Depression and alcoholism, or the dark side of medicine. Episode 49

Monika Rachtan
People think that doctors don't get sick, let alone that they can't get depressed. It is precisely depression that I will be talking about in today's episode of the programme "Po Pierwsze Pacjent" with Władysław Krajewski, a young doctor. Hi, a very warm welcome to you.

Wladyslaw Krajewski
Hello. A warm welcome to you.

Monika Rachtan
Depression is an illness that, it would seem, cannot affect doctors. However, very often its occurrence is a consequence of another phenomenon - professional burnout among medics. Tell me, at what point do doctors start to feel burned out? After 10, 15 or 20 years of work?

Wladyslaw Krajewski
And this is where I think I will surprise all listeners, viewers and also you. Burnout starts even before we start working, or more precisely during our studies. In fact, we already report burnout problems then, which start in the final clinical years, when we first start to move into the system and get to know it from the inside, along with the realities of Polish healthcare.

Monika Rachtan
Medical school is the dream of many young people, mine included. High school students dream of getting into medicine and dedicate three or four years of study to achieve that goal. So are you saying that you feel burnt out already in your studies? You said you are meeting realities. So what are those realities that cause burnout?

Wladyslaw Krajewski
To confirm my words, it would be worth asking the medical students present here. Usually, when asked jokingly or seriously, they answer that they do not recommend these studies. They wanted very much to get into these studies, but now they do not recommend them.
Monika Rachtan
Why wouldn't you recommend studying medicine?

Wladyslaw Krajewski
I actually recommend it very much, albeit presenting such an opinion, which has its basis in fact and has the basis of this. It has a basis in fact of burdens, mental burdens too. I would like to outline this problem, which we are very happy to hear about recently: it is bullying, which starts at university and then continues at work, which is also the basis, so to speak, for further professional burnout and, in addition, for all the depressive or anxiety disorders that occur among medics. I would like to point out that this does not only apply to doctors.

Monika Rachtan
But also the nurses, the midwife.

Wladyslaw Krajewski
Absolutely yes. So we're also just another, another issue in this, so to speak, that we all work in teams and it's crucial in health care to work in a team. If that team is burnt out, then one, it's ineffective, and two, those people actually drive such, drive such a merry-go-round on each other. I don't know, as if you could call it, they fuel each other's merry-go-round of these negative emotions.

Wladyslaw Krajewski
And this is one of the biggest problems we face, which is worth fighting, so to speak, for each individual, because it is in fact a conversation, a talk and a conversation between each member of the team, between the supervisor and the subordinate, so to speak. This conversation contributes to the fact that we can reduce precisely the professional burnout, the bullying by actually already treating the cause, not the symptom.

Monika Rachtan
The mental burdens that medical students face when they enter the corridors of hospitals, clinics. I would like to ask what these mental burdens are. And now, if we can talk very openly, is it that this young doctor, not yet a doctor, that this student enters a hospital and the staff who are in that hospital treat him badly? Or is it more that the problem is that he is facing the death of patients, that he is not ready for that? But is it who is working there that determines that this burnout occurs?

Wladyslaw Krajewski
I must point out that the problem of burnout is actually multi-level. And I would also like to point out that I personally could recommend the vast majority, just to give you an idea of what the majority is, it's about 95, 96 per cent of all the assistants I've actually had in my studies. So some people can't boast that number. And these are people who I also know would not certainly lie, for example, when encountering an unpleasant event. So certainly at university a mentor is a particularly key person, and a mentor is the whole team I mentioned earlier. If it doesn't happen sometimes that, for example, the medical team is very, very straightforward and, for example, the nursing team takes a different approach and they are, so to speak, on that line and tensions arise and then we also go in and already apart from the tensions the student and the team can be the opposite. I also come across situations where doctors by doctors, have been treated by students, quite, so to speak.

