In March 2015, the GMC launched Medical professionalism matters – a series of events and online discussions where frontline clinicians can discuss the challenges to professionalism that emerge in their daily practice. The contributions and discussions will feed in to a report next year about the state and future of medical professionalism. We will use this site to share early drafts of the report for comments.
Now halfway through the programme, the General Medical Council’s Chief Executive, Niall Dickson reflects on some of the issues raised so far.
Unsurprisingly perhaps, the mood of participants has been a mixture of enthusiasm and concern for the future of the profession.
Many see an increasingly pressured environment in which doctors are becoming ever more disengaged and disillusioned with the system in which they operate. The perception of being under pressure is widely shared, regardless of specialty, with reflections from more experienced doctors that there is more strain now than in the past.
Questions about medical morale have been around as long as the National Health Service but to many this feels different. Expectations are different among patients as well as doctors and the levels of demand are unprecedented.
Among GPs there appears to be particular strain, in spite of the fact that the hours they are contracted to work are more restricted than in the last century. Whatever the reasons, these perceptions may well present risks to morale and the recruitment and retention of doctors and, just as importantly, the degree to which they feel disengaged from the system in which they work. And that will without doubt have an impact on patient care.
The community of doctors taking part in this discussion have been clearly in favour of creating a more supportive culture than currently exists. Although not always overtly expressed there are worries about the failure to support and care for each other and the persistence of self-reliance and even a reluctance to voice concerns. As one doctor said on Twitter:
#gooddoctors work in environments that encourage questions and people who ask for help when they need it – then get it quickly and supportively.
There has also been quite a lot of emphasis on the need for better teamwork across disciplines. There is also a belief that this could only be achieved where doctors and other professionals had the time and space to build relationships and were underpinned by accessible and supportive leaders. Where this existed, it was possible not only to provide support when needed but also to create an environment where potential disagreements or issues could be recognised and tackled.
Another professional added: ‘More value of skill mix within teams and effective use of these team members.’ This sentiment was echoed by David Evans on Twitter: ‘Good doctors can learn from good nurses (and vice versa).’
At our event on the resilient doctor in Newcastle, Dr Andy Haynes told us about ‘the importance of personal and organisational support systems, work-life balance and self-awareness as elements of resilience.’
Dr A Haynes: Importance of personal + organisational support systems, work-life balance, self awareness=elements of resilience #gooddoctors
— Rachel Woodall (@WoodallRach) July 16, 2015
There has been a lot of discussion at the events so far around compassion and emotional resilience. Dr Alys Cole-King, a panellist in Newcastle, contributed a blog post on this subject which prompted considerable online discussion. Elle Javad replied to say that her experience pointed to a system that could undermine young doctors. She wrote: ‘As doctors and medical students we do our utmost to help but we are stigmatised for being off sick and causing problems with staffing. I took myself out of that environment and left medicine altogether.
With greater sight and wisdom, I hope to enter medicine once again but with more caution and self-awareness of how the staffing levels are run and when to say no to extra workload from nurses and SHOs. I burnt out just to help out and found myself being walked over. So, self-compassion definitely, but also a more realistic portrayal of the dangers of being a naive HO please! – Elle Javad
Following each event, we have run an online poll – to date, we have had 521 respondents. We will analyse these results together with those at the events themselves but it is striking that among those taking part online, 41% supported the contention that doctors are less compassionate now than they were 20 years ago. Behind that view of course lie many different factors and what we do not know is whether 20 years ago they felt the same about practice in an earlier era.
But some of the comments in the polls do reflect the changing world in which the profession now operates:
Doctors are not less compassionate, but they rarely have the time to show that compassion as a consequence of time pressure, increasing patient demand and increasing management demands.
Though it seems idealism has become a dirty word, it holds for society in general. It is unfortunate though, doctors’ dispositions are not looked into before entrance into medical school.
To give compassion we have to be self-compassionate and we are not taught, trained or shown how to do this – same for care, we need to live it for ourselves first to give it to another but in fact medicine teaches the opposite – that the others come first – so we end up with burnt out doctors because they do not know how to truly care for themselves first so they can work hard and not get detrimentally affected by the work they do.
At the last of our events Dr Mark Porter, Chair of the BMA, repeated the clarion call of the profession that ‘the care of your patient must be your central concern’ but added perceptively that it was a lifelong journey to understand what that meant.
— GMC (@gmcuk) September 9, 2015
And the events have once again underlined how far there is still to go in creating a culture in which doctors and others can freely raise concerns – in the online poll 58% of respondents were either unsure or not at all confident that they would be supported by clinical and other leaders if they were to raise a serious concern in their institution. A depressing thought.
At the three events to date, participants have raised a wide variety of issues and shared potential solutions. We have produced below a set of storyboards to capture the wider discussions at each event.
The compassionate doctor
The collaborative doctor
The resilient doctor
The doctor’s dilemma
The next event will be in Belfast on 2 February to discuss the doctor as a scholar with Professor Patrick Johnston, President and Vice Chancellor at Queen’s University Belfast as the keynote speaker.
This will be followed on 5 April with an event in Glasgow to discuss putting safety and quality improvement first.
After this, we will publish the draft report and then hold a further event to gather feedback before finalising and officially releasing the report.
Of course, in the meantime, comments online are welcome either on this website or in the LinkedIn group.