Dr Emily O'Conor, Consultant in Emergency Medicine, talks to Brendan about her experience of burnout and what we lose if we fail to value empathy in healthcare. Listen back above.
Dr Emily O'Conor loves her job. As an ED specialist, she jokes about the rare quiet days in A&E as being "the best 20 minutes of any other specialty". Stress, long hours, life-changing injuries, death and grieving families are all part of the job and doctors are well trained for it. But in recent years, as she explains to Brendan O'Connor, overcrowding in emergency departments has got to the point where nurses and doctors are all but unable to do their jobs. Dr O’Conor describes the effects of "moral distress" on medical staff, and explains how she found the language to understand burnout in the workplace, and engage with solutions for young and mid-career doctors to help them avoid it.
Working over Christmas 2022 and into the New Year left Emily exhausted in a whole new way. In January 2023, she spoke to Brendan on air about crowed A&Es, but now in mid-2024, she says that looking back, things had reached a new level:
"This was something different. This was really feeling that we were nearly being set up to fail patients. That we were being overwhelmed with incoming numbers of patients and we weren’t able to get to them on time."
Dr O’Conor describes being at a family party and sitting in the bathroom thinking about all the patients she couldn’t get to because there wasn’t enough time. Her job had gone from challenging to impossible and it was affecting her emotional life outside of the hospital. Emily says she and her colleagues were in a position where they couldn't win, no matter what they did. She says that in a high-stakes environment like an emergency department, this constant expectation of failure has personal consequences:
"I was beginning to feel what we call moral distress. It’s having to work in an impossible environment all the time, about having to make nearly immoral decisions, which are really incongruent with what our values and ethics are."
Dr O’Connor says it’s immoral to leave patients waiting too long. The fact that they are waiting longer than they should puts the medical staff in a moral bind. For the A&E doctor, the problem is not about being busy, tired or having to make difficult clinical decisions. The issue is knowing that you are unable to help everyone on your list, no matter what you do. Emily says she sometimes found herself pulling back from engaging with patients on a human level:
"Passing by patients all the time, elderly patients who’ve been on a trolley for 24-48 hours - Afraid even to make eye contact any more in the department, because I can’t make this better for them."
Working in this environment makes people become detached, disengaged and unmotivated, and this is not what we should be setting up doctors and nurses to do, Dr O’Conor says:
"The effect of moral distress and moral injury is burnout, because it’s the extinction of motivation. People are starting to go into work; the cynicism starts, no matter what I do, we’re going to drop balls today, no matter what I do patients are going to come to harm."
Dr O’Conor reduced her working hours and cut down on the hours she gave for free on other medical projects nationally. She regrets having to curtail her voluntary work, but she says she had no choice. Emily has also signed up for a diploma in Human Factors at the Royal College of Surgeons in Ireland (RCSI). The Human Factors course is about patient safety, teamwork and hospital culture and it’s also offered to medical students and younger doctors as part of their training. Dr O’Conor says part of the solution to avoiding burnout is knowing how to talk about it:
"Hopefully we are giving younger doctors maybe the language and the understanding to know what it is they’re experiencing when they begin to get a bit cynical, when the empathy drops off, when maybe the motivation drops off; that this is something and that there are solutions."
Brendan asks Emily if she’s had pushback from colleagues for speaking out. She says the response falls into three categories – those who think it’s great, those who say 'why bother?’ and those who are angry with her. She says she’s happy with her decision to talk about problems in emergency medicine, because some great people are leaving the profession. Emily says she wants people to stay in her specialty:
"I don’t want to spend the last 10 years of my career seeing really good staff just walking away from emergency medicine."
If you’ve been affected by anything that came up in this interview, go here for information on helplines.
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