health

"You’re isolated from the very first day": Young doctors are dying, and nothing's changing.

Trigger warning: This post features references of suicide and may cause distress.

Earlier this year, my fellow doctor and beautiful friend, took her own life.

The news was absolutely devastating. I was completely and utterly floored. Of all people, surely not her? Surely not one of the smartest and most motivated people most of us had ever met.

When I asked a colleague, let’s call her “Dr A,” to express how he feels about her loss she told me: “Every time it pops up, I think about it again and just feel so upset. The problem is, almost all of the junior doctors I know have felt that way at one time or another. We’ve all been through our gruelling medical degrees and ‘trial by fire’ starting out work.”

"Junior doctors are made to feel that they aren’t good enough." (Image: iStock)

I remember on our first day as medical students in the hospital setting, Dr A and I came face to face with death for the first time. Being young adults, it's just not ‘normal’. It is absolutely distressing. You see it on TV and we had already learned a lot about it in our text books. But to come face to face with it and try to rationalise and normalise it into your daily work is ‘a process’ to say the very least. I don’t know if that contributes to people killing themselves, it just is something that is abnormal and really hard to deal with.

When you finally come out of med school as an Intern, suddenly you are ‘it’. You are the doctor that a family of grieving people await to ‘certify’ the death of their loved one. You are the one that gets that phone call from the nursing staff at 3am and is asked to attend the dark, quiet private room full of grieving relatives.

When you enter you encounter all of that raw emotion full of expectation and pain. Then you have to ‘do your job’ and examine the freshly dead body lying in the centre of the room – listening for absent breath and heart sounds and shining a torch looking for pupil reactivity. That leaves you with an incredible amount of personal psychological distress for your sadness for that family, for the confronting reality of a ‘freshly’ dead body, and for the wording you have to carefully choose to deliver the terribly sad news.

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During that time you spend in that room, invariably you will have received 10-20 'bleeps' on your pager, for which you feel a rising sense of stress because you need to go and attend the several other patients who might currently be experiencing ‘chest pain’ or ‘shortness of breath.’ You know you still need to chart that heparin and check the bloods of the patient you saw that had a fever two hours ago. You’re hungry, you need to pee and because you are on the night shift, you’re so incredibly tired and experiencing perpetual nausea.

Unfortunately there is just no support system, because, hey, “you’re the doctor,” and therefore you should have to just deal with that. You’ve got to get on with your job. Your senior doctors that supervise you on the night shifts are terribly busy themselves, and they certainly don’t have time to sit and chat with you about the death you just certified.

“There is this ingrained culture where people don’t look after each other. I don’t know if it will ever change, because the first thing people do when they are super busy and distressed is put up a wall, and you see that in all the Registrars, you can see they are out of their depth and they are just trying to put up a front," Dr A says.

"So you’re isolated from the very first day. I think all in all, there is no support network. There is reasonable concern that if I do tell anyone that I’m struggling with my own mental health, how will that affect my future career.

"If someone knows that I have weaknesses, then how will they give me a glowing reference so I can achieve the job that I have earned through blood, sweat and so many tears.”

Dr A also states, “admittedly, there are ingrained cultures in all of the old professions like accounting and law and so on, where they equally do insane hours comparable to doctors. But the added pressure to that for doctors, is it’s peoples lives. At the end of the working day, it’s a lot harder to walk away and compromise people's health care than it is to not finishing an office based task.”

"There is this ingrained culture where people don’t look after each other. I don’t know if it will ever change." (Image: iStock)
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You finish late and then you take it home with you. You worry about your patients and you worry that they’re not improving. You hope they are on the right antibiotics. You hope the night team will remember to check the investigations you ordered and handed over to be checked.

A recent large cross sectional study by Beyond Blue found that one in five medical students and one in 10 doctors in training had suicidal thoughts in the past year. Regarding young doctors, the report noted they worked longer hours, had more psychological distress, thought about suicide more and are more likely to suffer  ‘burn out’ than their older and more senior colleagues.

The work culture in hospitals is a microcosm of huge amounts of unpaid overtime, intense scrutiny from superiors, unrealistic expectations of being in several places at once, bullying and a culture that says “it’s always been this way, so it must be YOU that is the problem.” Junior doctors are made to feel that they aren’t good enough. They feel discouraged because of the “medical student tsunami” – which has caused an extreme bottleneck for acceptance into speciality training.

It’s cut-throat. It’s brutal. Doctors are terrified to admit they are suffering or need help, because the mandatory reporting laws that surround doctors in psychological distress mean that any concerns for psychological ill-health could cost them their career.

Junior doctors are in a melting pot of daily psychological distress inevitably encountered when dealing with sick patients. This distress is only compounded by the antiquated and hierarchical public health system. Junior doctors are powerless to seek help and terrified to speak out about these issues, for fear of jeopardising the career which they have put so many years of study into and which is only just beginning.

Our job is caring for people, and along the way, the medical community has lost how to care for ourselves. I’m tired of saying goodbye to friends, taken too early, broken by a job. The time has come for a change.

If you or someone you know is struggling with their mental health, please seek help. You can get in touch with Beyond Blue by calling 1300 22 46 36 or visiting their website.