Clinicians are like hearts: they pump, every minute of every day, expanding and contracting to ensure that oxygenated blood – the stuff that keeps us alive – pumps around the body – or hospital system, continually, inexorably, the source of life, the oxygen in the system.

Clinicians are trained to do this and they keep on doing it because their experiences have shown them how vital a role they play. Expansion, contraction, in and out, over and over they beat. Without fail. Totally committed. They could not stop if they wanted to. It’s in their blood.

At a recent ATLS course in Iceland I witnessed the blood draining from a senior nurse’s face, when, as a course observer, she heard of the latest coach crash in her isolated region. Since the financial crash in 2008 Iceland has benefited from the tourist industry but not without cost; this nurse had been pivotal to the coach crash last summer in which lives were lost, as a first-on-scene trauma care provider. To watch her face as she learned of the latest incident, to see every fibre of her being want to be there, over three hours away, with her colleagues and those patients, made me realise yet again how in-built is the need to help, to save, to be in the eye of the storm, making the difference that needs to be made.

But clinicians suffer from tamponade, just as the heart does.

For those of you not familiar with the term, a cardiac tamponade occurs when there is a penetrating wound to the heart. The blood from the heart will leak into the pericardial sac and as the sac fills up with blood, the heart is prevented from pumping, and thus circulating oxygenated blood around the body.

Clinicians are sometime prevented from continuing to ‘pump’ their expertise into the system by a tamponade. Sometimes the tamponade is cause by the management priorities which prevent their clinical work, or by other systemic issues such as debates over patient ownership, insufficient staffing resources or accounting systems which deny patients the care they need at the point they need it. Sometimes nothing short of sheer arrogance and individualism can tamponade good work.

What is concerning is that often the heart, or the clinician, is blamed for the failure of the system, when it is in fact the tamponade which prevents the blood from circulating. Tamponade is not a heart problem, as such, and these clinicians should not have to carry the responsibility for the failure to act, when other factors have prevented them from doing so. In organisational terms, tamponade is a systemic problem.

A familiar concept in trauma programmes such as ATLS is the Monro Kellie doctrine. It states that inside the rigid box of the skull are three entities – the brain, blood and cerebrospinal fluid (CSF). Any insult to the brain that causes the brain to swell will result in expansion outside of the rigid box and down through the brain stem, causing, if unchecked, coma and then brain death.

The Monro Kellie doctrine, like cardiac tamponade can also be used as a metaphor for the impact on clinicians of the pressured environment in which they work. There is a fine balance at play in the way that clinicians are best able do their jobs. They need time to work with a patient, time to learn all the necessary information about the patient and their history, time to undertake tests, time to reflect and think, to relate to other specialists and to work through various diagnoses. Time is the CSF of the brain, it is the commodity which affords the brain, or the care that clinicians employ, to work. Just as the CSF cushions the brain so time to think cushions the work of clinicians, lubricating it with necessary conditions for clinical efficacy.

There is another fluid in the brain which is essential to its functioning that serves as a metaphor for clinicians’ work: blood. Clinicians work best, fastest, most clearly when they are safe. To be safe means to be valued. To be able to do their best, to be trusted to do so. To be supported in doing so. To have a team around them which enables them to work at their best level. To be free to do their work without threat from external, sometimes organisational priorities which often conflict with clinical priorities.

So what happens to the clinician when the CSF (time) and the blood (resources and support) are taken away ? When they are forced to work faster than is appropriate, with limited resources and no support, when they are criticised and measured and pushed ?

Just like the brain, they herniate. There is pressure on the brain stem, and they slow down, become comatose, and eventually if these conditions continue, they die.

Why, when we know so much about the body and its physiology, do we ignore the same principles when they come into play with clinicians who are our essential organs – the hearts and the brains of our healthcare systems ? If we cannot expect a heart to continue beating when its pericardial sac is filled with blood, why do we expect clinicians to keep on working in constricting and inhibiting environments ? If we know that a brain will herniate if it swells, and loses the delicate balance of conditions inside of the skull, why do we ignore the loss of the delicate balance of the environment for the clinicians in our systems ?

Healthcare systems are like human bodies. We ignore these physiological principles at our great peril. There is more than one heart and one brain at risk if we carry on ignoring what clinicians need to function well. Let’s apply those lessons from the body and start caring for our healthcare professionals as we care for our patients’ bodies.