A junior doctor had just finished a 14 hour shift, working in an environment that had them feeling cornered, alone and worthless. Only to go home, mentally exhausted and dreading to go in the next day. Many junior doctors are constantly walking on eggshells around their superiors upon juggling their other responsibilities. The fact is, toxic work environments are detrimental to doctors. More and more junior doctors are now refusing to look the other way, taking a stand to speak out about their experiences, and offering advice on managing this problem that’s no longer a secret.
Overworked, underpaid and burnt out – These are the common words many doctors use to describe their housemanship/internship, yet the injurious effects to them are still there today. Despite hearing all the stories, it is almost impossible to be prepared for a toxic work environment. In this environment, doctors are running like hamsters on a wheel to meet overwhelming expectations and earn the respect they deserve. Taking on heavy workloads while struggling to maintain their mental health, they don’t feel that they work in a safe environment to voice out their struggles and receive the support they need.
“I already knew it was going to be bad in terms of lifestyle and hardships. But it was a whole different ball game. It was so much worse.” – E
Dr. A, an intern doctor overseas, found herself in a workplace where her race seemed to determine the level of respect she received. “It’s like you’re at the bottom of the food chain and they’ll find any reason to put the blame on you”, she said. She even admits that being in this environment constantly has made her start to losing interest in not only the healthcare field, but other aspects of her life. Even when seeking support from HR, she couldn’t find anyone to empathize with what she was going through.
Recognizing a toxic work environment
Going through a long course of medical school, doctors are often taught that a strict work environment produces effective outcomes in patient care. However, the lines between strict and toxic may be blurred. Hence the importance of taking time to evaluate the kind of work environment you are in and validating your struggles. Some red flags include poor communication and teamwork, fatigue and burnout, low enthusiasm, cliques, exclusion, toxic team members, narcissistic leadership, and lack of accountability.
Do things get better after you become a doctor?
Becoming a doctor is no easy feat as many of you undoubtedly know. For many of us, it is something we start working towards years before we actually start medical school. And once we are in medical school, there is a chance we have to deal with the cutthroat culture of grueling competition, the seemingly never-ending amount of content, and so much more. But we push through with one thing in mind – only a few more years of constant studying, and we will achieve our dreams. It will become easier when we are doctors.
But the harsh reality is that it only gets harder. There may not be any exams to stress over, but there is still so much more to learn. On top of that, now you are responsible for the lives of patients. When interviewed, E, a local doctor, admitted that even though she knew it was going to be difficult, it was so much worse than she had expected.
“Everyone says once you finish housemanship that things will get better,” said Dr. E. “Nope. 200% untrue. You earn less, you still work like a dog, you have to do things your house officer doesn’t do, and think like a specialist as well.”
Hierarchy and bullying in the workplace
Bullying in the medical profession is, sadly, a lot more common than people think. It comes from long-standing hierarchical structures in the profession, in which the preferred teaching method involves intimidation and humiliation, as per an online article on the experiences of interns. This sets up a toxic and seemingly unbreakable cycle of bullying. It can add on to all the stress that a junior doctor already experiences, and lead to burnout, depression, and anxiety. On top of this, bullying is usually done by people in higher positions, so junior doctors are very hesitant to report these occurrences. S, a local doctor, reported that she had seen numerous occasions where bullying situations had been reported, but there were no actions taken. Instead, the blame was placed on the victims.
“I think senior doctors should call out colleagues who bully, and junior doctors should stand up for their colleagues and help them out,” Dr. S stated. “But I understand that it’s not easy to just complain about this unless there’s proper actions and support for the victim”, she added.
Clearly, there needs to be a system set in place to encourage junior doctors to report such situations. And senior doctors must also hold each other accountable for such actions and strive to end this toxic cycle.
Seeking help
Doctors are expected to sacrifice so much of themselves, that it’s no surprise that at some point, they start neglecting their own mental and physical health. It is definitely not easy to find time for themselves what with the back-breaking workload, long hours, and toxic environment. Getting mental help, particularly as a medical professional, is very stigmatized even in this day and age.
This leads to so many doctors suffering in silence up to the point where they just cannot cope with it anymore. They do not find any joy in doing the things they used to love, they withdraw from their friends and family, and they constantly feel sad or down. At this point, it is so important to reach out for help. Even something as simple as confiding about your problems to friends or fellow doctors can make a huge difference. There are so many online support groups and mental health counseling services that are widely available now. There is no shame in getting the help you need. In the end, you must place yourself before anything else.
Having “You” time
If the idea of speaking to someone else seems a little daunting, there are some things you can do on your own to reinvigorate your headspace. There’s a popular saying, “Work hard, play hard”. Although playing hard doesn’t have to be taken quite so literally, unwinding is crucial for your own state of mind. Finding activities to do and trying new things on your days off can help distract your mind from issues at work. It can also help you find something new and fun to be excited about. Along with fun, relaxing is equally as important. Getting quality rest or even listening to a quick meditation can help clear your head. According to Dr A, sometimes the best thing you can do on a hard day is to just give yourself a moment to cry it out!
As junior doctors, there are so many unfamiliar situations and responsibilities that are thrust upon you everyday. As you navigate this new world that will eventually become your new normal, we must check in with ourselves when this new world weighs us down. Talk to a friend, take a day off or treat yourself to your favorite food. It’s little things like this that can help take your mind off your toxic workspace and remind you of all the other good things out there. In an ideal world, this toxic cycle of bullying and intimidation will end to allow younger, aspiring doctors to feel safe, seen, and respected in their future hospitals. And if you’re a junior doctor today, this cycle can end with you.
This article was written by Fathima Niha Saleem, Minu Hussain Rafeeq, Maha Furqan Valiyakathu, Liaw Hui Min, Izzatus Syakirah binti Ariffin, and Tanya Samtani of the International Medical University (IMU), Bukit Jalil, Kuala Lumpur.
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