Wladyslaw Krajewski
Like they were an empty place, I would call it. But on the one hand, for example, the nurses took care of these patients, sorry, students and later on, for example, you can also learn a lot from the nursing team too, actually the nursing staff. So that's why the key here is the people really. For sure and the working atmosphere, because this tense that arises between the student and some part of the team really affects the whole team. And then that team is ineffective and the learning above all is ineffective. That's why I started our conversation with the fact that doctors and still young, young people who haven't really entered the profession yet, they just become victims of bullying sometimes or they're already disgusted with these studies just as you said, that it was many, many people who dreamed of these studies. And now imagine that they come together having this realisation that it is, however, hard, hard work, mentally taxing. It is, in fact, a human tragedy and this, so to speak, a desire to help.

Wladyslaw Krajewski
And then you encounter bullying, which just makes all this, so to speak, miserable. In fact, this course of study and not allowing you to learn, and in fact your ambition at the very beginning was just this learning, and it just amplifies such a wave, so to speak, of self-propelling, which at the end of your studies from year to year it just increases to such an extent that when you enter the internship actually a lot, a lot of colleagues start to wonder if they would really like and want to continue with it, because simply the perspective and they are no longer the young people they were, who they were at the very beginning, in the first year. They are already by the time they get into the system, they know what they are going to encounter there and sometimes also, so to speak, the perspective they see that, for example, the next 5, 6 years they are going to encounter the same attitude towards themselves or maybe worse. So that kind of perspective doesn't encourage young people just to work, to work in the profession, so they may also give up, and if they go in, then later on these situations can compound, so to speak, that they anticipated that they would be like this, that they would be like that, and yet.

Wladyslaw Krajewski
Yet they have moved on and are now disappointed. And that's why it's another one too. Another reason for this burnout that comes later. Of course, after 5, 10 years it shows up, but it actually germinates already at university.

Monika Rachtan
Many people who choose to go to medical school have medics in their family. Are your parents doctors?

Wladyslaw Krajewski
I am an exception in this respect. In fact. What is more, I would even say my fiancée is an exception. I would also like to say, as an exception, that indeed many people, many people have, have at least one, not even a doctor. Perhaps it is a lifeguard or a paramedic, a nurse or a nurse practitioner, or other medical professions. As much as possible. With me there is an exception in this respect, and in fact a little bit of rebellion in this whole story is due to the fact that at one point, just before the exams with a more technical profile, such getting ready for engineering, I decided to switch to an absolutely different profile. My mum thought that I had just read the books and now I was thinking. And I'll tell you frankly, it was that remark that crept into my life a little bit, that by the second year of probably university I was actually also wondering if I was in the right place.

Monika Rachtan
Whether I'm a medic or whether I'd like to go into construction, though.

Wladyslaw Krajewski
Perhaps my mother was right, and yet. But in that second year, as I worked with patients a bit more, I felt such a desire to do it, so to speak, and that I really wanted to do it.

Monika Rachtan
This issue of medics in the family is interesting to me, well, because in homes, after all, you talk about what that environment looks like. Those people who decide to go into medicine, however, hear what the job might look like, what these relationships with doctors might look like. And I wonder what they are driven by then. Well, because they know that this life of a doctor is hard, sometimes burdened with giving up their daughter's birthday, sometimes burdened with a lot of travelling, sometimes burdened with night duty and burdened also with that atmosphere you said. And yet they take up the gauntlet, they go into medicine. Are such people, for example, favoured by medical teams when they end up in hospital wards?

Wladyslaw Krajewski
It's hard for me to say whether they are favoured, although such people, for example, I could certainly point out that they are, they are ambitious, they are usually, not so much that I don't want to use the saying, more willing to work, but that they are courageous to do so. And it is precisely this courage that we need to have. I'll say from the perspective of a young doctor and I'm actually quite fresh, a fresh resident, so that's why the excitement of going down to consultations, to other departments, when I'm fresh with this, I'll say frankly that it's really exciting and it takes a bit of courage just to go and go and do it. That's why it's also hard for me to say from the perspective of my work and the work of my colleagues that these people are favoured, although they are certainly more noticeable due to the fact that I've spent more time on this work and it's also, so to speak, bearing fruit for them in this life. However, this is exactly what we, as the Residents' Association, as a trade union of doctors, as I am a member of the Gdansk Medical Chamber, so also as a self-government, so to speak, are pointing out that this work-life balance is something that we also have to strive for slowly.

