It’s now been a year since I resigned from Hospital X. Initially, I was too numb and exhausted to feel anything. I was so cognitively impaired from the sleep deprivation that I didn’t have the mental reserve to understand what happened, or have a reaction to it. When I blogged about my experience and made it public in February, there was outrage amongst the medical community, as well as people from other professions and industries. People were angry on my behalf, and that made me wonder why I wasn’t angry too? My department had made me feel like I was the one with the problem, so I guess I never thought to think that maybe I was the one that had been wrong done by. The outrage not only sparked debate about our industrial issues such as safe rostering and exploitation of junior doctors, it also validated my experience at a more personal level.
I recently decided to join Twitter. I had heard that the blog post had created a “Twitter storm” but I was already overwhelmed by the response I got from Facebook, Instagram, and mainstream media that I did not want to join Twitter at the time. Things have cooled off a bit, so I decided I was ready to engage with the Twitter audience (which, I must say, is totally different to other social media). The people I have connected with so far on Twitter have been passionate and vocal about the problems we have in our profession and I hope to continue participating in discussions that champion for change.
One comment I received on Twitter asked why the other registrars didn’t help me, and it jolted my memory about a few things. In an overworked system, doctors often just look out for themselves. I once worked with a registrar who was extremely stressed, so I took a weekend of on call off her and worked it without expecting her to “pay me back”. When I was burning out later that term, there was no reciprocation, nor any support. I was so disappointed in the lack of camaraderie, and felt betrayed especially after I had relieved that registrar out of goodwill earlier in the term. I think that sometimes we are so overworked that we don’t have that reserve to help someone else out, because we are all just treading water in this cesspool of a healthcare system. It really takes the ‘care’ out of healthcare.
When I think about my time at Hospital X, one thing that still stands out in my mind is when my head of department (HoD) muttered, “no one else has had a problem with this term before…” Now this makes me angry. We cannot (and must not) compare people’s experiences. Before I delve into that, I want to define bullying. No universal definition exists, but we understand it to be a pattern of repeated behaviour that physically, mentally, and/or emotionally harms another individual with the perception of power imbalance. The important thing here is that it is not to do with the bully’s intention (because the bully can argue that he or she did not intend to harm), but to do with the person being bullied or an external observer’s perception.
I feel that there is a parallel when it comes to an individual’s stamina, and when their maximum is reached to enter the realm of burnout. It is the individual’s experience, which cannot be compared to anyone else’s. Just because Person A can work 90 hours a week for X number of weeks, we cannot devalue Person B’s experience of burnout after working the same hours. We don’t know what happened during those contact hours, and we don’t know how many phone disruptions they had during the night that psychologically affected the way they functioned during that time and led to their experience. We cannot dismiss an individual’s experience of burnout just because somebody else has done the same (or even more) hours.
When I was at Hospital X, I had a number of nurses ask me where the other registrar was. Hxxx was usually at a private hospital or large, city-based public hospital assisting a consultant. I was told that in the previous term, the nurses saw a lot more of the senior registrar Axxx. I happen to know Axxx because we helped each other with interview practice for selection onto the advanced training program. Axxx had less experience than me in Plastic Surgery (especially in hand surgery) and therefore spent more time at Hospital X to gain more experience, often relieving the unaccredited registrar from theatre for this purpose. The two registrars appeared to have a much better relationship than what I had with Hxxx – relieving each other and covering for each other when necessary. Having followed up patients from the previous term, I could see from the operation reports that they operated on a similar number of patients. There wasn’t the gross imbalance that you could see from my term.
I also know that in another previous rotation, the unaccredited registrar had never done a registrar post in Plastic Surgery before, so he was reliant on the senior registrar and consultants coming in to do the cases, as he had never operated on his own before. He therefore never would have been doing cases on his own late at night or on the weekends. I also know that one of the senior registrars I have worked with in the past never got to leave Hospital X to go to the private hospital or to the city hospital because she had to help the unaccredited registrar who was not coping with the workload, nor was he able to operate independently as he too was a relatively junior registrar.
