By the end of my first year as a medical intern, I had attended two funerals of my colleagues who had died by suicide. Another two had made significant suicide attempts and several more were taking anti-depressants and undergoing professional treatment for depression and anxiety. In Melbourne in 2015, three psychiatry registrars committed suicide. In 2006, Dr Chanh Thaow committed suicide at work using a lethal cocktail of drugs.
The prevalence of depression, anxiety and suicidaity in the medical profession is incredibly high, much higher than that of other professionals and the general population. Doctors are more likely to complete suicide, with female doctors at especially high risk for suicidal thoughts and completing suicide. US data suggests the death of 400 doctors per year from suicide. What makes these statistics even more scary is how closely they hit to home.
When we see a colleague having a tough time, when they're exhausted, when a patient has died or when they are studying for expensive and difficult specialist exams, we know deeply that level of despair. We know the feeling of crying in the toilets or in the car. We know the tiredness that goes to your bones. We know all of this because it has been all of us, to some extent, especially when you are training to be a specialist. The hours are extremely long, the work is arduous, the demands are high and the culture can be toxic. Couple this with a group of people who tend towards being perfectionists and high achievers and you have a disaster.
In the years since I was an intern, I have attended more funerals, had more friends be hospitalised or seek treatment for mental illness. The unspoken, dirty secret of the life of a doctor is that while we care for you with the best of our ability, we get an F when it comes to looking after ourselves and each other. With the recent RUOK? Day and World Suicide Prevention Day, talking about mental illness in all of its guises is improving in the general community.
I am all for talking about mental illness. There is value in being able to admit that you are vulnerable to another person and say that you need help. Raising awareness and using the word 'depression' rather than breakdown or giving anxiety its recognition as a significant mental illness in our community are all important steps to improving awareness and help-seeking. When though will we progress from lip service and pretty packaged 'look after yourself' algorithms to actual, real change?
In the world of medicine, it is becoming increasingly recognised the toll that our work takes on doctors. In the US, where the work hours of specialist surgical trainees regularly exceed 100 hours a week, legislation introduced caps at 80 hours a week. The realisation that workplace bullying and discrimination has a serious negative effect on health and wellbeing has led to the development of policies against such behaviour. These policies are simply not good enough, not geared at truly changing the system that makes people prone to being worn down.
Medicine is not alone in this. In the excellent book, The Wellness Doctrines, lawyer Jeremy Doraisamy details similar ill effects in the legal profession where the long hours, job stresses and high-achievment orientated workplaces are also negatively impacting the health of young lawyers. In a highly publicised case, an intern at the Bank of America committed suicide after working for three days straight. They capped hours at 17 per day after this.
Only talking about mental illness that is born out of an incredibly stressful work environment is akin to closing the gate after the entire herd has bolted. Why are we ignoring the roles our unhealthy workplaces play in the loss of young lives? Why are workplaces so short sighted to see that they will get much better performances out of well employees? Where is our sense of moral obligation to other humans?
For our doctors, we are slowly starting to have these difficult conversations. We publicly denounce bullying and have vague frameworks of safe working hours. Much like a lot of the other professions mentioned, it's not quite the earth shattering change that needs to happen. Just like law, banking, emergency services, we need to be starting the drive towards mental health from the start. Teaching resilience, allowing flexible working, access to leave and truly changing the toxic cultures of our workplaces.
The time for just talking about problems has passed. Now, we need to progress from questions to action. Actions that have meaningful and real outcomes. I'm not sure why a profession of carers is so bad at looking after its own, why smart intelligent professionals from all areas are comfortable condemning their employees and colleagues to misery. Just like society at large, we should be caring for each other so that those around us never have to reach these incredible depths of despair.