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受傷的醫者: 心理學家帶你看見白袍底下的情感掙扎與人性脆弱
破除「醫生不能是弱者」的神話，溫柔照看白袍底下的真實血肉：醫生也是人，各有各的個性、夢想和欲望，同樣會迷惘、恐懼與憂傷。 他們受苦時得不到關懷，生了病卻不被視為病人，只能承擔理性至上的專業要求──我們常忘記了：在醫療前線的醫生們也有身而為人的感性需求。 莎拉是名婦產科醫生，但她始終無法受孕。 徹底的絕望侵蝕著她，同事們卻對她的遭遇不以為然…… 一切只因為她是一名醫生，理應擺脫任何煩惱。 白袍醫者常被套上「超人」般的濾鏡，期望他們應該要客觀理性、果敢抗壓、富同理心。這樣的認識，源自人們對「醫生」角色的扁平認知，對醫療體系的陌生，加上醫界不對外人言的潛規則，使得我們對醫學院學習、受訓、臨床等可能存在的體制問題一無所知。 事實是：醫生也會面對壓力、生病、歧視。但他們該如何照料自己的心理健康，又能向誰求助？ 本書作者艾爾頓身為一名心理學家，過去二十多年來，穿梭於各種醫療現場進行直擊觀察，並與無數心靈失落的醫生有過對談和交流。她關切的是：整個醫療體系哪裡出了問題？如何以人本角度出發，提供醫生更好的心理支持？如何讓醫生更具有情緒韌性？ 當整個&#
299 pages, Kindle Edition
Published December 30, 2020
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Displaying 1 - 30 of 111 reviews
March 12, 2018
In brief - There are gems in this however they are quite well hidden I think. I feel this could have been sharper and harder hitting.
A combination of some experience in psychology and an interest in the medical profession made this book appealing to me. The author is a vocational psychologist with considerable experience dealing with doctors. In this book she seeks to discuss issues affecting doctors illustrated with case studies from her own experience. She also looks at the topic of training doctors - particularly new ones in the UK and in other countries too. She starts with a statement of her background and aspects of the reality of being a doctor in the NHS .
The first chapter focusses on first year doctors in particular. The statistics for outcomes in the first week of August (when doctors first start work on wards) speak for themselves. The individual cases serve to underpin the statistics. The author makes some pertinent and, to me, intelligent observations on the issues and it simply emphasises the fact that the system is in need of review.
A number of areas where doctors have issues with their work are looked at in subsequent chapters. Those who have joined the medical profession because of incidents in their family which then cause them problems when treating particular conditions is an example. However both gender and sexuality are looked at too as well as other pressures on doctors.
There are some real gems in this book. The chapter that includes hospice care and training there was excellent for example. In general the chapters start with a case study by way of introduction. Other case studies are often offered. Then there is consideration of the issues at a more general level. The author then returns to the original case study. On a number of chapters this felt rather drawn out to me.
Without question this book shows doctors as "also human" living up to the title. It also shows them as laudable, dedicated and flawed. The system and underlying structure of the education and development of doctors is really in need of careful review. I did find that the gems in this book could be quite hard to extract from the narrative.
In part academic, in part case study based this book feels as though it can't make up its mind which it wants to be. There are no references here (although mine was an advance copy so presumably that might change) despite extensive mentions of research and publications . Equally there was no "further reading" section which I would have thought appropriate. Ultimately I'm not clear who this book is aimed at. It is not truly an academic book. I did not find it particularly readable compared with a number of other similar books I've read and reviewed. It is of interest but maybe the audience for it is a little limited sadly.
Note - I received an advance digital copy of this book from the publisher in exchange for a fair review
http://viewson.org.uk/non-fiction/als...
A combination of some experience in psychology and an interest in the medical profession made this book appealing to me. The author is a vocational psychologist with considerable experience dealing with doctors. In this book she seeks to discuss issues affecting doctors illustrated with case studies from her own experience. She also looks at the topic of training doctors - particularly new ones in the UK and in other countries too. She starts with a statement of her background and aspects of the reality of being a doctor in the NHS .
The first chapter focusses on first year doctors in particular. The statistics for outcomes in the first week of August (when doctors first start work on wards) speak for themselves. The individual cases serve to underpin the statistics. The author makes some pertinent and, to me, intelligent observations on the issues and it simply emphasises the fact that the system is in need of review.
A number of areas where doctors have issues with their work are looked at in subsequent chapters. Those who have joined the medical profession because of incidents in their family which then cause them problems when treating particular conditions is an example. However both gender and sexuality are looked at too as well as other pressures on doctors.
There are some real gems in this book. The chapter that includes hospice care and training there was excellent for example. In general the chapters start with a case study by way of introduction. Other case studies are often offered. Then there is consideration of the issues at a more general level. The author then returns to the original case study. On a number of chapters this felt rather drawn out to me.
Without question this book shows doctors as "also human" living up to the title. It also shows them as laudable, dedicated and flawed. The system and underlying structure of the education and development of doctors is really in need of careful review. I did find that the gems in this book could be quite hard to extract from the narrative.
In part academic, in part case study based this book feels as though it can't make up its mind which it wants to be. There are no references here (although mine was an advance copy so presumably that might change) despite extensive mentions of research and publications . Equally there was no "further reading" section which I would have thought appropriate. Ultimately I'm not clear who this book is aimed at. It is not truly an academic book. I did not find it particularly readable compared with a number of other similar books I've read and reviewed. It is of interest but maybe the audience for it is a little limited sadly.
Note - I received an advance digital copy of this book from the publisher in exchange for a fair review
http://viewson.org.uk/non-fiction/als...
April 2, 2019
This was a good follow-on read to memoirs I’ve read that reflect on the pressures faced by doctors, especially junior doctors working in the NHS system – such as Adam Kay’s This Is Going to Hurt (see also Your Life in My Hands and both books by Henry Marsh, but especially Admissions). As an occupational psychologist, Caroline Elton generally sees doctors when they’re at a crisis point and wondering if this work is for them anymore. There are many reasons why things get to that point: personal or family illness, the failure of the system to cope well with doctors’ differences including disability, race and sexual orientation, and the difficulty of maintaining any kind of sensible work–life balance. The attrition rate in the field is really very low, maybe 1–2%, Elton estimates, but has a high profile. In fact, it’s proof that the medical field is very difficult to leave, often because of social and familial pressure. Elton illustrates all of her points with fictionalized case studies based on real doctors she treated. I was particularly interested in the sections on the in-built masculinity of the surgeon’s discipline and how stereotypes reinforce the poorer performance of people of color in medicine.
[Some interesting related statistics: 1) “in the UK nearly one third of teachers who joined the profession in 2010 left within five years.” – My husband and one of our closest friends undertook teacher training: he never finished, while she completed the training but never procured work in a school. We have another close friend who was a very gifted teacher but left to start his own business after negative changes implemented by the Gove regime. 2) 40% of EEA doctors are considering leaving the UK after Brexit.]
Some favorite lines:
one of her patients, in an e-mail: “my current belief on working within NHS medicine: That it just doesn’t care. That it chews people up, spits them out and then gets another well-meaning chump to replace them.”
