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Depression, burn out, trauma, exhaustion: inside the minds of doctors

Top Stories - Sun, 03/11/2018 - 12:00

We like to believe doctors are all-powerful and omniscient. When we visit one, it is naturally concerns about our own health that are uppermost in our minds. Yet rarely do we stop to consider the psychological toll a doctor’s work takes on them. In my work as a psychologist specialising in helping doctors, I have seen at close quarters just how serious this toll can be. The emotional and physical strain experienced by those in the medical profession is described in my new book, Also Human: The Inner Lives of Doctors, in which I’ve tried to shine a light on the hidden cost of medicine. For more than 20 years, I have met doctors dealing with depression, burn out, extreme trauma, exhaustion, anxiety, and a whole host of other problems, which they must somehow set aside while powering through long shifts helping others.  Bella was one example; a real high flyer, she attended one of the most academic medical schools in the country, winning prizes in both medicine and surgery. But as her first day of work as a junior doctor approached, she experienced a mounting dread: how would she cope with the demands of the job?  A few weeks in, she was approaching the end of a 13-hour shift in A&E. She and her peers had been clearly told in their induction they must not work more than 13 hours at a time. Some doctors, once they’re 12-and-a-half hours in, will busy themselves with paperwork rather than take on any new cases, but Bella wasn’t like that, and took on a new patient just before her shift ended. First she made sure that all the immediate tasks had been completed. But when she went to her supervisor to try and ensure a safe handover, she was given a furious dressing down in front of the whole team and accused of being irresponsible. Caroline Elton, a psychologist who specialises in helping doctors Credit: Caroline Elton (c) Charlotte Knee Photography.jpg Despite what she’d been told in her training, Bella was ordered to stay for as long as it took to finish treating the patient, and ended up working a 15-hour shift.  “What really shocked me was that I worked so hard, and followed all the rules, but I still ended up getting shouted at,” she told me later.  Too exhausted to drive home, she went to the toilets and broke down in tears. When a colleague found her crying there, she was devastated the image of herself as a cool and competent doctor was torn to shreds. Perhaps society will eventually recognise that, while the demands of a job in medicine are exceptional, doctors, like their patients, are also human With her confidence destroyed, an insidious depression spiralled rapidly out of control. Again, Bella did as she’d been instructed to do in medical school and asked her supervising consultant for help. His response? “Of course this is how you feel. You’re an F1 [Foundation Year 1 medic]; you’re a girl. You’re going to be upset.” She ended up leaving frontline healthcare and working in pharmaceuticals. Bella’s case is far from exceptional. Over the years I have seen a number of junior doctors who have become so distressed in their first posts they have had to stop work. Some leave permanently while others - like Kelly - return to the profession.  Within days of starting her first job as a doctor, Kelly thought, ‘I can’t do this any more.’ So extreme was her anxiety, she vomited out of fear every morning before work. A couple of weeks later she went to speak to the senior clinician in charge of training; the clinician was so concerned about Kelly’s state of mind, she mentally ran through a suicide checklist before letting her go home.   Junior doctors can go for 13 hours without finding time to eat Credit: Peter Byrne/PA “I’m not going back,” Kelly told me in our first sessions. But she did, eventually, return, and is now on her way to completing her training as a psychiatrist.  Each year, at hospitals all over the country, newly qualified junior doctors start work on the first Wednesday in August and, like Bella and Kelly, become overwhelmed by the extent of their responsibilities. On a night shift, they can be called all over the hospital to deal with patients. If they feel uncertain, they can theoretically ask someone more senior, but these seniors have their own heavy workloads to manage and may not respond as quickly as needed, or at all. Unsupported and overloaded, junior doctors can go for 13 hours without finding time to eat, and sometimes, like Hilary, they face situations they do not feel equipped to handle.  The path to becoming a junior doctor Hilary, a GP who came to see me because she was also thinking of leaving medicine, described her first day as a junior doctor years earlier, in which she was the only doctor on the surgical ward that day. Faced with a very sick patient who looked like she was going to die, she had little idea what to do and no-one to ask. When a fledgling doctor attached to another ward walked past, she spotted Hilary’s distress and summoned her own mother, a highly experienced nurse in the same hospital, who immediately took control of the situation. Meanwhile Hilary’s bleep had been been going off repeatedly, summoning her to the surgical assessment unit (SAU). Once the initial patient had been dispatched for urgent treatment, she dashed down to the SAU and encountered an angry nurse. “There are nine patients waiting. Where have you been?” the nurse demanded. Before Hilary could explain, the nurse gave her a rushed account of each of the nine patients. “Could you possibly help me work out who I should see first?” Hilary asked.  “Figure it out yourself, blue eyes,” came the response. And with that the nurse walked off - probably to get on with her own enormous list of tasks.    There’s little understanding of what happens when doctors are exposed to traumas repeatedly Credit:  Sam Edwards/Caiaimage  Even when the systems function more effectively, and junior doctors aren’t thrown in at the deep end, it remains the case that death, dying and distress are inescapable components of a doctor’s work. Yet there’s little understanding of what happens when doctors are exposed to such traumas repeatedly. How do they respond when they hear a patient screaming in pain, or see the ravages of disease or trauma on somebody’s body? How do they cope when they need to tell a parent their child has died? A common defence is to shut down emotionally, unable to take on board so much suffering. This is understandable but can rapidly turn into burn-out. Yet if they can’t put any form of protective barrier between themselves and the suffering of their patients, very rapidly they can become overwhelmed. Neither response is healthy, but doctors are given precious little help with finding the middle way. Some specialties, such as surgery, remain hostile to women, and- as in many other professions - there is still not equal pay. At the same time, incidents of institutional racism are more common than we might like to think. One student felt humiliated when a patient refused to be examined by her because she was black. When she told her supervisor of her distress, the supervisor brushed it off, telling her it was no different to when a patient won’t let a junior doctor examine them because they fear they’re too inexperienced.  In another incident, a devout Muslim doctor was looking at an x-ray of someone with broken bones when a consultant said to him, “you people blow people up.”  Perhaps historians looking back at how we treated doctors in 2018 will regard our medical systems with the same horror we do when reading about surgeons in the 19th century refusing to wash their hands between patients. Perhaps society will eventually recognise that, while the demands of a job in medicine are exceptional, doctors, like their patients, are also human.  Names have been changed As told to Rosa Silverman Also Human - the Inner lives of Doctors by Caroline Elton is published by Cornerstone (£16.99). To order your copy for £14.99 plus p&p call 0844 871 1514 or visit books.telegraph.co.uk  

