UK

The grim reality facing junior doctors

Lucy Dunn
30 July 2022, 12:15am

The NHS is facing the biggest crisis in its history. GP surgeries are breaking under pressure, waiting lists could top nine million by March 2024, and there’s a huge shortfall of staff. Many medics are opting to simply throw in the towel. Having recently qualified as a doctor, I can't say I'm surprised.

For junior doctors, stress, burnout and bullying are quick to take a toll: seven per cent of medics leave within the first three years. This bucks the expected trend: that people are at their most vitalised nearer the start of their careers. For medicine, the evidence suggests otherwise.

Clinical placements reveal harsh realities early on, acclimatising trainees to the most appalling parts of the job, even before they have the chance to fully understand what it's like to be a doctor. This week, the health service committee cited bullying, sexism and harassment as reasons for doctors leaving medicine early. It drudged up a multitude of memories from my own experience training to be a doctor, so I can’t say the findings are especially shocking.

On my first day of hospital placement, fresh-faced and bright-eyed, I received a jarring introductory talk as my foundation year doctor told me matter-of-factly about how she already knew of three suicides attempts by colleagues across the UK. ‘That’s awful,’ I agreed. ‘Why? What causes it…?’ ‘The job,’ she said.

I’ve seen senior registrars bully their juniors, exercising the power they feel they ought to have over those who cannot risk complaining

I’ve seen medics humiliated in front of their colleagues by senior consultants, as we desperately averted our eyes in embarrassment while anxious to avoid becoming the next prey. I’ve seen nurses scream at doctors in front of patients, after they have received a snide verbal pummelling. Once, a shouting match disrupted a ward round for so long one elderly patient shuffled off to get a shower. He returned, freshly dried, before the argument had subsided.

I’ve seen senior registrars bully their juniors, exercising the power they feel they ought to have over those who cannot risk complaining. On one ward round, I witnessed a surgeon repeatedly verbally abuse a junior doctor; the insults became progressively more personal the further round the ward we walked. His junior was getting more embarrassed, and quite clearly more upset. At one point, he mumbled his excuses (something about leaving his notebook in the previous six-bed bay) and left quickly, covering his face as he went. He was my boss, but within the space of 40 minutes, he had been completely torn to shreds in front of me.

Everyone’s been humiliated at work, but I saw it happen continuously, day in, day out. Sometimes I was on the receiving end, but as students we changed wards so frequently that it rarely cut too deep. I came to better understand that junior doctor’s earlier cantankerousness, his pale face pulled taught, stressfully multitasking, flicking his head dismissively when us students offered our help. ‘See one, do one, teach one,’ is the educational mantra of medicine. No wonder the bullying becomes endemic.

I spent years seeing either myself or my peers being berated at patient bedsides, often by registrars pushed to breaking point, or consultants simply enjoying having finally reached the top of the food chain. Sexism has not been eradicated, no matter how many more female doctors there are now. My experience of it was often at the hands of women, whether doctors or nurses; again, perhaps another trickle-down effect of a culture that was even worse years before these staff rose the ranks. Colleagues of mine have complained of racism and the poor handling of related complaints by hospitals and universities, both unwilling to dive too deep into the murkiness.

A junior doctor once whispered to me and a group of my fellow medics as we walked along: ‘What do you think of the consultants here?’ I shrugged, not wanting to give anything away. ‘They’re too intense,’ I remember another doctor, still whispering, telling me. ‘They’re always on our backs. They’re always watching.’ There was a Big Brother joke in there somewhere, but she wasn’t laughing.

In medicine, as with other careers, of course you get the odd bad apple. But most doctors and nurses are good people who go into the profession to care for others, to make their patients better. So why is the bullying culture endemic? The answer lies in the pressures of the job. The emotional toll of having another’s life in your hands requires an incredible level of mental resilience in itself. People can only take so much.

Medical staff work in an environment that consistently demands more and more of you for less and less. Staff are increasingly stretched: one of my friends is due to start work in a hospital that has nine fewer first year junior doctors than the year before; another has been the sole doctor, in her first year, responsible for three entire wards when on night shift. It’s terrifying – and dangerous.

Perhaps if there were more doctors, or if there were better hours, or if the pay wasn’t so relatively decimated by years of caps and inflation, or if an improved work-life balance was achievable, the NHS wouldn’t be seeing this unprecedented resignation crisis. Many GPs have cut back to work only three days a week. Is it any wonder? They’re the lucky ones: they’ve escaped from what can often feel like the barren, unfriendly landscape of hospital life, where workers don’t experience the same work-life balance, particularly if you’re a junior.

The NHS is a victim of its own success: it has provided vital healthcare, free at the point of use, to those who need it most. But after the creation of a system that sounded too good to be true, it was inevitable that demand would very quickly outweigh resources. The NHS needed to reorganise well before Covid, but the pandemic has simply amplified any pre-existing issues tenfold.

The health service has been unable to slow down and revamp itself at the points it has most needed to because it’s never had a chance to stop. Old traditions and cultures have been stamped out; new changes jar with a way of working that refuses to fully modernise.

New jobs are being created without the problems of those pre-existing ones being solved. Different trusts operate in entirely different ways. Some hospitals are still paper-based; those that don't have tech teams that aren’t always available around the clock, when they are needed. Rotas are pre-arranged, annual leave is not always, if at all, easy to book, though nepotism may get you somewhere. Waiting lists are rising exponentially, emergency departments are routinely overwhelmed and Covid still causes staffing issues.

So when, given all this, the medical hierarchy punches down, it’s no wonder that the NHS is facing a record staff exodus. The NHS is breaking – and patients and doctors are paying the price.

WRITTEN BY Lucy Dunn  is The Spectator's social media editor. She studied medicine at Glasgow University