Monika Rachtan
How many hours do you work per week?

Wladyslaw Krajewski
It's usually, oh my gosh, counting already I say. We actually start at 7.30am and finish at 3.30pm, so it comes out to about eight hours. So standard and it comes out five days a week 40 hours plus another 10 hours five minutes. These are the accompanying duties and I will say that in real life it doesn't look like that in that respect. Yes, there is an official version, but I will say frankly that just sometimes trying to go out faster, sometimes it doesn't work out. Simply because of the patients, because of the desire to help as well. That's really what I'm looking out for, the team is key. If it comes to me, even I know that a colleague is operating at the moment or, for example, in the treatment room has to take care of a patient, such a situation just happened yesterday. I was going to leave at 17, 18 at the most, I left at 21, so the difference is that I am not going to say to a colleague that no, you are on duty. I actually have no obligation to stay today. It's found when I want it, or when I agree with my boss. Leave it alone. Let the patient with the fibrillation, herself.

Wladyslaw Krajewski
I'll leave that to the nursing team. So in that way it's absolutely even I would say irresponsible approach and not to say simply human such help. We all work that way, I know. And it's this confidence that I have, I have this team, I have these people. It also, later on, makes me a little bit stronger in this work. It also gives me courage, because I know that if I have to go down, if I have to do something or if I'm not able to take care of a patient on my own duty right now, I know that I have someone to turn to. I know that someone is going to catch me, so to speak, colloquially, and that I will be able to actually, firstly and effectively treat, and secondly, actually work in an atmosphere that is simply friendly, so to speak.

Monika Rachtan
From what you say, it sounds like you're working one full-time job. And you weren't so tempted to go to the POZ after hours for three hours.

Wladyslaw Krajewski
Tempting. Unfortunately, I will say frankly that it was even tempting in this respect, so to speak, financially, it was different, it was also different. I'm sorry to make such a small insertion, that from a survey, which was actually conducted by the All-Polish Physicians' Trade Union, it turned out that the majority of doctors, and even the media repeated this survey, express the desire to work in one place actually. And it seems to me that I am not an exception in this respect, because I prefer to have this team, these people, I have got used to them, I know what the realities are and I am simply, first of all, efficient in this work, secondly, it is also, so to speak, a friendly atmosphere and I also know that I do not have to rush after hours, that I can stay for a while, actually help someone, so. So this issue of time is the most limiting in this respect, although I can't hide the fact that it's really tempting at the beginning, especially at the beginning, because of the various commitments, entering a more adult life, trying to find oneself after studies, after the internship, so to speak, at the very beginning, you really want to work a little bit, as long as you have the will, but later on, as long as you have the will, and later on, you can slow down a bit and deal with the things you care about most, be it your family or your hobbies.

Wladyslaw Krajewski
Treating patients, of course. So that's why. Therefore, by all means.

Monika Rachtan
I hope you remember that this programme is primarily aimed at patients and that I am here for a bit, speaking with the voice of patients, at least trying to speak. When it comes to doctors' salaries, there is a lot of buzz on the internet. There are comments on Twitter. You probably know the saying, show a doctor what you have in your garage. Is being a doctor still a mission today? Is it a way to make money? And is the fact that doctors are working three jobs the result of the fact that you just can't live off that one job? Are they so ugly a word, greedy?

Wladyslaw Krajewski
I will say frankly, and this is the funniest thing about it, I get bombarded with these studies all the time because we can actually, we can talk about, as you mentioned yourself, that there are these discussions on Twitter, on social media, on conventional media and I will say frankly that we usually do too. I wonder if actually those comments are right because of the fact that we don't see all those colleagues being prescribed, so to speak. Yes, yes, yes, absolutely. Even in my situation, in my situation sometimes, to cover, to cover some of my expenses, then I also have to ask a colleague for an interest-free loan. So therefore, as much as possible, as much as possible. I am saying that we have cases that are earning, so to speak, from doctors earning horrendous amounts of money. Absolutely. We have, of course, those who earn the least. We have encountered situations like that too, even though we have had doctors reporting to us, so to speak, that I know are hard to believe. We couldn't believe it either. I had to contact these people to confirm this, but indeed the rate proposed in Kraków was the minimum, so to speak, the national rate, and it's really just that there are all sorts of human situations that sometimes, for me, it's also incomprehensible.

