Samantha Batt-Rawden, president of the grassroots campaigning organisation the Doctors’ Association UK (DAUK), told The BMJ that doctors continued to receive abuse despite “risking their lives since March 2020.” In a recent survey, DAUK’s members reported verbal and physical abuse including insults, racism, death threats, and violence. One respondent told the campaign, “Physical abuse is a regular part of being an emergency medicine doctor. I have been hit and bruised by many patients for a variety of reasons. All staff have a story to tell, and it’s rare that the patients ever have to face any consequences.”

“It is not enough simply to clap once a week for NHS staff,” as the public were doing in the first lockdown of 2020, says Batt-Rawden, DAUK president. “We have to create a protected workplace that doesn’t leave them at risk of abuse.”

Read the full article here: https://www.bmj.com/content/372/bmj.n739

Dr Samantha Batt-Rawden, an intensive care registrar, says NHS staff are facing “devastating” abuse online and at protests.

She thinks it’s driven by coronavirus sceptics and anti-lockdown activists.

In response Dr Batt-Rawden, who is president of the Doctors’ Association UK, started her own campaign for people to post blue hearts on social media to show their support for health workers.

Watch the video on the BBC News site: https://www.bbc.co.uk/news/av/uk-england-london-55616041

The NHS was struggling to cope before Covid struck, so the scale of the crisis quickly widened the cracks. It has highlighted the communication silos that slow progress between community care services and hospitals, and exposed the red tape and inefficiencies that exacerbate staff shortages and waiting lists. Clinicians are exhausted, patients are being let down, and the situation is set to worsen, as GPs scale back care to ramp up the vaccination programme.

The expectation is that GPs will start to deliver vaccinations as early as December. It will be a monumental logistical and human effort, consuming hundreds of hours of clinical time. We’re incredibly lucky to have so many skilled individuals poised to deliver this essential function. But stretched GPs will be forced to funnel yet more resources into the Covid response, worsening backlogs and reducing already limited community care provision.  

More public money (in excess of £150 million) will be spent reacting to the crisis and bolstering our defences. This is essential expenditure, but we also need funds to simultaneously start building a brighter and better functioning future for the NHS. Covid might become more manageable once enough of us are vaccinated, but there’s a long way to go before the NHS will be released from the virus’ grip.

Our healthcare workers themselves are another crucial piece of this complex puzzle. Without them, we have no NHS. Without them, we have no hope of recovery. But in the throes of the most debilitating health crisis in the NHS’ history, the prognosis is looking increasingly grim for the individuals at its heart.

Preliminary research has shown increased instances of depression, anxiety and insomnia in frontline workers, who have been up against the pandemic since March. A recent Doctors’ Association survey found that more than 1,000 doctors have seriously considered quitting this year, with 45 per cent of those asked citing the crisis’ impact on their mental health. Gruelling 12-hour shifts, exhaustion and burnout are also leading growing numbers of nurses to quit within three years of joining the profession.

Full article here: https://www.independent.co.uk/voices/nhs-covid-funding-vaccine-patient-care-b1721861.html

The DAUK chairman Dr Rinesh Parmar, said his members had reported that many dying patients had been deprived of access to care they would have normally received at the beginning of the pandemic.

“In reality, the late lockdown allowed far more infections to spread across the country than the NHS had the capacity to cope with … It left dedicated NHS staff in the invidious position of having to tell many critically unwell patients who needed life-saving treatment that they would not receive that treatment. Those staff will be mentally scarred for a long time as a result. They dedicate their lives to caring for people and never expected to be left in such a situation.”

The article can be found here.

https://doctors-in-distress.org.uk/useful%20resources/

If in crisis call 111 / 999

Samaritans helpline – 116 123 www.samaritans.org

Text “SHOUT” to 85258

Starting medical school in 2008 felt like a dream. I can’t say that it was a lifelong dream though. You see, I didn’t grow up wanting to be a doctor. Trudging through the pits of depression, anxiety, and agoraphobia through law school led me to medicine. Back then, my interests faced inwards. However, confronting myself emotionally made me realise that service is important. Medicine is how I chose to live out that value.