Trump To Visit Ground Zero Of The Anti-Trump Resistance: California

Top Stories - Sun, 03/11/2018 - 11:42

Trump’s fraught relationship with California, where he has some of his lowest approval ratings, is sure to cast a shadow on the visit. Gov. Jerry Brown (D) said this week he considers the state at war with Trump’s government, and has fiercely denounced the president on climate change, marijuana policy, offshore drilling and, lately, immigration. Trump’s administration on Tuesday  filed a lawsuit against California over its so-called sanctuary laws meant to protect undocumented immigrants.

Ethiopia command post says 9 civilians killed by mistake

Top Stories - Sun, 03/11/2018 - 11:39

ADDIS ABABA, Ethiopia (AP) — Ethiopian security forces mistakenly killed nine civilians in Moyale, located on the country's southern border with Kenya, according to a command post established to oversee Ethiopia's state of emergency.

News anchor who recently interviewed Vladimir Putin believes he 'has something' on Donald Trump

Top Stories - Sun, 03/11/2018 - 11:13

An American news anchor who recently interviewed Vladimir Putin, has suggested that the Russian leader "has something" on Donald Trump. Megyn Kelly said the US President hurled abuse at other premiers but was “so nice" to Mr Putin over fears Moscow could publish damaging information about him. Mr Putin dismissed the idea that the Mr Trump had singled him out for any preferential treatment, telling the NBC New host that, he merely showed a “partner respect”.

Treasury Secretary Is OK With Donald Trump Calling Maxine Waters A 'Low-IQ Individual'

Top Stories - Sun, 03/11/2018 - 11:09

“We have to defeat [House Minority Leader] Nancy Pelosi and Maxine Waters ― a very low I.Q. individual,” Trump said. As the crowd booed the targets of his derision, Trump continued to attack Waters, mimicking her calls for his impeachment.

Erdogan slams NATO for failing to back Syria campaign

Top Stories - Sun, 03/11/2018 - 10:46

Turkish President Recep Tayyip Erdogan on Sunday angrily lashed out at NATO, accusing the Western military alliance of failing to back Turkey's campaign against Kurdish militia in Syria. Erdogan's latest comments were among the toughest he has directed in recent times against NATO, which Turkey joined in 1952 as the US sought to make sure it did not fall under Soviet sway after World War II. Turkey launched its operation on January 20 seeking to oust the Kurdish People's Protection Units (YPG) from the Afrin region of northern Syria with its forces now just a few kilometres away from Afrin town.

More ways to get $10K off BMW i3 electric car: new utilities add discount

Top Stories - Sun, 03/11/2018 - 10:45

How badly do you want to buy a BMW i3 electric car?

Ford Gives the Transit a Facelift

Top Stories - Sun, 03/11/2018 - 10:30

It also gets a diesel engine option.