“It’s harder to be empathic when one is exhausted; that’s why reducing the working hours of junior doctors has been shown to enhance their capacity for empathy.”
“Being miserable at work eats into one’s confidence, and corrodes one’s self-belief. Conversely, feeling that one is able to put one’s talents to good use at work gives one a sense of identity and purpose which can spill over into how one responds to people outside work.”
[Some interesting related statistics: 1) “in the UK nearly one third of teachers who joined the profession in 2010 left within five years.” – My husband and one of our closest friends undertook teacher training: he never finished, while she completed the training but never procured work in a school. We have another close friend who was a very gifted teacher but left to start his own business after negative changes implemented by the Gove regime. 2) 40% of EEA doctors are considering leaving the UK after Brexit.]
Some favorite lines:
one of her patients, in an e-mail: “my current belief on working within NHS medicine: That it just doesn’t care. That it chews people up, spits them out and then gets another well-meaning chump to replace them.”
“It’s harder to be empathic when one is exhausted; that’s why reducing the working hours of junior doctors has been shown to enhance their capacity for empathy.”
“Being miserable at work eats into one’s confidence, and corrodes one’s self-belief. Conversely, feeling that one is able to put one’s talents to good use at work gives one a sense of identity and purpose which can spill over into how one responds to people outside work.”
January 6, 2019
Probably one of my top favorite non-fiction books that I've read this year. I borrowed it from the library and may want my own physical or e-book copy now.
This books looks into the lives of doctors and medical students who don't have it as smooth sailing as everyone thinks they do. The psychologist Caroline Elton shares countless stories of what it's like for them and what the system is like. There's so many aspects, stories, discussions, studies and statistics in this book that I don't even want to pinpoint some of the highlights because to me it all felt like important highlights. The main geographical focus of this book is the UK and the NHS system but a lot of references are made for the US health care system and doctors in comparison as well as some in Australia and New Zealand when the references are needed.
We may probably all know the toll in takes on doctors to be doctors, the amount of work hours, the exams and studies. But thats not all of the story and this book offers a completely different glimpse on what that toll actually means and it's full impact on some people.
It's incredible, interesting and fascinating, especially if you have any interest in doctors and the medical system.
This books looks into the lives of doctors and medical students who don't have it as smooth sailing as everyone thinks they do. The psychologist Caroline Elton shares countless stories of what it's like for them and what the system is like. There's so many aspects, stories, discussions, studies and statistics in this book that I don't even want to pinpoint some of the highlights because to me it all felt like important highlights. The main geographical focus of this book is the UK and the NHS system but a lot of references are made for the US health care system and doctors in comparison as well as some in Australia and New Zealand when the references are needed.
We may probably all know the toll in takes on doctors to be doctors, the amount of work hours, the exams and studies. But thats not all of the story and this book offers a completely different glimpse on what that toll actually means and it's full impact on some people.
It's incredible, interesting and fascinating, especially if you have any interest in doctors and the medical system.
May 6, 2018
I was really loving this at the beginning. I still think it's an important book, but I couldn't help but feel a bit defensive at times and that had an effect on my overall enjoyment/attitude towards it. I can't deny that issues are argued well and convincingly throughout, but I felt that some criticisms were slightly... unnecessary.
To be honest, it's my own fault for reading this as it is not really geared towards prospective medical students. Having said that, Caroline Elton should definitely write a book for medical students discussing the same incredibly important topics - without the overwhelming negativity.
To be honest, it's my own fault for reading this as it is not really geared towards prospective medical students. Having said that, Caroline Elton should definitely write a book for medical students discussing the same incredibly important topics - without the overwhelming negativity.
April 30, 2019
Mixed feelings about this one. On the one hand it is forming part of a collection of literature that is broaching the subject of 'doctor wellbeing'; a long overdue conversation is starting and this offers a different perspective from the usual 'diary of a doctor' publication. So for that I have to commend Caroline Elton for it. Medicine is a profession open to vulnerability, shame, prejudice...the list is endless, and she has broached it head on. As a doctor, there is a lot of relatable content.
However, the case stories were clearly designed to be at the extreme ends of the spectrum to demonstrate the challenges doctors face at every stage of their training and beyond. For me, that took away some of my ability to relate to the stories; I agree with another reviewer that it doesn't address the majority of 'average' doctors who don't necessarily have risk factors for psychological difficulties or significant precipitating events.
I also can't help but feel that the audience that will read this, is not the audience that should be reading this. I saw Caroline Elton speak at a recent healthcare conference and my overwhelming feeling at the end of the day was that the people who were there already got it. Ruth Bader-Ginsburg said about women's rights, "the gender line helps to keep women not on a pedestal but in a cage". It feels somewhat true for medical staff. The public and to some extent the government put us on a pedestal, perpetuating the myth that we are infallible and omniscient. Yet we are as human as anyone else. The public and those at the organisational level will likely not be the ones turning the pages of this book however.
I couldn't agree more with her views that 'patient-centred care' is mistaken, and the reality is the 'patient-doctor relationship' is all important. The ability to care is greatly diminished when the physical and psychological wellbeing of one party is excluded from the equation. A cultural and organisational shift is needed to change the broken system that Caroline Elton writes so passionately about.
However, the case stories were clearly designed to be at the extreme ends of the spectrum to demonstrate the challenges doctors face at every stage of their training and beyond. For me, that took away some of my ability to relate to the stories; I agree with another reviewer that it doesn't address the majority of 'average' doctors who don't necessarily have risk factors for psychological difficulties or significant precipitating events.
I also can't help but feel that the audience that will read this, is not the audience that should be reading this. I saw Caroline Elton speak at a recent healthcare conference and my overwhelming feeling at the end of the day was that the people who were there already got it. Ruth Bader-Ginsburg said about women's rights, "the gender line helps to keep women not on a pedestal but in a cage". It feels somewhat true for medical staff. The public and to some extent the government put us on a pedestal, perpetuating the myth that we are infallible and omniscient. Yet we are as human as anyone else. The public and those at the organisational level will likely not be the ones turning the pages of this book however.
I couldn't agree more with her views that 'patient-centred care' is mistaken, and the reality is the 'patient-doctor relationship' is all important. The ability to care is greatly diminished when the physical and psychological wellbeing of one party is excluded from the equation. A cultural and organisational shift is needed to change the broken system that Caroline Elton writes so passionately about.
December 1, 2019
This part academic essay, part case study book looks at the many issues surrounding medical students and junior doctors as they climb the career ladder. Written by an occupational psychologist, this is a fascinating look at how students begin and progress throughout their career.
I found the case studies as the most interesting part of this book and I almost wish there were more. The author eloquently discusses how students are treated especially in the first few years of the foundation training. The overall message of this book is that doctors are not immune from health conditions especially mental illness. The personal sacrifices required for a successful career in medicine are already quite well-known but this book manages to reemphasise the importance of this and how we as colleagues and users of the NHS can support junior doctors.
