We asked Guardian readers to share their experience about a prevalent issue among Australia’s doctors and medical students alike: unrelenting pressure, inhumane working hours and brutal competition is driving health professionals to the brink of suicide. Readers report depression, anxiety, burnout and post traumatic stress disorder. Our call-out revealed a toxic mix of a culture of bravado, antisocial shifts and the feeling of not being able to show weakness and fragility in a profession that is expected treat to the most vulnerable members of our society. ‘At my lowest I cried every day at work because I was so snowed under’ Laura (not her real name) says she had her mental health concerns laughed at and leave denied when she raised her struggle with superiors. “I didn’t have time for meal breaks. I developed an eating disorder and lost nearly 12kg in a year because that was the only aspect of my life I had any control over. There isn’t an out – you’ve worked at least 6+ years and there is so much pressure to be better than everyone else so you’ll be accepted onto a program.” Now halfway through her specialist training, Laura is told to diversify and consider other options because there is a high possibility that once she finishes her (very expensive, stressful and time-consuming) training, there won’t be a consultant job for her at the end of it because of oversupply. ‘I did not feel like myself on the inside anymore’ Nancy experienced severe burnout while working as a fellow overseas. Exhausted from sleep deprivation and regularly serving 100 hour weeks, having to make critical decisions and doing procedures became increasingly difficult. “The final straw came when I worked 17 days in a row including five 25-hour shifts. […] Never had I experienced such darkness and hopelessness. I found myself angry at the patients for being sick, and another night wishing that a sick patient would die so I could close my eyes for 10 minutes because I was so desperately tired. “The only way I could think of escaping this was to quit my job and I felt if I didn’t quit my job I would go ‘crazy’”. ‘The root cause is not being looked at’ “Doctors are depressed because the shifts are antisocial,” says David. “The training programs are taxing and take us away from our support base (family and friends). The senior doctors say, ‘This is what we’ve had to go through so stop complaining.’ It helps if we get a toilet break, I don’t care about a meal break anymore. There are things that make me feel worse: ‘You can’t hand over this patient until you do so and so. Thirty minutes after my finish time.” ‘Not being able to be on call goes right to the core of masculinity in medicine’ As acting medical superintendent in a small town in Queensland, Laura (not her real name) was the only doctor in town outside office hours. She was thrilled to be there and, despite her profound and constant fatigue, loved being able to use her skills to help people. “In the last couple of years, due to complex workplace issues, I had taken up a mindfulness and meditation practice. This resulted in me paying much more attention to the sensations in my body.” “I came to appreciate that when I was on call, what actually happened is that when the phone beside my bed rang, I leapt out of bed like a person possessed. I answered the phone, now fully alert and hypervigilant. I had chest pain, palpitations and nausea. I felt like vomiting.” “So, when I realised this – thanks to my mindfulness practice, I suddenly had a new insight into why I found being on call so difficult, and so exhausting. If I was ever called, I just didn’t get back to sleep. My doctor decided I was not to be on call, and have told me that I should never be on call again. I’m not sure about that. I will see how I go.” ‘Having a good GP, and psychologists help’ “Also having a strong family and friendship group, and a loyal colleague or two. Also a knowledge of industrial psychology. “Finally a union whose delegates have seen this before, and even some legal advice that recognises what is going on. Breaks by the seaside and with my family, friends, ie outside the medical culture can nurture the soul. Exercise and having a pet, and a creative outlet helped too.” ‘A fundamental change in the way Australians deal with doctors’ is needed “Doing medicine remains unquestionably the worst decision I have ever made. It has brought me nothing but anger, frustration and sadness.” Mike, a junior doctor in Queensland also says that for things to improve, “a fundamental change in the way Australians deal with doctors” is needed. “I have been hit, abused, screamed at, threatened with murder. I am frequently filmed by patients or their family ‘just in case’. I’m looking to leave the profession as quickly as possible.” ‘I am able to choose how much or how little I work and I have found a balance’ Greta developed an eating disorder, depression and anxiety. Having regular visits with her own doctor and taking medication helped. “A couple of people know a little bit about my issues but not the details, so have given support on the handful of times I have needed it. I have healthy boundaries with my patients and don’t take work home with me. If I find myself thinking about work too much in my own time, I know that there is an issue I need to confront. She now makes sure to have lunch and to exercise every day. Learning over many years to recognise her triggers and early signs of exacerbations have also helped to stop it progressing. “It has taken many years to get to this point.” ‘I felt completely unable to reveal my distress and emerging depression’ “Medicine would be transformed if doctors were able to admit freely to vulnerabilities, fears and failings. Yet no one does, despite the terrible costs. If even one of my peers had taken me aside and encouraged me to seek help, or even just let me know they were concerned and cared for me, I might have been able to halt the march of my depression before it became utterly devastating.” The prevailing culture of medicine measures success as working excessive hours, encouraging intense competition between peers from the very outset of training. “In my dual role as doctor and patient I feel the obligation to speak out about the terrible burden of mental illness within medicine. However, I remain to be convinced that this will truly change anything and have so far chosen to remain silent rather than risk my colleagues’ judgement and possible derision.” ‘The stigma of mental injury … allows institutional abdication of responsibility that needs to change’ Adequate staffing, honest appraisal of the workload, reallocation of tasks, proper debriefing – these are some of the solutions junior doctor Carly (not her real name) suggests. But what’s needed above all, she says, is a “narrative shift from personal to institutional responsibility. Even when colleagues and bosses are sympathetic to someone managing mental illness, I have observed that the onus remains on the individual to find a solution and make themselves well enough to work. “This is despite the fact that in many cases our working environment has contributed to our illness. There needs to be more meaningful concessions by hospitals to shared responsibility, just as with other OH&S issues. “When I reported my depression to my employer, I was told that I was not the first person to have become unwell working in that unit. This was meant kindly (‘It’s not you; it’s the job’) but on reflection I realised this meant my employer was knowingly subjecting staff to an unsafe working environment, without protective measures or even warnings.” ‘The AMA and health department’s stance on zero tolerance to bullying in medicine is trite’ The husband of one doctor says that everyone knew the truth about the bullying happening to his wife but through their silence condoned it. “We know now that these senior people actively colluded with the antagonists. Until this is resolved nothing will change.” Source
