Medics suffering in the world of anhedonia need to take a time-out to heal themselves

The sexy, dancing, tattooed, gaming, musical Chris Luke got his freak on at dotMD – and discovered that seeking and maintaining pleasure is an important part of avoiding the burnout of medical practice

Francis Bacon, the English natural philosopher, essayist and ‘father of empiricism’, is a great source of useful aphorisms. My favourite is worth reiterating in full: “Reading maketh a full man; conference a ready man; and writing an exact man; and, therefore, if a man write little, he had need have a great memory; if he confer little, he had need have a present wit; and if he read little, he had need have much cunning, to seem to know that he doth not.”

Setting aside the 17th century use of ‘man’ to mean ‘person’, I think this is still invaluable advice, and particularly those who are embarked – or embarking – on a career in medicine, with all its non-randomised trials and tribulations.

I was reminded of Bacon’s wise words as I drove back last week from Galway, following one of the most pleasurable conferences I’ve ever attended: dotMD – ‘A Festival of Medical Curiosity’. Organised by a trio of well-known Irish medics, Drs Ronan Kavanagh, Muiris Houston, and Alan Coss, the event spanned a few days and nights in and around the soothing setting of NUI Galway, with an explicit aim ‘to reawaken a sense of wonder and curiosity about medicine that some may have lost along the way, and to help them find deeper meaning and satisfaction’.

To my (retrospective) chagrin, this was my debut at what has been a fixture in many calendars since it was first held in 2012. But to my delight (and to echo a more contemporary sage, Austin Powers), the meeting was perfect for those who’ve lost their ‘mojo’; the fact is they will almost certainly rediscover it amid the audience of normally exasperated medics who are collectively transported by so much scintillating conversation back to the heady days – fadó fadó – between Finals and the start of internship, when they were so eager, curious and brimming with joie de vivre.

The authentically weird thing is that I hadn’t read the online explainer about dotMD until I returned home, and found that much of what I’d said on stage in my own talk (‘Confessions Of A Party Animal: Why Medics Need To Take Pleasure Much More Seriously’) was already covered in the website. In short, the organisers promise a ‘welcoming retreat where attendees can pause, relax and reflect…viewing medicine with fresh eyes through the lenses of culture, the arts, philosophy and technology’. And they specifically exclude ‘academic hierarchy’ or point-scoring.

For my piece, I’d reflected on how my own burnout (that drearily familiar but WHO-endorsed term) had ironically originated in the hedonism of my own undergraduate days; as a young consultant in an inundated emergency department in Liverpool, I’d harnessed happy memories in what I dubbed ‘Nightclub Medicine’, an initiative to identify the health hazards of the night-time economy and ways in which they might be mitigated (thus reducing the workload of most urban EDs).

Unfortunately, despite turning a former hobby (clubbing) into a (mostly) entertaining specialist interest, the combination of daily clinical inundation and years of studying ‘the perils of pleasure’ culminated in my own severe anhedonia (that old-fashioned psychiatric concept describing the loss of joy in relationships, work or favourite recreational activities).

The reason why I’d attended dotMD in the first place was an invitation to talk about my recently published memoir, A Life in Trauma. So I had no research paper to promote, as in most conferences and yet, in the process of preparing the talk, I realised for the first time that my own erstwhile joylessness had resulted from both overworking and overthinking the downsides of having fun. It occurred to me – in crystal clear hindsight – that, had I recognised that sustained loss of enjoyment is a major ‘red flag’ for medics’ spiritual well-being, I could have pre-empted the subsequent years of difficulty.

In any event, I told the audience that I had now concluded that the ‘hazard warning’ of anhedonia should really prompt a period of urgent reflection (and ideally a ‘time-out’ for all afflicted doctors).

The alternatives were simply too grim to ignore, even though they had been so realistically portrayed in the recent BBC TV black comedy, This Is Going To Hurt. In this, both main characters, the Ob-Gyn Registrar, Adam, and Senior House Officer-equivalent, Shruti, are obviously experiencing an anhedonia that made their family, professional and social lives equally miserable, to the point where Adam quits medicine and – in a shocking finale – Shruti takes her own life. In my talk, I cited headlines describing recent real suicide by actual doctors in training, and I suggested that – unlike the TV depiction – the deficiency of joy affecting these tragic medical victims was often unacknowledged or unnamed.

The remedy which I advocated for such anhedonia was for medics to take a far more serious and proactive approach to pleasure, and to ration the gloom and cynicism which envelope so many of us. I touched upon the art and science of sex, music, dancing, gaming and tattoos, among other sources of gratification, and I roughly summarised the advances in our understanding of the health pros and cons.

I itemised the many reasons to be grateful for the provision of practical antidotes to the stresses of yesteryear (like emergency contraception or HPV vaccination), and I made a point of highlighting the growing list of benefits from just a half-hour of reading daily (ideally fiction), like greater empathy, reduced anxiety and cortisol levels, and a reported extra 23 months of longevity in avid readers.

Believe it not, I garnered plenty of laughs (how else can you get people sufficiently relaxed to imbibe your argument?). But my most important message echoed that of the celebrated American neuroscientist, Professor Michael Merzenich’s prescription regarding love, that greatest source of joy: people should live ‘a life full of vitality, interesting and surprising things’ so they are open to the often-startling arrival of love in their lives. And I offered an old poetic saying, in parallel with the neuroscience: ‘If you would be loved, love and be lovable.’ In short, the burned-out dejected medic does neither, so a paucity of pleasure can be terminal in many ways.

The dotMD programme was full of wonderful conversations with visiting medics like Drs Roger Kneebone, Iain McGilchrist, Monica Lalanda, Benji Waterhouse, Suzanne Koven, John Launer, and Steve Schlozman, featuring generic expertise, discrimination against the right cerebral hemisphere, therapeutic movies, graphic medicine and the writing of funny and serious books.

Mind you, matching the international medics – move for move – were the ‘locals’, including the hugely charismatic Austin O’Carroll, who instigated the greatest flash dance ever seen at an Irish medical conference, the warmhearted Ide Delargy, who reminded us of the indispensable Practitioners Helpline, the witty Sumi Dunne, and the wise Rita Doyle. And, in-between, there was exquisite music from Iarla O’Lionaird, literary quips from Anne Enright, poetic tips from Martin Dyar, and comic insights from Tommy Tiernan, not to forget a spontaneous rave in the car park.

I hope this all sounds like fun, because it really was. I cannot easily distil the intense pleasure and inspiration I experienced at dotMD. Ronan, Muiris and Alan promised the audience an ‘inoculation against cynicism, isolation, burnout and boredom’, and they elicited the most extraordinary levels of sustained pleasure, indeed glee, I’ve seen among older medics.

Only one thing was missing this year, I think, and that was the value of gardening, as described so marvellously in Dr Sue Stuart-Smith’s book, The Well Gardened Mind (which makes her the perfect guest for the next meeting). And as for bringing home the ‘Baconism’? What went on at dotMD 2022 – getting medics to immerse themselves in reading, writing and conferring (conversing) about their humanity, and all that is entailed in the ‘humanities’ – strikes me as the closest thing I’ve seen in four decades to a genuine solution to the blight that is burnout.

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