As I’ve previously blogged about, it was my fourth unaccredited registrar post, and most of my past rotations had been in hand surgery so I was more than capable of operating on cases by myself. I was therefore left to run the unit, and was operating late at night to reduce the excessive emergency theatre list which was bursting at its seams with cases that there was no time nor staffing for during the day. I never had a senior registrar come in to take over the operating so that I could go home, nor was I ever allowed to defer non-urgent cases to the next day when I could operate at a more civilised hour, because cancelling a case would be marked as “Cancelled By Surgeon” on the computer system, making my department look bad. I was thus there as the lone soldier, doing case after case, as late as 3 o’clock in the morning.
Wouldn’t the patient with a non-critical condition have benefited from me having a good rest and operating on him or her the next day when my concentration might be a bit better? Apparently not. According to the KPIs set by the bureaucrats of the local health district who sit in their offices writing said KPIs and have no idea about what it’s really like on the clinical scene, it is much better to get cases done before X number of hours. Despite my efforts getting cases done at night instead of the next day, the numbers still looked appalling because I worked in a system that was severely underfunded and poorly resourced… but hey, at least saying that a patient waited 24-48 hours for surgery looks better on the surgical audit than >48 hours.
Back to my argument about comparison: clearly what I endured at Hospital X was very different to what previous unaccredited registrars endured because of our difference in clinical experience – this is not their fault, and neither is it mine. This is why it is dangerous and unfair to compare us. How dare the HoD say that previous registrars had no problem with the roster? First of all, they probably didn’t speak up because they were too afraid to, and wanted to get selected for the training program. Secondly, you cannot say that two registrars who did the same term had the same experience. This is totally ignorant. Just because a registrar seemed to have handled their term “just fine”, doesn’t mean that the term itself is fine. No, the term is fucked up (excuse my French). It is illegal and contravenes every Safe Working Hours guideline published in this country (by the likes of the Australian Medical Association and Royal Australasian College of Surgeons). Many doctors who seem “fine” are not. How many doctors have to die for us to recognise that many suffer in silence?
I finish with one question: Who is responsible for the safe rostering of unaccredited registrars in NSW (and the rest of Australia)? I know that every roster gets reviewed by the Director of Training (DoT, who would be appointed by the College) and/or HoD. Does the responsibility ultimately fall under each hospital’s administration, or is it the College that makes sure that the DoT/HoD approves a safe and fair roster? (Just asking for a friend).
Take care,
Miko xx
Hi Miko
I stumbled across your story and have been reading your posts all day. I just wanted to stay that your story, unfortunately, is by no means uncommon and is experienced by many (ex-) surgical trainees – including myself. You are very brave to tell your story and I have come across many similar stories where the trainee is too scared, too tired or too embarrassed to openly speak out.
Despite the hospital and training bodies getting back to you after the media storm and ‘attempting’ to address these issues and saying ‘lessons were learned’. In my experience, this is just lip service. I learnt the hard way the only real change you can do is ‘vote with your feet’ which you have done. You may not be able to change surgical training in Australia or elsewhere, but at least you can change your own life. In some ways, I think surgical training is like an abusive relationship. If you try to leave, the abusing partner claims “how dare you leave? You know there are so many other boys/girls that want to be with me, if you leave, there is no one else who would want you. ” — all lies. There are those that say surgery is a calling and you should not have quit –it’s career suicide (like your registrar colleague said when you told him you quit). I say to them angels have callings, human beings have jobs. Humans are not supranatural angels, we need sleep, love, rest and happiness. At the end of the day, despite the propanganda, surgery is just another job — no better no worse and if your employer does not respect the fruits of your labour — you should walk away. As you said, surgical trainees are replaceable, your HoD will find the next sucker to exploit — but at least you are free 🙂
Dear Marquis,
Thank you for your kind and beautiful words. I like that phrase ‘vote with your feet’. Reading your comment was very validating and reassuring. I do feel like I did the right thing for myself, even though I’ve had so many people (including myself) say to me that I should give it another go, and that I shouldn’t give up. I know that going back to surgery, even if it’s at a different hospital, will not make any difference because I will always encounter pockets of the same treatment everywhere I go because unfortunately it’s just a part of the culture that won’t change any time soon. I don’t want to dismiss the hard work that people are putting into anti-bullying campaigns but it does feel like ‘lip service’. I am enjoying the freedom, and I am not sure how to deal with all these loving and positive strangers around me because I’m not used to it… but then I realised that this is what ‘normal’ should have been. It’s normal to be kind to others, to compliment people for doing a good job, to give credit where it’s due, to just be a nice person! Thanks again for writing to me, and my warmest wishes to you! Miko