Spickard Jr A et al, Mid-Career Burnout in Generalist and Specialist
Physicians.
JAMA, September 25, 2002 Vol 288, No.12
I thought I would put this excellent review up for those who are lying awake
at night, becoming reclusive, feeling low (even if not recognising
depression) or just feel trapped,isolated, lost. I suspect most of us do not
recognise it when present in others, or even ourselves.
They end the article: "It is not incidental to medicine but is at the core
of the deepest values of the profession to first, do no harm. Doing no harm
begins with one's self." I think this article should be read and understood
by everybody in our speciality.
It resonates through a number of current issues that afflict us. Not least a
sense of direction / control. This seems to come out (in my view) of there
being an insufficiently robust purpose and vision for Emergency Medicine of
the future in this country.You know, if we do not have this, those outside
the speciality that do will take us with them, which may not be for the
best.
Unfortunately this seems to be happening. I keep hearing of the siphoning
off of elements of our case mix by in house specialities in many departments
on one hand. On the other are the platitudes from the centre of not to
worry, the future is secured. Maybe its a matter of Sir George walking the
talk (with our help). I believe he has sufficient integrity to do that,
however he had better act quickly.
The obsessive pursuit of narrow, measurable, simplistic political targets
with huge financial incentives is beginning to distort services in a way
that may not be of wider benefit to emergency care. This is Onorah O' Neil's
Reith Lectures on "Trust" from last year all over again (was I the only one
who listened to them?).
For example a decision for Acute Physicians to take all remotely medical
sounding ED cases from triage, or fast track Orthopaedic
cases through to their ward (never mind that the hypothermic old lady does
not warm up and her pneumonia is not diagnosed until the day of her
operation). Might help reach the 4 hour targets? Probably but not good for
the wider provision of emergency care and then the training and professional
issues for the speciality. Some in our speciality seem to have a blind spot
here.
This corner has to be fought but particularly by the powerful such as the
Modernisation Agency, Sir George and others (are you lurking?). Otherwise
our one day new College will be the Royal College of What is Left, Which is
Not Very Much Medicine.
Many may say that Emergency Medicine at present is clearly inadequate, but
no way is the current system nearly as good as it can be. The alternatives
being forced on some of us will be politically expedient but more expensive,
beaurocratic and probably no better for patient care in the long run.
Meanwhile, burnout beckons - so look after yourselves out there!
Tony Good
Liverpool
"Smouldering"
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