Is the Medical Profession in Crisis?

resuscitation adj

Across the globe, increasingly evidence is coming to light that people in our profession are suffering.

Its considered that we have about twice the rate of suicide as the general public. With reported rates being anywhere between 1.1-5.7 times higher than the general public6. It is known that our suicide rate is higher than any other professional group.

We have a higher rate of suicidal ideation than the general public, with 25% of doctors at any time having thought about killing themselves3. 10% in the last 12 months3.

We have a higher rate of both high psychological distress and higher rates of anxiety than the general public3.

We have far higher rates of burnout than anyone else in society. In fact, between 40-55% of the profession are burnt out with rates increasing over the last decade9. Burnout is not a benign condition. It is associated with exhaustion, depersonalisation and a feeling that the work is not worthwhile, and perceived errors. It is associated with higher rates of cardiovascular disease, depression, anxiety, diabetes, suicidal ideation and musculoskeletal complaints1. Furthermore, it is associated with higher rates of medical errors and lower rates of patient satisfaction2,7. Continue reading

Can we support one another in Medicine?

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In Medicine, we learn that life is about marks and doing work for patients. We are not taught to work together nor are we taught of the importance of working together in a collegiate manner. We are not taught to take care of ourselves or to take care of our colleagues. Too often there is open hate and hostility on display between doctors in hospitals and in private practice. Stress and tension run our relationships and very often judgement and condemnation of each other, whether vocalized or hidden, are the order of the day. In this day and age where the mental health of the profession is worse in many regards than that of the general public and suicide rates are higher than the general public, are our relationships with each other important in medicine?

I’ve been in Medicine now for over 20 years. One of the things that I have observed over the years is that our relationships with each other in Medicine are in general sadly not good. We are competitive. We work in isolation as a general rule. We don’t really support each other or ask for support, or allow support when it is on offer. We are the ones who are supposed to be ‘OK’. We learn to work with random people in teams in hospital and we keep the relationships ‘professional’ and consider them short term professional relationships that we have to ‘survive’! They are about work and they are about training. It is rare to develop relationships at work that are truly personal, ones where you feel truly safe where you can share and seek and give support and care that is non-judgmental. As doctors, we don’t let each other in, and we only share certain aspects of ourselves. We place huge expectations on ourselves and each other leaving little to no room for a true care.

In Medicine we learn that you have to be ‘tough to survive’. We learn to toughen up, and to not show any emotion. We pretend that we can ‘handle it all’. If we show that we are not able to ‘handle it’, then we learn that we are seen as defective, as a nuisance, and a problem who is not tough enough to handle it all. Those who are seen as weak in the profession are ostracized, eternally. I to this day remember a woman in my intern year who took a few days off ‘sick leave’ after a long stretch of days working, and was later seen down the street with her husband. She was judged within an inch of her life and complained about by many of the interns and she lost all credibility, forever. No care or concern was given towards her mental health and whether or not she was coping with the job or, whether she needed support. Support?! That thought never even entered our minds! The only focus was to judge her for not coming to work because she was clearly able to walk and to move and had not broken all 4 limbs.

And this is how it is in medicine. If you can breathe at least through one nostril, and stand up – at least on one leg, you must come to work no matter how you are feeling. There is no care and concern for how you are feeling. Mental and emotional health does not rate a mention. In retrospect, this woman was clearly struggling with the work and her life and she did the best thing she knew at the time to best support herself.  Looking back, she actually needed our support too! At the time she was judged and condemned as not being committed, as causing a strain on the rest of us who had to ‘pick up the slack’. And this is a common scenario in Medicine, more particularly in bigger institutions where people do not know one another. None of us took the time to consider the bigger picture, or to care for her health and well-being – as none of us took the time to take care of ourselves either. And how often does this happen in medicine when one part of the team is not doing well and the rest of the team instead of coming in to support and care simply judges and gets impatient? Continue reading

Why don’t we speak openly about doctor suicides?

