Enormous interest was generated by a recent Croakey article urging medicine to confront “the dark side” of its institutional culture in the wake of the recent deaths of four junior doctors.
The article was by Dr Kimberley Ivory, Senior Lecturer, Population Medicine and Sub-Dean of Student Support in the Sydney Medical School at the University of Sydney – and tomorrow morning, she will live-tweet a special report on ABC Radio National’s Background Briefing program, “Doctors in Distress” (the program will be available here).
Meanwhile – just to complete the online loop – Ann Arnold, the journalist who compiled the Background Briefing program, will be guest tweeting for @WePublicHealth next week, with a focus on stress in the workplace, and will be keen to hear everyone’s stories (including but not only doctors).
Many thanks to Ann for reporting below on some of the stressors facing doctors.
Ann Arnold writes:
Doctors give, and they give some more, and they’re not always aware of that themselves.
Anaesthetists? Well, ‘we’re with the patient at that very last minute before they close their eyes before an operation’, says Dr Genevieve Goulding. ‘So there’s an enormous amount of trust there.’
With that intimate connection comes an emotional load. Dr Goulding, the Brisbane-based President of the Australian and New Zealand College of Anaesthetists, says most doctors are exposed to pain, suffering and death. But each specialty has its own additional stressors.
As an anaesthetist, ‘you have to learn how to develop rapport very quickly and be able to handle all kinds of people of all different ages. It’s not easy, you have to give a lot of yourself, and it’s quite hard to be empathetic all day.’
For surgeons, there are obvious performance pressures, but there is also the role of delivering bad news. ‘I myself as a trauma surgeon in one four week period last year had to sit down with three separate families and tell them that their loved ones were not going to survive head injuries,’ said Dr Mary Langcake, chair of the NSW committee of the Royal Australasian College of Surgeons.
‘That leaves a little part of you behind every time you do that.’
One of the more common types of callers to the anonymous Doctors Health Advisory Service in NSW (there’s one in every state), is the junior doctor on duty in a country hospital overnight, according to Dr Jill Gordon. She is the service’s president, and one of the doctors taking after hours calls.
On top of feeling overwhelmed by the responsibility, the young doctor in the regional hospital may be battling discrimination. ‘Work related stress is the No.1 reason for doctors calling us,’ Dr Gordon says.
For psychiatrists, and especially trainee psychiatrists who are still developing resilience, one of the biggest challenges is preventing patients’ ill-health affecting their own mental state, according to Professor Mal Hopwood, president-elect of the Royal Australian and New Zealand College of Psychiatrists.
‘Working regularly with people suffering great distress, due to their mental health problems, who might often discuss their feelings of hopelessness and their thoughts that life may not be worth living, can be very challenging. We shouldn’t under-estimate how hard that work is.’
With three psychiatry registrars among the sudden, and as yet unexplained, deaths of four junior doctors in Melbourne last month, the wellbeing of doctors is a raw and painful topic.
The impact of those deaths was immense, Dr Hopwood said. ‘It’s almost hard to imagine the ripples that can cause for the person’s family, their colleagues and their training cohort, and, indeed, for patients who had recently been seeing that doctor.’
Doctors are, like the wider community, gradually opening the dialogue about mental health, and encouraging each other to acknowledge problems and seek help.
Every doctor, it seems, has a story of at least one suicide of a colleague. One of the more confronting, recalled by Mary Langcake, was the time a coroner’s van pulled up at Emergency so a body could be certified dead. A friend of Dr Langcake’s volunteered to do the job. She stepped into the van, unzipped the body bag, and there was a colleague from that very same Emergency department.
It was the oft-cited Beyond Blue survey of doctors published in 2013 that quantified what doctors had known anecdotally, and from personal experience: that many carry too-heavy burdens.
The survey found, incredibly, that one in ten doctors had reported suicidal ideation in the previous 12 months. It was one in five for medical students. This compared to one in 37 in the general community.
Beyond Blue’s data has been questioned because it was not a random sample, and it’s possible the respondents had a stronger interest than most. But senior doctors like Dr Langcake and Dr Goulding, who are pushing for greater recognition of mental health issues among their colleagues, argue that that does not diminish the study’s significance.
The rates, and concerns expressed by the respondents, were enough of a red light that more action and awareness was needed.
The barriers to seeking help, however, are many: fear of notification, through the arguably misunderstood mandatory reporting law; fear of being negatively judged, particularly acute for junior doctors; and the cultural tendency to self-diagnose and avoid opening up to a colleague.
Jane, a retired theatre nurse and the widow of Dr Geoff Perkins, a Queensland anaesthetist who took his own life on New Year’s Eve in 2010, implores the medical community to look out for each other, and to recognise signs of trouble – in themselves, and in others.
Geoff Perkins had died after a dispute at the hospital where he worked. He drove home angry and upset, and gave himself a lethal injection. In his suicide note he said he ‘can’t take the bullshit at work anymore’.
Jane said: ‘Most people will get depressed, down at some stage of their lives, and they will go to work and that’ll make them more depressed.
‘But over time something will happen and they’ll get over that depression. Geoff didn’t get to do that. It’s not always about severe mental illness. Suicide can happen to anybody, almost anybody.’
• Ann Arnold is a journalist with Background Briefing, Radio National’s investigative documentary program. Her program ‘Doctors in distress’ can be heard on Radio National on Sunday morning (15th Feb) at 8.05am. The audio will be online after that, at http://www.abc.net.au/radionational/programs/backgroundbriefing/2015-02-15/6083558
For help or more information
For people who may be experiencing sadness or trauma, please visit these links to services and support
• For young people 5-25 years, call kids help line 1800 55 1800
• For resources on social and emotional wellbeing and mental health services in Aboriginal Australia, see here.
• AMA Victoria’s Peer Support 1300 853 338
• The Victorian Doctors’ Health Program (VDHP) (03) 9495 6011