The author has a truly fascinating job and I hope to see a follow-up to this and which perhaps focuses more on the case studies and how she has successfully helped her patients within their careers. As an NHS nurse I have witnessed first-hand the dread and anxiety of the first Wednesday in August each year when junior doctors begin on the ward. This book has allowed me to reflect on that time of year and how I can support my new colleagues better.
I found the case studies as the most interesting part of this book and I almost wish there were more. The author eloquently discusses how students are treated especially in the first few years of the foundation training. The overall message of this book is that doctors are not immune from health conditions especially mental illness. The personal sacrifices required for a successful career in medicine are already quite well-known but this book manages to reemphasise the importance of this and how we as colleagues and users of the NHS can support junior doctors.
The author has a truly fascinating job and I hope to see a follow-up to this and which perhaps focuses more on the case studies and how she has successfully helped her patients within their careers. As an NHS nurse I have witnessed first-hand the dread and anxiety of the first Wednesday in August each year when junior doctors begin on the ward. This book has allowed me to reflect on that time of year and how I can support my new colleagues better.
September 30, 2019
This book confirmed what I already knew, that I would never in 1000 years want to become a doctor.
February 10, 2024
DNF at page 154.
This book drew me in in the first 50 pages and had me thinking it would be a really useful exploration of the struggles of being a doctor. However, I was so so wrong.
Chapter 4 came along with its blatant homophobic undertones - portraying gay doctors as sexual villains who couldn’t control themselves around male patients. Also the continuous hypothesising that doctors are often sexually aroused by intimately examining their patients. Though there is no doubt there are isolated incidences of this happening, the language of ‘all doctors’ and a whole chapter dedicated to the topic make this appear as a systemic issue. I would be very worried about my patients reading this chapter and getting the wrong idea about their medical care.
Aside from the gross generalisations and assumptions, this book reads like a reflective essay written as an assignment for school. She uses case studies as devices to make a point but in doing so almost makes up story lines for these doctors: ‘i wonder if she felt…’. There are also random references to medical training in the US and the use of research studies that seem to link little to the argument of the chapter.
It’s clear this was not written recently, some of the language is insensitive and made me cringe reading it. E.g. ‘She suffered from dwarfism.’ Suffered… really?
In conclusion, this book was making me angry so I decided to stop. Some of the topics were definitely important, but were just argued poorly. Perhaps a book looking into the lives of doctors would be better written by a doctor, who actually has insight into the issues discussed, rather than a psychologist looking from the sidelines….
This book drew me in in the first 50 pages and had me thinking it would be a really useful exploration of the struggles of being a doctor. However, I was so so wrong.
Chapter 4 came along with its blatant homophobic undertones - portraying gay doctors as sexual villains who couldn’t control themselves around male patients. Also the continuous hypothesising that doctors are often sexually aroused by intimately examining their patients. Though there is no doubt there are isolated incidences of this happening, the language of ‘all doctors’ and a whole chapter dedicated to the topic make this appear as a systemic issue. I would be very worried about my patients reading this chapter and getting the wrong idea about their medical care.
Aside from the gross generalisations and assumptions, this book reads like a reflective essay written as an assignment for school. She uses case studies as devices to make a point but in doing so almost makes up story lines for these doctors: ‘i wonder if she felt…’. There are also random references to medical training in the US and the use of research studies that seem to link little to the argument of the chapter.
It’s clear this was not written recently, some of the language is insensitive and made me cringe reading it. E.g. ‘She suffered from dwarfism.’ Suffered… really?
In conclusion, this book was making me angry so I decided to stop. Some of the topics were definitely important, but were just argued poorly. Perhaps a book looking into the lives of doctors would be better written by a doctor, who actually has insight into the issues discussed, rather than a psychologist looking from the sidelines….
April 4, 2018
Brilliant insights into what goes on behind the scenes for today’s doctors, including discrimination due to race and gender, the still ‘taboo’ issue of mental health, and the immense pressure put on the individual at every stage of their career as a result of our healthcare system, to name but a few. The chapter on the intimate nature of the work and sexualization of patients particularly interesting.
August 2, 2018
So glad I read this. Much that’s not new to me given that I spend much of my working life helping doctors who are falling apart to put themselves back together but I do do wish it could be compulsory reading for all muggle relatives of all doctors in the hopes they could try to understand a little of what it is to be human and a doctor.
I particularly liked the forward which has a lovely quote from another book about the dangers of walking onto ice to rescue a drowning person.
I particularly liked the forward which has a lovely quote from another book about the dangers of walking onto ice to rescue a drowning person.
September 14, 2020
What do we ignore when we ignore the examples of those that fail? What is there to learn from their pain?
The number of those who begin to study medicine who later permanently quit before retirement is vanishingly small. This can be read for interpretation as a highly desirable job or as extreme loyalty - but doctors would do well to pay attention to the details. Are struggling medical students pushed too hard to enter into practice? Should those failing to progress beyond their first year of work be pressured for years to remain on the wards?
Why are female surgical trainees so rare, and why are their small cohort bullied and discriminated against? Why do Asian and black doctors receive racism? Why are the medical students who are the least proficient and the least competent the ones sent away to the ends of the earth, stranded away from friends and family and crucially almost never in a 'centre of excellence' where they could attain the necessary skills - why are the worst doctors not given a chance to improve themselves at the start of their career, and why do the best doctors go to posts with the best teaching?
Is it possible to retrain after medicine? Can a person learn to let medicine go if it is too painful to stay? What should students who are considering the vocation consider before they apply - and what should medical schools do to assess their chances of a safe, competent and fruitful career?
I think this book would do well to make the rounds of those considering medicine right through to consultants and GPs about to retire. The more who know about the problems and risks in medical training, the better people can make these difficult decisions.
The style of this book was at times very simple, but the individual cases here make it an excellent read.
The number of those who begin to study medicine who later permanently quit before retirement is vanishingly small. This can be read for interpretation as a highly desirable job or as extreme loyalty - but doctors would do well to pay attention to the details. Are struggling medical students pushed too hard to enter into practice? Should those failing to progress beyond their first year of work be pressured for years to remain on the wards?
Why are female surgical trainees so rare, and why are their small cohort bullied and discriminated against? Why do Asian and black doctors receive racism? Why are the medical students who are the least proficient and the least competent the ones sent away to the ends of the earth, stranded away from friends and family and crucially almost never in a 'centre of excellence' where they could attain the necessary skills - why are the worst doctors not given a chance to improve themselves at the start of their career, and why do the best doctors go to posts with the best teaching?
Is it possible to retrain after medicine? Can a person learn to let medicine go if it is too painful to stay? What should students who are considering the vocation consider before they apply - and what should medical schools do to assess their chances of a safe, competent and fruitful career?
I think this book would do well to make the rounds of those considering medicine right through to consultants and GPs about to retire. The more who know about the problems and risks in medical training, the better people can make these difficult decisions.
The style of this book was at times very simple, but the individual cases here make it an excellent read.
December 10, 2018
Thank you Random House UK and Netgalley for an ARC in return for my honest opinion.
I am always interested in book related to the medical field and psychology so I was grateful for the opportunity to read this book written by a psychologist about doctors she sees in the course of her work.
