Precarious Workers in Health

Surviving Work in Healthcare

Chris “I’m not wishing to say we’re trained badly, I think we’re trained inadequately. I don’t think we’re prepared for the distress and the amount of work that’s expected of most people going into healthcare. The distress that has to be held – the fact that its recognised we need Schwartz rounds and Balint Groups. Psychotherapists, psychologists and psychiatrists can hold the distress they hold because they are in regular supervision. There is a lightening conductor for people working with distress in certain professions and not others and that seems to me to be a big hole in how we treat doctors. We’re now recommending self care for the general public and I think we now need self-care in the curriculum for doctors. We are wired firstly as people not as doctors – these things become part of our being, they may be thrust upon us and part of expectations of our families, even before we’re born.”

Clare “We’re here in the Tavistock Clinic which ran a whole series of seminars called Beyond Balint – run by Gerhard Wilke who is a group analyst and anthropologist and what he argues is that what general practice is now suffering from is the bereavement of the doctor-patient relationship being the most important relationship we can have in healthcare. Even that has fallen apart. We now have the ‘third eye’ in the consulting room – that’s the commissioner. How much are you spending? Where are you referring patients? General Practice has become both the scapegoat and saviour. Everything that’s gone wrong in England is our fault – from climate change to the price of oranges. But we’re also the saviours – GP led NHS, GPs running commissioning groups, go and see your GP. Being the saviour and the scapegoat does not sit well with individuals who just want to help their patients.”

Chris “As if the job wasn’t enough its all the things doctors are expected to do around commissioning – being all things to all people and having all capabilities and competencies – nobody ever thinks about capacity. Part of this is increased patient expectations and the politicians who encourage those expectations and make the job impossible.”

Clare “But most of it is that there’s no real interaction between us – patients and doctors, doctors and other doctors – its the relationship between you and me that makes the difference.”



Chris “I was a maladaptive perfectionist. I drove myself into the ground for the sake of my patients and my work. This is why I’m concerned that if we are deliberately selecting young people whose brains haven’t even finished developing and putting them under high degrees of pressure – for doctors as a specific group of high achievers – I see this as a potentially major dark hole for people to enter. People self-pressurise and unless we’ve got systems and measures in place for people to work safely there are going to be problems. It manifests itself in sickness absence, sickness presence dysfunctional teams and patient experience, negligence claims and costs generally.”

Clare “Its trainees in hospitals that are in the worst state. This is because we treat training grade doctors as commodities. So they’re there on a production line of care with no concept of them as a human being. For example, they might have a rota that is intolerable, changing daily, can you imagine what that does to your life? They also don’t know where they’re going to be long enough to get a lease on a property. They’ll arrive in a hospital and they’ll be homeless. We don’t provide them with sustenance any more – they might be on in the middle of the night and there’s no hot food just a vending machine. We imagine that they don’t need continuity when we all need continuity. And then we expect them to show compassion. Come on.”

Chris “This is one of the arguments about resilience. There are lots of resilient people around in this country, they’re running it and running lots of people into the ground. I don’t want resilience when I go and see a doctor I want caring and I want that person to be able to be healthy in themselves and supported. The greater the distress the more we need it. We can’t hold other people if we’re not in a position where we can hold ourselves.”

To hear the full conversation with Clare Gerada and Chris Manning go HERE.

Surviving Work in Healthcare is a free online resource Surviving Work in Healthcare designed for people working on the frontline. The website is a joint project by Surviving Work and the Tavistock & Portman NHS Foundation Trust offering podcasts, videos and survival guides that take a jargon free, de-stigmatizing and practical approach to addressing the real problems of working in healthcare.



We have developed these resources to be used on the frontline of health care. We hope that you can use them in your activities, meetings and trainings. Just send the link to anyone you think would find them useful. These resources are free –  all we ask is that you respect the copyright and attribute the resources to the authors when you use them.



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