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I recently attended a panel discussion that highlighted the profound influence of socio-economic factors, race, and ethnicity on health outcomes as this is a topic I deeply care about. The session underscored the significance of continuity, sustainability, and relationships in healthcare. A notable 25% mortality reduction was observed for patients with a named regular GP for 15 years1. The sustainability discourse focused on planetary health, illustrating the macro-level impact of climate change, especially food scarcity, on health. The session also focused on relationships and asking doctors and healthcare professionals to understand factors behind patients’ behaviour towards illness. A sustainable NHS (National Health Service UK) is dependent on preventative medicine2,3. All points which I completely agree with.
However, a sustainable NHS is also dependent on its workforce4. It is understandable that within an audience predominantly comprised of doctors, there exists a sense of cynicism regarding the escalating expectations placed upon them to embody an idealised archetype of perfection—an expectation to seamlessly integrate the multifaceted intricacies of core health determinants, delivering personalized medical care within the confines of an increasingly strained NHS. One doctor among many articulated this sentiment with poignant inquiry: “Am I to assume the roles of priest, confidant, and counsellor in addition to my medical duties? What further burdens must I bear?” Society already expects doctors to behave to the highest moral standards, and any minor mistakes are not taken lightly. It sometimes feels like doctors are increasingly being asked to make up for the failings of the State and individual patient responsibility. It is essential to recognise that doctors are not a separate entity from society, and they too could be affected by core health determinants, climate change impacts, and at times, are thrust into untenable circumstances such as conflict zones. While the privilege associated with the medical profession is undeniable, it is equally crucial to recognise the sobering reality that doctors are not immune to illness or injury and may find themselves in the role of the patient. Furthermore, junior doctors in the UK increasingly grapple with the reality of soaring living costs, often forced to make sacrifices in basic necessities like food and warmth5. In what manner are we expected to deliver optimal care to our patients amidst these lamentable circumstances? I shudder to think about those less privileged that I am.
Neglecting the fundamental needs of the healthcare workforce could risk restricting medicine to only the most privileged of our society, resulting in a workforce that struggles to relate to an increasingly diverse UK population. Expecting healthcare professionals to address these complex issues without adequately addressing their wellbeing, especially considering the prevalent issue of burnout6 due to unmanageable workload raises crucial considerations for safe, sustainable, and empathetic healthcare practices7. Recognising and supporting the financial, mental, and emotional needs of healthcare workers is essential for fostering a resilient workforce that can effectively navigate the challenges posed by issues like climate change and health disparities.
Amidst discussions and focus groups, a seemingly straightforward solution emerges: to re-establish a sense of security for the entire population, by addressing the most fundamental needs in Maslow’s hierarchy, can serve as a fundamental step towards a more resilient and sustainable healthcare system. Clinical training ought to transcend mere service provision and the perfunctory act of ticking boxes. If individuals are to acquire specific skills, it is imperative that such training be proactively provided, rather than burdening doctors with the responsibility outside of their designated working hours.
Another proposed solution to one of the questions raised during the discussion was advocacy training for doctors. While I have embraced advocacy in certain areas, it is crucial to recognise that expecting doctors to assume the role of activists universally may not be realistic. Historical examples, like Elizabeth Garrett Anderson, illustrate doctors as activists, and in my past, fuelled by idealism and naïvety, had encouraged all doctors to be activists. But not all doctors should become activists. Being an activist in addition to being a doctor does not imply superiority; rather, it highlights the diversity of approaches within the medical community. Furthermore, advocacy need not be characterised by constant social media visibility or vocal presence. I want to reassure patients that there are numerous doctors who are quietly attentive, internalising what they learn, and incorporating it into their practice, fostering a commitment to positive change in a more nuanced and impactful manner. But let’s not blame the failings of the State on the healthcare workforce.
More from Dr. Hannah Nazri here.
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