Many many years ago I worked In the public hospital system in an admin role and remember, as a young 20 year old, residents not much older than myself being subjected to the harshness described in this book. The memory of me finishing work at 3pm on a Friday excited to celebrate the next two days ahead with friends before returning to work on Monday morning. I distinctly remember one Monday morning, working on a ward in a large, public hospital in Australia and seeing the poor resident who had been lucky to take a toilet break and maybe get 15 mins rest (not sleep) in the whole 60+ hours since I had left. She looked, understandably spent after a weekend of covering the whole medical side of this large hospital with only one other resident covering the surgical side.
I am saddened that decades on this has not changed and stories are similar around the world.
We all know on some level, the difficulty of med school but this book has given me a deeper, greater appreciation of what anyone aspiring to be a doctor goes through, even before they put on that white coat. I hope that this book can help a large audience of readers be more aware of the difficulties doctors face and the strength they face on an hourly basis to make life threatening decisions whilst often trying to keep the,selves alive in the process.
I am always interested in book related to the medical field and psychology so I was grateful for the opportunity to read this book written by a psychologist about doctors she sees in the course of her work.
Many many years ago I worked In the public hospital system in an admin role and remember, as a young 20 year old, residents not much older than myself being subjected to the harshness described in this book. The memory of me finishing work at 3pm on a Friday excited to celebrate the next two days ahead with friends before returning to work on Monday morning. I distinctly remember one Monday morning, working on a ward in a large, public hospital in Australia and seeing the poor resident who had been lucky to take a toilet break and maybe get 15 mins rest (not sleep) in the whole 60+ hours since I had left. She looked, understandably spent after a weekend of covering the whole medical side of this large hospital with only one other resident covering the surgical side.
I am saddened that decades on this has not changed and stories are similar around the world.
We all know on some level, the difficulty of med school but this book has given me a deeper, greater appreciation of what anyone aspiring to be a doctor goes through, even before they put on that white coat. I hope that this book can help a large audience of readers be more aware of the difficulties doctors face and the strength they face on an hourly basis to make life threatening decisions whilst often trying to keep the,selves alive in the process.
June 29, 2020
I sort of wanted a more emotional take of the inner lives of doctors, but Elton does a good job of outlining all of the different ways that being a doctor can affect one's mental health and self-esteem. Interesting read for sure! But I wouldn't run to the shelf to grab it again.
May 27, 2021
Read in a bored haze in the hospital library
January 16, 2020
I picked this book up during one of the student placements in Melbourne at Readings, Carlton. I was drawn to it because it discusses problems faced by junior doctors, which is what I will be soon. So, it felt like a good way to prepare me.
What I liked about this book, is that though the author is speaking about a UK environment, I find these issues are quite universal. There were chapters that spoke of difficulties that arise in transitioning to medical school, or to clinical studies, or to a whole new country.
My favourite chapter was "Leaky Pipes", which looked at sexism in the medical workplace, especially in the surgical field. I found this chapter inspiring; Elton talks about the issues clients of hers faced, the facts of these issues and how her clients fared against these odds.
What I didn't like about this book was the cover. Honestly, I felt that a much more creative approach could have been taken. It is just too plain and uninspiring to me. The next factor I didn't like is that it ended! I just wanted more of Elton's experience when I kept reading, and it's a damn shame that the book had to end!
At the end of this book, I felt motivated, inspired and apprehensive. This book brought a lot of obvious and not so obvious workplace issues to my attention. A part of me is scared about how progressing into my internship years would play out, but the rest of me is excited to take the approaches Elton discussed in this book.
Full review available on my blog at https://bibliosini-inkonpaper.blogspo...
What I liked about this book, is that though the author is speaking about a UK environment, I find these issues are quite universal. There were chapters that spoke of difficulties that arise in transitioning to medical school, or to clinical studies, or to a whole new country.
My favourite chapter was "Leaky Pipes", which looked at sexism in the medical workplace, especially in the surgical field. I found this chapter inspiring; Elton talks about the issues clients of hers faced, the facts of these issues and how her clients fared against these odds.
What I didn't like about this book was the cover. Honestly, I felt that a much more creative approach could have been taken. It is just too plain and uninspiring to me. The next factor I didn't like is that it ended! I just wanted more of Elton's experience when I kept reading, and it's a damn shame that the book had to end!
At the end of this book, I felt motivated, inspired and apprehensive. This book brought a lot of obvious and not so obvious workplace issues to my attention. A part of me is scared about how progressing into my internship years would play out, but the rest of me is excited to take the approaches Elton discussed in this book.
Full review available on my blog at https://bibliosini-inkonpaper.blogspo...
This entire review has been hidden because of spoilers.
September 17, 2018
I really couldn't decide whether to do a 4 or a 5 for this book (I really wish I could do a 4.5...or a 4.75) but I figured I loved this book enough to write a quick review on it to put my thoughts down somewhere. I'm probably really reeeally biased to like Caroline Elton and her book because I feel really similar to her - her brother has autism and she's an intellectual who struggled to find her career niche and she has a professional goal of helping people struggling with their own professional goals. Reading this, I had a pretty self-important image in my head of this book being on a shelf in my counseling office someday. She really nailed all aspects that medical students could struggle with and had a great balance of explaining the medical system, sharing anecdotes, and bringing her own emotions into the narrative as well.
My only gripe is really a mini-gripe and that is her lack of emphasis on the dramatic costs becoming a doctor requires you to take on in the states. I understand she focused heavily on the work she does in the UK, and she did emphasize the financial woes of the students who tragically committed suicide, but there were many situations where she listed a difficulty medical students/junior doctors faced in exiting the medical profession and my brain immediately went to, "yea, that AND their 200k debt from undergrad AND their 200k debt from medical school AND their other debts from applying to those schools and paying rent without an income" and so on.
But at the heart of it, I want to recommend this book to anyone thinking about going into the medical profession, in medical school, or even already dropped out of premed. The content can be kind of a downer, but hearing these stories could really help make many medical students/doctors feel a little less alone. I think Caroline Elton's goals were for this too.
And just a bit aside - she's the kind of person that, when criticized by a friend for using the term "non-white" she actually....changed it?! Which I think is a good sign and makes me hopeful and anxious to see her future work.
My only gripe is really a mini-gripe and that is her lack of emphasis on the dramatic costs becoming a doctor requires you to take on in the states. I understand she focused heavily on the work she does in the UK, and she did emphasize the financial woes of the students who tragically committed suicide, but there were many situations where she listed a difficulty medical students/junior doctors faced in exiting the medical profession and my brain immediately went to, "yea, that AND their 200k debt from undergrad AND their 200k debt from medical school AND their other debts from applying to those schools and paying rent without an income" and so on.
But at the heart of it, I want to recommend this book to anyone thinking about going into the medical profession, in medical school, or even already dropped out of premed. The content can be kind of a downer, but hearing these stories could really help make many medical students/doctors feel a little less alone. I think Caroline Elton's goals were for this too.
And just a bit aside - she's the kind of person that, when criticized by a friend for using the term "non-white" she actually....changed it?! Which I think is a good sign and makes me hopeful and anxious to see her future work.
