I was impressed with a recent comment that 'You can only burn out if you
have been on fire' !
Now I know many have been on fire and even had their fingers burnt by the
embers but it is a line worth remembering for those who feel a little to
precious.
John Ryan
----- Original Message -----
From: "anthony good" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, February 06, 2003 09:41
Subject: Fw: Burnout at the Coal Face
> 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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