Moral injury in doctors – an exploration

    'Moral injury' is now the preferred term for burnout. And burnout is not going away. A recent GMC burnout survey found that over 60% of  trainee respondents felt it 'somewhat', 'to a high degree' or a 'very high degree'. Professor Andrew Goddard, President of the Royal College of Physicians, headlined with the term...

Autonomy and the changing self: commentary on ‘Patient Undone’

  I was immediately drawn to Deborah Bowman’s Radio 4 programme on how her approach to medical ethics changed during her own experience with breast cancer. It was her ‘undoing, personally and professionally’. By this she means that the certainties that had guided her as a professor of medical ethics, as a teacher, were upended...

After Bawa-Garba: the principle of shared responsibility

  The case had been rekindled in the minds of many this week for two reasons. Firstly, Hadiza Bawa-Garba has been allowed back to work, and secondly, court transcripts have become available. Excerpts from these have been Tweeted to counter several ‘myths’ or received facts such as ‘it was her first day back from maternity...

The banned list

Does language always reveal underlying attitudes? Do lazy words confirm lazy thinking? These questions were asked when, some time ago, I entered into an ultimately fractious debate with an ED doctor who had 'banned' certain words and phrases in the department where he worked. I reacted to the list, as I thought it was overly...

In defense of the single-issue consultation

I was struck this week by a sign in a GP surgery (seen on-line) that explicitly encouraged, or instructed, patients to stick to one complaint only. This seems contrary to every holistic instinct, to patient-centred care; perhaps it is inimical to good medicine. Yet it is a tendency I notice in myself, as a hospital...

Soulful yet soulless: Henry Marsh’s ‘Admissions’

For me, Admissions illustrates a great tension that exists in medicine. The need to feel, to be sensitive, to be humane, versus the need to be impervious to tragedy and move on to the next case. In describing his work in three countries (UK, Nepal, Ukraine), and the many successes and failures inherent in neurosurgery,...

The limits of kindness: a patient with ‘pseudo’ seizures

Twelve years ago. A hospital at night. 9PM, and the night shift has started. My raggedy handover list contains many jobs; patients to review, “sickies” to keep an eye on, a chest drain to perform. At 9.30PM the bleep goes off - ‘fast’ bleep. Not a full crash call, but I need to rush. The...

Fundamental

The ongoing debate about assisted dying offers many pauses of reflection. Having engaged in mini-debates on social media, in the safety of the written word, and only occasionally face to face, I find it hard to understand how doctors who are similar to each other in so many ways can end up so far from...

A moment before dying

I have been told all about him, but I barely know him. He was admitted in extremis, but tests quickly confirmed that his disease had progressed too far. He cannot survive. We were not involved. All this - the initial diagnosis, the failed treatment, the progression - happened elsewhere. An ambulance brought him to us...