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Over the past few years and months, I have noticed increased numbers of my colleagues from all over the UK complaining about various problems with their jobs and life in general, and it seems that since the COVID-19 pandemic the numbers of dissatisfied ophthalmologists have risen exponentially.

I doubt that this is in any way a reflection of any perceived danger to themselves or their family from the virus and suspect it is more to do with the sharp reminder to almost everyone that most of what we do is purposeless.

We like to think that what we do is vital for the health of our communities and if we stopped working there would be blindness everywhere. That we support our families, and our children grow by trying to emulate us and if we were in any way less perfect than we are there would be consequences not just for us but for society at large. That in work what we do makes a difference, and we are important, and our word counts for something. All these are lovely lies we tell ourselves consciously or subconsciously and most of the time we are old or dead by the time we realise the truth. But the truth is all around us.

“What is the point of an extra clinic?” my colleague asks. Well, to bring the waiting list down. “But one clinic won’t even touch the sides. It makes no difference!” It makes a difference to the people we do actually see. “The ones we don’t far outnumber them though! There are thousands waiting.” I then tell the tale of the wise man questioned by the little boy for throwing starfish back into the sea after tens of thousands have been thrown onto a beach during a storm; when challenged that it wouldn’t make any difference, he argued that whilst it didn’t to them all, it did to the individual ones he did manage to throw back. I think I misremember the story though and start questioning what the actual moral of that tale is, but I concede that my colleague has a point. What is the purpose of what we do?

Cataracts are dense and unsatisfying, complications commoner than ever; the easy ones are whisked away by the satanic Independent Sector. Clinics are less efficient than ever and pushy patients who know the internal mechanism of the hospital predominate while others go quietly blind at home. Trainees are rightly angry and annoyed at less surgical training opportunities and more stressful clinics. Colleagues jump ship as the current NHS ‘isn’t what they’d signed up for.’ Also, if I am totally honest, there hasn’t been a huge tidal wave of blindness caused by our massively reduced activity, but rather low-level flooding affecting some places more than others. So, if we are currently powerless to make a difference in work, what is our purpose? From where does the satisfaction come?

Some people crave money. There is much about at present if you look in the right places. Some feel that minting it now, with the purchase of bigger houses and fancier more electrical cars is some sort of end in and of itself. I think I am quite typical though, in thinking that none of us truly went into medicine for money. There are far easier ways to make it if that is what you want. Some might feel that they went into medicine to ‘make a difference’ but that is harder now than ever. I always dreamt of doing some work abroad with Doctors Without Borders (MSF), and in my mind thought that doing that sort of work would make more difference per unit of time than I could ever do here. But having recently read about James Maskalyk’s experience with MSF in his book Six Months in Sudan, where he describes whole different levels of work-related psychological torture, feelings of inadequacy and hopelessness, compounded by his throwing in at the end of the book how his hospital and the town it was located in was burnt to the ground shortly after he left, I just don’t think that work is as satisfying in reality as it is in my brain.

Some people leave medicine to pursue hobbies. That is good for them I suppose, though it clashes a bit with socialism’s doctrine of the Nobility of Work, that work is good for the sake of the soul, if it exists, and also ignores the fact that the state invested a lot of time, energy, money and vitreous in training us. So, we are less free morally speaking than we like to think in making our own choices in what we want to do. Thetis, the mother of Achilles, encourages her son to fight the Trojan War so the world remembers his name, as that is the most important thing. Perhaps in ophthalmology the equivalent of such fame is becoming the college president, vice president, or being one of the research professor bigwigs travelling all around the world to tell people how great a certain intravitreal injection is to consistent booming applause from a large audience of your peers.

To write huge numbers of papers, some of which you actually read before your name was applied, that are printed and sent to every library in the world in the best eye journals there are. But the research world is all out of bounds for the likes of you and me. My paper on the marginal benefit of meibopatch in treating blepharitis is still under consideration at the Saudi Journal of Ophthalmology two and a half years after it was submitted. It might be that the editors are too astounded by the findings to return a verdict, but I doubt it.

What I have come to realise is that it is not just me that has this strange black hole inside them that seeks to find a higher purpose to the cripplingly frustrating job that we do. It seems almost everyone I speak to has the same thing and that explains sometimes the odd things that people do; leave their job to become a driving instructor, go to work in Africa or the Middle East for a few months, take up private work with a hitherto unseen ruthless determination, or simply beat their heads into a bloody pulp trying to reform a perhaps unreformable NHS eye service. The effect of COVID-19 was to stop people meeting and talking and so we started to think it was only us that had these thoughts. Perhaps that explains the epidemic of dissatisfaction. So, I say let us talk once more; let us discuss life, work, eyes, children, wives, parents, the current exchange rate of the ruble and everything else, anything, with our friends, family, and colleagues. Let’s finally see Levellers live and have that beer we always discussed having. It doesn’t answer the Purpose of Life question, but it distracts us enough to forget about it for a while.


The views expressed are those of the author and do not represent those of the editorial team or the publisher.




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Gwyn Samuel Williams

Singleton Hospital, Swansea, UK.

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