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Understanding workplace challenges

Working in medicine is usually rewarding but at times can prove challenging. Any doctor, in any specialty can have times when they need support professionally or personally due to a difficulty. This can arise due to personal or health problems, difficult working relationships including bullying or problems with a certain part of their training programme or clinical practice.

Examples of trigger issues might be being involved in an adverse event or being sited in a complaint. Caring for a patient who is seriously harmed or dies unexpectedly can be incredibly hard.  Sometimes this may be due to a recognized complication or to an error. Doctors tend to be perfectionist and poor outcomes are difficult to resolve; it is the exact opposite of the primary aim of medicine. It is normal to need support when events such as these occur.  Similarly being part of a complaint process is incredibly challenging. It often feels personal and many doctors feel under attack or go through a bereavement type of process. There may seem to be no specific trigger issue but some doctors gradually realise they are experiencing burn out and need support for this.

Advocacy is one of the RCOG’s top strategic goals and advocating for (actively supporting) our members, so that they can more effectively advocate for the women they look after. Work-place based stress not only has a detrimental effect on doctors’ wellbeing but also on their ability to practice to their full potential. Often doctors under such stress will begin to practice defensively including overprescribing, referring too many patients, over investigation, not taking on complicated patients and avoiding certain procedures or more difficult cases. This is potentially harmful to patients, as well as to the doctors themselves.

It is very important to seek support at difficult times such as these situations.

  • If you are experiencing problems, always contact your Educational Supervisor/Training Programme Director (trainees) or Clinical Director (consultants, SAS and Trust doctors) for support and advice in the first instance. Many hospitals and deaneries have excellent local peer support or professional support set ups but there are also national help mechanisms (link to list page).
  • It is often helpful to see your own GP especially if you are experiencing physical, emotional and sleep related issues.
  • Any doctor who is required to write a formal statement for a risk review or SAE or who is referred to the GMC must inform their defence union for advice and must have any statement read over by their defence union advisor prior to submission
  • Any doctor who is being undermined of bullied should contact their local workplace behaviour champion. The BMA advisor is a good source of support and advice in this case also.
  • Other sources of support might be as follows:
    • Your BMA representative
    • Your local peer support or professional support unit
    • RCOG peer support link
    • Your mentor
    • Occupational health/staff counselling
    • GMC website (link)
    • Schwartz or Balint rounds if available in your hospital/region.

What sort of difficulties do doctors find themselves in?

Doctors in training may experience problems when they ‘fail’ an assessment, such as an exam or the Annual Review of Competence Progression (ARCP), or when their trainer or Training Programme Director considers they have difficulties. They also may be involved in adverse clinical scenarios which can have a devastating effect even if very junior and part of a large team.

Independent practitioners may find themselves involved in an adverse event or a complaint; this can be devastating at any time of your working life. They may become the subject of a Practitioner Performance Advice (formerly National Clinical Assessment Service (NCAS)) review or a General Medical Council (GMC) assessment, or their behaviour or performance may have come to the attention of their Medical Director.

Being reported to the GMC is something that most doctors dread and may be of life changing significance.  Feelings of failure, loss of identity and social shame are frequent in this situation. Clinical issues and/or professional issues may lead to GMC referral. GMC offer advice to any doctor in this situation.