22 Jun Medical hierarchy; a risk factor for burnout and adverse events?
The current structure within medicine is a product of centuries of tradition within the profession. Yesterday I spoke with a good friend, an archetypal ‘junior’ doctor: she in her early 30s, has been a doctor for seven or eight years; academically brilliant, passing all her basic physician exams first time; a highly respected medical registrar who goes above and beyond for her patients. She said that when she was burnt-out, there was no-one talk to. She was aware of a registrar the previous year who was considered a trouble maker for going about discussing their issues with their job in a way that was not respected; my friend was worried that she would be perceived the same way. She, like many other doctors still in postgraduate training, was deterred by the power that ‘senior’ doctors hold over their next career step. Her boss, instead of taking an interest in her well-being, reiterated his own achievements at her stage in training.
In 2017, Ben Veness, a psychiatry registrar in Melbourne, described ‘the tyranny of excessive medical hierarchy’:
‘By our figuring, three young doctors taking their own lives within just 4 months was the final straw in a decades-old, multifactorial mental health problem in our profession. We believe it warrants a special commission of inquiry into the training and workplace factors that affect doctors’ wellbeing…In addition to changing mandatory reporting, it would help if doctors-in-training weren’t so scared and unsupported in claiming all of the overtime they work, so it could be clear how much the system demands, so doctors felt their time and efforts were valued, and so that department “business cases” could justify employing more doctors by saving on overtime. It would help if we borrowed from the airline industry, and not only introduced safer rostering practices, but addressed extreme power differentials and negative aspects of medical culture by, for example, always introducing ourselves and using only first names instead of distancing junior team members from their senior colleagues with the selective use of the “Doctor” title. It would help if the specialist medical colleges had to justify low pass rates for their assessments despite having such intelligent candidates, abolished all-or-nothing exams that are hugely expensive and run only once a year, and were required to regularly justify or else lose their monopolies.’
How significant are these issues as a contributor to the problems in healthcare culture? Are specialist medical colleges anachronistic? How could they advocate better for doctors’ well-being? How should fatigue be monitored and measured?