Doctors’ grief gives way to action

3 minute read

AMA Mental Health

By

Felicity Nelson

Doctors who have lost colleagues to suicide are demanding that the medical profession make serious structural and cultural changes

Pink, orange, and blue socks – mismatched to maximise the visual clash – were out in force at the AMA conference in Brisbane on Friday.

The #crazysocks4docs advocates had a serious message to send the medical profession: real cultural and structural change is urgently needed to prevent doctor suicide.

“A huge component of prevention is addressing these modifiable stresses,” said Dr Jessica Dean, an intensive care trainee and former AMSA president, in an address to the conference.

“They are appropriate rostering, access to sick leave and other leave entitlements, flexible working conditions, appropriate staffing and appropriate workloads. It isn’t rocket science. We now know exactly what has to be done. We just need to do it.”

Dr Jessica Dean

Pilots spend 50% of their time resting on long-haul flights, she said. “We are still trying to stamp out the 16-hour shift [at hospitals]. Why do we think we are invincible to fatigue?”

Sitting in the front row at the AMA conference were Micaela and Jessica Abbott, the sisters of Chloe Abbott, a 29-year old junior doctor at St Vincent’s Hospital who died by suicide in 2017.

“When Chloe took her life, it was really close to heart to this organisation,” said former AMA President Dr Mukesh Haikerwal.

“And a lot of the action that we’ve seen has been driven by that. This family has actually changed the language, has changed the dialogue so that we are now talking about [doctor suicide].”

Micaela Abbott addressing the AMA conference

“Thank you so much for having us here,” said Micaela Abbott, addressing the conference. “I have just been sitting listening to this just in awe of everyone’s absolute commitment and dedication to this issue.”

The founder of #crazysocks4docs, cardiologist Dr Geoff Toogood, spoke about stigma and vulnerability.

“The first time I walked into a psychiatric consultation I sat behind a magazine because I feared being seen,” he said.

“I didn’t want people to know that, as a doctor, I’d failed.

“Many colleagues suggested after 15 years or 20 years of clinical practice that perhaps he wasn’t cut out for this job. I should try something else. Or I wasn’t resilient enough, I wasn’t strong enough.

“I thought when I was actually ill and suicidal and not coping that I was the only doctor in the hospital who was like that. But I’ve come to realise, that’s not true.”

Dr Michael Myers

Professor Michael Myers, a psychiatrist and author from New York, explained why it was often so hard for some doctors to ask for help.

“Physicians are notorious for beating themselves up for becoming ill,” he said. “When I talk to my doctor-patients about why they don’t have a GP often the first response is – and they say this somewhat laughingly – ‘Oh, I don’t really trust other doctors’. It is said in jest, but I think there’s a little bit in earnest there.

“There’s an inability to accept the patient role. And then there’s hypertrophied altruism – that we give so much to others that we just don’t take care of ourselves. And I say of this without judgment.”

To maintain absolute confidentiality, mental health services for doctors could offer after hours care, in a discrete location with no signage, with at least 15-minutes between appointments, said Melbourne-based psychiatrist Dr Helen Shultz.

Left to right: Dr Michael Myers, Jessica Abbott, Dr Geoff Toogood and Micaela Abbott

 

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lou lewis
lou lewis
5 years ago

Now that we are accepting the fact that there are many doctors compared to other professions committing suicide, and the impression being that there is a high rate of mental illness in the medical profession, I personally am not convinced that this is the case.
When we are students and choose medicine as a profession, it is usually the top 1/2% of the state that actually get into medicine, and I do not believe that this small percentage represents a very high percentage of people with mental health disorders. Of course there are exceptions to the rule and this is the case in any field of life but the high proportion of doctors committing suicide after they graduate as doctors must raise red flags . I think the question that we have to ask ourselves as medical people is why so many doctors commit suicide and I think we have to look at the way the junior doctors are treated by the administration. Each generation of graduating doctors are told by their lecturers and supervisors hoe lucky they are because in their day they had to work eight days a week and 25 hours a day!. The funny thing is that not much had changed when I first graduated and did my first junior resident term at Orange base Hospital in the mid-1970s, when we worked shifts that started at 8 AM Saturday morning and did not finish until 6 PM Monday night, then we had Monday night off and we then worked from Tuesday 8 AM until Wednesday 6 pm and this was repeated week after week. The only difference from the previous generation was that we were paid normal hourly rates for our rostered time on and then 1/2 the hourly rate for the overtime, whereas the previous generation was paid nothing for the overtime. Because there was only one or two residents at the base hospital at the time we accepted that this was the way things should be because they always had been, but when we started to realise that other workers in the hospital such as nursing staff, ward clerks , cleaners and so on worked hours that were in keeping with other professions then we realised it was time for a change.
When I went back to RPA to do the rest of my year a colleague decided to take on the system and as his pay was from 8 AM to 6 PM as soon as 6 PM arrived he stopped whatever he was doing and said I will not do any more work unless I am paid overtime. This was the first ripple in what was to be a small wave for future junior residents like himself and myself who had no intention of specialising and just wanted to go into general practice after our compulsory first year.
However I still read that junior doctors or as they are called nowadays interns are still expected to work long hours, and because the big emphasis nowadays is on specialising most of these doctors had no choice but to do what the administrators want otherwise they may not be selected to study that particular specialty. This of course must lead to stress and fatigue and a normal person with no mental disorder will develop what I prefer to call mental stress contributed to by these long hours, fatigue and fear of showing the inability to do these hours in case they are not deemed worthy for that specialty.
If the powers that be were really serious about addressing these problems then they would roster these inters and registrars to far less demanding hours and keeping these doctors ‘fresh’ during their shifts, but this would entitle hiring more doctors to do these shorter shifts and this would, in the eyes of the administrators, adversely affect budget of the hospitals concerned.
Don’t worry about the health of medical staff, worry about the health of the hospital budget!
I know that I have offered a very simplistic solution to the problem of doctors suicides but I firmly believe that making working life easier and more pleasurable and more manageable for doctors with families will go a long way to reducing stress and reducing the inevitable tragic outcome of not being able to cope with an unrealistic workload and responsibility especially when fatigued.
I can’t really discuss the suicides of other members of the profession such as GPs of my generation, because personally I do not know of any of my colleagues who have committed suicide due to forced excessive hours of work, and I would like to hear from other people who have experienced GP suicide in the city due to mental stress (as opposed to financial stress leading to mental stress), although I can understand rural GPs beng in a far more precarious situation regarding suicide than a city based GP.
Finally, although my family, of which quite a few are in the medical profession, have not experienced first-hand a relative committing suicide, I can sympathise with all the relatives that have suffered as a result of just one person’s suicide,
And I must point out that as long as we have these archaic mandatory reporting rules doctors will not seek the help that they need and the cycle will continue to be repeated.
Dr Helen Shultz is quoted as saying “To maintain absolute confidentiality, mental health services for doctors could offer after hours care, in a discrete location with no signage, with at least 15-minutes between appointments”, but this would be contrary to mandatory reporting rules.
Dr Lou Lewis

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