While the first and second year of medical school was a blast in every way, the third year whiplashed me into a stormy path to learn some hard lessons. I had a car accident. Worse yet, I sustained a spinal cord injury and quadriplegia.

Despite all this, I still love life. I’m grateful for everything that I have. This includes some of the intricacies that such an injury bestows on life. 

I was in New York during a December. Coming from Australia’s hot summer, this was a chilly change. Thanks to the condition that changes the body’s response to thermoregulation, I wandered around shivering in New York looking like a well-wrapped ninja stopping occasionally for hot water. These are things that few people realise about a spinal cord injury. Not even I understood what was to come when I woke up on an intensive care bed in 2010. Apart from the very dramatic changes physiologically, life suddenly changed socially as well. We lost money, friends, and family. My own family, which was once a warm fortress of safety, fell apart. What was left was mum and me. I often felt physically and figuratively naked.

Being a patient was tough. I watched medical students do ward rounds on me, addressing me clinically. I rarely felt like a person. There were harsh doctors. There were encouraging doctors. There was a loss of autonomy and empowerment. For months, I didn’t even choose when I showered or ate.

In that hospital was a nurse who was oddly particular about cleaning the male patients’ privates. While one was chilling out in the ward waiting for the day’s therapies, you would often hear this nurse’s booming voice rolling down the corridor. If you were unlucky enough to remain in their path, the inevitable question came. “Have you cleaned your little man today?”, they would say. Regardless of the answer, you would be dragged off to the bed to have the little man cleaned.

With an unusually clean little man, five years went by. I slowly put life back together and plotted the never-ending dream of coming back to medicine. Some said that I shouldn’t do it. Some of my best friends talked about the challenges that would lie ahead and encouraged me to pursue another path. They wanted me to avoid the pain.

This was a time that I remembered the very thing I understood during that time in law school. When we come to the end of our life, no one else will be accountable for the choices we made. If I didn’t give medicine a try, I would regret it forever.

My mum and I, with the support of a forward thinking medical school, came back in 2015. I started life again in Gold Coast, Australia with nothing. We had a couple of bags, a broken wheelchair and some borrowed furniture. I spent weeks in the medical school’s clinical skills lab with a supportive general practitioner, school staff, and a simulated patient learning how to do a physical examination again. This time, I had to think laterally about achieving the same clinical outcome through different physical means.

I figured out how to do most things. I put my head down in a way that I never have before. The injury has forced me to focus my head more. I passed exams and started proving that this can be done. Perceptions however, were still adversarial.

I became privy to a disturbing email circulated on 14 October 2015. In the email, an academic stated that they had developed national inherent requirements for medical students. The academic, who knew me, wrote, “we should refer to them if we are making any difficult decisions about candidates’ suitability to enter or remain in the MD.  They do not bind us to exclude anybody but it is hoped that they will provide some legal protection where we do have to make the difficult decision that a candidate’s disability cannot reasonably be accommodated to enable them to study medicine.” Reading these words was nauseating. By this point, I’d gone through many clinical rotations successfully. Why was there suddenly policy that allowed schools to prevent people like me from study medicine?

I read through these inherent requirements. They prescribed physical qualities that would surely exclude me from going through medical school. Fortunately, I wasn’t affected by and graduated in 2016.

Then, another challenge came. In our state, domestic graduates are guaranteed internships. I also had a contract with the Health Authority that bound me to work for them for five years after graduating. Nonetheless, my application was removed from the pool to be “considered separately in a bespoke process”. As the opaque process dragged on, I asked more questions. At one point, I was told that I wouldn’t be starting work with my colleagues and was offered free psychological support instead of a job. After going through the rigours of a spinal cord injury and depression previously, psychological support was not what I wanted. I wanted to work.

I had a lot of supporters in the community, doctors, media and politicians. Emergency physicians in our department even offered to give up some of their salary to fund my position. Thanks to everyone, I was offered a job at the twelfth hour and I started work in 2017.

