“Picture me standing on a floor made entirely of glass. If something good happened to me, or if I had a good day with a friend or family, the glass I was standing on would become a bit thicker, meaning that my resolve was stronger and I was less brittle. But if something bad happened, or if I had a setback, cracks would start to appear in the glass. If those cracks ever became numerous enough, the glass floor would shatter and I would fall” – Jerome Doraisamy, The Wellness Doctrines
I have written about mental health (or lack thereof) in doctors on several occasions. The upcoming week or so has two very significant events for mental health. Firstly, September 8 is R U Ok? Day, a day that we are encouraged to ask the people around us if they are doing okay and if they’re not, act on it. Secondly, the AMA(WA) Doctors In Training Wellbeing sub-committee has a symposium coming up on how we can facilitate keeping our doctors well and help those who aren’t overcome their difficulties.
Depression, anxiety and suicide in doctors is rife. US data suggests that 400 doctors per year commit suicide which is the equivalent of losing an entire medical school every twelve months. Beyond Blue has determined that the risk of depression and suicidal ideation is much higher than that of the general community and higher than other professionals. Doctors face an enormous amount of stigma if they suffer, especially openly from the public and their colleagues alike. Despite existing to fight disease, doctors are blind, ignorant or dismissive of this disease in themselves and in their colleagues.
The factors contributing to poor mental health in doctors are numerous. Obviously, a number of doctors who experience depression have pre-existing traits, genes or personality structure that sees them prone to this. When we add into this equation the incredible stress faced by doctors, it’s hardly any wonder. I personally feel like the stress in medicine is increasing, despite the fact that as a registrar, I worked many less hours than my most senior boss, who trained 20+ years before me.
Doctors are now faced with new and difficult stressors including an increasingly competitive training environment, layers of bureaucracy and unnecessary paperwork and exposure to increasingly sicker patients. This in addition to the ‘run of the mill’ stress of long hours, social isolation, long training times as a specialist, relocation, personal cost of training to name just a handful. While hospitals and specialty colleges are offering access to support services such as counselling and moving to combat stressors like bullying, this in itself is not enough.
Most of us do actually realise the significance of these major bodies coming out and saying ‘we understand you need support from time to time’ but we are doing very little to prevent mental illness, target stigma and facilitate meaningful recovery.
A doctor admitting they are unwell is still such an incredible taboo and can be an enormous barrier to seeking help in a timely fashion. There is the ever present threat of having conditions placed on your practice by the Medical Board and having your colleagues be made aware that you are not up to scratch.
Prevention of mental health by truly taking steps to reduce the common stressors in the life of doctors is also an area that needs improvement. Access to part-time or interrupted training may be beneficial to those who are unwell but do not want to leave their training program. Truly developing no tolerance policies when it comes to bullying hospital-wide, not just in surgical circles may relieve some of the stress experienced by our doctors. Successful implantation of wellness programs have taken place in Stanford General Surgery in the USA where surgical residents are given time to go outside, play games and generally destress.
Finally, as a profession that strongly identifies themselves as their vocation, facilitating return to work programs and allowing time off and other access to mental health professionals and programs can help validate the doctor as useful contributor, even in the face of their illness.
The irony of all of this is that whenever I see a patient who to me, is depressed, I have no problems being a compassionate listener and offering the help that they need. As do my colleagues. Doctors, ourselves, prefer to live in a ‘Do as I say, not as I do’ fashion. While we stand silently and let ourselves, our friends and our colleagues be consumed by illness, we fail to offer the help we vowed to take. We also fail to stand side by side with those who need it and let them know that they are not alone and that things can get better.
Nobody really wants to suffer in shame and silence. And so, this Thursday, ask those around you if they are okay. And take steps to be a loud voice for you and everyone around you and demand that as a profession, we start taking care of each other in the same manner we take care of our patients. Mental illness is not shameful, no matter who you are. It’s time that doctors start to take proper care of themselves and for those around us to say that it’s okay to need a little looking after.