July 1, 2019
when we are sick, we almost always think that so long we go to a doctor we will be fine.
How many times have you seen when ppl are at their end's wit on their loved ones being sick, they pin all their hopes on the doctor that's treating their kin? We beg, we cry and tell the doctors we will do anything and expects the doctor to be able to do something somehow... and if the doctors fail, they get screamed at, blamed on and even complaint on.
Times when we feel that doctors are not supposed to "not know how". Well this book lets you see the perspectives of being doctors. Whilst you are thinking they can do anything, we somehow forget they are but human too. And sometimes not all doctors can do something.
If the patient they are attending to gets well under their care, we think its a doctor's job. But when the result is something not humans can achieve, we blame them, they in turn blame themselves. looking at another person dying even though they have tried their best can haunt them forever. Why do they wanna live life in this manner? I personally dont think that anyone would want to have this job.
I salute all the doctors and nurses for their courage and wanting to save...
ok, I have to say not all doctors and nurses are genuine, there are always black sheeps in all aspects, but to those working hard to save lives... I can never do what you do.
Thank you.
How many times have you seen when ppl are at their end's wit on their loved ones being sick, they pin all their hopes on the doctor that's treating their kin? We beg, we cry and tell the doctors we will do anything and expects the doctor to be able to do something somehow... and if the doctors fail, they get screamed at, blamed on and even complaint on.
Times when we feel that doctors are not supposed to "not know how". Well this book lets you see the perspectives of being doctors. Whilst you are thinking they can do anything, we somehow forget they are but human too. And sometimes not all doctors can do something.
If the patient they are attending to gets well under their care, we think its a doctor's job. But when the result is something not humans can achieve, we blame them, they in turn blame themselves. looking at another person dying even though they have tried their best can haunt them forever. Why do they wanna live life in this manner? I personally dont think that anyone would want to have this job.
I salute all the doctors and nurses for their courage and wanting to save...
ok, I have to say not all doctors and nurses are genuine, there are always black sheeps in all aspects, but to those working hard to save lives... I can never do what you do.
Thank you.
September 11, 2019
wow this was absolutely brilliant. i wasn't expecting to enjoy this book as much as i did. so many different subjects are covered, and while ultimately this is a criticism of the system (elton discusses burnout, depression/anxiety, people feeling trapped in the wrong careers, people who struggle with medical school), there's also a lot of positivity and uplifting stories. the whole book was a perfect balance between anecdotes and more objective studies, and a lot of suggestions on how to improve things were put forward.
the sections on disability + chronic illness were so so interesting. the way that some doctors aren't respected at all because of their visible disabilities, or being deaf/blind and needing extra accommodations, even though they're as competent as everyone else. there are people who have invisible disabilities and have to fight to get the accommodations that they need.
the chapters on misogyny and homophobia in the medical profession were hard to read because it's so frustrating that such things still happen to this day, but really well written.
a particularly good quotation that stuck with me: 'disabled people remain unknown with a view which constructs them - in an unreal manner - as either heroic or helpless'
the sections on disability + chronic illness were so so interesting. the way that some doctors aren't respected at all because of their visible disabilities, or being deaf/blind and needing extra accommodations, even though they're as competent as everyone else. there are people who have invisible disabilities and have to fight to get the accommodations that they need.
the chapters on misogyny and homophobia in the medical profession were hard to read because it's so frustrating that such things still happen to this day, but really well written.
a particularly good quotation that stuck with me: 'disabled people remain unknown with a view which constructs them - in an unreal manner - as either heroic or helpless'
March 22, 2018
Working in the medical field (not as a Dr) for the past 30 odd years, the subject of how Dr’s cope with what they see and their hours always interests me. I have not worked a hospital setting since the early 1990’s but reading this book is exactly like I remember, even if it was based around the UK. I wonder if Australia’s conditions for their medical staff have improved.....I’m not sure they have.
I loved reading the personal stories of the doctors but sometimes it became lost in all the ‘jargon’ and it slipped into being a ‘paper for submission’ type of reading, with lots of facts and figures.
My interest waned when I came across those passages/chapters, so I did find myself skipping to the more personal stories. These were varied and interesting and a common theme of being under supported and over worked ran through them. I have a lot of respect and empathy for these Doctors and I really hope conditions are improving for them.
Thank you to Netgalley and the publisher for a copy to read
I loved reading the personal stories of the doctors but sometimes it became lost in all the ‘jargon’ and it slipped into being a ‘paper for submission’ type of reading, with lots of facts and figures.
My interest waned when I came across those passages/chapters, so I did find myself skipping to the more personal stories. These were varied and interesting and a common theme of being under supported and over worked ran through them. I have a lot of respect and empathy for these Doctors and I really hope conditions are improving for them.
Thank you to Netgalley and the publisher for a copy to read
September 28, 2018
I am a PA, and while this book is primarily geared toward MDs, I found it insightful into my own training and practice. It's also helpful now for me to not only pay more attention to how to care for myself so I can better care for patients, but also how to care and watch out for the MDs, PAs, and NPs in training at my teaching hospital. I have already recommended that the Health Professions advisor at my alma mater add it to the reading list for his students. I don't want them all depressed, but I think that, before they start spending thousands of dollars on applications (let alone the money for their training), they think about why they want to go into medicine, ask themselves if they're prepared (not just academically, but psychologically as well), and also get a fuller picture of just how hard medical training and practice can be. The goal isn't to squash dreams, but to have new providers enter their training better prepared for what they might struggle with and more knowledgeable about where and when to seek help.
April 25, 2021
I read this book because a doctor I know was given it to read in a dispute with her (hospital) employer. As a doctor myself, who has been practising for more than 40 years, there wasn't much in here to surprise me. It was gratifying to see that the author was available for distressed doctors to consult, and has been very successful with the cases that she writes about, looking behind the presenting symptoms to find out why they were distressed.
What resonated most with me was her chapters about the selection of future doctors, and how we have been doing this wrong for years; it isn't just brains that are needed, it is resilience and the ability to cope under the huge stress that comes with trying to heal unwell and broken humans- these are difficult things to test for when someone first presents wanting a medical career. If we could improve the selection process, we could save these people a lot of time and distress, and point them in the direction of other careers before they get into the medical training treadmill.
What resonated most with me was her chapters about the selection of future doctors, and how we have been doing this wrong for years; it isn't just brains that are needed, it is resilience and the ability to cope under the huge stress that comes with trying to heal unwell and broken humans- these are difficult things to test for when someone first presents wanting a medical career. If we could improve the selection process, we could save these people a lot of time and distress, and point them in the direction of other careers before they get into the medical training treadmill.
April 16, 2020
The first half of this book was a page turner for me. It lost its steam toward the end as the personal stories lessened and it became a bit more factual. Still good but that's what kept my rating at 3 stars.
June 24, 2024
A poignant quote from the last chapter...
"Taken together, doctors' psychological needs are denied, ignored, not thought about. Umet. A systemic 'psycholectomy' has been performed on the profession as a whole. But its impact is felt most acutely in the doctor-patient relationship."
