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Clinical homework: the imperfect work-life balance?

Authors: Yasmin Akram 

Publication date:  26 Oct 2012

Many doctors can’t help but bring the emotional baggage of their work home with them, writes Yasmin Akram

To an outsider—if I may call someone who is not associated with the healthcare profession an outsider without being politically incorrect—it may seem that doctors do not or cannot bring their work home with them. I mean how many doctors do you see popping a patient into the boot of their car or filing a set of notes into their backpack? None, I hope.

A recent episode of panic made me consider how much clinical baggage we carry away from the hospital. Having finished a long, hard on-call shift I was glad to get home and wind down. I wandered wearily into the kitchen to get a bite to eat; suddenly my pupils dilated and I felt my heart racing. The patient—what had I done with the patient? I recalled handing him over, but had I remembered to prescribe the intravenous furosemide? What if I had forgotten? What if he went into fluid overload and pulmonary oedema? I frantically called the ward staff, and they reassured me that I had in fact written the prescription, it had been administered, and the patient was fine. I sighed with relief.

I know I am not the only one who has these episodes of alarm. I make a habit of always checking and rechecking my list of jobs before leaving work, ensuring that everything is done or at least handed over. But let’s say that one time I didn’t, and a patient suffered as a result: it could be the end of my career, either through litigation or guilt.

More often than not we are dealing with more than one unwell patient at any one time, sometimes being interrupted midway through an assessment to deal with a more pressing issue. It would be easy to overlook something, especially at the end of a long shift or on your last night of a set, when you are inevitably exhausted and deprived of sleep. We’ve all heard that the acute response reflexes of a doctor starting a night shift are more impaired than those of someone over the legal drink driving limit. Surely that is a disturbing statistic that we should have done something about by now?

As a child I was in awe when I learnt that Margaret Thatcher ran the country on only six hours of sleep a night. You wonder whose stakes were higher: hers running the country or ours as doctors, with the responsibility of people’s lives more directly in our hands.

I recall when I was at a meeting once and, as I’m sure we all are from time to time, was guilty of being distracted by random thoughts. As I looked around the room from one person to another I noticed something they all had in common, aside from the fact that they were all doctors: they all had dark bags under their eyes.

I and many of my colleagues seem to take our days off to recover from busy weeks; and if we decide we are going to treat ourselves to a real break we end up all the more exhausted before and after our holiday because we have had to rearrange our on-call duties, packing them in either side of the time off. Maybe medicine naturally selects people who thrive on permanent stress responses and minimal sleep, though a quick search of the literature confirms my suspicions that doctors have the highest suicide rates of all professions.

No doubt our perfectionist trait of paying attention to the detail that our patients’ clinical conditions demand is what makes us good at our jobs. But we need to make sure that we don’t lose ourselves somewhere along the way.

Competing interests: None declared.

Yasmin Akram specialty trainee year 2 West Midlands Deanery, UK

 y.akram@doctors.org.uk

Cite this as BMJ Careers ; doi: 

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