Wladyslaw Krajewski
That's why I always have to confirm it in this respect, that it is incomprehensible how, working in such a flexible profession, with so many opportunities, one can agree to such conditions. But I also see the other side of it, that if an employer offers such conditions, it means that they know that there will be people willing and eager to do it. This simply means that, for example, in this particular case, there are too many of these people, so to speak, specialists or doctors in this particular place, and then it comes into play, so to speak.

Monika Rachtan
Well not the lowest country, it's kind of impossible.

Wladyslaw Krajewski
That is exactly the point. We couldn't, we couldn't believe it either.

Monika Rachtan
And this doctor practised there?

Wladyslaw Krajewski
Absolutely. It was even reported to us, so to speak. I think it's also a matter of familiarity, which is why we're a little bit happy that we're going out to the people, because these situations stay under the table, nobody finds out about them. It is. And such situations just love silence. Besides, we can only envy the creativity in coming up with various additions to these agreements or the rates themselves, so surely these things are not usually so obvious that someone will come and say directly that here's your rate, especially if it's so low, so that's why we try to get to it somehow through various ways.

Wladyslaw Krajewski
But coming back to the substance, I would also like to say that this is why we carried out a study, there has been a lot of talk recently about three, in fact it is three national for a specialist doctor, this is what the Minister of Health said, this is also what the trade union usually calls for. So I would also like to point out that most people, when they point out how much these third nationals are, there is a bit of a misinterpretation in this respect, that three national averages. What does that mean? It means that three times what I make. Well, that's a lot. And if you actually compare, compare, even calculate the hourly rate from that, it comes out to 120 zloty per hour. So if you see for example me, so to speak.

Monika Rachtan
But then you earn almost a thousand zlotys in one day. For a Pole, that's a lot, a thousand zlotys for a day's work.

Wladyslaw Krajewski
And I would also just like to compare it to other professions. If everyone doesn't even want to, so to speak, pay attention to who earns how much aboslutely. That's why I'll throw in such a generalisation, so as not to draw attention to the fact that everyone should see for themselves how much they pay, how much they actually pay for other people's services. Of course, these are hidden costs. This is the amount that one usually pays or even I have accoutrements, my cousin works in a hairdressing salon and I will say frankly that these, so to speak, these treatments that they perform exceed this amount absolutely. Of course, as I say, these are, so to speak, hidden costs in that, of course, for this service so much, this beauty salon will not really receive. But the difference is that still, if we simply compare this rate to the rate of actually this treatment, which usually, let me use just such a more or less specified time, usually, which appears on some box-type applications, that it is written about 30, 40 minutes, it actually comes out that if even there some haircut costs 100 zlotys, it is actually written 30 minutes, it comes out that for an hour it comes out 200 zlotys.

Wladyslaw Krajewski
So this is of course, oversimplifying like that, but really, as we surveyed this public opinion, it really diverged a lot with the reality actually, which is also important for us, because it means no, it's not that people can't count one with the other, it just shows that we also need to educate the public, especially as activists, socially, to show that these are the realities. We don't want to impose some opinion that they earn a lot or earn little. We simply want to show how it is, how it really is, so to speak, what these amounts really are, what the rate really is. And then let that person decide for themselves whether it is too much or too little.

Monika Rachtan
I always say, I always say, that everyone had a choice after all, they could also go into medicine, and it is kind of an open question here. Let us return to the health of medics. Depression, professional burnout. Exactly, the depression that comes when this professional burnout occurs. What's your bet on how many percent of doctors might suffer from depression?

