Medical professionals are burnt out, overworked and more prone to psychological distress, but when it comes to their own mental health many fear the stigma of treatment. NSW general practitioner Dr Rebecca Black was at work when her husband, Tom, took his own life 10 months ago. Before his death, Tom Black — also a doctor — went to great lengths to keep his depression secret from his colleagues and friends. He was conscious of the stigma. "I feared that if I divulged his secrets that I could worsen his mental state," his wife said. "He did see a psychiatrist, but I think he would have seen one sooner if he had not been a doctor." Rebecca and Tom Black met during first year medical school. They had been together for 26 years, but in the months before Tom's suicide Rebecca felt alone in caring for her husband and raising their children. "I knew he was severely ill, but I had hoped he wasn't terminally ill. I had very little support because of the secrecy he insisted upon," she said. "It left me quite isolated and dependent, on just the one or two people who did know, for any support." Rebecca said she would never really know what led her husband to take his own life, but that there was not just one reason. "Tom was a typical doctor — he refused to reduce his workload or take time off. He was at work on the Friday and dead on Monday," she said. Doctors fear being barred Beyond Blue has found that 3.4 per cent of doctorsexperience very high levels of psychological distress, higher than the general community, and 10 per cent have experienced suicidal thoughts. But many doctors fear asking for help will stymy their ability to practise medicine. In all states except WA, if a medical practitioner, such as a psychologist, believes the doctor could pose a risk to the public they must report them to the medical board. Dr Jason Lam was considering suicide but postponed getting help because he feared being caught up in the mandatory reporting process. "I still couldn't ask for help and the only point where I could, was when I actually decided I was willing to give up medicine to get help." Consultant psychiatrist Dr Helen Schultz said mandatory reporting laws, which vary from state to state, create fear because their wording can be misinterpreted. "The issue for doctors is that they just don't know if the person they divulge their problems to is someone who is going to understand the interpretation of the law." Being reported could potentially lead them to being barred from practising. And Dr Schultz said that doctors can be caught off-guard: "If you are actually reported there is no triaging system that goes along with that … you get an email, you don't know it is coming — what other profession would you break bad news that could actually impact on this person's livelihood without making sure they were ready or supported to hear it?" Former AMA president and former chair of Beyond Blue's Doctors Mental Health Advisory Committee Dr Mukesh Haikerwal wants other states to follow Western Australia's lead: "you shouldn't have your human rights taken away from you for having a medical degree or other health degree." Victim-blaming and judgment Dr Schultz counsels doctors and medical students and is mindful of their need for privacy: she sees them in an "inconspicuous" clinic and allows fifteen-minute gaps between appointments to ensure her patients don't run into one another. Beyond Blue found 40 per cent of doctors judged their peers with mental health concerns, perceiving them as less competent. Dr Schultz has witnessed this judgment first-hand. "In January 2015 we lost three psychiatry trainees and an intern in Geelong to suicide in three weeks," she said. "Very quickly it turned to victim-blaming, which we see all the time in medicine — victim-blaming and minimising." Dr Black paints a similar picture of the medical community. "It's regarded as weakness if you can't cope with the demands of the job and people within medicine are not sympathetic, understanding or supportive of health professionals with mental health issues." Burnout is common Over half of doctors are working rosters that put them at significant or high risk of fatigue, according to a 2016 AMA study. The average doctor's work week was 78 hours with the average shift lasting 18 hours. One doctor did a 76-hour shift. "I have a sneaking suspicion I was the doctor who did the 76-hour shift and recorded 118 hours per week in terms of workload," Dr Lam told The Drum. "We were working crazy hours, I was on call for an entire year." A recent survey of 1351 doctors-in-training found 65 per cent were worried their fatigue could lead to clinical error. Yet medical graduates say they dare not complain with an oversupply of graduates competing for training positions. "At one of my jobs where I made the foolish mistake of putting down my [long] hours I got quietly taken aside and the consultants would say to you, 'I'm not telling you to work these hours but if you don't, people will suffer'," said Dr Lam. A former professional dancer, Dr Lam had dreamed of being a plastic surgeon — drawn by the creativity and precision of it — but after a year in an unaccredited position he lost his edge and drive and says he was moody, unable to dance and was gaining weight. He eventually gave up his dream. At one clinic orientation he said he was told: "You have three chances with me, if you displease me three times, I will call all the relevant people and make sure you never work in this specialty again". "We're reliant on these consultants to give us references," he said. "With that over our heads, how can you say that you can't do something or that you feel that you can't cope with a workload?" Indigenous locum medical officer Dr Erika Chapman-Burgess said even having a sick or mental health day is stigmatised. "We are made to feel like we're super human. We don't get sick. "You hear about registrars who have 500-700 hours' worth of sick leave and they aren't taking it and they don't take it over years because if you take a sick day you are expected to be actually in hospital to be sick enough." Source
