The woes of wellness

The wellbeing of healthcare staff depends upon  greater resources for services, not more wellness programmes

What is our health service’s most unwelcome import from the world of business? Ponder it a little because there are some strong candidates out there. There is the use of ‘revert’ instead of ‘reply’ in emails, which can grey blameless hairs on a daily basis. There is our fondness for outsourcing, which has not weathered well the storm of the CervicalCheck controversy. Or perhaps the belief that the invisible hand of market forces can solve any problem we encounter in medicine, reducing the complexity of human beings with illness to a car assembly line?

A leading contender this year, though, must be wellness. The word, cheerfully unspoken and unheard before this decade, describes ‘an active process of becoming aware of and making choices toward a healthy and fulfilling life’. In practice, in our health service, it involves campaigns, events, and information updates focusing on your wellbeing as an employee. And unlike every other resource in our health service, there is no shortage of them. I have received 69 emails focused on ‘wellbeing’ since the July changeover. There have been male voice choirs and an ‘employee wellness day’, with free sausage rolls to boot. We even have a designated wellbeing officer who sends regular advice (‘make a new friend’, most recently).

For medical higher trainees, there is a mandatory ‘Wellness matters’ course too, but all openings for the next seven months are booked out. It will probably be stressful for final year trainees to get an opening and find someone to cover them at work, but they will at least have the irony of the situation to warm their hearts. And medical senior house officers have a mandatory training day in ‘resilience’, which helpfully shifts the responsibility for dealing with unbearable stress to the sufferer, rather than the source, of stress.

The wellness movement in the Irish health service is clearly born of legitimate concerns and sincere intentions: We know that those in the caring professions are vulnerable to unique physical and emotional stresses. The RCPI’s study of workplace wellbeing in Irish hospital doctors recently found burnout evident in almost 30 per cent and that 50 per cent reported being emotionally exhausted. We have all been left pale by stories of nervous breakdowns and suicide among colleagues. The diagnosis is spot on, but the treatment prescribed is not.

Similar to homeopathy, the real concern regarding wellness campaigns is not that they are harmful themselves – they are mainly advice and support, after all. Rather, the risk is that they pose an unhelpful distraction from the interventions that we really need. Almost all of the experiences that have stretched me to breaking point so far in six years of medicine have resulted from short-staffing, anti-social hours, or lack of senior help. As a prescription for this problem, mindfulness and vegetables simply will not fly.

Why is this distraction such an issue? For one, every minute and euro spent on resilience training is money and time that is not being spent elsewhere: On adequate staffing during sickness and leave, experienced support when we really need it, and better training to ensure confidence dealing with the challenges that the wards throw at us. This money could have been spent ensuring that specialist registrars actually are allocated their protected training time during their scheme, for example, when so many are not. The opportunity cost is large.

Moreover, and more cynically, what elaborate and well-advertised wellness campaigns do is provide a smokescreen for a management and a medical culture that is not doing enough to fix the real problems. These projects carry an aura of proactivity and compassion, but this does not chime with an NCHD being asked if their wedding date was ‘flexible’ by HR, or being asked to relocate to Limerick when your children are in school in Dublin. These are merely two stories I have heard in the past week, but we all have more.

Of course, there have been positive sides to this new focus on wellness: A culture where doctors feel comfortable discussing their mental health has value beyond measure. NCHDs themselves have put a great deal of work into these projects and are now seeing the fruit of this.

But a narrative that sees struggling doctors as insufficiently resilient is not a helpful one. We are told to get better sleep, but only when not on-call. We are asked to improve our diet, but barely get time for lunch. And we are urged to embrace mindfulness, but only after we finish our audits, presentations, and ePortfolio. NCHDs generally expect a robust pace at work, and nobody is asking for a free lunch (sausage rolls notwithstanding). However, the days of being stretched to breaking point for months on end should be behind us. The wellness movement has a good sales pitch, but we should perform due diligence before we buy in.