The Big Five" animal tag as a reminder of the five pillars of mental health that we all should have and are fundamental somatic defence mechanisms - the animals are Lion, Leopard, Buffalo, Elephant and Rhinoceros. The five pillars are - a good night's sleep, and adequate nutritious diet, exercise appropriate to our stage of life, someone to talk to and be friends with, and an occupation or job of good fit. These are also defence mechanisms any stressed doctor can incorporate into their lifestyle to enhance those defences Clare Gerada mentions in her article. Some jobs are toxic, some are stressful, some are routine and all need to be studied to see how to improve motivation, fulfilment, satisfaction, collegiality, and seeing how to bring the joy back into medicine. Jobs can overwhelm and incapacitate staff especially conscientious staff.

Doctors and nurses and their staff need to assess their job spec and see if they have a job description, a clear outline of what their responsibilities are and are not, and an avenue of consultation to iron out discrepancies in their real world from what it says on their paper job description (if they have one). A toxic work situation - bullying, very unsuitable material conditions, excessive demand and protracted hours, absence of support or acknowledgement, etc - is a health and safety issue and staff need to exit or be protected. Many medical jobs are toxic and the morbidity and mortality related to them speaks volumes. The ultimate defence mechanism in a toxic environment is to exit it and find alternative work.

Competing interests: No competing interests

07 March 2019
Eugene Breen
Psychiatrist, Associate Clinical Professor
Mater Misericordiae University Hospital Dublin, University College Dublin