16 OPINION
Boosters provide additional protection against COVID-19
16 OPINION
16 JUNE 2023 ausdoc . com . au
Insight
Saying no to the system
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Dr Ashlea Broomfield GP on NSW ’ s Mid North Coast .
Sometimes , doctors must put their needs above everyone else ’ s .
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break , communicated that and it was received well .
Patient care did not suffer , the care need was not urgent and I was able to tend to the issue later .
However , I was much more fearful about asserting a boundary in this way among my medical colleagues .
As doctors , there is an unwritten but very much spoken expectation
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that we prioritise everybody else ’ s care needs above our own .
We are told , expected and asked to put the care of our patients first . Rightly so . They are sick . They need help . If I had to choose between doing a cardiac arrest or having morning tea , I would choose facilitating the CPR every day of the week .
And yes , that is a conscious
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choice , with a decision and awareness of this decision .
However , we work in a system that is under-resourced and understaffed . So sometimes the choice is to see an extra patient in our lunchbreak because , if we don ’ t , there is no other time to see them .
This situation is even more dire for rural doctors . “ If I don ’ t see them , who does ?” No-one .
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No wonder our profession is burning out . No wonder we are struggling . Our system is broken . I believe it is no longer okay for us to weather these boundary incursions — for us to say yes when we should be saying no .
If we do not start setting these boundaries ourselves , history tells me the system will not do it for us .
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DOCTORS are not good with boundaries . Let me be clearer about this : I am not talking about professional or ethical boundaries with patients .
I am talking about those that are broken when we disregard our own basic needs in the service of something or someone else .
Toileting — taking a urine break when the bladder gives a signal to the brain it is full ; taking enough time in the toilet to fully empty the bowels , without pressure .
Eating — taking time for breakfast , for morning tea , for lunch , for an afternoon snack ; spending time to enjoy and savour the food we are consuming .
Sleeping — having uninterrupted deep rest , consistently each day .
Resting — where there is not one ear on , waiting for a call ; where there is not an email to check , a note to write or an article to read . And yes , having fun . Not only do doctors struggle to do all this , we often assign achievement to the failed struggle .
“ I haven ’ t been to the toilet ALL DAY .”
“ I haven ’ t had a chance to eat ALL DAY .”
“ I haven ’ t had a break since ( insert time here ).”
The person who wins this collegial competition is the one who has negated their needs the most or longest .
That person is subconsciously meeting the unspoken expectations of the medical system : everyone else ’ s needs matter more than yours .
As an intern , I remember ringing a nurse to discuss a patient and was told : “ Sorry , I ’ m on my morning tea break . Can you call back in 30 minutes ?”
I thought that was a pretty novel idea . At the time , I was quite irritated — perhaps even a little angry . How come , when I have all this work to do , someone else is taking a break ? So , I tried an experiment . When I was on lunch next and received a phone call from my nursing colleagues , I triaged the call and determined the care need was not urgent .
Then I set a boundary : “ Thanks for letting me know , but I ’ m actually on lunch now . Can I come chat or call you back after my break is over ?”
I am not lying when I say it was received really well . I was gobsmacked . How about that ? I set a boundary around my very basic nutritional needs and legislated safety requirement to have an actual
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