‘Hello? This is Jenny the colorectal intern. I’m incredibly sorry for this late consult…’
My knuckles were white as I gripped the open medication chart and progress notes which were held on standby ready for a barrage of closed questions from the aged care registrar on the other end of the phone line. It was 3:45pm on a Friday, and I expected to be berated for asking for this untimely consult for consideration of inpatient rehabilitation for my patient which probably could have waited until Monday.
I was shocked, instead, to hear words of praise on the other end, ‘What a fabulously concise yet detailed consult. Thanks for outlining all their allied health reviews and rehab goals. Sounds like he needs inpatient rehab. I’ll bring the aged care boss around this evening.’
Four years on, I can say that unexpectedly positive response from the registrar had left a lasting impression on me.
The term resilience has earnt a dirty reputation in the context of junior doctor mental wellbeing, as outlined by Dr Toogood’s excellent article (1). The suggestion that doctors facing mental distress and burnout at work need to ‘bounce back’ from adversity and be more resilient has understandably resulted in significant backlash from both junior and senior doctors, about the system not taking responsibility.
Of course, long work hours, lack of schedule breaks, difficulty in taking sick leave and ADOs are systems-based rostering and funding issues that are in desperate need of improving. But the culture of the health system is created by the individuals within it, and to delegate responsibility to improve the culture without reflecting on and changing our own behaviours would be irresponsible.
A few weeks ago, as the medical admissions registrar I took a number of calls from emergency colleagues, both junior and senior. They were of varying quality and thoroughness. Against my instinct to take the bare details of handover and then hang up, I made an effort to give a piece of positive feedback for all of them, even sometimes a teaching point or two. The experience was eye-opening. It turned handover from a chore into something rewarding, for both parties involved. Acknowledging the human at the other end of the phone line, trying their best to do their work under time stresses and limited resources was gratifying.
Sadly, in the currently over-stretched, mentally exhausted junior doctor workforce, praise is often the last thing we are likely to give or receive. Contributing to the lack of praise is the high level of neuroticism – a common personality trait amongst doctors (eloquently discussed by Linda Wu in the blog ‘Physician Know Thyself’) (2). High levels of neuroticism and perfectionism in an era of endless ‘CV creep’ (3) as jobs become more scarce and competition escalates, drives junior doctors to strive for individual achievement without giving time to recognise our own and our colleagues’ praise-worthy moments.
Neuroticism has been shown to predispose to doctor burnout in a recent systematic review of UK doctors, (4) but also contributes to the ruthless culture in the hospital system where ‘no news is good news’. Other possible contributing factors to the lack of praise in the hospital workplace could be the lack of time and the concern that any feedback, if interpreted in the wrong way could be seen as ‘bullying or harassment’ by junior staff.
Also, hospitals, especially tertiary centres, are so subspecialised that compliments may not be deemed appropriate between specialties. Perhaps it’s not the job of a medical registrar to give constructive feedback to ED, and that ED physicians should feedback to ED? Should only consultant physicians give feedback to medical registrars? And so forth? The strong hierarchal nature of medicine is also likely to hinder junior doctors from giving feedback to their seniors, thereby limiting the extent of 360-degree feedback, which has been shown to improve performance and collegiality (5). Unfortunately, in many instances feedback and term evaluations for junior doctors has been reduced to simple, impersonal tick box exercises at the end of terms, where only when the individual is truly struggling do they get personalised, goal-orientated feedback and ‘action plans’ for improvement.
Just as there is not a single antibiotic for all infections or a magic bullet cure for cancer, there is no one solution which can address the multifaceted burnout epidemic being faced by junior doctors. Yet, what is common for most of us at least is that we chose this profession to make a difference during the most challenging times in the lives of our patients. To give acknowledgement for doing that successfully amidst a hellish day on the wards is perhaps one of the cheapest, simplest and most effective steps to remind the overworked junior doctor that their 15-hour shift was worth it (to an extent). Adequate breaks, rostering and provision of sick leave are of course all still critically important to ensure junior doctors can recharge.
So next time you see a fellow junior doctor do something well, acknowledge it with a compliment. Likewise, compliments and praise can and should be given to anyone in the hospital – from the ward clerk who kindly booked all your patients’ follow-up, to the porter who came on time to transfer your patient for urgent imaging, to the nurse who astutely recognised a transfusion reaction and appropriately escalated, and finally the consultant who artfully lead a family meeting and reconciled advanced care goals for the patient at the end of their life journey.
Above all, praise and thank your patients, who bravely endured the cannulas, agreed to be guinea pigs for Saturday physician training exams, kindly donated their time to enrol in a research study, or simply held it together best as they could despite feeling absolutely miserable.
Together, let’s improve the culture and resilience in our hospital family, one praise at a time.
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