Systemic changes needed to address doctor mental health

Dr Tessa Kennedy delivered a moving speech to the NSW Health junior medical officer wellbeing and support forum. Read it here

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We are here because four NSW doctors-in-training died by suicide within six months.

However, I believe the solutions we seek today are to a much more widespread problem: the psychological distress and mental ill-health which may be created, exacerbated or perpetuated by the culture of medicine and way we work as doctors.

This is my seventh year as a doctor in training, or DIT.

I’ve worked in 10 NSW hospitals, across a range of specialties, and with hundreds of colleagues in different teams providing care to thousands of patients.

Personally,

• I’ve worked back to back 16 hours shifts, 90 hour weeks and then gone home to study.
• I’ve felt unable to call in sick because there is no one to cover me.
• I’ve regularly stayed hours late to complete all tasks required for my patients, only to be told I can’t claim any overtime.
• I’ve caught myself falling asleep driving home from night shift at a rotation 90km from home.

Three friends have crashed their cars in this situation, one into her daughter’s daycare.

• I’ve had a sleep-deprived panic attack before a high-stakes college exam.
• I’ve sat in my car and cried inconsolably after a near miss for which I felt culpable.
• I’ve worked with a consultant for three months who only communicated with me through his secretary, and never remembered my name.

As the doctors in the room will tell you, there’s nothing remarkable about these stories.

The experience of postgraduate medical training challenges us all – so this May, the AMA/ASMOF Doctors in Training Committee conducted a NSW-wide survey of doctors-in-training, the Hospital Health Check, to add some numbers to anecdotes.

Overall, 1,107 DITs – around 20% of all those in NSW – completed the survey, which yielded some confronting, though frankly not surprising results.

• As a result of fatigue, 71% have been concerned about making a clinical error, and 68% have been concerned about their personal health or safety.
• 42% have experienced bullying or harassment, and 53% have witnessed a colleague being bullied or harassed at their hospital.
• Yet 66% are concerned there might be negative consequences in their workplace if they reported inappropriate workplace behaviours.
• 89% are not paid for all the unrostered overtime they work, and 46% aren’t paid for any of it.
• 31% rated their hospital’s support for their mental health and wellbeing poor or very poor.

To me, these results resonate with the stories we hear all too often from DITs:

• Who are overworked, underpaid, tired and disengaged, burnt out and not seeking help when they need it most.
• Who’ve been told not to cry, not to claim, not to take leave, not to complain –
  • Because that’s not what we do.
  • Because I went through it, and so will you.
  • Because you don’t want it bad enough. Maybe this job’s not for you.

This is unhealthy not only for us, but for our patients, who are at increased risk of harm when DITs are working in these conditions.  But it doesn’t have to be this way.

No doubt there are certain stressors inherent to the practice of medicine: dealing with death and suffering, high stakes decision making, unpredictable workloads often at unsociable hours. But there are a range of stressors that are not inevitable, rather the result of a culture steeped in history and habit that is no longer fit for purpose. The result of a system under strain, asked to do more and more with less and less.

So, if we are to succeed in achieving meaningful, sustainable improvement in the wellbeing of doctors, we need to change the system and we need to change the culture.

It may be hard, slow, and complicated, but the stakes are high.

While I can’t presume to know what role, if any, working and training as a junior doctor played in the recent untimely deaths of my colleagues, there is enough evidence from those still living the DIT life that the system is causing harm to a much greater number.

So, let’s approach this like we would any other adverse outcomes we seek to improve: see the big picture, consider all the contributors to the problem, remove what risks we can, and mitigate those we cannot.

Despite its many challenges and frustrations, I love my job. I can’t imagine doing anything else and I truly believe it to be a privilege to care for my community. But doctors are part of that community, and we are deserving of the same care and compassion we afford our patients.

All of you here today have been invited because you are responsible for some part of the culture of medicine, and the system of healthcare delivery in which all DITs work.

The only way we are going to make progress on this issue is by working together, by considering what we can each do in our patch to help reduce the burden of psychological distress, allow for safe and accessible management of mental ill health when it occurs, and prioritise the things that permit resilience in the face of future stressors for all doctors, starting with those in training.

I look forward to hearing your plans. Thank you.