The majority of Australian adults have some sort of experience with our country’s Primary Healthcare system. Those that do not, are either (A). Non-smoking, non-vaping, non-drinking, physically active members of society, or (B). In complete denial (there is, in fact, a difference between not having any medical conditions on account of being physically and mentally healthy versus on account of not having seen a doctor for 40-plus years). Regardless, most are familiar with the current flow of the structure: book a General Practitioner (G.P) appointment (which, in regional and rural areas, may not be available for weeks-to-months), attend the G.P. appointment (which, may require an hour-or-so of waiting time once checked-in), be referred to a specialist doctor (if necessary) OR (worst outcome of all) be referred to the Emergency Department (E.D).
In our society, being a patient is synonymous with demonstrating incredible patience, of which many people embody with grace.
From a young age, I understood the widely-accepted societal belief that “doctors are always running late. “never on time,” and “only contact you if something is wrong…” (now, as a doctor myself, I want to emphasise that this is not intentional at all, but rather, a by-product of practising within a web of systematic, workplace and individual limitations). The depth of the workload for medical practitioners - G.P’s in particular - is so great that phone calls are predominantly reserved for bad news - results the require urgent investigation, management or intervention by hospital-based specialists. So often, in the world of medicine, radio silence is taken to be a good thing.
No news is good news, right?
Throughout my years as a doctor - initially as a Junior Medical Officer (J.M.O) working on the wards, and now as a registrar working in Critical Care - I have noticed the “no news is good news” mantra play out amongst doctors too. Perhaps the context is slightly different, but the outcome is equally, if not more detrimental, to the recipient of the silence.
As with many female clinicians, I have spent large portions of my career plagued by self-doubt, self-judgement and stuck in the endless pursuit of perfection. I have poured immeasurable emotional and mental energy into doing the best job possible, not just for the wellbeing of my patients, but also for the wellbeing of my ego. Like many eldest-child-Type-A-female personalities, my sense of self was established early in my childhood, built on the praise and recognition from impressed elders. Achievement has long been my source of dopamine, fed throughout High School and University by an endless stream of certificates of achievement, medals, school reports and a rip-roaring G.P.A. Assessment provided a means to grade my capability, and therefore, my worth as an individual.
Fast forward to my first job as an Intern on the Acute Surgical Ward, and I found myself drowning in sea of perceived incompetence. For the first time in my life, I had no recognition, reward or positive reinforcement to buoy my ego. I had gone from being the top of my class - both at School and University - to the least knowledgable individual on the ward, with no way to gauge myself against the expected competencies nor my peers. I felt completely lost as a doctor and as an individual. Despite trying my best (which until this point in my life, had always guaranteed my success), I left every day from that ward feeling dumb and defeated. It was during one Friday afternoon tearful conversation with a J.M.O one year my senior that I encountered for the first time the “no news is good news” paradigm playing out amongst doctors. “If you were doing a bad job, they would tell you,” the Resident told me. “If you hear nothing, take it as a good thing. Assume everything is fine, and just keep doing what you’re doing. No news is good news…”
Three years later, through many mistakes, meltdowns and psychology sessions, I proudly have a much stronger sense of my value as an individual, let alone as a doctor. Despite this, I still find myself clinging to the desire for feedback, particularly on the days and weeks when I question the purpose of work within my life. Positive reinforcement and recognition of achievement is necessary to the human mind’s perception of work satisfaction. This is even more necessary when the work is laced with negativity - an inherent part of any work within the medical industry - particularly in the E.D.
A standard day in the Emergency Department may present any combination of unexpected death, untreatable disease, distressed, frustrated or abusive patients, exhausted colleagues, outdated systems, inadequate staffing and a list of patients that never ceases to grow.
What is more, there is no way to predict in which order or combination said challenges may arise. Whilst some clinicians thrive off the unpredictability and high-cost of the job, increasingly, doctors are finding themselves spiralling into emotional exhaustion and resentment towards a job that demands so much of their emotional, physical and mental selves. Although many of the factors that precipitate burnout can attributed to the physical workplace, a lack of positive feedback and recognition for hard work can certainly perpetuate the issue, particularly when the recipient is one who embodies an internal complex that tells them (they) will finally be good enough when they receive a small bit of praise.
There are few feelings in the world worse than simply evaporating from a department that you have fed so much energy into, seemingly without your presence even being noticed in the first place. The E.D is perhaps one area of the hospital where we at least try to be more transparent with patients, communicating results and a plan for admission or discharge with both patients and their anxiously awaiting families. However, the “no news is good news” model still exists in the form of little to no recognition of the staff working within the department. We are expected to show up day after day, to a list that never ends, with an increasingly high level of acuity and workload.
And yet, when looking at the documented workplace elements of burnout - unmanageable workload, lack of control, poor reward, conflicting values - positive feedback and recognition is perhaps the one element that can be tangibly changed.
Such positive reinforcement does not have to take the shape of a star chart on the department entrance wall. It does not have to be a “Shoutout of The Week” or a “Registrar of The Year” presentation at the annual Christmas Party. Small recognitions such as, “thank you for your work today,” “you managed that conversation well,” or “it was really lovely to work with you…” could be enough to make an awful day feel less painful, or even, keep Junior Doctors in the job when it seems all else is futile.