"Taken together, doctors' psychological needs are denied, ignored, not thought about. Umet. A systemic 'psycholectomy' has been performed on the profession as a whole. But its impact is felt most acutely in the doctor-patient relationship."
September 7, 2023
Worth reading for anyone considering a career in medicine, or doctors who are having career difficulties or doubts. Medical school staff and hospital administration would also benefit.
April 5, 2021
Contains spoilers.
This was book was upsetting but very worthwhile to read. The book has been sat on my shelf for a couple of years but I've been putting off reading it. I think because I have been worried that the content will be familiar and it will force me to reflect on my own negative experiences through my career. I was right that it was very familiar however I found the process of reflection helpful personally and as an educator.
Essentially the author describes the pressures put on doctors through training and medical culture, and the damage this causes psychologically.
She describes a system where the weakest students based on the Foundation entry test scores are placed in the least desirable placements. Trainees may be many miles from their support networks and may have to change frequently through their careers. Transitions are difficult and this is made worse through the uncertainty of where you will be placed through training, and the expectation that you will easily be able to uproot every 6 months and change hospital. You may start on call and not get an adequate induction.
Trainees describe high levels of stress, negative impact on their mental health and frequently feel under-prepared for the tasks they are expected to complete. Long hours and shift patterns lead to fatigue. The change in work-patterns has had the unintended consequence of breaking up the traditional firm with less consistent supervision, more fragmented teams, more intense work and more handover of tasks.
There is a tendency for doctors to intellectualise emotional situations, that is to focus on the dry, factual bits of a situation and remove the emotion from it. Doctors re-conceptualise situations as scientific challenges or problems to solve rather than focus on the emotional content. This can be a way of coping. On reflection I can see this all the time in medicine for example trying to problem solve too soon in a GP consultation or at the more extreme end, retaining organs because they are helpful for research but failing to see they are someone's child. Senior doctors may put juniors in situations they are not prepared for and pay no attention to the thoughts and feelings of the junior. An example might be witnessing suffering or experiencing the death of a patient. They may not stop to think about the effect this has on them as a human being.
The author talked about avoidance as a psychological reaction to challenge. For example, taking a long time to perform tasks, going missing from the ward, turning up late or leaving dead-on time. These are signs the doctor is finding work too difficult and avoiding it. This may not be conscious.
She talks about medical school admissions and how the only thing that is not tested for at most medical schools is whether the person has the emotional resilience to cope with distress in themselves and those around them.
She talks about how lack of empathy develops. This can be through intellectualisation, exhaustion, avoidance and the the type of early relationships the doctor had as an infant. I would add to this some doctors not perceiving themselves as care-givers and more as skilled technicians, with care being delegated to nurses.
She raised the difficulty of admitting and sharing negative feelings about patients. We fear making mistakes, feeling overwhelmed, feeling despair we cannot help, fear of litigation, receiving derogatory remarks, disgust, contempt of patients' behaviour, unrealistic expectations - the list goes on.
All in all this was a very helpful read. It helps as a trainer to remember what trainees go through. I feel that we surely must be able to organise training better that is less damaging. We must be able to prepare students for becoming doctors. We must view trainees and ourselves as humans and become more emotionally and psychologically aware.
This was book was upsetting but very worthwhile to read. The book has been sat on my shelf for a couple of years but I've been putting off reading it. I think because I have been worried that the content will be familiar and it will force me to reflect on my own negative experiences through my career. I was right that it was very familiar however I found the process of reflection helpful personally and as an educator.
Essentially the author describes the pressures put on doctors through training and medical culture, and the damage this causes psychologically.
She describes a system where the weakest students based on the Foundation entry test scores are placed in the least desirable placements. Trainees may be many miles from their support networks and may have to change frequently through their careers. Transitions are difficult and this is made worse through the uncertainty of where you will be placed through training, and the expectation that you will easily be able to uproot every 6 months and change hospital. You may start on call and not get an adequate induction.
Trainees describe high levels of stress, negative impact on their mental health and frequently feel under-prepared for the tasks they are expected to complete. Long hours and shift patterns lead to fatigue. The change in work-patterns has had the unintended consequence of breaking up the traditional firm with less consistent supervision, more fragmented teams, more intense work and more handover of tasks.
There is a tendency for doctors to intellectualise emotional situations, that is to focus on the dry, factual bits of a situation and remove the emotion from it. Doctors re-conceptualise situations as scientific challenges or problems to solve rather than focus on the emotional content. This can be a way of coping. On reflection I can see this all the time in medicine for example trying to problem solve too soon in a GP consultation or at the more extreme end, retaining organs because they are helpful for research but failing to see they are someone's child. Senior doctors may put juniors in situations they are not prepared for and pay no attention to the thoughts and feelings of the junior. An example might be witnessing suffering or experiencing the death of a patient. They may not stop to think about the effect this has on them as a human being.
The author talked about avoidance as a psychological reaction to challenge. For example, taking a long time to perform tasks, going missing from the ward, turning up late or leaving dead-on time. These are signs the doctor is finding work too difficult and avoiding it. This may not be conscious.
She talks about medical school admissions and how the only thing that is not tested for at most medical schools is whether the person has the emotional resilience to cope with distress in themselves and those around them.
She talks about how lack of empathy develops. This can be through intellectualisation, exhaustion, avoidance and the the type of early relationships the doctor had as an infant. I would add to this some doctors not perceiving themselves as care-givers and more as skilled technicians, with care being delegated to nurses.
She raised the difficulty of admitting and sharing negative feelings about patients. We fear making mistakes, feeling overwhelmed, feeling despair we cannot help, fear of litigation, receiving derogatory remarks, disgust, contempt of patients' behaviour, unrealistic expectations - the list goes on.
All in all this was a very helpful read. It helps as a trainer to remember what trainees go through. I feel that we surely must be able to organise training better that is less damaging. We must be able to prepare students for becoming doctors. We must view trainees and ourselves as humans and become more emotionally and psychologically aware.
January 10, 2020
This book gives an insight into the medical system and medical education in the UK and a must-read for all junior doctors. 5 key points I learned from this book are as follows:
1. Inverse care law - those who most need care end up receiving the least! In the UK you need to score very well on the “Educational Performance Measure” and “Situational Judgement Test” for the successful application of the foundation program. Otherwise, they will end up with an F1 job somewhere, maybe far from home, and it may not be one that they want—but it will be a job.
2. Personal and professional dysfunction - In many countries, the methods of training doctors no longer match the delivery of health care. There is a “disconnection” between the theoretical knowledge and practical reality of what they are facing as a working doctor. Improving medical education is like solving a Rubik’s Cube - you twist one way and will get all sorts of untoward changes on the five other sides which remain hidden from view.
3. Physician burns out - Empathy is the act of correctly acknowledging the emotional state of another without experiencing that state oneself. But it is harder to be empathic when one is exhausted and the best doctors should find the precise balance—neither too detached nor too caring- which is something few learned. Schwartz round gives an hour-long opportunity for all staff from across the hospital to get together to discuss the difficult emotional and ethical issues that arise in their day-to-day work.
