Past: what was the Doctors’ Mess?

Dr Alena Chung

The Doctors’ Mess conjures up a room in the furthest reaches of the hospital, with a TV in the corner and several nameless junior doctors slumped on non-matching frayed sofas – all alone, yet united by the common need to seek sanctuary from patients and colleagues. A little time for themselves, if only for ten minutes. That would suffice – although it had already taken ten minutes to walk there. Each extra minute of peace was a blessing. The highlight was cold curry for dinner on Saturdays (organised by the Trust) or a pizza takeaway for an extravagant treat on that birthday, when it was not possible to swap out of the on-call shift. The intrusion of bleeping noises often heralded a look of anguish followed by a terse dialogue on the nearest phone and a speedy exit. The coffee had been too hot to drink in time – must be jinxed. This experience of the physical Doctors’ Mess barely fulfilled Maslow’s hierarchy of physiological needs (Maslow 1943). Indeed, the situation has hardly improved over the last 30 years and most senior doctors never set foot in the Doctors’ Mess nowadays.

Present: the re-invented Doctors’ Mess

Our vision of the modern-day Doctors’ Mess is different. It is a virtual space that can be accessed from home or work, where doctors around the UK can see and speak to each other, and think through heart-felt, challenging situations. Anyone and everyone are welcomed, from trainees to consultants and GPs of every description: a GMC number is the only key needed for an invitation – importantly, there is no charge or pharma involvement. The facilitators are educationalists by nature. They are responsible for creating a psychologically safe environment, where double confidentiality is paramount: doctors who have never met before, create deep connections with other attendees through their conversations. The agenda is set by those who are courageous enough to share their stories. Stories are welcomed. There are friendly ears to listen: such stories have never been told before and were purposely hidden from family, friends and colleagues – censored for a more appropriate listener. Everyone in the group ends up sharing their experiences and drawing comfort from each other – even though they may never meet again: empathy and deep reflections echo and bind the group together with care and compassion. A coaching approach addresses the need for esteem and journeys are taken together into the realms of self-actualisation.

Attendee feedback includes comments that the Doctors’ Mess was ‘brilliant’ and ‘excellent’, ‘I can’t thank you enough’, ‘I really appreciate the notion of a doctors’ mess – as did the other doctors in my group’. Attendees thanked the facilitators for ‘setting up the Doctors’ Mess’, ‘the support, wisdom and coaching’, ‘warmth, kindness and helping hand’ and for ‘thinking of me’. Although there was initial uncertainty about what to expect, an attendee ‘joined in for the first time just to see what it was. I didn’t think I would talk so much’: ‘I was unsure that it would be so happy to experience’. Attendees felt ‘truly touched’: ‘touched by how supportive and helpful you have been so far’, ‘people were kind, everyone contributed’. ‘I appreciate all your time and effort today’. There was a ‘warm positive welcome’ and attendees ‘felt safe’ and ‘at ease’: ‘I was expecting to feel a bit peripheral. But felt very welcome and appreciated. Lovely ++’. They ‘really appreciated the openness and honesty’ and ‘shared feelings of loss in common with humanity’. Whilst the Doctors’ Mess was an opportunity to ‘see former colleagues’, many attendees did not know each other, so it was ‘nice to meet friendly people’. ‘Colleagues [were] very respectful and supportive’: ‘how well the group trusted each other with complex feelings about grief, bereavement, abnormal funerals – having not all met before and being in a virtual environment’. ‘Small groups helped me lots personally’ and attendees ‘witnessed good help with participants in need’ due to the ‘skill of [the] facilitator in drawing out a very vulnerable participant’. Group dynamics and the ‘confidential’ space provided a ‘good space for doctors to share concerns and anxieties’: a ‘safe enough environment for someone to share something they’d not talked about with anyone before’. There was ‘freedom of speech’, an ‘open discussion’ that ‘flowed’, where attendees were ‘able to speak’ with ‘plenty of listening going on’. Attendees also noted: ‘how quickly the group got down to deeper issues’ and ‘how quickly we got into really serious conversation’. ‘How fast the hour went’ - ‘make it longer’. ‘We stuck to one problem as I feel that my colleague did not have enough time to deliberate on his’. Attendees ‘had something useful today’, such as ‘communicating touch to patients via video’: ‘really valuable insights and contributions’ and ‘hearing about how everyone is keeping’. ‘I look forward to connecting with you and the virtual doctors’ mess again’ and ‘I am amazed by how fruitful the virtual doctors’ mess was and am so glad I took up the opportunity’: ‘sorry about the tears – I do feel a lot better’.

