NHS Doctors and Happiness

One of the perils of developing a happiness hypothesis is that one feels compelled to test it every chance one gets. My friends have had to put up with me evaluating their problems as case studies, and I’m constantly reading books and articles and watching TV with my mind half on how the stories I encounter are explained (or not) by my hypothesis. This is how The Right Hand of Long-Term Happiness evolved to include autonomy, which is the one Need not covered by Abraham Maslow’s Hierarchy of Needs.

I just finished reading This Is Going to Hurt: Secret Diaries of a Junior Doctor by Adam Kay. Adam Kay was a writer for television at the time he published this book, but he had previously been a doctor for the National Health Service in the UK. In press interviews Kay highlighted that doctors in the NHS have a higher suicide rate than the national average, and anecdotally his colleagues often turned to unhealthy mechanisms to cope with the stresses of their occupation (e.g. drugs and alcohol). Kay used his diaries to vent his frustrations, and the result (after editing it into book form) is a funny and sad account of life as a junior doctor. Kay’s book is rife with explanations of how his Six Needs were negatively impacted by his work.

Feeling undervalued (esteem):

I'm happy to look back on my time as an SHO with a bit of objectivity and declare I was profoundly underpaid. The money is utterly out of step with the level of responsibility you have--literally life-and-death decisions.

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There's no dazzling your superiors and leapfrogging over your peers or any opportunity for promotion; you progress up the ranks at a regulation rank.

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None of my consultants had ever taken me aside to say I was doing a good job or I'd made a smart management decision, saved a life, cleverly thought on my feet, or stayed at work late for the thirtieth consecutive shift without complaining.

Difficulties with relationships outside of work (social):

Most doctors' relationships crumble after a year or so. The cracks they all develop would appear far too early, like some bizarre premature-aging disorder. Certainly the hours don't help.... But it's more than the hours; you're generally no fun to be around when you get home. You're exhausted, you're snappy from a stressful day, and you even manage to deny your partners the normal post-work chat of bitching about their colleagues. They know as soon as they start on their workplace quibbles you'll reflexively talk about the horrors of your own day.

Guilt or shame about crumbling relationships (esteem):

A few of my colleagues had kids by this point and lived their lives in constant childcare hell, adding “guilt” to the psychology textbook of emotions that a career in medicine bestows upon you.

The danger of working with stressed out patients (safety):

[She] picks up a sharps bin- and throws it at my head. I yelp, duck, and constrict my anus to a one-millimeter bore. The bin hits the wall above my desk and a shower of virulent needles rains down around me. Somehow, like Road Runner escaping a Wile E. Coyote assassination attempt, I’m not hit by any of them and avoid catching twelve strains of HIV.

——

Colleagues have had scrub pockets picked, bags nicked from the nursing station, and lockers broken into, not to mention tires slashed in hospital car parks and even the odd physical assault.

Regularly feeling sleep-deprived (physiological):

We’re repeatedly reminded not to use empty patient rooms to catch any sleep overnight—the management maintains we’re paid to work full shifts. I want to ask the management if they’ve heard of that big ball of fire in the sky that makes it slightly harder to sleep during the day than at night? Or how easy they think it is to suddenly switch from working during the day and sleeping at night to the exact opposite within twenty-four hours? But most of all I want to ask if they or their wives needed an emergency cesarean section at 7a.m., would they rather the registrar doing it had caught forty minutes’ sleep when things were quiet or had been forced to stay awake every second of the shift?

Kay touches on autonomy by mentioning he had no control over his assignments (which hospital he worked at) nor his schedule, and he felt like he didn’t have any choice about working long hours because leaving when his shift ended meant patients possibly dying. Kay also describes a time when he was sued by a patient, and one paragraph contains a number of hits:

Unfortunately I wasn’t able to countersue for the hours needlessly spent going through old medical records and meeting with lawyers and defense unions, the damage the lawsuit inflicted on my relationship by eroding the precious little time we spent together [social], or the cost of Red Bulls that kept me awake on night shifts after sleepless days of report-writing [physiological]. Or the suffering I felt—the anxiety [safety] and guilt [esteem] mounted onto an already stressful working life, the unfairness of being accused of being terrible at my job, the fear that maybe I was terrible at my job.

Based on Kay’s depiction of the life of an NHS junior doctor, they’re working such long hours that they don’t have time to invest in their Six Needs. Therefore, it wouldn’t surprise me if there are a lot of unhappy doctors serving in UK hospitals. However, there was one area where Kay found loads of fulfillment as a junior doctor: his growth needs. He did note that he misses how meaningful his work as a doctor was since leaving the profession.

Have you had a job that negatively impacted fulfillment of your Six Needs? On the flip side, what jobs have helped you meet your needs?

Notes:

• I’m not sure about the high rate of suicide amongst NHS doctors. A lot of articles posted on the Internet refer to the statistic that suicide rates amongst UK health care professionals is 24% higher than the national average, but when you dig down, they’re referencing a 2007 study that is identifying suicide risk. A recent meta-analysis found that male doctors had no higher rate of suicide, and female doctors had a 75% higher rate of suicide than the general population, but this was using data from 20 countries and over 60 years. IMO the jury is still out, but this is not to say that NHS doctors aren’t unhappy, generally speaking.