Student Wellbeing

A Medical Ethics workshop for Sixth Form students thinking about applying to medicine, one student lingered at the end. Expecting the usual questions about directions to the station or finding good work experience, I was a little taken aback when the student came straight out with, ‘Does doctors’ mental health not matter?’  

‘Of course, it does!’ I instinctively replied, ‘…but what made you think it doesn’t?’ ‘Well, it’s just something I was thinking, say my patient dies because they refuse the treatment I tried to give, how do I live with myself knowing I’m responsible for their death?’ 

A very astute thought for a 16-year-old and perhaps something we don’t consider often enough. Patient autonomy is so embedded in all that we do, and rightly so, but perhaps we fail to consider the impact that accepting a patient’s choice, one which may not be in their best interests, has upon our wellbeing.  

I’m sure we’ve all met patients who we wished we could ‘fix’, if only we could get them to stop drinking, stop smoking, attend their follow up appointment. You’ve spent half your afternoon with ‘Bed 21’, patiently explaining why smoking is harmful, how it’s making their COPD worse, talking through how we can help them cut down – it’s all feeling positive. They agree with you, they’re ready to take the first step, you’ve ‘succeeded’. You leave for the day feeling like you’ve achieved something and then you come back to the ward the next day, ‘Where’s ‘Bed 21’ you say?’, ‘they’ve gone for a cigarette’… and as quickly as that optimism arrived yesterday, it’s snatched away. You should have known you weren’t going to be any different to before, why did you waste your time? Who were you to think you could change 30 years of behaviour in an afternoon? 

My SSP working with the homeless community challenged me in coping with the desire to ‘fix’, helping settle the idea that this need not be our only goal. One patient I met there has always stuck with me, let’s call him John. John had recently been released from prison and found himself back on the streets. He was in his early 40s but had a troubled past which had unfortunately led to years of drug abuse, leaving him with health issues so severe he was now terminally ill. When I met him, he openly admitted to still battling drug addiction and turning to crime to support this. He had so many issues and it was clear we couldn’t address all of them. I wanted to help as best I could – if we could just have long enough maybe we could convince him to change his lifestyle and set up all the support there was to offer. Yet equally we could not force him to accept our help as his right to autonomy was paramount, yet it was key to do all that we could to make healthcare as accessible as possible for him, to treat him with empathy and kindness and without judgment.   

I think of him often, I suspect he’s no longer with us and I question if there was more we could have done; probably along his pathway, yes, yes there was more we could and should have done, but I seek comfort in knowing that the afternoon I spent with him, he experienced kindness and empathy. He came to see us, unable to walk, but he left delighted with a pair of crutches. I hope he felt a positive experience of healthcare, I suspect he probably did. 

So, going back to that question, ‘How can we maintain our mental wellbeing in difficult cases, navigate the vitally important patient autonomy alongside our desire to do good for our patients?’. First, I think we acknowledge it’s hard. Our very motivation to be doctors likely stems from our desire to help and to care but I’ve come to see that to do that doesn’t mean we have to compromise our patients’ values. We must view our pursuits in the context of these values and measure our positive impact alongside these. We don’t all have to be heroes or ‘fix’ everyone we meet. But equally, being a ‘hero’ doesn’t always mean saving a life, sometimes it means enabling someone to live their life in line with their values. It’s okay to be upset by people you meet, people you can’t ‘save’.

Talk to someone, you’re almost certainly not alone. Remember to make your actions about what you can do and what your patient wants – let that be the measure of your success.  

Florence Kinder

If you need support during this time, please find links to the University of Leeds, and Leeds University Union support pages below:

https://students.leeds.ac.uk/info/100001/counselling_and_wellbeing