I have loved every minute of this job. It’s everything that I imagined it to be. And more. The challenges medicine places on a person allows one to experience parts of humanity that would otherwise be inaccessible. I have not only grown as a person, but have come to appreciate people even more.

They have been more than one tired nightshift in the emergency department where I have shared journeys with patients going through life changing events. Medicine happens. We all have the technical skills. My most memorable moments on the job have been the difference just a cup of tea and a chat has made.

The challenges didn’t stop with the internship though. I once started a conversation with a radiologist about pursuing a career in the specialty. Their first reaction was, “I have so many concerns about this. Can you even type?” Later, in response to my questions about the roadblocks roadblocks they kept putting my way, I got a call one day. They said, “You cannot work in our department with a spinal cord injury. If anyone asks, you can’t tell them that I said this. You have to tell them that it is the position of our whole department that you are not wanted.”

Lucky for me, there were many more radiologists that were willing to fight for what’s right. Right now, I work in Australia’s busiest emergency department surrounded by a supportive team that I call family. I even met my beautiful fiancé there.

I am heartened that we are now changing policies about medical students with disabilities in Australia. We are developing professional standards to include a variety of people in this profession.

 I like to think that having a wide variety of perspectives benefits our patients. After all, shouldn’t our lived experiences go towards caring for our patients better? The arguments for including a diverse group of people in the practice of medicine are many and obvious.

Most importantly, what we do as doctors has an effect on the rest of the community. We have always had the privilege of being thought leaders. The work that has been done on doctors with disabilities have had widespread repercussions for employment and education broadly. For our profession, leading the way is a must.

Dr. Dinesh Palipana OAM, LLB, MD

Doctors with Disabilities Australia

Griffith University

The stories include:

• a pregnant doctor who fainted after being forced to stand up for 15 hours straight and being denied water. The junior doctor was subsequently shouted at in front of colleagues and patients on regaining consciousness and told it was her choice to be pregnant and that ‘no allowances would be made’.

• a doctor who told us that a junior doctor hung themselves in a cupboard whilst on shift and was not found for 3 days as no-one had looked for them. His junior doctor colleagues were not allowed to talk about his suicide and it was all ‘hushed up’.

• • a doctor who was denied a change of clothes into scrubs after having a miscarriage at work despite her trousers being soaked in blood.

(Additional stories can be shared on request).

In 2019, The Doctors’ Association UK (DAUK) compiled a dossier of over 1000 stories of 2 frontline doctors brutally treated by the NHS .

DAUK subsequently launched anti-bullying campaigns #NHSMeToo and Compassionate Culture. The grassroots campaigns were supported by the Health Secretary Matt Hancock who spoke of the need to develop compassionate leadership in our NHS and vowed to see that changes are made.

Despite the promises and assurances of a culture change it is evident that this has not happened. During the worst winter crisis on record DAUK was inundated with stories from doctors, yet again, all attesting that conditions on the frontline have worsened, to the point feel they have no option but to leave the NHS. With so little regard for doctors’ wellbeing it it cannot come as surprise that we currently have nearly 10,000 vacancies for doctors across the frontline.

The time has come to act. With a deepening workforce crisis the NHS cannot continue to treat its staff with so little regard.

Dr Rinesh Parmar, Chair of The Doctors’ Association UK and an anaesthetic doctor said: “These heart breaking stories from across the country show the extent of bullying and harassment that doctors face whilst working to care for patients. Heart wrenching examples of being denied access to tap water after the tragic loss of a patient just reveals how heartless and inhumane conditions can be for doctors working on the frontline.”

“It is easy therefore to see why the goodwill that the NHS relies upon has truly run dry. Doctors have spoken in their droves of being denied access to drinks, being accused of theft for eating a biscuit even though they’ve foregone their breaks, and this may be the only thing they eat or drink all day. A learned helplessness cannot be allowed to develop, it is vital that our doctors, the very backbone of our NHS are respected and looked after so that they’re at their very best when caring for patients.”