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Just over a week ago, I read an obituary in a medical publication about a young talented and clearly lovely junior doctor (not pictured above). Her life and achievements were celebrated, but naught to mention was made of the cause of her untimely death. Some colleagues and I surmised it was suicide, but then we wondered why it was it was not mentioned in the obituary?  At the time it felt as though there was an embargo on talking about doctor suicide, and we wondered why. There is a shame about discussing it in public, and if this is the case then how can we possibly learn about the things that lead to suicide in our colleagues? We discuss medical cases openly so that we might learn, but why not of our colleagues who reach a point of no return? Subsequently it has been confirmed in the media that the death was indeed a suicide, but it was not mentioned in the medical publication.

It is well known that doctors do have a higher rate of suicide than the general public. These results have been reported as being up to 5.7 times higher than the general public, with female doctors being at the greatest risk, with rates between 2.275.7 times higher than the general public. 

These results are quite staggering, but to speak truthfully, the fact that we have suicide at all in the profession is indicative of a deep dis-ease in our profession.

It concerns me to question:

How is it that can we have people who are caring and sensitive by nature, who choose to do medicine to care for people, ending up so despairing of life and caring so little for themselves that they take their own life?

And worse, that their colleagues and medical friends do not notice their decline to that point and are often completely surprised to hear of the death of a colleague in such a fashion.

How can this possibly occur in a system about health ‘care’?

These suicide statistics have been known for some time yet until now, no true action has been undertaken.

The NSW Health Minister has now instructed his staff that they have 1 month to find a solution to the doctor suicide crisis. It is great to see urgency brought to this matter, but is 1 month really enough and will it really get to the root of the cause? Continue reading

Medicine is about Relationships

In our training, we are taught that medicine is about facts. It is about figures. It is about classifying and diagnosing diseases. It is knowing the right treatment. It is about knowing the side effects.

But Medicine is all of those things, but that is not the heart of medicine. Over and above all medicine is about people, which means it is about relationships.

Sound strange to consider?

People come and see us, and we see people in the hospitals and the health care industry. We don’t see ‘illnesses and diseases’, as much as we learn to see people as those particular categories. We don’t see machines who automatically follow instructions – people come with their different understandings and approaches to health care. There are many facets to the people that we are seeing, and if we are not connecting with them and building relationships, we are not going to be able to communicate with them, and they are not going to be able to freely communicate with us.

How we relate to people is at the heart of how well we are able to practice medicine. The thing that hurts us most in life is how poor our relationships are or when there are relationship breakdowns. Medicine is no different and people are no different when they are seeking health care.

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To medicate or not to medicate. That is the question. Or is it?

In modern day times, pharmaceuticals have become the centre of medical treatments. We learn and indeed expect that when we go to a doctor that we will receive a script recommendation for a medication, a pill, to treat our ills. Many of us want that unquestioningly, want that little small thing to make the problems go away, and on the other hand, many of us are increasingly suspicious of medications. Some of us want medications, are in search of that little white pill to cure our ills, and then many of us do not want to take medications, no matter what, in fear of side effects.

These positions bring to light certain questions:

  • There certainly can be many side effects from medications. But are we to avoid them ‘no matter what’?
  • Is there in truth a place for medications in the management of our health? Or are we putting our health at risk by not taking medications?

People are not really ambivalent about taking medications, they are absolutely polarised.

I see people who want medications, and then those who refuse to take medications, and then there are of course those who have side effects to all medications, and then those who have no side effects to any sort of medication. Strangely, I don’t see people who are ambivalent about taking medications!

Our response to medications appears to be quite an individual thing, as much as our attitudes towards taking medications and this is to be respected and understood.

But what’s behind our desire to not take medications at all?

Whenever I prescribe medications, one of the common responses I hear is people tell me that they are ‘going to rattle’. Yet, medications are usually smaller than the proverbial tic tac – and people aren’t worried that they will rattle when they take tic tacs…… we happily have tic tacs, or other forms of food, several times a day with no issue, yet we resent having to take medications several times a day, or even once a day……..

So I wonder, what is it that underlies our relationship with pharmaceutical medications and what sort of ‘medication’ are we really seeking? Continue reading

Doctor Burnout. A World Wide Epidemic.

