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NHS bosses must tackle mental health crisis among doctors, says BMA

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5974 (Published 10 October 2019) Cite this as: BMJ 2019;367:l5974

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Re: NHS bosses must tackle mental health crisis among doctors, says BMA- Mentoring with Intent

Physician burnout and moral injury is now recognized as a crisis within our profession. Also, at the forefront of many discussions is the concept of mentorship and sponsorship. Might we consider the two as a packaged deal in terms of shifting culture?

Surgery has long depended on the passing of knowledge and practice from generation to generation. In centuries gone by, apprenticeships were undertaken by aspiring physicians who would learn the particulars of the craft for years prior to undertaking independent care of the sick and injured. There is no doubt that still today, the techniques of surgery are taught through closely monitored experience and that we advance to independent practice once we are deemed competent. This is called training. It is not, by definition, mentorship.

Mentorship differs from training in that it is a form of all-inclusive guidance down a given path. It includes not only technique training but modeling behaviors, providing support, advice and giving direction for how the future of the profession should look. Surgical consultants in teaching roles may or may not intend to disseminate this non-technical information, but nevertheless it is occurring. We do not choose to be mentors but are chosen by mentees or otherwise forced upon them by our academic position. The result of this relationship is us, whether intentionally or unintentionally, perpetuating our values, beliefs, and behaviors.

Surgery, we know, is a particularly treacherous path in terms of mental and emotional health. We are all aware of the concept of the second victim, and the pressure, responsibility, and emotional toll that caring for the sick can take. Even with that knowledge, we continue to model and mentor behaviors within the surgical community that add to the moral injury incurred throughout training and into practice. Examples of would-be mentors using intimidation, discrimination, marginalization, cynicism, fear as motivation, and harassment continue to be a normalized part of the experience of residency training.

We look to self-care, wellness initiative, work-life balance, restricted work hours, and resilience training for answers to the low morale, job dissatisfaction, and demoralization of doctors. I have no doubt that all of these initiatives are important for the overall wellness of physicians. I also believe that this represents an empirical treatment for an illness that is much more deep rooted in the genetic fabric of surgery than we truly understand and is progressing with each new generation of surgeons.

This, I think, is the role of the modern mentor:

To recognize and understand that regardless of choosing to be, we are mentors.
To mentor with intent by recognizing flaws in our own behavior, their origins, the effect they have on us and those we teach.
To mentor behavior that improves our culture, relationships, and wellness by creating safer workplaces free of harassment and intimidation.

Stephanie Atkinson, MD, FRCS(c) is an orthopaedic surgeon and Clinical Assistant Professor of Memorial University of Newfoundland in Newfoundland and Labrador, Canada. She is currently completing a MSc in surgical science and practice at the University of Oxford.
Twitter @abonesurgeon
Instagram @barbiefixesbones

Competing interests: No competing interests

14 October 2019
Stephanie E Atkinson
Orthopaedic Surgeon
Newfoundland, Canada