How do doctors cope

[BeaFox]

If you are a medical doctor, how do you cope with the human suffering you see day in day out? How do you cope with the 'gross' factor?

Ds says he wants to study medicine, I can't say I'm thrilled about this.

What makes a doctor be able to process all that trauma they observe and sometime are part of?

Only going by friends, family members, and acquaintances, not personal experience, but as far as I can tell, it's some combination of training, compartmentalisation, desensitisation, being busy, feeling that they're helping in some way, healthy coping strategies, unhealthy coping strategies, very unhealthy coping strategies, and/or quitting.

Detachment and humour. Great colleagues. The feeling of doing something good to ease the suffering.

I come from a family of doctors. They just are not bothered by blood and guts etc. I guess you know this before you go to med school. And they must compartmentalise, though I know my sister does feel a lot of responsibility for her patients and my father had sleepless nights if he had to give someone really bad news.
Doctors also have a slightly distracted air when not working - like many professions that require years and years of training and focus. It's like part of their minds are always on the job.

The 'gross' factor not an issue....you are either someone bothered by that (then maybe not the best career choice) or not really bothered at all. I have seen lots of gory things but dont remember hardly anything particularly bothering me.

Emotional stuff is harder and I think that list by @FurryDandelionSeekingMissile is pretty true. You have to remain detached ie you see really sad stuff but it doesn't make you sad on a deep level/for a prolonged time....which I struggle with more now I have my own kids (I'm a paediatrician). Most medics have lots of medic friends and chatting helps offload difficult stuff. I personally struggle most if I feel I have made an error that has caused someone to suffer in any way. That's when my detachment skills fail.

The gross stuff is just stuff, you get used to it pretty quickly. The emotional stuff? Not so easy. I'm a paediatrician. I carry with me the memory of every child or baby that we couldn't save. It leaves scars on the soul. But the day it doesn't get to me I'm quitting, whilst I have any soul left.

No idea.

everyone always tells me I’m strong and that they wish they were strong like me

I couldn’t do the job drs and nurses do. I’ve spent enough time on paediatric wards to know anyone who can turn up there knowing what they’re setting themselves up for is a better person than I’ll ever be.

Not a doctor but
Working as a carer - I struggled a little bit at first with some body fluids but vicks in my nose! I've never been bothered by blood etc though, I'm more of the "ooh interesting" type
999 call handler - some are tough, sometimes would drive home in silence as couldn't face the radio. It's the ones you don't expect to get to you that do. Lots of dark humour, talking with colleagues and remembering how many people you've helped
I'll panic over tiny things like if water starting coming in the ceiling now. But if someone needs CPR, I just do it and everyone always says how calm I am in an emergency unless it's a DIY one

I remember feeling deeply ashamed when Dd was really ill that I hadn’t worked harder and become a Dr. How lucky we are that some people can and do.

Doctor here. Honestly I have never in my life considered that answer. But equally, I know I couldn't have done veterinary medicine because I couldn't have coped with animals suffering

Few pointers

• in most specialties there are many lows but so so many highs. It's an incredibly rewarding job on the whole
• seeing people in pain from a broken hip is sad the first time but when you see them day in day out, although always a listening ear and as sympathetic as possible, one does get a little desensitized
• I can think of very very very few cases in my career that were genuinely tragic suffering that we found incredibly hard to deal with (eg awful accidents, unexpected deaths, child abuse) - I don't work in a trauma/paeds/burns centre though so am relatively sheltered from this
• I'm in anaesthetics ... so day to day I anaesthetise relatively well people, who are keen for their procedures and appreciate good pain relief. Obstetric anaesthesia is up and down, but it can be wonderful to provide good pain relief that enables baby to be delivered safely and for mum to be comfortable
• ICU is a different kettle of fish and the emotional burden is massive. I would struggle with family discussions all the time. Covid took its toll on many of us

And also, we all have a good dry sense of humour. It's compulsory to get through it all.

