The importance of taking care of our own
I’ve read a lot of articles lately about the issues of mental health and suicide in medicine, and to those within medicine there is no surprise about the sentiment in these articles. Each one addresses a different issue, although often talks about a “profession that eats its young” or the “importance of standing up for yourself”. In times of emotional upheaval, we all want to find the root cause an issue and fix it as soon as possible. This is especially so for us physicians and surgeons, ever ready to treat illness as effectively and as quickly as possible. In this spirit, many a person is quick to the conclusion that “This is it! This is the problem! If we just fix these things everything will be better!”. I just don’t think it’s that simple. It never has been and it certainly isn’t now.
Never in my time as a doctor have I ever seen a patient and have expected them to solve their problems by themselves. And yet, this is what we often expect of our colleagues, or our colleagues think it is what's expected of them. If someone is under-performing, too often the system assumes the problem is with them. Individually we can be kind, compassionate and caring. Collectively as a workforce, we can sometimes be cold, unfeeling and quite simply just out of time. There are systemic supports in place for the underperforming doctor, but we fall through the cracks so easily time and time again. And most of us are so busy just trying to get the job done that we don’t even notice those falling off the edge, let alone help them back up.
We have a system where unhealthy rosters make it near impossible to take leave in times of stress or crisis. We have a system in which part-time employment is practically non-existent and approaches to change this are met with 1950s attitudes about professionalism and practice. We have almost no opportunity for those who are burned out or mentally unwell to gradually return to work in a supervised and supportive manner. And we certainly don’t have a workforce in which it is OK to be mentally ill. Mentally ill doctors are outcasts; pariahs amongst scores of highly functioning practitioners. This is not helped by the fact that in all states except Western Australia, you are expected to report these critically unwell colleagues to a registration board that has an incredibly unhealthy approach to conditions and notifications, thus making the problem worse.
Personally, I’ve worked in wonderful workplaces. I’ve seen initiatives for better rostering supported. I’ve seen part-time work embraced as a way to improve training and workforce flexibility. I’ve seen a colleague supported back to work in a manner that suited their illness. But I’m concerned that while these examples exist all over the country, they are not the primary way of doing business in medicine. Healthy workplaces need to be the rule, not the exception.
There are plenty of reasons for why this is the case. We know how hypercompetitive medicine is, even after medical school. We know there is an ever-tightening workforce with fewer job prospects. We can talk about the divorce of clinical management from administrative management and the distance between clinicians and departmental rostering and staffing. But I don’t want to talk about these things. I want to move forward.
I want to talk about you about the actions that we can take. Chances are, you’re a healthy doctor-in-training, with strong social supports and an optimistic future. We are the ones who needs to stand up for our unwell colleagues. We are the ones who will be able to change the system and make the profession a healthy and sustainable one again. Don’t expect those who suffer from mental illness to make the first steps; you don’t expect it from your unwell patients and it’s cruel to expect it from your unwell colleagues. Maybe it’s something as small as a frank discussion around unhealthy rules and regulations at your hospital or practice, but it’s a start and an important one at that. Systems change isn’t just about helping those in crisis. It’s about enabling those who are doing well to help those around them.
I’m not writing this to you as a motivating plea to naively revolutionise a whole profession overnight. I’m writing this to you because I’m tired. I’m tired of seeing my friends having to deal with the onslaught of depression and anxiety that this job can bring their way. Not just for them, but because I know all too well that mental illness doesn’t discriminate, and that most of the difference between a healthy doctor and an unhealthy one is luck half the time. We’re just not that special. That’s why we need profession-wide organisations like the AMA. We can’t expect a handful of people to shoulder the burden. The whole profession has to bear it, and take ownership of the future.
You may or may not agree with my sentiment and my position in this article. But surely we can all agree that when doctors-in-training are committing suicide and leaving the profession, there is something terribly wrong with our culture and our workplaces. So let’s change it. It’s as simple, and as complicated, as that.
Until next time,
Dr John Zorbas
Chair, AMA Council of Doctors in Training