Dr Natalie Ashburner, The Doctors’ Association UK Wellbeing Lead and psychiatry doctor said: “It is extremely disappointing that doctors are reporting a lack of access to basic resources such as drinking water at hospitals all over the UK. The effect of these inconsiderate, short- sighted and bureaucratic decisions on both the physical and mental wellbeing of staff who already work long antisocial shifts under tremendous stress in a climate of unprecedented demand for already stretched resources should not be underestimated. NHS trusts must urgently take measures to make the mental and physical wellbeing of doctors a priority by addressing the issues we have highlighted, creating a compassionate culture and remembering that doctors are human too.”

CONTACT press@dauk.org

The investigation has uncovered harrowing stories of young medics being denied drinking water during gruelling shifts, working for 15 hours on their feet non-stop and of uncaring managers tearing into them for breaking down in tears over the deaths of patients. One was even accused of “stealing” surgical scrubs she took to wear after suffering a miscarriage at work. The distraught woman finished her shift wearing blood-soaked trousers, instead of going home to rest.

Doctors are now quitting in their droves, leaving those left ­struggling to cope with a growing ­workload. Our probe reveals the reality of working for an NHS which has been subject to a record funding squeeze and is 8,000 medics short.

Health chiefs vowed to ­investigate the Mirror’s evidence from 602 ­testimonials submitted to grass roots lobbying group The Doctors Association UK.

Heartbreaking examples of being denied access to water after the tragic loss of a patient reveals how ­heartless and inhumane conditions can be.

Dr Rinesh Parmar, DAUK Chair the Daily Mirror

Chairman Dr Rinesh Parmar said: “These heartbreaking stories from across the country show the extent of bullying and harassment that frontline doctors face whilst working to care for patients. Heartbreaking examples of being denied access to water after the tragic loss of a patient reveals how ­heartless and inhumane conditions can be.

“It is easy to see why the goodwill that the NHS relies upon has truly run dry. Doctors have spoken in their droves of being denied access to drinks, being accused of theft for eating a biscuit even though they’ve forgone breaks and this may be the only thing they eat or drink all day.

“A learned helplessness cannot be allowed to develop, it is vital that our doctors, the very backbone of our NHS are respected and looked after so that they’re at their very best when caring for patients.”

Doctors Association UK wellbeing lead Dr Natalie Ashburner added: “It is extremely disappointing that doctors are reporting a lack of access to basic resources such as water at hospitals. “The effect of these ­inconsiderate, short-sighted decisions on the physical and mental wellbeing of staff who work long, anti-social shifts under tremendous stress in a climate of unprecedented demand for already stretched resources should not be underestimated.

The NHS is already haemorrhaging doctors

Dr Natalie Ashburner, DAUK Wellbeing Lead the Daily Mirror

“The NHS is already haemorrhaging doctors. Trusts must urgently take measures to make the mental and ­physical wellbeing of doctors a priority, creating a compassionate culture and remembering doctors are human too.” A recent poll found almost a third of doctors may be suffering from burnout, stress and “compassion fatigue”.

The NHS has some of the fewest doctors in proportion to the population compared to other developed nations. NHS funding increases have been at a record low of 1%, compared to a 4% historical average.

The Department of Health and Social Care said of our investigation: “These accounts are deeply distressing. This type of behaviour has no place in our NHS and nobody should have to face bullying or harassment in the workplace. “We take these kinds of reports very ­seriously and we’re committed to making the NHS a better place to work.”

Excerpt from the Daily Mirror article by Martin Bagot, read the full article here: https://www.mirror.co.uk/news/uk-news/harrowing-stories-burned-out-nhs-21487129

Why do those who work in healthcare, some of our most compassionate people, lose their empathy?

In her TED talk Sammy reveals how tough things are on the frontline for NHS doctors and speaks candidly about her struggle to keep patients safe.

The first NHS winter crisis had hit and it was a war zone. The waiting room was standing room only. Trollies lined every corridor. Resus was overflowing. Ambulances stacked outside the doors. Every shift was fighting fires we could never get on top of. I lived in constant fear, knowing, as exhausted and run ragged as I was, eventually I was going to miss something. And boy did we have our near misses.

