The idea of ‘us and them’ in healthcare is quite literally an illusion to Grace Anees – Psychiatry trainee, hypnobirthing teacher and breastfeeding peer supporter – as she is both doctor/healthcare provider and patient/service user. And she has experienced trauma from both sides of the healthcare system, as both doctor and ‘patient’. To her, it seems as though both traumas are driven by the same force.

TRIGGER WARNING: Please read this story with care. If you’re finding the content challenging, please give yourself permission to step away. If you need support click here, if you need urgent help click here.

To prefix this I want to say that if you have experienced trauma on either side of the healthcare system then I respect your own experience and your own narrative. Your own narrative is entirely valid and your anger, whoever that may be directed at, is entirely valid. Trauma stories belong to whoever experienced it and so this is my own perspective and how I relate to it.

I have experienced trauma as both doctor and ‘patient’. To me, it seems as though both traumas are driven by the same force. Both are symptoms of the same condition. This condition is a crumbling and, at times, archaic system. It’s not one thing that can easily be fixed, it’s more like a complex mix of ingredients that come together to create a perfect storm. Ingredients such as underfunding, understaffing, daily micro-aggressions, toxic cultures, an outdated hierarchy, power imbalances, the hero/superhuman illusion of staff (exemplified during the Covid pandemic) and yes, institutionalised misogyny and racism.

“I feel that the goal is to keep people alive and everything else is a luxury that our scarce staffing and resources just can’t afford”

I feel it’s quite clear that traumatised staff struggle to hold space for the trauma of patients. Trauma breeds trauma in this sense. We need to break the cycle. If I’m told as a trainee to just get on with it, come into work despite my own health, if I’m made to feel like my emotions don’t matter then I’m quite literally being taught not to lead with compassion. If the system isn’t nurturing self-compassion, then it’s also causing a poverty of compassionate care (that no amount of ‘compassion training’ is going to fix!)

It makes more sense to me when I think of this in terms of generational trauma. If a father verbally abuses his son, that verbal abuse can become an inner voice which can damage self-compassion and empathy towards others. The hierarchy in hospitals can often reflect the hierarchy within families with seniors having a huge capacity for both good and harm when they interact with trainees.

“By creating ‘us’ and them’, we are missing out on becoming one team with a shared goal”

More and more I feel that the goal is to keep people alive and everything else is a luxury that our scarce staffing and resources just can’t afford. Or, if we can afford it, it’s at the expense of our own mental health because it’s above and beyond what you can fit into your working hours so you end up staying later and giving more (and probably being told off for not keeping to targets.) This is heartbreaking to perpetuate. But I’ve often felt conflicted between giving people the time they actually need and also taking time for myself. It seems impossible to do both properly.

So, to me, we have to address the trauma of both ‘us’ and ‘them’ because I fear you can’t prevent one whilst the other carries on. I fear that by creating an ‘us’ and ‘them’ we are missing out on becoming one team with a shared goal. And, more cynically, ‘us and them’ is a great distraction from our actual barriers and our obvious shared goals (more staff and more time!)

However, I’m also very aware that when these traumas sit beside one another there is a danger that we use one to dismiss the other. For example, if we use the trauma of doctors as an excuse for them perpetuating trauma, or likewise if doctors don’t feel allowed to express their trauma for fear that it doesn’t compare to the person they are treating. But, both things can be true. They don’t cancel each other out.

For me, there is no ‘us and them’. There is just a ‘we’. Who are both being harmed by the current system. And are both desperate for some change. Perhaps we could be stronger together.

There is no ‘us and them’: we are all being harmed by the current system