Being a junior doctor is difficult, and there are many reasons for burning out:
There are many solutions to burning out as a junior doctor, but one method that’s worked for me is my interest in the medical humanities.
Not many people know about the medical humanities, so I thought I’d start off with a definition.
We define the term “medical humanities” broadly to include an interdisciplinary field of humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice. The humanities and arts provide insight into the human condition, suffering, personhood, our responsibility to each other, and offer a historical perspective on medical practice. Attention to literature and the arts helps to develop and nurture skills of observation, analysis, empathy, and self-reflection — skills that are essential for humane medical care. (1)
Personally, I find the arts remind me of just how wonderful it is to be a doctor, and the enormous privilege of being able to become involved so intimately in the lives of strangers at times of stress, fear and vulnerability. I’ll be blogging on various types of art that have relevance to medicine over the coming months.
This first blog post will be about one of my favourite books “Cancer Made Me a Shallower Person” by Miriam Engelberg. The author was diagnosed with breast cancer, and following this she began writing comics. It’s a tragic, funny and inspiring book and has implications for the way healthcare professionals communicate with patients with cancer, the way all of us talk to patients with cancer, and most importantly, what it might be like to be diagnosed with cancer.
The shock of a cancer diagnosis is difficult to imagine. Cancer has an enormous cultural cachet. Many people are not aware of heart failure or chronic renal disease or the ravages of dementia, but almost everyone is wary of the threat of cancer. It’s a public disease, one with a history and one with stigma. It’s synonymous with death in many people’s minds, and often in the emergency department or general practice, patients present because they are worried they have cancer. This comic demonstrates the jumble of thoughts, fear and panic that may accompany the first diagnosis.
The mastectomy in breast cancer is a physical reminder of illness in a way that other illnesses do not mark the patient. The patient with brain cancer, an ischaemic heart, hypertension, high cholesterol may appear as all of us externally. The physical fact of surgery is hard to escape, and it is impossible to deny the importance of breasts for women and all the implications their removal entails (the recognition of this is evident in the number of women who elect to undergo breast reconstruction following surgery). This comic explores this and also the all-important aspect of the reactions of others to the diagnosis. Cancer is a difficult enough diagnosis but made more difficult by the patient having to deal with the feelings of others.
One of the difficult aspects of a cancer diagnosis is stigma, and the hidden thoughts that people harbor about people who get cancer and people who do not survive cancer. Our culture is filled with messages about eating healthy, regular exercise and relaxation strategies. In fact, health is within our control and we can prevent lifestyle diseases such as diabetes, heart disease, high cholesterol and high blood pressure. But unfortunately many diseases are idiosyncratic, genetic, and outside the patient’s control. The tragedy lies when we mistake our ability to control our weight with our ability to not get cancer. These assumptions are dangerous and hurtful. In my opinion, even when there is justified evidence (e.g. smoking causing lung cancer), discussing aetiologies with the diagnosed cancer patient is unhelpful.
If not already evident, this book is ultimately funny, and this for me, is the most important part of the book. Medicine deals with disease, and disease is rarely funny. It causes suffering, reduces people’s function, reduces people’s life expectancy – it’s hard to find the humour in it. But ultimately, people live with diseases, and in that time, it is part of our role to ensure that they live with dignity. Part of living with dignity is to be able to laugh at oneself, to have others laugh at us – in other words, as we were when we were healthy. This final comic looks at the underlying tensions in the chemotherapy suite.
In conclusion, this book changed the way I communicated with and talked to patients with cancer, and also patients in general. Empathy is central to the practice of medicine, and books such as these help us to imagine what it might be like to be unwell. There is an extensive literature created by patients about the experience of illness and many are fascinating – Jean Dominique Bauby’s The Diving Bell and the Butterfly, John Diamond’s Cowards Get Cancer Too, and Kay Redfield Jamison’s An Unquiet Mind.
As junior doctors we are often spending the most time with patients and families in hospital, and it is a wonderful opportunity to make a positive difference to a patient’s experience of their illness. Being kind, listening and taking some time out are some simple things that can make a difference.
Please leave comments below with any suggestions of poems, film, literature or art that have changed the way you practice medicine or you think are valuable for other doctors.