How can we build healthcare systems that also protect the health of the carers?

By Dr Cyan Brown

The sharp focus that has been put on our healthcare workers and healthcare system during the Covid19 pandemic has illuminated some dark and uncomfortable truths that are not easy to digest. Many of these are not even easy to name. But name them we must for what remains unnamed also remains unchanged.

These big, complex issues that often hide under societies’ metaphorical rug must be brought out into the open- the power of doing this is best illustrated through the paraphrasing of a children’s story by Jack Kent. One day a small boy Billy awoke to find a tiny dragon on his bed, the size of the kitten. He looked at it curiously and patted it. He ran downstairs to tell his mom and she simply said: “There is no such thing as a dragon!” Billy went off to school, but throughout the day the dragon continued to grow and grow and grow until it exploded through the roof and filled the house. The father came home to see their house being carried off with the dragon inside and when the mother looked at this, she was forced to concede that: “I admit now, there is obviously such a thing as a dragon.” Suddenly, the dragon started to shrink until it was kitten-size again and eventually Billy’s family go their house back from the dragon. All the dragon needed was recognition it existed.

This story powerfully illustrates the things in our lives that we don’t acknowledge can grow so big that they completely destabilize us, and it is only when we confront and name them can we address them. The issues regarding burnout of healthcare workers are large, complex dragons that are suffocating our healthcare workers and healthcare system and need to be named to be addressed.

These issues aren’t new to healthcare, we frequently hear of the tragedies including the many healthcare worker suicides, post-call car crashes due to fatigue and many healthcare workers suffering from burnout and yet year after year the system remains unchanged and somewhat immovable.  Other high risk industries like the aviation industries have responded to the realization of the need to manage risk and the health of their employees proactively to ensure safety for society by introducing limits on the number of hours worked, regular health checks and basic checklists to reduce error. Yet, the medical profession has done little to protect its workers and in turn to protect society from the harms of exhaustion. This isn’t just an issue focusing on the health of healthcare workers- it is an issue rooted in health equity and questioning if the status quo allows for those that serve in the health care system to care for patients from a point of dignity.

For all the darkness and loss that has characterized this pandemic, could somewhere in this messy despair be filled with the illumination necessary to change this system? Covid has shown us how interconnected we are, for a disease starting in one country with one patient has swept the planet and impacted us all significantly, but also inequitably. These facts of interconnectedness and inequity reveal that the issue of healthcare workers burnout will impact us all differently but impact us all it will, healthcare worker or not, as these issues are pervasive across geographies and everyone at some point needs to interact with a healthcare worker.

We are told year in and year out that fatigue is simply part of the profession and this is simply the way it’s always been done. Evidence is clear this is dangerous for everyone involved and yet the system continues. This exhaustion coupled with the steep hierarchies, microaggressions, lack of mental health support and culture of stoicism that healthcare often models means that junior healthcare workers often have no space to raise their hand and ask for time off or support when needed but are forced to operate from a point of disconnect and exhaustion that harms patients, harms themselves and harms our society . Perhaps we need to question why we are operating within an old model of healthcare rooted in charity and unhelpful norms that don’t allow carers to have boundaries, instead of reimagining and creating a healthcare system that allows for both employees of the system and those being cared for by it to be seen, humanized and valued whomever ever they are.

Our responses to these issues must be bigger than just individual-level responses for the most impacted individuals or only for one profession. As Dzifa Afonu poignantly puts it this individual approach ‘is like putting out a single match whilst standing in a forest fire’ and rather, we have to start asking ourselves and those around us honest questions about what type of healthcare systems are we building and is this sustainable. In our lifetimes we will face the next big threat of climate change and antibiotic resistance, both of which require healthcare workers to assume leadership in the protection of our society. However, we cannot expect those healthcare workers to make wise decisions about health and building a more sustainable future if they are permanently exhausted and running on empty because our legislation and system fail to look after them.

The care of carers should be embedded in systems and for this transformation we need to look to all of us. To the healthcare workers to courageously share more openly and honestly the stories of our lived realities, to those who design the health curricula, to policymakers, media, seniors within the healthcare system who themselves have been traumatized by a dehumanizing system and often subconsciously repeat cycles of harm, to the patients, to those in all other sectors and to anyone who cares about creating kinder, more dignified ways of being and working. Enough is enough and the pandemic has made it clear this all of our urgent, collective mandate

The documentary ‘A Quiet Implosion’ was produced to tell these stories and change the narrative on what should be normalized in healthcare as part of my fellowship in health equity as an Atlantic fellow at Tekano. The launch happened on the 27th of May 2021 and saw over 200 people from around the world join the conversation. It’s my sincere hope “A Quiet Implosion’ can inspire a community of action and change. Our actions can no longer just be polite requests for this to be addressed, powerful advocacy and campaigning is essential. These brutal truths need to land on the desks of those that make the decisions and all of the dragons that have for so long remained unnamed need to be acknowledged, or we face the risk of burning in the fire they breathe into our healthcare system and society.

If you missed the launch, you can find the recording here

Here is the summary video of the documentary with highlights
Here are the three interviews that form a part of the docuseries capturing the untold narratives of junior doctors. Please feel free to share as widely as you want or use them as teaching tools or conversation starters in work or communities