Medicine, nursing, paramedicine are friggen hard jobs. We are expected to be experts in people skills, multiple technical skills and have and keep up to date a huge body of knowledge. Especially as newbies in the system our workloads and hours can be harmful to all concerned.
We are required frequently to make important decisions based on imperfect information about incredibly complex organisms – humans in human society.
We make mistakes, and when we do they can have disastrous effects.
And sometimes The System is not very supportive, and sometimes positively harmful to us.
All of us struggle sometimes. Many of us struggle a lot of the time.
I’ve had my share of struggles and clashes with The System, I’ve been summoned to several offices for various telling offs and warnings, and I’ve mentored a lot of junior, and some senior doctors, nurses and paramedics through various tribulations and lots of dealings with Medical Council of NZ in my role as an Intern Supervisor. I have some suggestions / advice based on my experience.
The System is imperfect but it is improving and it is beneficent
The medical, nursing and paramedic systems have come along way in the last 20 years, and they will continue to evolve and improve. The systems very much works to help/rehabilitate clinicians who are struggling. I don’t think many other professions would do the same.
Ask for help
If you are struggling, ask for help. It can be hard to seek help, especially when everyone else is busy, but be humble enough to ask. Ask your boss to clarify his/her instructions. Talk to your mentor. Discuss cases with your peers. If you are overworked tell your boss, discuss with your mentor. For example may be able to get a reliever to come and work beside you for a day and give you some tips on how to do the job smarter.
The System must protect the public
The System must protect the public from under-performing or crazy health professionals. Make sure the System doesn’t see you as either or both of these.
Acknowledge your share of the problem
Sometimes thinks seem to be very wrong. You have an awful boss. The workload is impossible. You’ve tried all the above and it isn’t working. First think: “How can I improve?” Almost always when there is a clash between a clinician and the system the clinician has been under-performing/struggling in some way. This may be their first job, they may be new to the country and medical system, they might be having problems at home, they may just have found the limit of their ability. Some times we attack The System because we know we are not coping. Accept your share of the problem. Be reassured that most people “get it” / get the hang of their jobs pretty quickly.
Be patient with your senior
Accept that those in The System – your boss, your manager, that registrar – are human too, and may be struggling with some aspect of their jobs. Most doctors have had very little training in supervising juniors for example. They may not be coping with their workload. They may be stressed out trying to double check on your work. They may be trying to improve things as much as you are, but fighting even more bureaucracy.
Don’t fight The System alone
If it really seems there is a problem with The System, eg everyone has a problem with this boss, this ward or this run, don’t try to fight it yourself. Talk to a mentor, they may be able to have a quiet word (or a loud word) with your boss. Talk to the management unit that looks after your workload (eg the RMO unit). If that doesn’t work make use of your union. Let them do the dirty work, leaving you to concentrate on patient care. Above all continue to do your best for your patients, don’t be distracted by political battles.
Take feedback onboard
Listen to any positive or negative feedback and learn from it.
Occasionally we have clinicians say “but nobody told me I was under-performing.” We do have to get better at being explicit about this but if every time you present a case you are being corrected, you are getting emails daily from different consultants pointing out mistakes … take a look at your practice.
Be patient with yourself
This is a hard job. You will not master it overnight. People who have been doing these jobs for 40 years, lecturing around the world, talk about Imposter Syndrome the fear that someone one day soon will stand up and say “You are crap at this job, you’ve just been hiding it very well, you are an imposter!”
We and our society have such high expectations that we can never live up to them. Accept that this job is hard, that it takes time and work to master.
Keep studying, keep seeing patients
When we graduate we often think “Whew. Now I know it and I can have a rest.” We are also often struggling with our first few years in the job and being over worked. But to do this job well we have to keep on studying, not necessarily more degrees or diplomas, but keeping up with the latest ideas and thinking. A lot of us use Free Open Access Medical Education (FOAM) resources like podcasts and blogs to keep up, quickly and relatively easily. The more you know the easier the job gets.
If you had an interesting patient or presentation today, do a few minutes finding out more about that case, then what you learn really sticks.
Do simulation with your mates. Do your own mental simulation “What would I do if I had that patient that Jo had today?” and run through the case. If you don’t know how to do some part of it look it up or ask somebody (asking is often much quicker).
See as many patients as you can. The more patients you have seen, the easier the job gets.
Look after yourself
You are an high performance machine. You need good fuel, rest, exercise, social, emotional and spiritual nourishment. You need to train you most important asset, your brain, to operate at its peak. It can be hard to cram all this in to a busy working life, but prioritise all these things. They all help keep your work in perspective, and you will find work easier if you declog your brain regularly. I’ll so another post soon on mental training.
Change The System from within
If you want The System to get better, do it from within. This isn’t a great analogy but a lone animal straying away from the pack is easily picked off. If you point out the glitches in the Matrix too often, the Smiths will come.
Much better to get to the front of the pack and change the direction of the whole herd. Get yourself on some committees (groan)(I acknowledge the wonderful people who have rewritten the FACEM curriculum to give much more clinical focus to the examining of provisional ED trainees in Australasia – much more effective than my complaints about the exam). Make gentle, polite suggestions to your bosses and managers when appropriate.
Jump through hoops, play the game, do the work, and in time you will become more influential, work with like minded individuals and groups and you will be able to help make The System more humane. Work with people, get them onside. Back down when you need to. Do what is best in the long term. Be patient. One person can not change The System overnight. Lots of us working together are improving the system.
As my wife says Evolution, not revolution
Revolution 1 The Beatles
The Matrix: http://www.totalmediabridge.com/what-is-the-matrix-the-beginning-of-the-bloated-franchise/
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