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Published Online 3 September 2018

Surgery and emotional health

Publication: The Bulletin of the Royal College of Surgeons of England
Volume 100, Number 6

Abstract

Do feelings have a place in the operating theatre? What emotions underpin the experience of surgical practice? A recent workshop at the RCS tried to find the answers to these questions.
Operating with Feeling, an interdisciplinary workshop held at the RCS on 1 June 2018, was organised in collaboration with Surgery & Emotion, a Wellcome Trust-funded project based at the University of Roehampton that examines the role of emotions in surgery from 1800–present. The workshop brought together surgeons, healthcare practitioners, historians and policymakers to discuss the emotional experiences of surgery, past and present. Here we present the most salient discussion points and proposals for next steps.

Exploring emotional health

The day was divided into three themed sessions, each comprising a panel of speakers and breakout discussions. The first panel – on stress, burnout and bullying – featured Alice Hartley discussing her work as Chair of the Royal College of Surgeons of Edinburgh’s campaign against bullying in surgery, Simon Fleming exploring the #HammerItOut Campaign spearheaded by the British Orthopaedic Trainees’ Association, and Richard Jones, Clinical Director of the NHS Practitioner Health Programme, speaking about mental health among the NHS workforce. The second panel – on anxiety, doubt and grief – shifted attention to practitioners’ emotional connections to their patients. Sally Frampton, a postdoctoral research assistant at the University of Oxford, discussed anxiety in Victorian surgery, focusing on the innovative and risky operation, ovariotomy. The Point of Care Foundation’s Chief Executive, Jocelyn Cornwell, discussed how Schwartz Rounds provide opportunities for staff to reflect on the emotional aspects of their work. Siné McDougall and Catherine Johnson, from Bournemouth University’s Surgeon Wellbeing project, presented their research on surgeons’ responses to adverse events.
The final panel explored compassion and sympathy. John Collins, Professorial Fellow in Surgery at the University of Melbourne, discussed the value of compassionate care in surgery, past and present. Rose Glennerster, a junior doctor at the Royal United Hospitals in Bath, reflected on whether surgeons could have too much compassion for their patients. The RCS’s former Director for Professional Affairs for the East of England, Surjait Singh, spoke about his work for the BMA’s Doctor Support Service, which supports practitioners undergoing GMC investigations. Finally, Michael Brown, Principal Investigator on Surgery & Emotion, reflected on what surgeons today can learn from cultures of compassion in the early nineteenth century. The day closed with a keynote presentation from Averil Mansfield on The Humane Surgeon. Drawing on her own experiences, she spoke about shifting public attitudes towards surgery, the links between altruism and professionalism, and the importance of humane decision-making and leadership.

Recommendations for change

Breakout discussions enabled delegates to explore the issues in more depth, and to consider opportunities and challenges in surgical training, practice and patient care. Participants were encouraged to devise recommendations for change. Rather than focusing on high-level policy ‘asks’ (such as funding and resourcing), we asked them to consider interventions that could take place at grassroots or trust level. Much of the conversation focused on how to improve the emotional health of the NHS workforce. Delegates emphasised that hospitals needed to make surgeons and their teams feel valued and appreciated, and help their staff develop supportive working relationships.
Delegates emphasised that hospitals needed to make surgeons and their teams feel valued and appreciated, and help their staff develop supportive working relationships

Working relationships

Delegates argued that a more compassionate community among staff would enable surgeons to develop better relationships with their patients. New forums for socialising, like mess parties and team lunches, could help break down hierarchies and boundaries between clinical and managerial staff. One participant suggested that chief executives could set aside time to join staff in the hospital canteen. Attendees also spoke about the dangers of isolation, particularly for trainees, who are a largely transient workforce. Participants suggested that mentoring or buddy systems (perhaps at a vertical level, bringing together colleagues of a similar grade) could provide more accessible and open support networks.
Surgery & Emotion’s Principal Investigator, Michael Brown, shares feedback from one of the breakout groups
In terms of tackling bullying, some attendees recommended further training on workers’ rights in relation to harassment. Delegates also emphasised the need for more awareness of freedom to speak up guardians, and greater assurances that those who raised concerns would have their anonymity protected. They recommended that emotional health and effective communication should be compulsory elements of CPD rather than optional add-ons.

Spaces of care

In discussing how to ameliorate feelings of grief, anxiety and doubt, delegates suggested that Schwartz Rounds should be rolled out to every trust in the UK. Delegates also recommended the creation of ‘emotional firms’ – collections of surgeons from different specialties and career stages in different teams who come together regularly to talk about the social and emotional aspects of their work. This would offer new networks for surgeons, away from the traditional hierarchies of hospital work. Existing morbidity and mortality meetings could also be restructured to allow time and space for emotional reflections, not just clinical commentary, and trained facilitators could be brought in to transform ‘name and shame’ cultures.
Delegates also recommended that the built environment of the hospital could be altered or adapted. Staff need spaces – away from patients – where they can take time to process difficult or emotionally intense events. For example, the doctors’ mess provides a crucial environment for reprieve and social support.

Time pressures and emotional labour

Finally, delegates considered how compassion and sympathy might be curtailed by time restraints. For example, some mentioned how busy days and geographically dispersed hospital sites made it difficult for them to attend Schwartz Rounds, while others talked about the challenges of giving patients adequate time to express themselves within brief consultations. They also reflected that compassionate care is a form of emotional labour often taken on disproportionately by women and that it should be distributed more evenly among colleagues. Sympathetic attachments to patients can leave practitioners feeling emotionally drained.

Next steps

A key theme coming out of the day was the importance of team working. Building on the success of this workshop, Surgery & Emotion are planning a programme of events that will include more people from the surgical team and NHS workforce in dialogue about emotional health. We want to transform conversations about workplace cultures; rather than putting pressure on individuals to be more ‘resilient’ or improve their ‘wellbeing’, we would like greater attention on the responsibility of hospital management and statutory bodies to protect the emotional health of the workforce, which is so crucial to safeguarding the future of the NHS.

Further information

If you’d like to find out more about the Surgery & Emotion project and its upcoming events, please visit: http://www.surgeryandemotion.com/.

Information & Authors

Information

Published In

cover image The Bulletin of the Royal College of Surgeons of England
The Bulletin of the Royal College of Surgeons of England
Volume 100Number 6September 2018
Pages: 265 - 267

History

Published in print: September 2018
Published online: 3 September 2018

Authors

Affiliations

Arnold-Forster Agnes
Research Fellow
University of Roehampton
Moulds Alison
Engagement Fellow
University of Roehampton

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