Wladyslaw Krajewski
I will, so to speak, respond straight away with another estimate from the foundation. And you can't see from me, which is quite aptly named in my opinion, because these topics of depression, anxiety among especially, I don't want to say our professional group, although of course it is exposed, but in general professional groups, doctors or the uniformed services is quite silent, so to speak. And it is, it even seems to be a taboo subject at times, that one is not allowed to admit in this.

Monika Rachtan
There was a situation on the internet when one psychiatrist just revealed that she suffers from depression and was lynched by people. On what I think was Twitter she only admitted by the psychiatric community that she could have said something like that at all. For me, the phenomenon was very interesting because I fought for many years for the media to talk about the fact that doctors can suffer from depression just as much as they can break an arm, have a car accident or whatever else can happen to them. In the same way you may not believe it, but they can also have a runny nose sometimes and they can suffer from depression. And this problem of talking, talking about it, because it is a problem of not talking about it is very important. And I'm very much asking you here to kind of voice a little bit of reason to people that depression is some other disease than osteoarthritis. If that's how you look at it as a medical professional yes?

Wladyslaw Krajewski
Absolutely not. I will say frankly, of course in terms of medical, medical terms it is. It is different diseases, if you compare yourself. Only difference is that we still use the term disease, it is, so to speak, there are a separate number prescribed in the International Classification of Diseases, there is a separate code number assigned for one entity and for the other entity. It is, we have the same treatment pathways, so to speak, diagnostic and treatment plans. So treating this as something inferior or a disease, an inferior disease is a curiosity really I. And again, it seems to me that simply society also needs to educate itself, so to speak, to educate itself, and that's also why we're coming out with these talks, to show that actually these illnesses, especially mental illnesses. I would even personally say that sometimes they are, they are sorry. They're more, they're more insidious and for me they are, because such a broken bone as you mentioned you can see it either on the x-ray or it sticks out or whatever. There's just swelling, it hurts.

Wladyslaw Krajewski
We have this cause. If we do a multitude, a multitude of examinations, imaging examinations, for example an MRI, let it be a CT scan, whatever, whatever other examination, we don't experience it, we don't really experience it, we don't really see the mental illness in these pictures. But the hardest thing is that this disease kills and there is not this broken bone. You can't see that. Of course there may be, so to speak. I don't want to speak for the department of psychiatry as well, that there are certain, certain, certain, so to speak, diagnostic factors in the tests that may draw attention that this very person may have a mental illness, but most of them, as far as I know, don't have that.

Monika Rachtan
Somatic symptoms are not apparent.

Wladyslaw Krajewski
That's why there used to be experiments like this, now of course it has moved on a lot. The experiment was that people, as actors, faked certain symptoms and it seemed at the time that all psychiatry was pointless, because you could fool the doctor. And that's the point: we have to be honest too.

Wladyslaw Krajewski
If, in this experiment, these people pretended, they knew what to say, the opposite is true. It means that these psychiatrists are well educated, they know, so to speak, what the symptoms are, they know what these people said and they recognised the disease entity well. The fact that it was, so to speak, substituted is already something, something else in that respect. So that's why I want to, I want to point out that it's absolutely not, it's not such a different disease, that it's still a disease and a disease that kills.

Monika Rachtan
What other problems can this professional burnout lead to among medics, because you observe this environment, you are there every day, so you see what is going on in it.

Wladyslaw Krajewski
I will say frankly that in this respect, whether we are talking about the individual, whether we are talking about the relationship with patients, whether we are talking about the team, because professional burnout, as I said before, it is multilevel, it is multilevel, it is multilevel and it affects each of these individuals in the same way. The individual themselves are usually just discouraged by the job, they even get tired, they possibly fall into addictions.

Monika Rachtan
What are the addictions?

Wladyslaw Krajewski
Thank you so much for this question actually, because when I started exploring this topic six months ago, I was just appalled at how it wasn't being talked about.

Monika Rachtan
But about what? Can we say loud and clear in our programme what is not being talked about, because there is a great need for us to highlight loudly in the programme just what the problem is.

Wladyslaw Krajewski
The problem is usually falling into alcoholism among doctors. Of course, in other groups, in professional groups, it also happens, but the 'You can't see past me' foundation just mentioned it. According to its estimates, in fact, around a third of doctors may have a problem with alcohol consumption.