A medical family member of mine would sometimes go a little white and queasy when seeing something very gory and painful happen to someone on TV. With their close relatives, even a minor thing like seeing a couple of teeth that had been extracted to allow a brace to be fitted was clearly very difficult for them.

But when they needed to be involved in the situation in some way, or when they were going to work, that's where Doctor Mode could kick in, almost like a slight adjustment of personality. No pale queasiness, no hesitation or discomfort. I asked this family member once how they coped at work with seeing terrible injuries, or making incisions in people, or other things of that nature, without going pale and funny, and got the response, "Because you're helping someone", with an "Isn't that obvious?" facial expression.

There's some interesting stuff going on mentally with doctors. I wonder if, as well as all the information and clinical skills and all the rest of the stuff they have to learn, one of the reasons for the very long, very intense training process is that the demanding nature of it, things like being a new doctor but maybe the only person there who can do the urgent thing that needs doing right now, is part of how they learn these aspects of psychological self-management.

As a non-doctor I find it difficult to understand, but I'm glad there are people who do learn to handle the difficult aspects. But I wish there was more/better help for those who have difficulties.

I have seen some pretty awful things that would probably be grounding for PTSD. We generally are OK by these events. I suppose as awful as some situations are - our safety isn't at stake and we are actually there to make things better for the person.

As someone mentioned upthread - I also couldn't look after ill animals, they completely freak me out. When my cat was ill a few years ago, I had to hide in the other room while dh hugged her until she died (she was already terminal but suddenly took a turn for the worst and we felt bundling her in the cat box and driving to the vet to be PTS would be too traumatic for her).

Over the last few years its got busier and busier. Lots of staff are feeling the effects of 'moral injury'. This is a term to describe the horrible feeling at the end of a shift where you have been forced to spread yourself too thinly as its so busy. You feel that you just covered the bare basics and weren't able to provide a good care. That is affecting us more than the gory stuff.

I read an article recently about moral injury Mossyeyes, people may be interested, www.scientificamerican.com/article/moral-injury-is-an-invisible-epidemic-that-affects-millions/ - we've going it relevant in the sector I work in, which is providing support to people with experience of childhood trauma / domestic violence etc.

My DD is at university doing nursing, and although she had an interview for the course I was really surprised that they only really seemed to be testing her communication skills and desire to care for people, they didn't appear to broach the more difficult parts of the job at all. I don't know whether this is purposeful and this is what they prepare them for during the course, but I was surprised that there didn't seem to be any emphasis put on it.

I agree that the “gross” stuff barely registers. In terms of coping with the bad stuff, you just do, because you can’t go to bits every time or you won’t be providing good care. Some stuff does hit closer to home for whatever reason, and that can be hard, but you have to find ways to cope. I personally find it much harder to deal with a bad outcome if I feel as if I’ve made a mistake or I think I could have done something differently to change the outcome. I’ve definitely had sleepless nights following difficult cases and I’ve seen experienced consultants crumble when a trip to coroners court is looming. I think we all live in fear of making a mistake, and those that don’t are foolhardy, or just too junior to have felt The Fear.

The Bawa Garba case is a really good example of the kind of scenario I fear and I would definitely encourage you and your son to read about if he’s serious about medicine. An extremely overworked doctor made a mistake while unsupported by her consultant, and facing multiple systems failures. This contributed to a little boy’s death. She was held in custody, tried in the criminal courts, her face was plastered all over the papers, and she was ultimately struck off. It’s frightening because if you read the details of the case, the odds were stacked against her and there’s a sense amongst doctors that it could have been any of us that day. That’s what I find hard to cope with, much more than the bloods and guts.

I have family members who are in the NHS, some in emergency medicine.

The bit that stands out in your post is Ds says he wants to study medicine, I can't say I'm thrilled about this This is a really negative attitude, are you not pleased your child a) has a plan b) may be clever enough to enact their plan and c) wants to help others?