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An apple a day won’t make doctors stay

By Mindo - 01st Oct 2019

It will take more than wellness initiatives to improve consultant morale

As I prepare to speak on burnout and the recruitment crisis at the annual IHCA conference, I am reminded of a recent Saturday morning conversation with consultant colleagues on the topic of wellness initiatives for consultant staff. “I don’t need a manager leaving an apple on my desk. I don’t need onsite yoga. I need enough colleagues for a manageable workload and a humane call roster. That will do much more for my “wellness” than any PR resilience initiative. It’s the equivalent of a sticking plaster on a dirty open wound. A total waste of time and worse: Hopelessly inadequate.”

I looked around the table. Lots of us nodding vigorously. Some of us barely concealing our frustration at the ridiculous scenario in which we find ourselves. 20 per cent empty posts, the lowest consultant numbers in the EU and the longest waiting lists. Once again, despite Dáil commitments and public proclamations of planned engagement on the consultant recruitment issue there was no action at the time of writing in mid-September. Not even a date. An appalling dereliction of duty. It is the political equivalent of the emergency medical situation of carrying the cardiac arrest bleep for the health service and listening to the call, but brazenly and callously ignoring it. If a medical doctor did this, they would be referred to the Medical Council.

What about the duty-of-care of the Government to provide timely access to high quality care? We hear so much talk of the importance of open disclosure from doctors and rightly so. But once again I find myself asking, given the complete failure of the Government to tackle the consultant recruitment crisis, what about the harm they are inflicting on patients with the excessive waiting times for access? Some patients are deteriorating while on waiting lists. Are they not also entitled to open disclosure on the additional morbidity inflicted by the excessive waits? Even if you take a wildly optimistic view that it is less than 1 per cent of patients of the current waiting list figure, this would be in excess of 5,000 people. Each of them matter. Each of their lived experiences matter. We will be judged harshly by the next generation for how we are failing our society’s most vulnerable.

And so to yoga and apples and a bunch of consultants sitting around a table talking about the well-intentioned but inadequate attempts at promoting physician wellness in our health service. It is easy, at an organisational level, to focus on fixing or indeed replacing, the humans. If the individual doctors could be tougher, more resilient, the system could maintain status quo. Yet in spite of this, almost every report and investigation into safety events, seems to identify “systems failures”. Yoga and apples and even massage are transient sticking plasters. The idea that if we can just make the doctors stronger we can avoid the recruitment and retention issues we face across medicine is a fallacy. I personally find this concept both infuriating and insulting. We keep replacing the doctors, but what we need to do is fix the system. What is needed is system resilience. If the system is resilient, the people in it can be human.

Speaking as a radiologist, future challenges specific to our specialty include non-radiology managers prescribing relative value units (RVUs) to our workload, the increasing complexity and volume applying ever increasing pressure on individuals. We have to be realistic: Some people can do high volume, some can do high complexity, some can do both, but it is the exceptional outlier that can do both at the same time. We need to factor the average radiologist in our workload expectation and also factor in the intangible tasks that are critical to our added value to clinical care. These include: Discussing cases with clinical colleagues, mentoring at the read out stations with our excellent trainees and research, audit, and quality improvement. These are not optional extras, but complementary strands that drive clinical excellence.

We risk being micromanaged by non-clinical managers with emphasis only on our measurable RVUs, but it is the clinical relationships based on trust between our clinical colleagues, ourselves and our patients where we often have the most impact on care. This is also often where we find sustenance and satisfaction in our contribution to care that meets some of our core emotional needs. Healthcare is people looking after people and for any safe, high-quality system, doctors need the time and space to be curious, to innovate, to feel valued. The importance of our humanity, our curiosity is increasingly being recognised. The recent annual dotMD conference organised by Dr Ronan Kavanagh, Dr Alan Coss, Dr Muiris Houston, and Dr Eimear Duffy took place in Galway. Over 500 people attended this unique conference focussed on creativity, curiosity, humanity, art, storytelling: The connections that drive us all. Described by one delegate as “replenishing, from start to finish”, the organisers are to be applauded for creating such a wonderful shared space. We have so many great people in our health service. Now to fix our system so they can flourish.

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