Monika Rachtan
And it is also young doctors who are affected by this problem?

Wladyslaw Krajewski
All doctors in fact.

Monika Rachtan
Where do doctors drink? At home or on the wards.

Wladyslaw Krajewski
And that's the hardest part - it starts at home. In fact. Usually, because the home is such our fortress, we feel safe there, so that's why they unwind these problems at home, coming later, when it's actually become an addiction, when they're no longer able to function without it, it starts to come to work. I took the liberty of saying just that. About the fact that it's jokingly said that before, he couldn't imagine being on duty without a flask and in fact it showed in those jokes a little bit is such a truth that before, before that I've been saying since 30 years ago. In fact, there have already been rapid changes in this respect, but it shows that already then the problem of burnout was actually this stress was noticeable and that already at work these medics were actually trying to unwind in this way.

Monika Rachtan
That they drank together on duty?

Wladyslaw Krajewski
It is, so to speak, out of such jokes as I say, yet I am not. Sometimes I wonder if there is a bit of truth in these jokes. Especially as this problem has not disappeared. In fact it has disappeared in workplaces, that it has become more, increased awareness. Certainly the public, not just, so to speak, the medical community and the medical community, just the public on the harmfulness of alcohol, so to speak.

Monika Rachtan
Have you happened to meet a drunk doctor on duty? Or have you seen one under the influence of alcohol? Have you had these situations?

Wladyslaw Krajewski
As, in my career no, it happened once, when I was a teenager still. And this doctor was just examining me and we had to repeat the examination in the respect that my mother just left with me. Simply because of the fact that it had already started to get uncomfortable. Maybe I will call it that. So that's why a little bit of this problem, which is somehow my kind of, such a personal experience. So that's why I'm more, more observant in that respect, so fortunately, fortunately during my whole studies, during my work in the hospital, in different hospitals, in my internship, I haven't encountered a single situation like that. I've heard that, for example, it's been rather individuals, such isolated cases, but as I say we also have to distinguish that there is such a thing as high-functioning alcoholism, i.e. that this person, and on the surface she's very nice every day, Very usually she's also talkative, very extrovert like that. She really encourages herself, but then when she comes home, there are, colloquially, 2, 3 beers a day, some wine, a bottle of wine, then that amount of alcohol.

Wladyslaw Krajewski
In fact, the amount of alcohol simply increases in such a way that this person is unable to function without it, and it seems that such a problem does not exist. And the worst thing is that we can also miss such cases, which later result, unfortunately, not only in diseases, chronic diseases in such a person, but also in problems, problems, mental illnesses. And let us also remember that alcoholism, like any addiction, what kind of burnout, these are actually symptoms, and the cause is somewhere else. That's the key thing, that we can't treat the symptoms themselves, waiting for the cause to go away. I don't know, we just cover up the issue. That is why, in the case of alcoholism among our professional group, among doctors, surely the beginning of the problem has to be looked for in bullying, burnout, which are, so to speak, components of the fact that this person, does not feel able to cope in a more, so to speak, in a more adequate way, only harms himself.

Wladyslaw Krajewski
And that foundation I mentioned, you can't see from me, also worked that actually two thirds of doctors in Poland feel, feel burnt out, and in the case of oncologists that percentage is 70, it's 75%, so it's just skyrocketing, skyrocketing numbers. And 75% of the overall doctors are also the ones who report that they either have been diagnosed or are being screened for mental illness or anxiety disorders. So it's a problem that's pervasive.

Monika Rachtan
When you talk about addictions, I can't help but ask, do doctors smoke cigarettes too?

