“Help for my junior doctors isn’t there”: Dr Hilali Noordeen on burnout in the NHS

After 36 years of working in the NHS, the surgeon warns that his colleagues on Covid-19 wards need more support.

Three years ago, spinal surgeon Hilali Noordeen’s eldest son told his father he was considering becoming a doctor. Rather than sitting his 15-year-old down for a parental chat about prospects, Noordeen decided to write him a series of letters.

Illuminating the lengthy path to and through the profession with self-deprecating anecdotes, lyrical musings on the philosophy of care and gritty detail about daily hospital life, these notes make up his new book: Letters to a Young Doctor: Exploring and Surviving a Career in Medicine.

Writing for medical students and junior doctors across the UK, Noordeen, 60 – whose career spans 36 years full-time in the NHS – neither patronises by casting himself as a wise elder nor sugarcoats the struggle with wellbeing and work-life balance afflicting doctors in today’s NHS.

Although he began jotting down his wisdom years before Covid-19, Noordeen includes a chapter for health workers battling the pandemic. His advice is well-timed. Nearly half of NHS staff working on intensive care units in England reported symptoms of post-traumatic stress disorder, severe depression or anxiety.

During the first wave, the Royal National Orthopaedic Hospital NHS Trust in Stanmore – where Noordeen works – was a non-Covid hospital, offering a service for all trauma operations across London.

Since the second wave hit, it has changed to a Covid hospital, with very few beds for other patients. Every morning at his 8am multidisciplinary team meetings, Noordeen and his colleagues must decide which patients are the priority.

“All of us orthopaedic surgeons are fighting for very few beds,” he says, speaking during the second wave from his west London family home, before heading to his clinic. A facemask hangs around his chin and his phone repeatedly buzzes, over the sound of his youngest son’s online lesson in the room nextdoor.

Six of the hospital’s nine operating theatres have been converted into ITU bays. Doctors are only allowed to operate on patients who have cancer or are “about to lose their life or limbs”, he says. “I haven’t as yet managed to do a single case on the NHS since this lockdown.”

Patients are waiting in “pain and agony”, with some receiving treatment at his private practice.

While Noordeen praises the NHS for “a wonderful job” fighting coronavirus, he is concerned about his junior doctors as well as patients. “My juniors have been taken away and repurposed to being doctors on our Covid wards, which they were never trained to do,” he says. The effect of this work can be profoundly traumatic.

“There are so many people who are having great difficulty at this time. I’m not sure the professional support that is required is available,” says Noordeen. “They need to be supported to share their concerns, tell us how they’re feeling – and we need to be able to escalate that up and get the support they need.”

Surgeons and other medics like himself who are not treating Covid-19 patients should be seconded to hospitals as emotional and professional counsel for doctors on the pandemic frontline as soon as possible, he argues.

“We have a large number of doctors not allowed to work in the NHS because all the theatres have been taken over for Covid patients,” he says. “We should use the resources we’ve got in a positive way.”

This can only be organised “systematically, not as an initiative by one surgeon”, Noordeen says. “It’s very difficult to take an individual initiative in the NHS; it’s like it’s frowned upon.”

Indeed, his book documents the drawbacks of a top-down, “command-and-control” structure in a health service he believes should empower doctors more. The model should instead be more like that of John Lewis, giving staff a stake in the organisation and devolving power from managers, he writes.

Drop-out rates were rising among doctors in the NHS before the pandemic. Only 37 per cent of doctors go straight into training to become specialists or GPs after completing their foundation years, and 5 per cent are lost from the health service for good, according to 2020 figures.

“One of the reasons people drop out is that most go into medicine because they want to care for people, and they soon realise much of medicine is not about caring, it’s about command and control,” says Noordeen.

He fears this trend will rise following the pandemic. “Staff may not be able to do their jobs in future, for burnout, psychological reasons, PTSD,” he says. “We need to put a mechanism in place for dealing with a catastrophic event, and the psychological trauma about to come, right now.”

In his book, the NHS’s bureaucratic obstacles contrast with his mother’s view of care in his home country of Sri Lanka (he left for boarding school in Britain at 13).

Once he’d qualified in 1985, she would insist he treated a long queue of local people whenever he visited, free of charge. She insisted “every single one of them should not only be seen, diagnosed and treated, but also fed, watered and conversed with”, Noordeen writes. He learned the humanity of “the giving of care, with compassion and empathy”.

Noordeen realised his chosen profession was uniquely rewarding, paid in the joys of caring as well as a wage. He is not from a background of medical professionals, and contrasts his work with that of the family business, which trades in gemstones – a history for which he also has great pride. “In the Old Testament, Solomon got his gemstones and peacocks from literally my town in Sri Lanka!”

As the NHS prepares for imminent reforms, its health workers face a long and uncertain road to recovery. Noordeen’s eldest, now 18, will soon witness first-hand what that looks like. Having read his father’s letters, he is now studying for a medical degree.

Letters to a Young Doctor by Dr Hilali Noordeen is out from Whitefox Publishing on 25 February