'No one else has had this problem before.' How I burnt out while training to be a surgeon.

It’s now been a year since I resigned from the hospital I was working at.

Initially, I was too numb and exhausted to feel anything. I was so cognitively impaired from the sleep deprivation that I didn’t have the mental reserve to understand what happened, or have a reaction to it.

Months later, I realised my department had made me feel like I was the one with the problem, so I had never thought about the fact that maybe I was the one that had been wrong done by.

In an overworked system, doctors often just look out for themselves. I once worked with a registrar who was extremely stressed, so I took a weekend of on call off her and worked it without expecting her to “pay me back”. When I was burning out later that term, there was no reciprocation, nor any support. I was so disappointed in the lack of camaraderie, and felt betrayed especially after I had relieved that registrar out of goodwill earlier in the term. I think that sometimes we are so overworked that we don’t have that reserve to help someone else out, because we are all just treading water in this cesspool of a healthcare system. It really takes the ‘care’ out of healthcare.

How to know if you’re suffering from burnout. Post continues after podcast. 

When I think about my time at the hospital, one thing that still stands out in my mind is when my head of department (HoD) muttered, “no one else has had a problem with this term before…” Now this makes me angry. We cannot (and must not) compare people’s experiences.

Just because Person A can work 90 hours a week for X number of weeks, we cannot devalue Person B’s experience of burnout after working the same hours. We don’t know what happened during those contact hours, and we don’t know how many phone disruptions they had during the night that psychologically affected the way they functioned during that time and led to their experience. We cannot dismiss an individual’s experience of burnout just because somebody else has done the same (or even more) hours.

In the months before I resigned, my life looked like this:

I was on call from Monday morning 7:30am until the next Monday 4pm… about 180 continuous hours. This means that at any time during those 180 hours, I could (and did) get called by the hospital. From the first week I was receiving phone calls every night until about midnight, and sometimes even a 3am call here and there. I would then get Monday night off – a momentary relief of one night’s uninterrupted sleep – and then back on call again the next morning until Friday afternoon – another 80 continuous hours of being on call. I got two days off, and then the cycle started again.

Watch: What is burnout, and how can you avoid it? Post continues after video.

My days were long. I kept a log of my hours; I was at the hospital for 120-140 hours a fortnight, and work would follow me home with phone calls whilst trying to park my car in the garage, whilst I took a shower, whilst I was trying to cook dinner, and whilst I was trying to fall asleep. Every fortnight I would only be guaranteed four nights of uninterrupted sleep. The other 10 nights were unpredictable. Maybe I’ll get woken up, maybe I won’t. This mental unrest for 10 days a fortnight was taking a toll on me. I couldn’t exercise, I couldn’t plan anything social… I had to be on standby.

The HoD had heard some whisperings about my fatigue and gave me a call that weekend. “We need to look after you. You’re damn good, you’re damn good,” said the voice on the other line with so much conviction that I believed it. “I don’t want you to burnout” … but I already was. For a moment I thought that maybe this roster might change.

But this was my fourth unaccredited registrar post, and most of my past rotations had been in hand surgery so I was more than capable of operating on cases by myself. I was therefore left to run the unit, and was operating late at night to reduce the excessive emergency theatre list which was bursting at its seams with cases that there was no time nor staffing for during the day. I never had a senior registrar come in to take over the operating so that I could go home, nor was I ever allowed to defer non-urgent cases to the next day when I could operate at a more civilised hour, because cancelling a case would be marked as “Cancelled By Surgeon” on the computer system, making my department look bad. I was thus there as the lone soldier, doing case after case, as late as three o’clock in the morning.

 

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???? S C R U B L I F E ???? This is my every day #ootd ???? Back to fitness & lifestyle soon! I took some videos this week ????????????‍♀️Some are running / yoga specific, but hopefully everyone will find something that’s relevant to their activities ???? Stay tuned . . . #surgeon #doctorlife #thisiswhatasurgeonlookslike #workhardtrainhard #happyweekend #ドクター #仕事 #手術 #病院 #医者

A post shared by  Dr Yumiko Kadota (@mindbodymiko) on May 26, 2017 at 2:17pm PDT

Wouldn’t the patient with a non-critical condition have benefited from me having a good rest and operating on him or her the next day when my concentration might be a bit better? Apparently not. According to the KPIs set by the bureaucrats of the local health district who sit in their offices writing said KPIs and have no idea about what it’s really like on the clinical scene, it is much better to get cases done before X number of hours. Despite my efforts getting cases done at night instead of the next day, the numbers still looked appalling because I worked in a system that was severely underfunded and poorly resourced… but hey, at least saying that a patient waited 24-48 hours for surgery looks better on the surgical audit than >48 hours.

Back to my argument about comparison: clearly what I endured at the hospital was very different to what previous unaccredited registrars endured because of our difference in clinical experience – this is not their fault, and neither is it mine. This is why it is dangerous and unfair to compare us. How dare the HoD say that previous registrars had no problem with the roster? First of all, they probably didn’t speak up because they were too afraid to, and wanted to get selected for the training program. Secondly, you cannot say that two registrars who did the same term had the same experience.

Just because a registrar seemed to have handled their term “just fine”, doesn’t mean that the term itself is fine.

Many doctors who seem “fine” are not.

How many doctors have to die for us to recognise that many suffer in silence?