Dr Samantha Batt-Rawden TEDxNHS

Sammy explores her research into empathy, and explains how and why doctors’ empathy takes a hit during the early stages of training, and never fully recovers. Introducing the concept of moral injury Sammy explains the psychological toil that working in a broken systems takes on a doctor. She suggests that being unable to provide patients the with the care they need results in moral injury, and over time this leads to burnout and a loss of empathy.

Take a bright eyed healthcare student and put them into a healthcare system. It will change them. Sleep deprivation, long hours that isolate you from your friends and family, the blame culture, bullying…the dark side of medicine. It’s the best job in the world, right? But it comes at a price.

Dr Samantha Batt-Rawden TEDxNHS

Speaking of her own experience of burnout she argues that the resilience movement has placed too much onus on individual doctors, allowing the system to avoid all accountability for putting employees into a broken system and blaming them when ‘they inevitably break’. She argues that resilience should not be simply a personal responsibility but a ‘team sport’. Calling for a widespread culture change Sammy argues that unless we start looking after our doctors, we will have no-one left to look after our patients.

Speaking about her own journey, Sammy talks openly about finding herself on the other side of the NHS after going into premature labour as an A&E Registrar. After her son Joshua was born at 27 weeks, Sammy talks through the worst day of her life, when her son needed to be resuscitated and his life was in the hands of her colleagues.

Then a face around the door. A consultant we had never met in. “I’m sorry, I’ve not got good news”. With boundless compassion and endless empathy he told us what had happened to our son.

Dr Samantha Batt-Rawden TEDxNHS

There was not a dry eye in the room as Sammy talked through Joshua’s heartbreaking journey through 3 months of intensive care. Paying tribute to the doctors and nurses whoshowed her family so much kindness, Sammy explains how this has forever deepened her already deep appreciation for the NHS, which saved her son’s life. After bringing Joshua home Sammy founded The Doctors’ Association UK, determined to fight for the NHS.

Watch the full talk here on the TEDx platform:

Sammy cites the blame culture, the pensions tax, the junior doctor contract and impossible workloads, amongst others, as key causes of rock bottom morale. She also warns that doctors may be suffering from ‘moral injury’ the psychological harm associated with witnessing sub-standard care due to the system we work in.

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‘Would you choose medicine again?’ I look into the eager faces of the sixth-formers I’ve been asked to speak to. Not for the first time, I hesitate before I answer. I love my job – it’s a great privilege to be a Registrar in Emergency and Intensive Care Medicine. But there’s no doubt it’s hard. The specialities I’ve chosen to train in mean being there 24 hours a day, seven days a week, for our most critically unwell and injured patients. Many don’t survive their journey in intensive care. We do what we can to ease their suffering. Being human means that we often we take that suffering home.

These were struggles that I was prepared for. What I wasn’t aware of was how things would change over the 14 years I’ve been part of the NHS – and it’s these changes that have made it so much harder to do an already hard job. I graduated as part of one of the last cohorts of junior doctors who had onsite accommodation provided in England. I lived with three other new doctors, out of a group of 30 or so of us. None of us knew what we were doing. One day we were medical students, the next we were on call, looking after over 100 patients. We stumbled through it and learnt quickly. There was an unspoken camaraderie. No-one batted an eyelid if you staggered in after several days straight on call and needed to sleep for 24 hours or if you had been involved in an unsuccessful resuscitation and needed to offload in the middle of the night. We worked hard, but we were all in it together. Doctors started losing their physical spaces soon after that. Traditional doctors’ messes were closed to make way for office space. Gone were our on call rooms and canteens so there was nowhere for us to connect with our peers, get our heads down or grab a much-needed coffee after a stressful shift. I feel for our newest doctors who most desperately need those spaces – I’ve found more than one distraught junior doctor who has resorted to using a cupboard as a bolt hole.

