Elton - Also human: the inner lives of doctors

Doctors are the people we turn to when we fall ill. They are the people we trust with our lives, and with the lives of those we love. Yet who can doctors turn to at moments of stress, or when their own working lives break down?

What does it take to confront death, disease, distress and suffering every day? To work in a healthcare system that is stretched to breaking point? To carry the awesome responsibility of making decisions that can irrevocably change someones life or possibly end it? And how do doctors cope with their own questions and fears, when they are expected to have all the answers?

Caroline Elton is a psychologist who specialises in helping doctors. For over twenty years she has listened as doctors have unburdened themselves of the pressures of their jobs: the obstetrician whose own fertility treatment failed; the trainee oncologist who found herself unable to treat patients suffering from the disease that killed her father; the brilliant neurosurgeon struggling to progress her career in an environment that was hostile to women. Drawing on extraordinary case studies and decades of work supporting clinicians, Also Human presents a provocative, perceptive and deeply humane examination of the modern medical profession.

Dr Caroline Elton completed her undergraduate degree at the University of Oxford, was awarded a postgraduate fellowship to the University of Pennsylvania, and completed her PhD in the Department of Academic Psychiatry, UCL Medical School. She is a chartered psychologist and has held a number of positions working with doctors. Her first role involved shadowing senior clinicians on ward rounds, in outpatient clinics and in operating theatres, as part of an initiative to challenge outdated models of medical education. Later she was appointed as Head of the Careers Unit, responsible for supporting trainee doctors across the whole of London. She has also worked as Head of the Extended Medical Degree Programme the largest widening participation medical degree course in the UK. Caroline has written extensively about doctors, the problems they face and how best to support them, and is a regular speaker at conferences in the UK and abroad.

For my family

Mary W is a psychologist who lives in Michigan More than a decade ago, when I was trying to decide whether to go to medical school to become a psychiatrist, I called her to talk about her practice Mary shares my love for northern Michigan and its lakes. Without thinking, she reached for that shared territory for a metaphor.

The patients we work with have fallen through the ice in the middle of a frozen lake My job your job should you take this path is to go out to them, to be with them on the thin ice, and to work with them to get them out of the frigid water. But you must know that if you go out to them on the thin ice, theres a real danger that youll fall in too. So if you go into this work, youve got to be anchored to the shore. You can reach out one hand to the person in the water, she cautioned, but your other hand needs to have a firm grip on the people and things that connect you to the shore. If you dont, you lose your patients, and you lose yourself.

Falling into the Fire: A Psychiatrists Encounters with the Mind in Crisis, Christine Montross

A note on client confidentiality which I have taken very seriously. I have changed names and all identifying particulars so as to preserve my clients anonymity. Before using any personal information in the book (even under the guise of anonymity), I showed each client the draft, invited comment and sought their permission: all were willing to share their experience. Most were willing to do so on the basis that it is this books aim to help doctors facing career struggles and highlight the extraordinarily difficult pressures that many doctors face.

AS THE AEROPLANE wheels touched down on the tarmac I instinctively reached for my mobile phone, like many others around me. The flight from London to Washington DC was only eight hours, so there wasnt much to work through. And there was nothing that a breezy out of office message wouldnt hold at bay for the next eight days. Nothing of concern until I reached the last email:

Dear Caroline

I have questioned from day one whether medical school was right for me, and since then things have only gotten worse: I have got more depressed and felt more hopeless as I have gone through persisting always with the hope that things might get better (and everyone around me encouraging me to do so). But I just cant cope with the pressure and stress of hospitals, and the thought of starting work as a doctor fills me with dread.

I am now a month away from finals and very distressed about what to do. I keep trying to tell myself that I just need to pass my finals then can always stop and do something else with my medical degree. But I have no real clue about what I would do instead and am just as scared that I may regret it if I stop

I am just not sure I will survive working as a doctor, and Im worried I would get so stressed, anxious and depressed that I would end up either hurting someone else by accident or more likely drive myself to the edge. I am sorry if this comes across quite melodramatic. I really have reached crisis point though and am in desperate need for some sane input.

Leo

I froze. This was not an email to ignore. But how could I provide sane input when I was on the wrong side of the Atlantic? In the taxi to my sons house, I phoned a colleague in order to pass the baton to her but I only got her answerphone. There was no option but to answer Leos email myself.

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Everybody goes to the doctor from time to time. For some, visits are a frequent occurrence, whilst for others they are mercifully rare. But however often we seek medical advice, or need treatment, most of us, quite naturally, tend to be preoccupied with our own concerns, and to make all sorts of assumptions about the doctor who is listening to us, taking our medical history, or cutting into us during an operation. If we think of them at all.

We take it on trust that the doctor is up to the task, and doesnt feel tired or overwhelmed. We rarely consider whether the doctor, like Leo, is terrified of accidentally hurting us. We simply assume that if they are relatively junior, there will be a senior clinician somewhere nearby to answer their questions and ensure that theyre doing their job correctly. We tend not to worry whether or not they are bright enough for the job after all, they will have trained for years and will have passed countless exams to get through medical school and beyond. And when parts of our body are being examined, we dont want to entertain the possibility that doctors may find some patients attractive. We dont wonder if the doctor likes patients at all, finds them disgusting, or resents the responsibility inherent in patient care. Instead we imagine that doctors enjoy their work and find it satisfying to treat patients like us.

For many of us, much of what we know about the medical profession comes from watching television. But neither the medical soap operas, nor the fly-on-the-wall documentaries paint an accurate picture. We dont see junior doctors feeling so overwhelmed by work that they run away in fear. Neither, for ethical reasons, would we be shown doctors telling parents that their baby has died. Yet thats just one of the many traumatic tasks that might be on a doctors to do list alongside calming down a delusional patient or deciding whether to call a halt on a failing resuscitation attempt. And television, compelling though it may be, is restricted to sights and sounds; it cant convey the smell of decaying flesh, or as one doctor described it to me the feel of burnt, crispy, human skin.