Over the past few years we’ve seen a dramatic increase in public discussion and media coverage of issues impacting the ability of doctors to provide safe medical care.  You’d only have to spend a few minutes on Twitter scrolling hashtags like #MH4Docs and #MandatoryReporting to see the loud acknowledgment from the profession that the issues are there and need to be addressed. 

Doctors are scared to seek care for health issues, particularly mental health concerns, because of mandatory reporting laws and the risk of career damage.  Not only is seeking care problematic, the exposure to risk factors for mental health issues are significant; long hours, bullying cultures, victim blaming and endless competition for training and job opportunities are rife in medical workplaces.

Despite the profound levels of discussion and advocacy around effecting positive change in these areas, you’ll still find comments that are seemingly negative and critical of attempts to improve the system(s).  

Why is that?  These individuals are frequently health professionals also facing these issues.  Why wouldn’t they want to see change implemented?  I have not found one negative comment or criticism of advocacy in these areas that actually denies the issues exit:  There is a resounding agreement that they most certainly do. The criticisms and negativity appear to be focused on the hurdles and challenges that will need to be overcome to successfully overcome these endemic system problems.

There’s the group that are advocating for changes and striving to take steps towards better systems, that will be safer for doctors and patients.  There’s the group that are too drained and thwarted by the very systems that need changing to do anything more than watch the advocacy and efforts of others, hoping that change will occur.  Then, there’s the group that seem to discourage the advocates, loudly proclaiming the awful realities of the hurdles that have to be overcome before change can occur; and, at times, implying that those hurdles are impossible to get over.

The final group are sometimes assumed to be trolls on social media platforms.  However, after some serious consideration I’ve decided that as frustrating as their defeatist attitudes may be, they aren’t trolling. These individuals are evidence of just how damaging the systems we are seeking to change are.  They’ve moved past being overwhelmed by the traumas/dangers of working in these systems, while still holding onto threads of hope that the issues will eventually be addressed, and they’ve moved into a place where they believe the situation can’t be addressed because it’s just too hard. It is the final group who are sometimes identifiable through comments like “That’s how it was when I went through” and “It worked for my generation”.

The advocates aren’t blind to the immense challenges associated with pushing for change; but choosing to give those challenges too much power steals away the chance of taking even small steps towards system(s) improvement.  

In a way, the defeatist group, have developed a form of Stockholm Syndrome to the very systems that have stolen their own health, relationships and hope.  Accepting system problems as facts and realities that are unable to be addressed for one reason or another provides a level of self-protection: If you accept that the problems can’t be changed then there is no inner turmoil associated with not addressing them.  Agreeing, and sympathising, with the administrators and organisational power holders who say “we can’t fix that because…”, they’re almost defending the perpetuation of these issues which are affecting each new generation of health professionals who graduate into these systems.

When I consider the defeatist group with this perspective, they become less like ‘thorns in my side’ as I join with others in doing everything I can to bring about change, and more like ‘fragile, broken reminders’ of what the outcome for for many more doctors will be if we don’t succeed in changing these systems.  And, I realise, that for several years I was one of them…

With that perspective, the urgency and importance of fixing our broken systems becomes even greater. Those of us who are able must push hard, and with strategy, to ensure that we do not become the next cohort of defeated and accepting broken professionals.  We must fight for those who are not yet broken, but currently swimming upstream against such powerful system issues that all they have capacity for is their own survival (I dare say, that is probably the majority of junior doctors – it was definitely me).  And, we must fight for change and hope that even small steps forward will bring those who have been defeated back from complete brokenness (and acceptance of the systems that broke them), to a place where their wounds can heal and allow them to nurture future generations.

In no way should this post be taken to be a criticism of those who have suffered through the current systems to the point of being broken; I am only sad that the changes we are pushing for now were not there before they, and I, became so damaged.  

History isn’t my strong point, but I can’t identify any moment in history where great change began with someone saying “This is too hard” or “It isn’t possible”.  Change is rarely easy and rarely cheap.  It doesn’t happen overnight, and it takes unity and alliance to truly implement.  

Knowing that, I’m committed to continuing to try and effect change in our broken medical systems for the safety of doctors and our patients (two cohorts with equal importance).  If I see a hurdle, I’ll acknowledge it, but only so that I can try and identify a way to overcome it.