My colleague, Tom, shared his reflections as we discussed the year which is drawing to a close.
Tom has worked in emergency departments as a junior doctor for years and my heart thudded as he voiced this scarring memory.
It wasn’t just the scene that he was describing which spooked me, nor his fear that somebody might have been hurt because the department was unmanageably busy. It was that knowing sickening feeling creeping up – the usual feeling of fear that comes with the heightened demand at this time of year.
Through each year, the lines become less and less defined as year-round ‘winter’ pressures on the healthcare system become the norm and can no longer be brushed off as seasonal. There is simply no room for further demand.
One of the key problems facing emergency medicine is its struggle to recruit and retain doctors.
The privilege of providing life-saving care, the satisfaction of comforting an old lady when she is too scared to be admitted to hospital, and the pleasure of working with colleagues across different specialities – are all reasons why I thoroughly enjoyed my rotation in emergency medicine.
Despite the satisfaction myself and my colleagues take from our work, there are continual challenges that present themselves across all medical specialities – stress, low morale and burnout.
Figures this year show that more doctors are leaving the NHS across England, and fewer people are applying to medical school. Sadly, Yorkshire is among the worst areas in the country for recruitment and retention.
Earlier this year, my dad underwent a life-saving procedure for his heart before dawn on a Monday morning. Undoubtedly, he is still with us today because of the excellent care he received, and I have immense gratitude for my colleagues who treated him.
Yet, despite the life-saving work, doctors are not superhuman. Though myself and my colleagues strive to consistently deliver the best care possible, there will inevitably be times when this is not achievable.
It is a vicious cycle. The more overstretched staff become, the more they are rushed and overworked leading to daily concerns such as lack of sleep. Long-term exposure to this becomes more problematic leading to more serious health issues such as stress and burnout. Ultimately, this strain on doctors leads to worse care for patients.
The British Medical Association is currently running a campaign to tackle stress and fatigue among doctors, focusing on improving their health and wellbeing. Their ‘Gift of Five’ campaign is promoting the use of the Headspace mindfulness app – encouraging doctors to take their breaks and spend short space of time out of their hectic schedules to cope with working under winter pressures and exam stress.
This is a welcome incentive and one that will hopefully continue. However, the root causes of the problems facing the NHS will not be solved with a five-minute fix. Over the last few years, I have seen many colleagues burnout from the burden of working as a doctor and the daily struggles of a broken system.
For this to change, we need to address the underlying issues: recruitment and retention, workforce planning and underfunding. We need longer-term planning that will put the NHS on the sustainable footing it needs rather than the usual short-term solutions that provide a sticking plaster but fail to repair the underlying damage.
Over the last year, I have seen babies who have been victims of abuse, children facing death and families struggling to accept a life-changing diagnosis for their child.
Like many doctors, I worry that I have made the wrong decision for a patient, fear that a patient may not survive, or feel guilt that I cannot spend as much time with a patient as I would like.
Despite this, I take a great deal of joy in caring for my little patients. As doctors, it is in our nature to want to fix a problem and help. Yet on a larger scale we are powerless to fix the wider problems facing the NHS; this must come from government.
As I wander through my hospital full of wonderful Christmas decorations, glitter-coated play specialists and a surprising amount of cheer, I long to know that our health service is safe.
I think of my patients: Paul with his muscle weakness, Jeannie with her immune system problem and Zainab with her lung condition. These children are all unwell with chronic illness through no fault of their own. They will require the help of the NHS for many years to come. I can only hope that their care will be safe in the future ahead.
My wish for 2018 is that the Government looks after our NHS, so that we as doctors and healthcare workers can look after you.
Melody Redman is a junior doctor in children’s medicine in South Yorkshire and is a BMA junior doctor representative. Names have been changed to protect the identity of patients and colleagues.