4. Impact on career choices and sensitivity to transitions - The most common reasons why junior doctors choose a particular specialty are the role models they aspire to be in the future, prior experiences of that particular specialty and work-life balance. Those who have suffered repeated disappointments in life, or who have regularly had their confidence undermined, are more likely to experience difficulties at points of transition- from student to foundation doctor.
5. Doctor-patient split, inequalities, and discriminations - Doctors unconsciously try to position themselves as “other” than their patients which help them not to get psychologically overwhelmed by anxiety. It is impossible to be both a doctor and a patient at the same time. The tendency to reach snap judgments based on stereotypes - gender or race or disabilities is hardwired into all of our brains. The unconscious biases of clinicians impact not only on the quality of their relationship with patients and the likelihood that patients will follow their medical advice but also on the actual treatment decisions that doctors make. Being on the receiving end of stereotypical perceptions impairs performance.
1. Inverse care law - those who most need care end up receiving the least! In the UK you need to score very well on the “Educational Performance Measure” and “Situational Judgement Test” for the successful application of the foundation program. Otherwise, they will end up with an F1 job somewhere, maybe far from home, and it may not be one that they want—but it will be a job.
2. Personal and professional dysfunction - In many countries, the methods of training doctors no longer match the delivery of health care. There is a “disconnection” between the theoretical knowledge and practical reality of what they are facing as a working doctor. Improving medical education is like solving a Rubik’s Cube - you twist one way and will get all sorts of untoward changes on the five other sides which remain hidden from view.
3. Physician burns out - Empathy is the act of correctly acknowledging the emotional state of another without experiencing that state oneself. But it is harder to be empathic when one is exhausted and the best doctors should find the precise balance—neither too detached nor too caring- which is something few learned. Schwartz round gives an hour-long opportunity for all staff from across the hospital to get together to discuss the difficult emotional and ethical issues that arise in their day-to-day work.
4. Impact on career choices and sensitivity to transitions - The most common reasons why junior doctors choose a particular specialty are the role models they aspire to be in the future, prior experiences of that particular specialty and work-life balance. Those who have suffered repeated disappointments in life, or who have regularly had their confidence undermined, are more likely to experience difficulties at points of transition- from student to foundation doctor.
5. Doctor-patient split, inequalities, and discriminations - Doctors unconsciously try to position themselves as “other” than their patients which help them not to get psychologically overwhelmed by anxiety. It is impossible to be both a doctor and a patient at the same time. The tendency to reach snap judgments based on stereotypes - gender or race or disabilities is hardwired into all of our brains. The unconscious biases of clinicians impact not only on the quality of their relationship with patients and the likelihood that patients will follow their medical advice but also on the actual treatment decisions that doctors make. Being on the receiving end of stereotypical perceptions impairs performance.
January 27, 2018
Doctors are seen as the pillars of our communities, they look after us when we are ill but who looks after them? Making life and death decisions each and every day do we put them under too much pressure?
In the book we get to see the world of medicine from a psychological viewpoint, how do we support our doctors? Is their training really meeting their needs? Caroline gets to see a side of medicine not told in the media and not discussed on the wards but she gets to see this in her unique role.
We see doctors unable to cope with the challenges they face, from confronting illness their family has been affected by to the long unsociable hours they work each week. Unfortunately, ensuring doctors mental and physical health is not being affected by there work doesn’t seem to be a priority in many places around the world.
I was fascinated to see the selection process of medical students and this differs around the world, with some of the universities adopting the MMI method which unlike a traditional entry interview panel gives the student the opportunity to show a wider range of skills from problems solving to people skills.
Another topic discussed was how F1 assignments are allocated, seeming to leave the most vulnerable students at the most risk while this affects the performance of the doctor, it in turn may keep the hospital from improving. Questions from the SJT are included, a test that assesses doctors on their clinical judgement rather than their medical knowledge. Combined the SJT and the final exams will determine where they are placed.
When cases regarding individual doctors were discussed I found it really interesting, the thoughts and feelings behind decisions where explained but the second half of each chapter contained the theories and some studies which lacked any form of character. On some of the topics, I didn’t agree with her point of view and noticed she didn’t offer any counter-arguments therefore not allowing for a balanced discussion.
To begin the book was very engaging and drew me in to keep reading but the further I was reading the more I couldn’t relate to it. I don’t think it’s a book to pick up randomly and get lost in with intrigue unless of course you have a deep interest in medicine or psychology however for studying purposes the book is excellent at bringing together different ideas and studies.
3/5 for general reading
4/5 for studying – needs to have a proper reference list
In the book we get to see the world of medicine from a psychological viewpoint, how do we support our doctors? Is their training really meeting their needs? Caroline gets to see a side of medicine not told in the media and not discussed on the wards but she gets to see this in her unique role.
We see doctors unable to cope with the challenges they face, from confronting illness their family has been affected by to the long unsociable hours they work each week. Unfortunately, ensuring doctors mental and physical health is not being affected by there work doesn’t seem to be a priority in many places around the world.
I was fascinated to see the selection process of medical students and this differs around the world, with some of the universities adopting the MMI method which unlike a traditional entry interview panel gives the student the opportunity to show a wider range of skills from problems solving to people skills.
Another topic discussed was how F1 assignments are allocated, seeming to leave the most vulnerable students at the most risk while this affects the performance of the doctor, it in turn may keep the hospital from improving. Questions from the SJT are included, a test that assesses doctors on their clinical judgement rather than their medical knowledge. Combined the SJT and the final exams will determine where they are placed.
When cases regarding individual doctors were discussed I found it really interesting, the thoughts and feelings behind decisions where explained but the second half of each chapter contained the theories and some studies which lacked any form of character. On some of the topics, I didn’t agree with her point of view and noticed she didn’t offer any counter-arguments therefore not allowing for a balanced discussion.
To begin the book was very engaging and drew me in to keep reading but the further I was reading the more I couldn’t relate to it. I don’t think it’s a book to pick up randomly and get lost in with intrigue unless of course you have a deep interest in medicine or psychology however for studying purposes the book is excellent at bringing together different ideas and studies.
3/5 for general reading
4/5 for studying – needs to have a proper reference list
October 8, 2021
This is a really interesting book. Granted, I was hoping for personal reasons that it would be more about ‘dissatisfied doctors finding an exit strategy’ than it is. There’s a certain amount of text devoted to this topic, but it's far from the majority. Instead, Elton delves into institutional issues like racism, sexism, bias, and sexual feelings for patients. The last is one I can’t comprehend, but that’s because nothing turns me off faster than whining, and for obvious reasons all patients are at peak whine when they see doctors. Elton is deeply sympathetic to our plight, which is nice, because doctors seem to be treated like rich people – AKA, not entitled to have any problems.
“Isn’t it paradoxical, considering the burden of responsibility junior doctors are expected to bear as soon as they start working, that the application system in both countries manages to infantalise final year medical students?”
FUCKING HELL ACTUALLY IT IS.
“He suggests that if we really want to help people make better career decisions we need to encourage them to think about, and inhabit, the feelings associated with their day-to-day experiences at work.”
This was useful for me.
“Tiny examples of being cared for or nourished by the training system are often in short supply for junior doctors.”
I, too, have got this excited about free biscuits.
