The Plimsoll Line
Christopher I. Doty, MD
Loice Swisher, MD
Samuel Plimsoll was a social reformer known in England for his work in shipping reform. Plimsoll became interested in the “coffin ships” used in the Northern Atlantic shipping trade between Europe and America. Plimsoll was concerned with ships being overloaded by the greedy shipping merchants and therefore more likely to capsize and sink in the treacherous North Atlantic thus killing the generally poor crew members on the boat. After years of effort, in 1876, he was able to get the English Parliament to give significant powers of inspection to the English Board of Trade which lead to the requirement that ships were marked with a safe loading line commonly referred to as the Plimsoll mark or Plimsoll line. This mark is a visible signal on the hull of a ship that shows a safe burden of loading at a distance. This allowed regulators and sailors to know if a given ship were overloaded prior to leaving port. This mark is credited with saving many sailors lives.
The Plimsoll line effectively marks the minimum freeboard required for a vessel in a certain sailing environment. The free board is the vertical distance between the waterline and the breech point of the boat where it will begin to take on water. This is effectively the deck line of the boat.
The Plimsoll line became more complex and also was adjusted for different shipping environments over time. For example, the Plimsoll line was higher in tropical freshwater because less treacherous waters allow for less minimum freeboard and more cargo burden.
This imagery struck me as I began to think about healthcare workers in chaotic and stressful environments. We are often like ships in a stormy sea and require a certain minimum level of freeboard before the stress overwhelms us and we ourselves, begin to take on water. Depending on the environment of our personal and professional lives at the time, we might require more or less freeboard in order to safely function in that environment. If someone were undergoing personal stress around marital issues, a sick parent or child, an impending or ongoing lawsuit, or other stressful life situations, in our metaphor, the “safe” Plimsoll line would be different.
Unfortunately, healthcare workers do not have Plimsoll lines. Where is our Plimsoll line on any given day? How do we recognize a coworker may be “riding too low in the water” and be above their Plimsoll line?
Perhaps a safe way is to take time to think about the environment that we are operating in on a given day. Perhaps we should be more likely to ask a colleague or coworker how things are going in their lives. Perhaps we need to create an environment where those sorts of conversations take on an element of normalcy rather than risk. Perhaps we should just assume that everyone is it risk for burnout and depression. Have you thought about your Plimsoll line recently? Have you thought about someone else’s?