The biggest challenge that all of us, including doctors, face today is climate change. Unless we succeed in keeping global warming below 1.5 degrees in the next ten years, the number of natural disasters, including massive loss of biodiversity, will escalate and the future for us, our children and grandchildren, is bleak. All of us, governments, institutions, communities and individuals have a part to play and doctors have a particular role. The climate emergency is a health emergency and doctors can use their voices to share this message and to contribute to planetary health.
When we advise someone to eat healthy local food, it’s good for their health, good for local business and jobs, and good for the planet. Five thousand people a year in the UK die from the effects of air pollution, so, when we suggest walking or biking instead of driving, it’s helpful for patients’ cardiovascular systems and also for the reduction in fossil fuel consumption we need to achieve. Social prescribing, ie recommending outdoor activity, walking, gardening, instead of routinely relying on medication for social conditions like loneliness and low mood, encourages people to engage with the outdoors and to value it. A simple thing like changing the type of inhaler for asthma from an MDI, a metered dose inhaler which has a high carbon footprint due to the greenhouse gases in the propellant, to a DPI, dry powder inhaler, makes an important difference.
2. Maintaining balance and wellbeing
Eco-anxiety, anxiety about climate change, is prevalent and the most effective way of responding to it is to take action. Health professionals’ daily work offers opportunities for action but the desire to engage and contribute can create pressure. Emotional wellbeing requires a sense of balance and stability and doctors often face strong, sometimes competing, demands and responsibilities. Wanting to be a good doctor, a good parent and family member, and a good engaged citizen can be challenging and stressful, and doctors need to find ways of maintaining balance and looking after themselves. To be able to care for others we need to care for ourselves. Gone are the days when it was considered weak and indulgent for doctors to acknowledge when they are struggling and need help. The COVID pandemic opened people’s eyes to the realities of working on the “frontline” and the need for psychological or other forms of support.
3. Nourishing compassion
Working as a doctor is a privilege; it can also be demanding and draining. Compassion is an integral part of good health care but it can fade when you’re exhausted and feeling that bureaucracy, lack of resource or insensitive systems are against you. To maintain and nourish compassion for others, we need to show self-compassion and be kind to ourselves. We need to recognise when we’re tired or need a break, and to set realistic aims. Striving to learn and to be better is positive; putting yourself under undue, damaging stress is not.
Most people enter medical school compassionate and wanting to make the world a better place. Unfortunately the system often counteracts that and compassion can easily become the victim of unsympathetic rotas and protocols. Medical curricula now give space for talking about compassion and programmes like the Global Compassion Initiative, originating in Edinburgh University’s Global Health Academy, are developing ways of prioritising compassion in doctors’ work.
4. Appropriate use of technology
The pandemic pushed people towards exploring new forms of communication technology. When consulting face to face was risky or impossible, virtual methods were developed. While many doctors caring for patients in remote locations were used to on-screen consultations, others who had been previously averse to them quickly grew to accept them. Used appropriately, they can save time, both the patient’s and the doctor’s, and some traditional patterns of work, for example overfull outpatient clinics, have been usefully modified.
But, with this, comes the challenge of not undermining or adversely affecting the quality of the consultation and the value of the doctor-patient relationship. A quick email or on-screen consultation may be effective and efficient for a minor problem or review of a chronic condition, but will be far from ideal for a sensitive conversation about a serious new diagnosis or a palliative care situation. In any conversation or consultation, information is gained, not just from the words, but also from the body language and the context, and this is hard to glean from an email or a video.
Good training in communication skills can include ways of optimising communication on screen but the challenge is to avoid any pressure from people managing resources to promote (cheaper) virtual communication as always being an appropriate substitute.
5. Dr Google
The internet is a vast resource of health information, some reliable, some unreliable and some actually dangerous. When patients consult their GP or hospital doctor, they have often consulted Dr Google first and what has stuck in their mind is the gruesome, but very rare, diagnosis that he/she has suggested. Despite common things being common, patients often arrive convinced that they are suffering from a serious condition which fits with a couple of their symptoms and it can take valuable time, and be challenging, to reassure them otherwise.
6. Information overload
Talking to many doctors and health professionals working through the pandemic, one of the most stressful things they experienced was the deluge of information constantly arriving. Although the guidance, advice and protocols had usually been sent with the intention of providing useful data and support, the effect could be overwhelming and disempowering. Guidance could change on a daily basis, as new evidence emerged, and it could be hard to see the wood for the trees.
Extracting the essence of information made available to doctors working in “normal” times can also be challenging and finding effective ways of prioritising it and making it easily accessible is an important skill to learn.
7. High expectations
As medical advances continue to accelerate and sophisticated treatments are more available, people’s expectations for health, and responses to ill health, are rising. As in many aspects of life and society, a false sense of entitlement can lead to unrealistic expectations. For doctors, managing such expectations for longevity and absence of disease can be very challenging. We need to get better at helping people to understand that, usually, death is not a failure of health care but a part of life.
A risk factor for dying is being born.
Dreaming about doctors can also represent your own intuition about your health. Is it time you went to a professional to talk about a niggling health concern you’ve had? More generally, have you been neglecting your health lately? It could be a gentle reminder to take better care of yourself or your current behaviour might result in a visit to the doctor to undo all your bad habits and choices. Doctors can indicate someone you trust in your waking life. Has this trust been broken or have they proved to you lately that they are the right person to confide in and rely on? Do you trust yourself?...