“Little wonder then that a respondent in another study of female doctors concluded that ‘medicine is one big career of loss.’”
Yes.
“ ‘Siblings never have the same parents,’ a psychologist colleague once remarked.”
Ha, very pertinent for me currently … why does my brother get so much sympathy in his career woes and I don’t?!
“One decision aged sixteen, for people with a certain personality type, and a certain background, can take years to repair … Medicine can be very consuming. The hours you work, the constant exams. It’s a bit like a cult.”
It’s not a bit like, it IS.
“[…] it’s so easy to fall into the trap of becoming busy and practical – pointing out all the other great careers that they could pursue in future – rather than attending adequately to the distress that the need to leave medicine can cause. It’s difficult to stay with the sense of quite how painful life can be without a skin.”
“Helen Rose Fuchs Ebaugh: “Exiters can feel in mid-air, ungrounded, nowhere. The future is unknown and they no longer belong to the past.”
Yup.
“Isn’t it paradoxical, considering the burden of responsibility junior doctors are expected to bear as soon as they start working, that the application system in both countries manages to infantalise final year medical students?”
FUCKING HELL ACTUALLY IT IS.
“He suggests that if we really want to help people make better career decisions we need to encourage them to think about, and inhabit, the feelings associated with their day-to-day experiences at work.”
This was useful for me.
“Tiny examples of being cared for or nourished by the training system are often in short supply for junior doctors.”
I, too, have got this excited about free biscuits.
“Little wonder then that a respondent in another study of female doctors concluded that ‘medicine is one big career of loss.’”
Yes.
“ ‘Siblings never have the same parents,’ a psychologist colleague once remarked.”
Ha, very pertinent for me currently … why does my brother get so much sympathy in his career woes and I don’t?!
“One decision aged sixteen, for people with a certain personality type, and a certain background, can take years to repair … Medicine can be very consuming. The hours you work, the constant exams. It’s a bit like a cult.”
It’s not a bit like, it IS.
“[…] it’s so easy to fall into the trap of becoming busy and practical – pointing out all the other great careers that they could pursue in future – rather than attending adequately to the distress that the need to leave medicine can cause. It’s difficult to stay with the sense of quite how painful life can be without a skin.”
“Helen Rose Fuchs Ebaugh: “Exiters can feel in mid-air, ungrounded, nowhere. The future is unknown and they no longer belong to the past.”
Yup.
This entire review has been hidden because of spoilers.
April 2, 2019
A must read for physicians and other medical professionals
Dr Caroline Elton is an occupational psychologist specializing in physicians and dentists. She had the unique opportunity to shadow a number of different medical teams in their daily work, and has worked with a large number of physicians during her career. Thus, she is very well qualified to write about this topic. I don't think her book is much suited for the general public, but should be a must read for physicians.
"We take it on trust that the doctor is up to the task, and doesn't feel tired or overwhelmed. We rarely consider whether the doctor (...) is terrified of accidentally hurting us. We simply assume that if they are relatively junior, there will be a senior clinician somewhere nearby to answer their questions and ensure that they're doing their job correctly. (...)"
Elton touches on a number of issues that doctors face today, including getting through Med school, starting work as a junior doctor,
unpreparedness, exhaustion, lack of support, working long hours, leaving the field of medicine and more. I especially enjoyed the first part of the book, as Elton reminded me of lots of experiences I went through in my early career, and still go through. The second part got a bit more difficult to read through as it was more dry, but still enjoyable. Elton mentions a number of resources (books and studies) which sound like interesting reads, but unfortunately the ebook did not include a reference list. This is definitely something I'd recommend for later editions. I would recommend this to every physician and med students becoming junior doctors. As Elton closes, "Perhaps in 150 years' time, society will recognize that, whilst the demands of the job are exceptional, the person inhabiting the role of the doctor is, just like their patients, also human.".
Dr Caroline Elton is an occupational psychologist specializing in physicians and dentists. She had the unique opportunity to shadow a number of different medical teams in their daily work, and has worked with a large number of physicians during her career. Thus, she is very well qualified to write about this topic. I don't think her book is much suited for the general public, but should be a must read for physicians.
"We take it on trust that the doctor is up to the task, and doesn't feel tired or overwhelmed. We rarely consider whether the doctor (...) is terrified of accidentally hurting us. We simply assume that if they are relatively junior, there will be a senior clinician somewhere nearby to answer their questions and ensure that they're doing their job correctly. (...)"
Elton touches on a number of issues that doctors face today, including getting through Med school, starting work as a junior doctor,
unpreparedness, exhaustion, lack of support, working long hours, leaving the field of medicine and more. I especially enjoyed the first part of the book, as Elton reminded me of lots of experiences I went through in my early career, and still go through. The second part got a bit more difficult to read through as it was more dry, but still enjoyable. Elton mentions a number of resources (books and studies) which sound like interesting reads, but unfortunately the ebook did not include a reference list. This is definitely something I'd recommend for later editions. I would recommend this to every physician and med students becoming junior doctors. As Elton closes, "Perhaps in 150 years' time, society will recognize that, whilst the demands of the job are exceptional, the person inhabiting the role of the doctor is, just like their patients, also human.".
October 27, 2018
Caroline Elton is a psychologist who has made a career of working with doctors, both in education and as a counsellor. Building from this experience, she has written a wide ranging book about psychological issues which have an impact on doctors' lives.
Some of the issues covered include:
Difficulties of being a junior doctor, lack of support, both within the job and externally relating to frequent moves etc, feelings of unpreparedness, exhaustion.
Lack of emotional support when things go wrong, failure to recognise that an event will cause or has caused distress.
Issues in family or personal background which may influence a decision to study medicine or choose a particular specialty, but which may affect the doctor's ability to thrive there.
Personal experience of illness or disability.
Intimate examinations and sexual feelings towards patients. The system denies that this exists
Forces of sexism and racism.
Difficulties around deciding to change direction or leave medicine altogether, both from the point of view of the individual and the institution.
I found this an interesting book, eye-opening but at times quite difficult to read. It brought back to me some of the feelings and problems I experienced through medical school and as a junior doctor, and opened my eyes to some of the issues that still affect my work today, both as an employee and as a clinician.
It has made me very glad none of my children are interested in studying medicine.
Some of the issues covered include:
Difficulties of being a junior doctor, lack of support, both within the job and externally relating to frequent moves etc, feelings of unpreparedness, exhaustion.
Lack of emotional support when things go wrong, failure to recognise that an event will cause or has caused distress.
Issues in family or personal background which may influence a decision to study medicine or choose a particular specialty, but which may affect the doctor's ability to thrive there.
Personal experience of illness or disability.
Intimate examinations and sexual feelings towards patients. The system denies that this exists
Forces of sexism and racism.
Difficulties around deciding to change direction or leave medicine altogether, both from the point of view of the individual and the institution.
I found this an interesting book, eye-opening but at times quite difficult to read. It brought back to me some of the feelings and problems I experienced through medical school and as a junior doctor, and opened my eyes to some of the issues that still affect my work today, both as an employee and as a clinician.
It has made me very glad none of my children are interested in studying medicine.
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