Alain de Botton, philosopher and author, suggests:
“A firm belief in the necessary misery of life was for centuries one of mankind’s most important assets, a bulwark against bitterness, a defence against dashed hopes – and yet one cruelly undermined by the expectations incubated by the modern world view.” *
More and more, there is an expectation that work ought to make us happy. This modern view is certainly appealing, though the former may seem more appropriate for some NHS surgical trainees facing unstaffed rotas and covid-related disruption to training!
Most previous civilisations considered work a necessary practical burden. The first hint of a more positive outlook came from the Renaissance. It was suggested that work could, in fact, be a route towards authenticity and fulfilment – especially amongst the great artists and thinkers.
This idea that work could not only deliver necessary remuneration, but also provide stimulation and self-expression, evolved over the coming centuries. The subsequent vision of a meritocracy – where talent and effort replace unfair privilege – took us further. But have we gone too far? Fulfilment comes with many jobs – healthcare arguably more than most – but do we expect too much from work, based on unfair preconceptions and pretensions?
The economic imperatives that govern healthcare vary wildly according to the delivery system and wealth of a nation or individual. The NHS is cash-strapped and always will be (with occasional subtle fiscal oscillations). Whilst profit is not a motive, squeezing every last drop from the system (especially its workforce) is a constant. This sometimes makes the work hard and tiring - and possibly out of sync with some modern expectations of how work should be.
So perhaps we should realign our expectations a little. Working for safer systems, safer staffing levels, and safer training remains crucial. However, a mindset where we do not expect work to reliably generate happiness may well be a wise adaptation. Work’s rewarding aspects, including those unique to surgery, would only be heightened.
Consultant Neurosurgeon and Honorary Senior Lecturer, Edinburgh