“Burnout isn’t a trophy” – Breaking the Stigma Around Taking Time Off in Medicine
Written by Jasmine Elliott
As a third-year medical student, Jasmine Elliott reflects on her journey of coming to prioritise recovery over resilience and challenges the insidious culture of overworking and presenteeism endemic in medicine.
“How long do I have to stay here?”
This was the first question I asked, tears in eyes and a plethora of questions rocketing around my skull. Attendance requirements, missed ward rounds and lectures, the stigma of dropping out of my cohort, the loss of purpose, the impact on future career progression— all threatened a metaphorical cranial fracture.
It was strange that in a conversation where I’d been told that I had risked my life and long-term wellbeing, the thing that hurt the most was the prospect of needing to take time off to get better.
Somehow almost losing my life paled in comparison to the potential “loss” of a year of med school to recover from my illness. The thought of progression paralysis was terrifying and instead of fighting for my life and my recovery, I fought for my right to keep pushing. I was a medical student, a future health professional — I needed to soldier on.
In her recent MJA Insight piece, Dr Kate McCrossin suggested that COVID-19’s ‘silver lining’ was defining a new normal for how doctors approached their own health by encouraging a move away from the insidious culture of presenteeism— turning up to work while sick — which she wrote, is “endemic in medicine and indoctrinated into junior doctors from the beginning of their careers.” Doctors working while unwell were publicly scrutinised at the beginning of the pandemic, with health care workers such as Melbourne GP Dr Chris Higgins being attacked for unknowingly exposing the community to the virus.
Even though, as Dr McCrossin pointed out, prior to the pandemic, Dr Higgins working while having mild cold-like symptoms would have been par for the course. Few commentators suggested that Dr Higgins actions were more symptomatic of an underlying unhealthy work culture. An underlying culture which sees up to 99.2% of healthcare workers going to work with flu-like symptoms outside of a global pandemic. An underlying culture which sees junior doctors working themselves to the bone, with approximately 65% reporting burn out.
And an underlying culture where illness can be perceived as weakness, and when doctors push themselves to the brink we blame the failing of the individual, rather than the failing of the system we’re all a part of.
The mindfulness, healthy eating and exercise tips littering my university email account are mere band-aids that fail to protect the festering culture of the ‘stiff upper lip’ that invisibly shames medical students and doctors. We need antibiotics, not band-aids. Sutures rather than a ‘kiss to make it better.’
We need structures that move away from seeing ‘unprofessional conduct’ as the centrepiece of attendance policy which exacerbates the psychological distress underpinning absenteeism to begin with. Protected lunch breaks shouldn’t be revolutionary. Claiming overtime should be the norm. Time to sleep isn’t a utopia, but needs to be the reality.
Always saying yes, working later and later and pushing ourselves harder isn’t the ideal we should be striving for. Burn-out isn’t a trophy to place on the medical mantlepiece, alongside our certificates for mental health stigma and overrepresentation in suicide rates.
An underlying culture where illness can be perceived as weakness, and when doctors push themselves to the brink we blame the failing of the individual, rather than the failing of the system we’re all a part of. - Jasmine Elliott
I’m almost a hypocrite for writing all of the above.
It’s been almost six months since I lay in that hospital bed and refused to swallow the pill of time off. I’m almost ashamed to admit that I pushed through the past six months. Six months of living that I’d just survived. Six months of returning to my GP and hearing the same thing every week. Six months of tears, isolation and burnout which could have seen me thriving instead of shivering through winter.
So this week I’ve booked a flight back home, leaving behind my ‘unique and exciting opportunity’ to continue on placement. I’m not ‘unprofessional,’ ‘lazy’ or ‘rebellious’ as our attendance structures might have us believe.
I’m sick and I need to get better.
So instead of feeling that inexplicable feeling of being a bad medical student, I will prioritise a feeling of hope.
A hope for a future where medical education and workplace structures provide the flexibility to take time off. For a future where recovery is privileged over resilience. Where we take our own medicine and take time off when we need to.
A future, as Dr McCrossin describes, that sees us ‘embrace the new culture around sick leave where people can truly heal themselves by staying at home, resting, and returning to work healthier, happier and better positioned to provide excellent health care.’
At the end of the day, you have to be alive to save lives, but we shouldn’t get to near-death before taking the time to recover. For our patients, but most importantly – for ourselves.
DRS4DRS promotes the health and wellbeing of doctors and medical students across Australia. For more information go to www.drs4drs.com.au
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