Wladyslaw Krajewski
This is, unfortunately, a mean question. A mean question, but I'll answer honestly. Some, some people probably do. But again as I am against actually smoking. Not just because I'm a doctor a priori for that reason I would have to be so really, but in general for me. For me, smoking in itself doesn't have, so to speak, these effects that are, are from this addiction, are not commensurate with the harm that it brings. So for me it's a game not worth the candle. Yet some doctors actually smoke. The only thing that pleases me is that even in student groups it's not really doctors yet, it's students even, so it would seem that a student can indulge more, but even then there's an awareness that it's just harmful, that it's absolutely unnecessary. So even in student groups it's usually a couple of people actually. What's more, usually when you ask at university if someone smokes, nobody usually says anything either. In that respect it's a bit of an embarrassing problem.

Wladyslaw Krajewski
That is what it is. This is the fact that the alcoholism I mentioned, these addictions, it is not an embarrassing problem, it needs to be discussed, because in order to find the cause and cure it, and this harmful addiction in the form of these, these cigarettes and so on, it is necessary to talk about it. I for one am glad that society's awareness of the harmfulness is growing so much that this problem of someone smoking is becoming shameful. So that, too, I hope, can serve as motivation for someone to quit smoking.

Monika Rachtan
We had a lady professor who treats lung cancer on the programme and she herself talked about the fact that she quit smoking 20 years ago. And she says you know, Madam Editor, 30 years ago it was everyone who smoked. It wasn't talked about the harm of smoking at all. That's where my question comes from. But you represent a generation of young doctors. Tell me, how do you young doctors, how do you imagine your life being reconciled with work? You talked about work life balance. Is it at all possible, being a doctor, practising medicine, to maintain this balance?

Wladyslaw Krajewski
At the beginning indeed, it is a sincere answer on my part to say that it is certainly difficult at the very beginning. Later on, as I say we have opportunities, we have flexibility quite this profession, we can take a path that even not obligatory it has to be a medical path, we can just continue in other professions. Absolutely. So that's why, as in any profession as much as possible we can. What is more, I would like to point out that we are, in fact, the generation that has done its homework, done the homework of our relatives, parents, acquaintances, older colleagues who, just as the professor mentioned, point out that 30 years ago it was a different situation with these, with these cigarettes. If it was a different situation in terms of this culture of overwork, of keeping quiet about problems, then now it's bouncing back the other way. And I'm very, very glad that it's really developing in this way, that young people actually want to have a bit of time for themselves and for their families too. Seeing those problems we mentioned earlier, they also understand that they don't want that.

Wladyslaw Krajewski
And that is the clue really, which I hope will one day allow us to have this problem of burnout at all. The problem of bullying might in fact otherwise become a marginal problem because of the fact that people's awareness of the issue and, most importantly, their willingness to do so will grow.

Monika Rachtan
That is, this need for change. When it comes to looking at the medical profession. What that medic should be not a medic who is on call 24 hours a day, who doesn't go on holiday, who doesn't have children, who forgets his daughter's birthday and the secretary has to buy flowers for his wife because he forgot their wedding anniversary, that you don't want that anymore, that 8 hours at work and then live a little bit, and then that professional burnout probably if it comes, it will come after 20 years of practice, after 30 years of practice, not at university.

Wladyslaw Krajewski
Maybe not at all really, because let's just point out that if you work in such a team like this supporting each other really, having a good working atmosphere, this burnout might not really come due to the fact that there are no such reasons for it. Especially if you want to actually do it, it doesn't come up like that I would say. It's not going to appear such, such a big mental ground for that person to actually burn out. That's why, of course, at a certain age we already want to stop a little bit, leave it. To take care of, as we point out, also things that are already, less obliging to us, but still many. That's why a lot of doctors, of course, apart from doctors who do it simply out of that aforementioned culture, overworking themselves, then a lot of doctors, also out of passion, just get on with it and years later. So that's it, that's it.

Monika Rachtan
And how does a burned-out medic respond to a patient?

Wladyslaw Krajewski
And it's also, as I said, that there are actually three levels, apart from the fact that this person doesn't find herself with herself, it's the same in the form of this patient. In fact, she is usually less willing to help. It's really as human as we approach it. If we don't like something, something tires us out, bores us, that we don't want it, we try to pull it away or do it faster, by any means, just to just free ourselves like that, free ourselves from it. So here we come to a similar situation. So for such a burned out medic actually the patient is sorry to say it, but he is a burden, just another mental burden just. So that's why, that's why it's important. What I mentioned that it doesn't even lead to leads to ineffective treatment of that patient. In addition to the fact that the treatment itself is ineffective, the patient himself is not satisfied. The doctor himself is dissatisfied, because I recall that there are many, many cases. It's just that they are ambitious in fact and there is also a kind of personalisation of this person.

