Health professionals like to do a good job. With some illnesses, it is very hard to know you have done a good job.
An illness may make the patient get worse whatever anyone does. Without a ‘cure’, nobody may be grateful for any work put in – even if the situation would have been worse without their input. The patient or their family may not be aware of all that has been done. Even other professionals (such as a doctor) may not acknowledge the work of all the other members of the health team. Commissioners and management may also not recognise all the supportive work which has been provided.
Support from colleagues
Support from colleagues and from other professionals can be very important in helping a health professional to know that, in spite of ungrateful patients or unrelenting illnesses, some good work has been achieved.
Unfortunately, support from colleagues is not always available. Work may be organised in such a way that staff have no time to chat or to discuss difficult situations with each other. Tasks are sometimes allocated in such a way that the professional very seldom has a sense of a good job well done. Those holding the purse strings may not be aware of the stressful nature of the job, and of the need to factor in time and facilities for staff support.
Illness itself adds to the professionals’ stress.
With some illnesses, people can work very hard to bring about an improvement – only to see it lost after a further attack. This can be very dispiriting for all concerned. The professional can find themselves getting angry with the patient, even if they know it is not the patient’s fault. They can also get angry with themselves for being irritated or annoyed or fed up, or for feeling that their work has been wasted.
(How many times will this happen before the professional finds themselves not wanting to put the effort in the first place – even though there is a chance that the change will last for a bit longer – or even for quite a long time? How long is a long time? How long is ‘too short’? Will management decide the cost is ‘not value for money’? What happens to those who cannot afford to pay for their own treatment, then? They may feel they have been abandoned – and the professional may be aware of this.)
Uncertainty, and the inability to make things better, can be hard for professionals too. Until the professional has learnt to settle for a slight improvement, or for preventing further deterioration, or for making someone feel temporarily more comfortable, they may often have a sense of failure.
There are many illnesses where the behaviour of the patient can make things worse. Suicide attempts are an obvious example. Many professionals find it very hard to feel sympathetic to those who try to kill themselves, but there are many lesser examples of mild self-harm, or refusals to engage in treatment. It is hard to feel one’s work is being destroyed deliberately, and professionals can sometimes react angrily to sabotage. Even when (or if) they know that the illness itself has contributed, by making the patient forget appointments or medication, or making it hard to make decisions, or to keep to a decision once made, or even to want to self-harm or neglect themselves, they may find this behaviour maddening and interpret it (rightly or wrongly) as a deliberate attempt to cause trouble or to reject help, or even to punish the professional for ‘not being ill’ themselves.
Working with an illness which has a hope of cure can be more stressful than knowing that the work is to help somebody live to the end of their life in as good a way as possible.
When a professional has learnt how to value their own input with their particular patients, they still have to deal with other people’s attitudes, which may be very different. It sometimes seems that those commissioning services, and the public too, only value work which cures. Funding may not be available either for prevention, or for helping people to live with a chronic illness, particularly one which slowly deteriorates. Both patient and professional may feel a sense of abandonment, of undervaluation. Home carers in particular may suffer from low wages, low expectations, little training and low respect from employers.
Working with other people’s distress
Illness often makes patients depressed or anxious or frightened – and professionals can find themselves depressed or anxious or very concerned after meeting them. This can even happen with patients who seem very cheerful, if their cheerfulness covers very disturbing or frightening fantasies or feelings. These patients can evoke distress in others as part of their way of avoiding feeling it themselves.
Each new patient and their family may also have to learn to settle for some improvement which is less than they wanted – and the health professional may have to talk them through this. Patients and their families can be very distressed at this point, and the professional has to bear their upset as well as the professional’s own.
Talking people through these disappointments can be stressful for the professional, particularly if they feel responsible for the situation, whether or not they they have power to influence it. It is painful to know that actually the patient needs far more support or appointments or treatment than they are going to be given, and to have to witness the anger and distress of relatives or the patient themselves – and perhaps be accused of deliberately failing to provide something which the patient feels is their right.
Dealing with the professional’s own distress
If the distress becomes too much for a professional, they may deal with their own conflicts and upset by trying to cut off their emotional reactions. Unfortunately, this can make them appear hard and lacking concern. It can allow both thoughtless and cruelty, since empathy and sympathy are what prevent cruelty and thoughtlessness. If this happens, they may feel bad about it – or their patients may be made to feel bad instead. Colleagues witnessing this kind of ‘hardness’ may also be affected. Younger, newer colleagues may be given the sense that ‘this is professional behaviour – you are foolish if you allow yourself to feel sympathy with patients’. They may not like what they see, but find it hard to criticise or challenge. Older colleagues may be in a position to collude or to challenge – and colluding may be more comfortable at the time, though in the long term, dissatisfying. In the long term, the service, the staff and the patients all suffer. So too may the professional’s own family, if they become hard and dismissive towards their own children’s or partner’s or elderly parents’ minor illnesses.
If the distress is not too powerful for the support systems available, professionals can think through their emotional reactions and find ways of handling their distress without passing it back to the patient. For this they will need time and space to think and to feel in safety. Colleagues, or someone outside work, may be able to provide a safe thinking space – but there are always competing demands on the professionals’ time. Many professionals find it hard to allow themselves to be aware of their own need for support, and somebody else, such as a senior colleague, a manager, a friend or a family member may need to notice and to insist that thinking time is taken.
Even after a professional has had considerable experience, some patients can have a powerful emotional impact, perhaps resonating with some aspect of the professional’s own life. When this happens, it can be quite disturbing and distressing, and need considerable emotionally-draining work by the professional before they regain their sense of balance and competence.
The nature of the work
Professionals sometimes feel they haven’t helped at all if they have not done something, or provided something: they may not always recognise the value of thinking with the patient, or of understanding: and their job description may not include this nor provide time for it.