Chronic illness is common in the UK population, with 14 per cent of under-40s having at least one long-term condition, yet as healthcare professionals we seem surprised and under-equipped when dealing with the chronic health conditions of ourselves and colleagues. More than a quarter of the shielding group in England are in employment.
As the single biggest employer in the UK, with an intimate knowledge of the importance of work on wellbeing, the NHS could have been at the forefront of supporting its vulnerable staff and yet there was – and continues to be – minimal guidance or acknowledgement of staff in the clinically extremely vulnerable category. Indeed, when shielding started, colleagues were surprised to hear that any of those who were shielding could be working as a doctor.
For many doctors with long-term physical health conditions this has been a challenging time. Some have been forgotten, with no contact from seniors or peers. Some have been criticised for remaining at home, even pressured by their departments to return despite shielding advice.
Others have been working full hours at home, often with minimal support or an expectation that they are having the ‘easy ride’. Some who fall just outside of the shielding category have had to make difficult decisions about whether to stay in the workplace exposed to risk, or to work from home.
Working (or not being facilitated to work) from home has many challenges, but perhaps the biggest of those for many of us is the guilt. We are not ‘on the frontline’, do not feel like ‘NHS heroes’, not seeming to play our part in what is the biggest challenge healthcare has faced in generations.
However, there are many ways in which colleagues working from home have been excelling. We have heard many stories of colleagues keeping up with their full clinical workload, supervising juniors remotely and taking on rotas, education and management tasks for their departments.
As doctors who have had chronic health conditions throughout our whole careers, we are aware of the challenges facing doctors like us even in non-pandemic times. Difficulties obtaining support are not a shock to us, as we have had many experiences of balancing dedication to our work with health concerns, sometimes with excellent support and understanding, sometimes sadly with very little.
Searching the web for ‘doctor health’ or ‘sick doctor’ finds many support organisations for those with mental illness or addiction. There are a couple of excellent organisations for doctors with disabilities, but precious little for those with long-term physical illness, many of whom do not see this as a disability (even though it may meet the definition of such in the Equality Act).
Support for both mental illness and addiction is vital. But so is recognition of the challenges of being a doctor with physical illness. How many times have we heard the boastful phrase ‘I’ve never taken a day off in my life’? This may be protective for our colleagues who do not want to think that they, themselves, may one day be ‘on the other side’, but for us it just adds to the guilt of sick leave or working less than full time. Should there be shame in needing shorter runs of long days while working with a haemoglobin of 70? In taking time off when you have been admitted to ICU having dropped your oxygen saturations to the 80s as the SHO on a post-take ward round?
As we look back on these months of the pandemic, just as we are asking in our clinical work what we have done differently that we would want to keep, we look at shielding with the same question. One of the best aspects of shielding has been the connection with other doctors in similar situations, as we reach out to support one another. This networking will help us to make a difference for doctors with long-term conditions in the future, in many different ways.
Sarah Miller: I have had severe asthma since I was at medical school, but despite multiple admissions I have managed to progress through training and am now in a consultant post. I have learned lots over the last 20 years about how to balance work and health (often by getting it wrong!), and would love to be able to support colleagues in a similar situation, whether less experienced in medicine or in the doctor-as-patient role. The shielding network has started some of these connections, and I hope that we can build on this to support one another in a more effective way.
Carly Webb: My massive splenomegaly was found during OSCE practise at medical school, resulting in a diagnosis of myelofibrosis. I progressed through foundation training and ACCS with the ‘badge of honour’ of only a few sick days per year for tests and clinics. This was still begrudged by some supervisors. When I took an extra day off to recover after being told I’d need a stem cell transplant in FY2, my supervisor called to tell me that I was inappropriately abandoning my team. I was a 27-year-old processing the news of a diagnosis with a five-year survival rate of around 40-50 per cent, I just needed a day to regroup. Thankfully, the transplant was delayed until recently and my current department have been behind me every step of the way and I cannot be more grateful.
The key question for us, moving forward, is how do we make fulsome support of vulnerable doctors the common, rather than exceptional, experience?
Sarah Miller is a consultant in palliative medicine in Denny, Falkirk and Carly Webb is a clinical fellow in anaesthetics in Bristol
The Shielding Doctors Network on Twitter (there is also a WhatsApp group)
There are organisations which provide support to some doctors with chronic illness, as well as disability:
Working with Cancer provides coaching and advice for employees and carers affected by cancer to help them successful return to or remain in work