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Wilkommen to my blog - my name is Karin Purshouse, and I'm a doctor in the UK. If you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I'm currently a doctor/research trainee in oncology after spending a year doing research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Thursday, 28 November 2013

Pure Guilt

With my new-found SWIM empowerment, I have decided to do something extremely non-SWIM-esque, in that it's not particularly sensible.

Next year I will be unemployed. I am not applying for a job. I have no discernible income mapped out. I haven't got anywhere to live. I'm not even planning on being a clinical doctor.

I am crossing the pond and becoming a lab researcher. Some have said this is 'cool' or 'crazy' or 'wow how nerdy'. No matter. Either way, I'll be poor for a year. And I need to fall in love with medicine again.

I remember once watching an episode of Question Time (other TV political debate shows are available) where they were discussing doctors' wages and pensions, and a member of the audience said something along the lines of 'doctors shouldn't be seeking financial gain. They should be doing the job because they want to help people out of a sense of altruism'.

In my opinion, this is the primary motivator of the vast majority of doctors. For myself, it's my raison d'ĂȘtre. You don't go through the high school trauma of applying for medical school, plug through six years at university and commit yourself to a potential lifetime of night shifts and antisocial hours if you don't love it.

But that's why the guilt is so extreme when you realise your love for it has waned. You feel guilty for all the 17-year-olds you know, and knew, applying for medical school who would be desperate to be in your position. You feel guilty for the patients you have met and are yet to meet who still believe that doctors and nurses are these pseudo-heroes. You feel guilty for your colleagues when you have to ask for yet another multi-source feedback which is basically a way of asking 'how much do you like this person?'.  There is a guilt and a fear - what if they knew the truth?

And of course I acknowledge that with this sort of post, I am attracting a barrage of 'you don't know how lucky you are, whining about your job, laughing all the way to the bank'. Let me be clear. People work hard in all kinds of jobs, and I know I am lucky to have one like this. There is certainly no bank laughing. Far from it.

But even in my second year of work, the challenge doesn't seem to be getting any easier.  Just like a blog from a nurse describing her experience of the NHS, I share her concerns and fears. And saying how you feel seems like a sign of weakness. I've done a couple of very long shifts recently, but it doesn't seem acceptable to say 'I'm worried about how tired I am' or similar because you're sort of stating the team vibe and frankly, what's the point? No-one likes a whiner. Senior colleagues perhaps don't see the impact of pure criticism on the junior doctor. To them, they have seen only your sickest patient and have found plenty of holes in your plan. They didn't see the struggle in finding out the story, or getting the blood test or discussing things with the family. You are just another junior doctor. To you, it's stomach-churning confirmation of every fear you had that you're actually not very good.  And all the while you've got the Mid Staffs enquiry (See Francis Report) looming large and you think, if this was my granny, would this be good enough? The fear, embarrassment and panic are all too real in your mind.

I spoke about plans for next year with my best friend from medical school (who is also taking time out), and I suggested this problem of 'falling out of love with medicine' - and there was a sigh of relief down the phone. Thank goodness, he said. 'I feel so guilty for feeling like that, but that's exactly what it is'.

No-one should tread softly about quality and safety in healthcare, but I can't help feeling we've got it wrong from the inside out. I remember after the avalanche thinking that if I channelled anything positive from it, it would be to have more concern for the well-being of my colleagues. Another is to always take at least one positive from every day. There is always something you could do better, and that's what makes us human.

As for the guilt, I'm starting to think it's part of the job. I'm sure this is just a 'down day'. I guess all you can do is your best, keep a smile on your face and, like any relationship, you'll realise there's a reason why you loved it; it just might take a while to find it again.

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