There is a richness of themes that have arisen from such conversations in the Doctors’ Mess. Facilitators reported common themes in the stories that were told, such as status, which included issues related to childcare, retirement and maternity leave. Doctors ‘showed high levels of autonomic stimulation’ with their feelings of stress, grieving, sadness, anguish, sadness, bullying, self-doubt, ‘abandonment and neglect’ - ‘painful isolation’ from others, ‘betrayal over PPE’, ‘frustration from doctors who felt that they were not being fully utilised during the pandemic’, ‘guilt about not being able to do more during the pandemic’ and a ‘deep fear of the virus’ which were shared, heard, held, supported and coached by the facilitators: ‘the ability to sit with sadness and anguish is a skill’. Coping with change, such as technology echoed in groups:

‘The advantages of video and telephone consultations, sometimes the “old” values of general practice are nevertheless the “true” gold standard. There isn’t really a total substitute to being able to be in the same space as the patient and assess them physically and mentally with one’s physical presence’

Values caused dissonance, such as:

‘Safety of self versus the vocation of serving patients and risk of death, morbidity and infecting loved ones’

‘Duty to patients and duty to family, e.g. if shielding others’

‘Duty to serve and duty to preserve’

‘The augmentation of existing challenges – relationship with medicine and relationships within teams’

No topic is taboo and the aim is to de-stress from the distress. For example, an attendee felt ‘lighter’ by the end of the session and that feeling reverberated amongst the group. May it long continue.

Future: the impact of the Doctors’ Mess

Facilitators’ experiences resonated with the narratives and they acknowledged that ‘growth takes time’. Re-energised by the Doctors’ Mess as a forum to ‘release a lot of tension’, ‘nudge introverted members of the group’ to speak up and to ‘weave and make sense of the stories whilst providing structure’, facilitators are exploring how to ‘support those who are undergoing trauma and the hidden traumas that can resurface’, ‘psychological first aid’ and the ‘power of supervisions for reflective practice’.

With many 'thank you's and positive descriptions of the Doctors' Mess, attendees described uncertainty about what to expect and that they are 'looking forward' to returning to the Doctors' Mess. There are also comments about the quality of the space, time and group dynamics, including the role of the facilitator. Importantly, the feelings described by attendees from feedback at the end of the Doctors’ Mess session seem to have transformed into positivity when compared with the facilitator-identified feelings amongst the group. Reflections from facilitators in the Doctors’ Mess included themes of ‘managing perfectionism in a crisis situation’, belonging to another supportive network, cross-institutional systems leadership and re-energising.

The outcomes on the wellbeing of attendees and facilitators has been a lived experience of self-care, vocation and altruism: a Covey ‘win-win’ situation (2004). Feedback shows that the Doctors’ Mess is achieving its goal of promoting the agendas for the ‘Freedom to Speak Up’ (2020), the wellbeing of doctors and ‘caring for doctors’ (West and Coia 2019). Time will tell if potential PTSD is transformed into Post Traumatic Growth (Tedeschi and Calhoun 2004) to achieve the ultimate goals of promoting CPD, career development and a sustainable, enriching work-life balance.

References

Covey, S. R. (2004). The 7 habits of highly effective people. 2nd edition. Simon & Schuster UK.

Freedom to Speak Up. https://www.nationalguardian.org.uk/ Accessed on 18 June 2020.

Maslow, A. H. (1943). A theory of human motivation. Psychological review, 50(4), 370-396.

Tedeschi, R. G. and Calhoun, L. G. (2004). Posttraumatic growth: conceptual foundations and empirical evidence. Psychological inquiry, 15(1), 1-18.

West, M. and Coia, D. (2019). Caring for doctors: caring for patients. GMC. https://www.gmc-uk.org/-/media/documents/caring-for-doctors-caring-for-patients_pdf-80706341.pdf Accessed on 18 June 2020.