“I wasn’t alone after all”—how modelling vulnerability can support staff wellbeing
BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q1313 (Published 14 June 2024) Cite this as: BMJ 2024;385:q1313
- Jess Morgan, Dinwoodie RCPCH clinical fellow
I was a couple of months into my paediatric training when I experienced the death of a child for the first time. Afterwards, in the darkness of the medicines’ cupboard, I cried, but it wasn’t long before a senior doctor found me. They told me that this was part of the job and I simply had to “toughen up.” Ashamed of the tears I had shed, I concluded that displaying emotion was to overstep the professional line between doctor and patient. “Empathy,” I was told, “is not the same as sympathy and you won’t make it in the specialty if you get upset.”
I did my best to take heed of this advice, yet somehow I couldn’t shut out my emotions. I would cry in the sluice after the death of a patient or feel upset after resuscitating a child. I’d battle the guilt of calling in sick, the overwhelm and anxiety of rota gaps, or the sheer exhaustion of a long day, all the while wondering how my colleagues seemed to cope with everything seamlessly.
I carried this narrative for years, coming to believe that I was somehow flawed for not being “tough enough” as a doctor. Then, during my registrar training, I became unwell with burnout, anxiety, and depression. This was a whole new level of vulnerability, one that I’d never seen anyone talk about in medicine. How could I begin to share this information with colleagues and how would I shake off the sense of shame?
After almost a year off sick, I started to return to work. Unsure of how to justify my absence, I practised set phrases again and again. When asked directly, I made up excuses and brushed over the truth. Then gradually, I felt able to share what had really happened, first over a cup of tea with a few kind and compassionate colleagues, then at departmental teaching and wider regional study days. Being a more authentic version of myself felt empowering, but more than anything, revealing my own humanity seemed to offer my colleagues permission to share their stories. Soon I came to realise that I had never been alone after all.
Building belonging
Why is it that doctors find it so hard to show this side of themselves when emotion is an integral and unavoidable part of the job? From as early as medical school, doctors build a sense of collective identity, a professional persona that unites them. Yet this sense of self too often comes with an unrealistic expectation that doctors will not be affected by witnessing the suffering and pain of others.
This ingrained culture of stoicism leads doctors to conceal their feelings, impassively complying with the demands of the job.1 Without the space for day-to-day conversations about how doctors feel, emotions are inadvertently pathologised, leaving staff to feel “abnormal,” “sensitive,” or “unable to cope” when they do experience them. If we start to depathologise vulnerability, however, we begin to recognise that grief, upset, stress, overwhelm, and the vast array of other emotions we experience when practising medicine are an inevitable part of being human.2
In a bid to connect with our inherent vulnerability, it is imperative that we focus our efforts on fostering a sense of belonging within teams. In busy healthcare settings, with staff shortages, irregular shifts, and rotating doctors, it can be hard to maintain this connection, but it’s worth the effort. Evidence shows that belonging is fundamental to wellbeing and departments with thriving staff have better patient outcomes.34 We need environments that are inclusive and that offer spaces where people feel brave enough to be their authentic selves and speak up without fear of repercussions. Staff need to feel seen, valued, and recognised for their effort.5 Despite the finite resources and incessant pressures in healthcare systems, these things are well within our control. So how do we begin to create this kind of organisational culture? Conversations that chip away at the professional mask of indifference are a start.
Over the past 15 years, a growing number of organisations have begun using Schwartz Rounds as a way to support staff and encourage teams to discuss the emotional impact of their jobs. Evidence has shown that these multidisciplinary forums reduce stress and feelings of isolation, improve teamwork, and enhance empathy and compassion towards patients.67
Charities such as Doctors in Distress also host facilitated peer support groups for sharing and processing the emotional impact of caregiving. Vulnerability doesn’t need to be confined to designated spaces such as Schwartz Rounds or peer support groups, however. A compassionate, curious, and vulnerable conversation over coffee can be a hugely empowering and supportive experience.
Finally, don’t underestimate the power of modelling your own humanity. We all have patients that we carry with us. For me, it’s the case of a 2 year old child who had a prolonged and traumatic resuscitation, one that left me with confusing and upsetting emotions. I sat with a senior doctor and I cried. Then I realised that he too was crying. At that moment, I was no longer a “sensitive” doctor who couldn’t handle the job. Instead I was someone who cared deeply for my patients, and perhaps that wasn’t such a bad thing after all.
Footnotes
Competing interests: JM advocates nationally to reduce the stigma around doctors’ mental health. Through this work she has been appointed an ambassador for the charity Doctors in Distress but at the time of publication she had not yet taken on any activities in this role.
Provenance: commissioned; not peer reviewed.
Jess Morgan will be speaking about this topic at the International Practitioner Health Summit 2024: The Wounded Healer taking place on 27-28 June 2024.