Zeshan Qureshi

I’ve been a paediatric trainee since 2012. I’ve been lucky to work across many hospitals, all with varying learning opportunities, not just in clinical practice, but also in terms of strategies to promote doctor wellbeing.

Healthcare systems are making doctors mentally ill. Unfortunately depression, anxiety, burnout, substance misuse and other mental health disorders are common in our profession. Doctors have double the suicide rate of the general population, including recent cases of paediatric trainees taking their own lives.

In the TEDx talk here, I reflect on my own experiences surrounding doctor wellbeing, and propose some broad solutions on how individual doctors, hospitals and governments might take action to improve the situation.

In addition to this, here are ten top tips on promoting wellbeing in the workplace for us as individuals (with NO mention of the ‘R’ word!)

1. Invest in teams and relationships.

When work is really busy, it can be easy to focus solely on getting through the jobs list and just trying to look after yourself. However, too often this can lead to us practising in isolation rather than spending time developing positive, supportive relationships with colleagues. When these relationships are strong, colleagues can support each other through difficult times as well as fostering a sense of camaraderie and belonging at work. I’ve known people that have been in a job for four months without their consultant knowing their name. Perhaps organise a team lunch or simply put your phone away whilst waiting for teaching and get to know your colleagues.

2. Don’t neglect your personal life.

Medicine will always come with highs and lows. Hobbies and relationships outside of work will always be a welcome distraction, as well as a source of positivity to avoid becoming over-reliant on positivity from work. Treat your hobbies like they are part of your ARCP! Another important part of this is keeping yourself physically and mentally healthy. Remember the basics: eat, drink, exercise and sleep. It sounds simple, but a healthy body makes everything easier.

3. Debrief.

Doctors in general deal with a highly unusual emotional burden, but arguably what paediatricians experience is particularly difficult to process, with issues surrounding child protection and the death of sick children and babies being commonplace. Too often, clinical demands trump time to debrief, but you might not see the same team together for a long time after a critical event. Therefore debriefing should always be prioritised on the same shift, even if it’s only brief. Otherwise, unprocessed emotions and doubts are left lingering and can be damaging in the long term.

4. Ask for help unashamedly. 

In my experience, paediatrics is a particularly supportive specialty. I have twice asked a consultant to come in at night because the Emergency Department was too busy, and they have done so without hesitation, not for sick children, but to help share the workload. There is no pride to be taken from taking sole responsibility for an unhealthy workload, and it will only lead to burnout and the comprising of patient care.

5. Get night shifts right. 

Aside from having fewer people around, and patients being at higher risk of things going wrong, our bodies aren’t designed to be shifting from day to night working. There are clear and simple things that can be done to facilitate effective night shift work.  For example, breaks are not a luxury – they are essential. Taking 15-20 minute naps can considerably improve alertness. Other things you may not have even considered: think about wearing sunglasses on the way home as sunlight makes you feel more awake and less likely to get good quality sleep. I learned everything I know on this topic from Michael Farquhar here.

6. Capture the happy days and happy memories. 

In times when things aren’t going so well, it’s important to remember the good times. A child that got better in front of your eyes, a present you were given for doing a good job, a colleague that really appreciated your support and help. These memories can fade, but if you record them then it’s always a helpful reminder when you’re thinking of giving up. Perhaps keep a diary or a scrapbook.

7. Acknowledge when parents/children are being unreasonable. 

Although usually positive, like anyone, parents and patients can be unreasonable. Illness is not an excuse for being rude or inappropriate, and even if you are in the middle of a consultation, ensure that you are treated with the respect that you deserve. This is more difficult to do the more junior you are, but by standing up for yourself, you are making it clear what your very reasonable expectations should be when delivering care.

8. Speak up when the behaviour of colleagues is inappropriate.

Sadly, bullying and harassment have the potential to occur in any unit, and if you don’t speak up, then poor behaviour will continue unnoticed by the people that can help you. The key is knowing who to speak to so that you are protected and that constructive change can occur. Often the best first person to speak to might be a colleague outside the hospital to give an outsider’s perspective.

9. Specialist doctor’s mental health support.

No matter how good things are in your hospital and no matter how much support you personally get, we still live in a profession with a catastrophic emotional burden as we take on responsibility for looking after the sickest children in the country on top of working intense, and often understaffed, rotas.

This may lead to requiring professional help, and the mental health support required for doctors is in many ways subtly different to that for the general public.

Doctor-specific mental health support includes:

1. Practitioner Health Programme (020 3049 4505). The PHP team have expertise in confidentially treating health professionals with addiction and mental health problems. The service has seen and treated thousands of practitioner patients from across the UK.
2. BMA Counselling service (0330 123 1245).24/7 telephone advice and support.

 The online community of “Tea and Empathy” is another good source of support: it is an online peer to peer network with support provided 24/7 by an international community of doctors.

10. Know that even though you’ve signed up to paediatrics, it’s still OK to question whether it’s right for you.

Paediatrics can be a very rewarding profession, but it is by no means the ‘right fit’ for everyone. Sometimes, the more difficult aspects of paediatrics don’t become apparent until months or years of exposure to the profession. If you’re starting to have thoughts like this, first of all – do not feel guilty or that you are ‘letting anyone down’. This is YOUR career – it should not make you miserable. Then go and seek some expert medical career advice – go and talk to a colleague you trust, or if you would prefer to speak to someone outside your workplace for medical career advice there are some great options here via the Doctors Support Network.

Zeshan Qureshi, Paediatric Registrar