And why "I'll just power through" probably isn't the best treatment plan
Last week I had the very unfortunate turn of being unwell. And even though I felt like a sickly Victorian child, modern medicine means I was alright.
Like most people who work in healthcare, I’m not very good at being unwell. I’m guilty of not listening to the exact advice I give to patients.
Where I would tell someone:
“If it gets worse, get it seen to.”
What I tell myself is more along the lines of:
“It’s fine. It’s probably nothing.”
And then soldier on, like the silly man I am, until it’s really not... fine.
There is something very strange about healthcare professionals when the patient suddenly becomes us. We can spend an entire working day telling people to rest, drink plenty, take their medications, listen to their bodies and seek help if they deteriorate.
Then we develop a temperature of approximately 400°C, writhe around in pain and think “Hmm. Probably just tired.”
Doctors make terrible patients.
And I am absolutely part of the problem.
The great medical double standard
If a patient told me they'd been feeling increasingly unwell for several days, hadn't really been eating, weren't sleeping properly and were continuing to work despite feeling dreadful, I would probably have some fairly sensible advice for them.
Rest. Look after yourself. Don't push yourself unnecessarily. Get reviewed if you're worried. If things deteriorate, seek help.
Perfectly reasonable.
If I develop the same symptoms?
My treatment of choice is my very own self-care triad:
Paracetamol. Coffee. Denial.
Perhaps an ibuprofen if things become particularly dramatic (technically making it a tetrad for any word nerds out there).
There is a remarkable amount of hypocrisy involved in being a healthcare professional.
We are often brilliant at identifying what other people need and absolutely dreadful at recognising the same thing in ourselves. And I don't think this is entirely because doctors and nurses are uniquely stupid. Although some of our behaviour certainly makes a compelling case.
I think a lot of it comes from the environment we work in.
But the ward needs me!
Healthcare runs on people.
And, unfortunately, there often aren't quite enough of those people.
Most of us have worked on wards where somebody calling in sick immediately changes the entire day. The jobs don't vanish. The patients don't disappear. The bleeps don't politely announce “Steff isn't feeling very well today, so we'll save this potassium of 9 until tomorrow.”
Although this would be a great feature...
Someone else picks up the work.
And when you know your colleagues are already stretched, calling in sick can feel awful.
You picture the rota. You picture the ward. You picture your mate now covering approximately fourteen square miles of hospital because you decided to stay in bed.
And suddenly you begin bargaining with yourself.
I'm not THAT ill.
I'll probably feel better once I'm there.
It's only one shift. I'll just load up on some paracetamol.
And my personal favourite:
“I don't want to let everyone down.”
That one is especially poignant. Because healthcare attracts people who care.
Most of us genuinely want to help. We feel responsible for our patients and our colleagues. That's a good thing. But sometimes that sense of responsibility becomes distorted. And being relentlessly available starts to feel synonymous with being a good healthcare professional.
It isn't.
The big wheel keeps on turning
Wise words from Tina Turner, and also the slightly uncomfortable truth.
The NHS is enormous.
Absolutely enormous.
It employs well over a million people. Every day there are operations, clinic appointments, ambulance calls, babies being born, emergency admissions, prescriptions, scans, discharges and approximately seventeen billion discharge summaries that somebody forgot to start until 16:47.
And the wheel keeps turning.
You can stay an extra hour. You can miss your lunch. You can pick up another shift. You can answer emails when you're supposed to be off. You can drag yourself into work when you feel dreadful.
And do you know what happens afterwards?
There is still more work.
There is always another patient. Another referral. Another CRP to chase. Another clinic. Another rota gap. Another person waiting.
That isn't because nobody appreciates what you've done.
And it certainly isn't because the work doesn't matter.
It's because healthcare is effectively like a Christmas cheese board; infinite.
The need never completely stops.
Which means if your strategy for coping with healthcare demand is:
“I'll rest when everything is finished.”
I have some fairly devastating news.
Like the toilet dealing with the aftermath of said cheese board, you are never resting again.
You cannot personally fix a system by exhausting yourself
I think this is something I've gradually had to learn. And begrudgingly, still learning.