Wladyslaw Krajewski
That is, it becomes, it becomes reluctant towards itself, towards its achievements, towards its co-workers, which then doesn't just stay at work, which just becomes reluctant also when it comes home, to spend time with its family. And that's the worst thing is that once it starts and it actually progresses in that way already, a little bit of it goes, as I said, such a driving wave, a driving wave itself. So that's why while this wave is still literally at such a bad start, we want to. We want to make the point that in order to help that person, in order to stop it, because later on it's not going to be there anymore, and let's also remember that by the way. In fact, the quality and safety of the patient in health care is also what we have been pointing out, that in fact a burned out medic, an overtired medic is much more, much more likely to have an adverse medical event that the patient would absolutely not want, the doctor would not want or anyone from the hospital would not want. But it can happen without us wanting it to happen.

Wladyslaw Krajewski
And this exhaustion is actually one of the main factors, and this professional burnout already as a proceeding of this stress and exhaustion is one of the factors that leads to this.

Monika Rachtan
Do you see a chance for the environment to change on its own, for doctors to bring about this change themselves. But do you need some systemic solutions to make it happen?

Wladyslaw Krajewski
Exactly, all the time, I will keep coming back to this, that due to the fact that this problem unfortunately cannot be solved alone we would very much like to. In fact, we as social activists or we as a system or we as simply as people would like to solve it, But due to the fact that this problem is multi-level, it both needs to be solved at the level of this individual both systemically. Such an idea, which is also proposed by us as the Residents' Agreement, by which in fact by the trade union has been, has also been created. It is the introduction of a minimum physician staffing per patient, that is, there will be so many patients per specific physician. I know that this is, this is obviously a challenge for actually the whole Ministry of Health and the hospital. Absolutely. But then patients will feel more looked after. It will be safer for both the doctor and the patient. So that's it, so to speak. It's that systemic change that would obviously help.

Monika Rachtan
We already have the first concrete one for Minister Izabela Leszczyna. But since we have three levels of this whole burnout problem, what are two more demands from you, from young doctors? What changes do you need?

Wladyslaw Krajewski
I would ask not only the Ministry in this respect, but also the environment, as far as the Ministry is concerned, for such a system change, which will really bring a lot, a lot, both in terms of patient safety and in terms of the quality and safety of doctors' work. It is to relieve the burden of unnecessary documentation, of which we have a huge amount. What's more, you can combine this just a little bit, a little bit by also introducing students, students into the system, by introducing medical assistant positions. Because many of the patients, it used to be my dream, that there were not, so to speak, these places to work more as a doctor, not as a student, but to see already in such a job, to be a part of this team. So to introduce such a position, to relieve the bureaucracy, it seems petty in this respect, but whichever doctor you ask about it, and especially the surgeons, they will be in favour of it with both hands and will say that it will make their work easier, it will make it easier, it will improve the quality of this work, and they will be doing what is proper treatment, what we are taught to do.

Wladyslaw Krajewski
And the third level actually addresses our environment. There is no denying that we need to talk about it. We need to talk about the problems that arise. We need to talk about bullying, because bullying usually rules that the most important thing, especially the person this bully. As a colleague of mine has just pointed out, that he is such, he feels he is king alone. If we talk about it and that's the key, that we can get rid of, get rid of this problem, we can start to fix it. So it's also such an importance to our environment to talk about it, to talk about it, to talk about burnout, to talk about mental illness, to talk about bullying. Because of the fact that we already have to treat these problems. Maybe differently, we need to treat the very cause of these problems, not the symptoms. When it is perhaps already too late.

Monika Rachtan
Then I with an appeal to the public, but also to the medical community, that a burnt-out, overtired doctor is a dangerous doctor