Saudi sets up departments to investigate, prosecute corruption cases

Top Stories - Sun, 03/11/2018 - 10:04

DUBAI (Reuters) - Saudi King Salman has ordered the establishment of specialized departments in the public prosecutor's office to investigate and prosecute corruption cases, the government's information office said in a statement on Sunday. The move is intended to increase effectiveness and accelerate the process of combating corruption, the statement quoted Attorney General Sheikh Saud al-Mujib as saying. Saudi authorities detained hundreds of top businessmen and royals in November and held them for several months at the Riyadh Ritz-Carlton in a sweeping anti-corruption probe. ...

Trump Is Remaking The Courts In His Image: White, Male and Straight

Top Stories - Sun, 03/11/2018 - 09:08

WASHINGTON ― More than a year into his presidency, Donald Trump is making the nation’s courts look a lot more like him: white, male and straight. To date, Trump has nominated 87 people to be judges with lifetime tenure on U.S. district courts, circuit courts or the Supreme Court. Eighty of them are white, or nearly 92 percent.

The rich and the right want to dynamite Dodd-Frank – and Democrats are helping them do it

Top Stories - Sun, 03/11/2018 - 06:00

Senators voted with Republicans to cripple banking oversight. The Senate is not on the side of those who elected its members. In an economy hollowed out by the Great Recession, legacy Democrats lurch, occasionally, in a populist direction before retreating to where they are most comfortable: doing favors for the rich in exchange for campaign donations.

Pakistan activists say court ruling threatens minorities

Top Stories - Sun, 03/11/2018 - 05:50

ISLAMABAD (AP) — Rights activists in Pakistan expressed concern Sunday over a court ruling that would require people to declare their religion on all official documents, saying it could lead to the persecution of minorities, particularly adherents of the Ahmadi faith.

California man arrested for killing one police officer, wounding another

Top Stories - Sun, 03/11/2018 - 05:15

A California man was arrested Saturday after a 15-hour standoff with a police SWAT team and charged with killing one police officer and wounding another, authorities said. Pomona, Ca., Police Officer Gregg Casillas was shot and killed, and a second officer was shot in the face, authorities said on the Pomona police Twitter and Facebook pages.

Full Panel: Is Stormy Daniels About An Affair, or Campaign Finance Rules?

Top Stories - Sun, 03/11/2018 - 03:01

Andrea Mitchell, Peggy Noonan, Eugene Robinson and Matt Bai respond to the latest news in the Stormy Daniels affair and question whether the issue is moral or legal.

Mnuchin: Trump's Attacks on the Press Are 'Campaign Rally Issues'

Top Stories - Sun, 03/11/2018 - 01:49

Treasury Secretary Steven Mnuchin tells Chuck Todd that President Trump's vulgarities and attacks on the press are less important than policy, and should be seen in the context of a "campaign rally."

'This Is U.S.' Is All Tears With Ben, Jared And Sarah In 'SNL' Parody

Top Stories - Sun, 03/11/2018 - 01:41

“Saturday Night Live” couldn’t wait to do a “This Is Us” parody with guest host Sterling K. Brown, who plays grown triplet brother Randall Pearson on the hit NBC series.

Former Trump Aide Sam Nunberg Says Mueller Probe 'Not A Witch Hunt'

Top Stories - Sat, 03/10/2018 - 23:19

The probe by Mueller into whether Russia interfered in the U.S. presidential election and possible collusion by the Trump campaign is “warranted,” Nunberg told ABC News. He made the comments after testifying for close to six hours before a grand jury on the Mueller probe. “I don’t think it’s a witch hunt,” Nunberg said.

Twitter Bans Popular Accounts Accused Of Stealing Jokes And Selling Retweets

Top Stories - Sat, 03/10/2018 - 22:44

Twitter suspended several popular accounts on Friday in a major crackdown on “tweetdeckers,” a secret network of accounts that make tweets go viral by retweeting the same content in exchange for money. The company suspended several notably large accounts in Friday’s cleanup, including @GirlPosts, @Dory, @CommonWhiteGirl, @SoDamnTrue and @memeprovider. Some of these accounts, which mostly tweeted jokes and memes, had millions of followers.

Veterans home workers remembered as devoted caregivers

Top Stories - Sat, 03/10/2018 - 21:46

After a work conference, Maura Turner was looking forward to a girls' weekend with her close friend, Christine Loeber, a social worker and executive director of The Pathway Home that treats veterans with post-traumatic stress disorder.

Five years on, Pope Francis under fire over sex abuse scandals

Top Stories - Sat, 03/10/2018 - 21:10

As Pope Francis marks the fifth year of his papacy next week, the pontiff once hailed as a fearless reformer is under fire for his handling of the sex abuse scandals that have rocked the Roman Catholic Church.


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