There is a difference between occasionally going above and beyond because somebody genuinely needs you, and routinely sacrificing your own health to compensate for a system under pressure.
The first is part of being a professional. The second is not a sustainable workforce model.
If the only way a service can function is by healthcare staff repeatedly ignoring their own basic needs, then the problem is not that those healthcare workers need to become more resilient. The problem is rather larger than that...
No amount of mindfulness, yoga or suspiciously expensive herbal tea will magically create another registrar. And I say that as somebody who’s currently drinking a fancy camomile tea.
We should absolutely support each other. We should help when things are difficult.
Sometimes we'll stay late because a patient is unwell. Sometimes lunch gets delayed. Sometimes medicine simply does not fit neatly into a working day.
That's the reality of looking after people.
But “sometimes” cannot quietly become “always.”
Because there is a cost.
And it's a lot more than buying a kilo of silver needle loose tea from Whittard.
Being unwell doesn't make you more useful
There is also the fairly obvious point that going to work genuinely unwell doesn't necessarily help anybody.
If I'm exhausted, dehydrated, feverish and concentrating at approximately 14% capacity, am I really providing excellent clinical care simply because I managed to physically transport myself into the hospital?
Probably not.
If I'm infectious, bringing my exciting collection of microorganisms onto a ward full of vulnerable people is also unlikely to win me any awards. And if I keep pushing through something that actually requires rest or medical attention, there is every chance I simply become more unwell and end up needing even longer away.
Sometimes staying home is not failing to work.
Sometimes it is the sensible thing that allows you to come back and actually function.
I know this. You probably know this.
And yet healthcare workers seem remarkably capable of applying this logic to absolutely everybody except themselves.
Looking after yourself is not selfish
I think the phrase self-care has acquired slightly unfortunate branding.
It conjures images of candles.
Bath bombs.
Face masks.
Possibly someone called Willow telling you to practise gratitude.
And all of those things are absolutely fine if you enjoy them.
But looking after yourself is often much less glamorous.
Sometimes it means sleeping. Sometimes it means actually eating lunch. Sometimes it means exercising. Sometimes it means seeing your friends. Sometimes it means doing absolutely nothing for an afternoon without convincing yourself that you should be revising for an exam. And sometimes it means admitting “I'm not well enough to work today.”
That isn't weakness.
It isn't laziness.
And it doesn't mean you care less about your patients.
In fact, there is a fairly compelling argument that recognising when you're not fit to look after somebody else is part of looking after them properly.
I'm still terrible at this
I should make something very clear before this starts sounding like I've achieved some enlightened state of personal wellbeing.
I haven't.
I am writing this largely because I am guilty of everything I've just described.
I stay late. I take things home mentally that should probably stay at work. I convince myself I'm fine when I'm quite clearly not. I sometimes treat rest as something that needs to be earned.
And last week I once again discovered that ignoring your body does not, strangely, cause it to stop being ill.
Very inconsiderate.
So this post is probably as much directed at me as anybody reading it.
I don't suddenly have an immaculate work-life balance.
I haven't discovered the secret.
I'm not about to launch a Four Eyed Medic wellness retreat. Although if anyone wants to fund a spa in Bannau Brycheiniog, I am prepared to reconsider.
I'm simply trying to get slightly better at recognising that my health is not separate from my ability to do my job.
It is one of the things that allows me to do it.
The hospital will still be there
Medicine can very easily convince you that stepping away means you're abandoning something.
But the hospital will still be there tomorrow.
The ward round will still happen.
The bleeps will continue bleeping.
Someone, somewhere, will still order a D-dimer for reasons nobody fully understands.
And the great big wheel of the NHS will continue turning.
Your job is not to personally keep it spinning. Your job is to contribute to it while you're there, look after people as well as you can, support the people around you and then, occasionally, go home.
Rest. Recover. Have a life.
Because there will always be another shift. Another patient. Another difficult day. And if we intend to spend decades looking after other people, it might be worth learning to occasionally extend the same courtesy to ourselves.
So next time I'm unwell, will I immediately follow all of the sensible advice I've written here?
Of course. Absolutely.
I've learned my lesson...
Probably.
Four Eyed love,
Dr Steff
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