Around the same time our medical family was also being disbanded. We used to work in ‘firms’ under a consultant, a team made up of very junior doctors through to senior registrars about to finish their training (still, perversely, called ‘junior’ doctors). That meant someone was responsible for you, had a vested interest in your training, and, if you were lucky, made sure you were fed. Sadly, that structure no longer exists. The reforms were pushed through in spite of widespread protests and mass resignations (as were the ruinous junior doctor contracts, enforced by Jeremy Hunt in 2016). It was a significant blow to our profession from which morale has never truly recovered. Doctors were no longer part of a team but just another number on the rota. We now rarely stay in one hospital more than one year. With little to no say in where they are moved to next, doctors often have to uproot their lives and their families every 12 months, to fill the gaps in their region. Even within that time doctors are shunted around departments every three or four months and – as of last winter – can now be moved around the hospital on a daily basis to work in specialties or wards they have no prior experience of, to cover gaps. If you’re thinking this doesn’t sound safe, you would be right.

Tragically, there have been a number of high profile cases of patients coming to harm, at least in part as a result of under-staffing and rota gaps.

Most recently, a junior doctor was convicted of gross negligence manslaughter following the death of a six-year-old boy from sepsis. The day the child died, the junior doctor was doing the job of several doctors at once, covering six wards, over four floors, without the supervision of the consultant who should have been there that day. The case was a lightning rod for a profession with already rock-bottom morale. For many doctors who had been working themselves into the ground trying keep patients safe, it was the final push they needed to hang up their stethoscopes for good. We probably do work fewer hours than before but 70 hour weeks are still not uncommon, and the workload during those hours has increased phenomenally. I can’t remember the last time I walked in to anything less than a four-hour wait to see a doctor over the winter. ‘Corridor medicine’ has now become the norm, with nurses being allocated to a stretch of hallway instead of a number of cubicles. It’s degrading for our patients, and the least safe option. The situation is hardly better in intensive care. While we have the beds, we don’t have the staff, meaning we have to accompany ventilated patients to other wards around the country that have the capacity. This combination of spiralling workloads and a decimation of morale and camaraderie has been toxic for our profession. Last year, 55 per cent of UK doctors met the criteria for burnout and ‘emotional exhaustion’, with one in five resorting to the use of drugs or alcohol as a ‘coping strategy’. It’s hardly surprising that we are haemorrhaging doctors out of the profession, and it’s only getting worse.

In 2018, just 38 per cent of second year doctors chose to continue their careers in the NHS and enter specialty training with the aim of becoming an NHS consultant or GP – compared to 83 per cent in 2010. This has been compounded by a crisis at the other end of a scale due to punitive pensions tax which has forced up to 69 per cent of consultants to cut their hours. This is a disaster. There is a desperate need for doctors across the whole of the NHS. I can’t blame those who walk away, but each colleague that leaves makes it harder for those of us who are left behind. It is increasingly recognised that what doctors may be suffering from is not burnout at all but ‘moral injury’, the psychological harm that occurs as a result of not being able to give patients the care that they need due to working in a broken system. The term came from the military and refers to veterans that were suffering low level trauma from seeing things which went against their ‘moral code’. For doctors, it’s witnessing substandard care and not being physically able to give patients the care they deserve. I used to walk up and down the trolleys lining the corridor in A&E, already run ragged, looking for that patient who couldn’t wait and knowing I would eventually miss something. It was enough for me to walk away from emergency medicine. I still don’t know if I will ever go back.

So, how do we fix this? First, we need to treat staff like human beings if we are going to have any hope of stemming the exodus of clinicians. It’s as simple as restoring some on-call rooms so we can get our heads down, and stop crashing our cars on the way home. Or it’s as basic as ensuring that junior doctors have leave for our own weddings. Honestly, at this stage, just letting us have access to now-outlawed NHS coffee overnight would be a significant morale boost. It’s not going to sort everything, but it might make it that tiny bit easier to do an increasingly tough job. If we don’t start looking after our doctors, we won’t have anyone left to look after our patients.

If we don’t start looking after our doctors there will be no one to care for our patients