Burnout is the modern day pandemic affecting the medical profession. It is a condition that many of us are still in denial of. After all, it can’t be seen on a biopsy result or under an electron microscope, so how real can it be?!

Very real.

Up to 59% of doctors are burnt out, and the rates of burnout have increased over the last 10 years. It would be unlikely to consider that this is simply because there is greater awareness of the condition.

50% of medical students and 70% junior doctors are reported to be burnt out.

This is staggering, and these results are across the board globally. Not just the USA and not just UK. These are overall global professional rates of burnout and the rates are deeply alarming.

Even if we had 30% of the profession suffering from burnout, this would still be a pandemic, yet there is not the global attention to this matter that it deserves.

If there was an outbreak of influenza or a critical disease globally that was wiping out even 5% of people and removing them from the work force, there would be a world wide inquiry.

Yet here we have matters where there are 59% rates of burnout, over half of the entire medical profession, including students, and there is no world wide inquiry into what is going on in medicine.

Certainly there is no vaccine likely to be available, but the matter is critical.

Ought not the World Health Organisation be taking a key interest in this matter?

Ought there not be a global inquiry into the culture of medicine and the attitudes of medicine towards doctors and health care professionals? Continue reading

What is ‘care’ in Healthcare?

 

When we are trained as students, we are trained to present a ‘caring’ front to patients, to be seen to be ‘caring’ and to be ‘caring’. But we are not really taught what care is…. I recall being told to show sympathy and empathy to people in their situation, told to say ‘the right thing’ to express ‘concern’ which made me profoundly exhausted and did not hold the person I was with in equalness. But sympathy and empathy are not care. They are reactions to care.

The sort of people who do medicine are on the whole innately ‘caring’. It is a quality that we can all feel.

I recall the first day of medical school and the first years of medicine being so impressed at how interested my colleagues were in people, about understanding people and about caring for the people with illnesses and disease who came to visit us and teach us about health, illness and disease. They inspired me. I like many others found it quite overwhelming to see the vast extent of human suffering and distress, and did not know how to handle that with my deeply caring nature. I felt that I needed to be able to fix everyone and take away all of their suffering. That was a big burden to carry, and one that I know many doctors do.

I then watched many of these same caring people, who were so interested in people, move away from people oriented professions in medicine, seemingly suffering ‘caring’ or ‘compassion’ fatigue, finding it overwhelming to spend so much time with sick people.

I have spoken to several colleagues and read many shared stories where people have either left medicine for ‘survival’ reasons, or chosen professions where there is less contact and less ongoing ‘care’ for people as a survival thing. It is well known that the burnout rate is far less in professions where there is less ‘patient’ contact.

This is disturbing and a shame, because medicine is about people, and if we cannot be with people without getting exhausted or overwhelmed then there is a real issue.

If we are not taught how to be with people in a way that does not exhaust or overwhelm us, given that everything about medicine is about people, then we are missing something fundamental in our medical training.
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Medicine in the age of technology. Does the personal matter?

There is much talk about ways we can reduce the costs of health care and to ‘streamline’ health care. There are some conversations that are happening about people putting symptoms into machines to generate diagnoses and then generate a treatment algorithm instead of seeing a doctor. This would of course make the cost of health care cheaper by eliminating the role of the physician, but is this really the best practice of medicine?

Can computers and algorithms really replace the role of doctor, or even nurse?

Even if it would reduce ‘costs’ by eliminating the personal contact in medicine, is this really the way forward in medicine?

Would it offer better patient ‘care’?

Would it even offer better patient ‘diagnosis’?

Many patients come to see me having put their symptoms in a symptom checker online only to be freaked out by the potential of multiple serious diagnoses, only to then find when they see me that they have something quite simple and nowhere near as severe as the symptom checkers had lead them to believe.

It takes skill, connection and experience to diagnose what is happening in a person as no two people have the same presentation of an illness and disease.
Continue reading

Competition in Medicine. Who does it serve?

To get into medical school we learn that we need to ‘compete’ with others, that ‘competition is fierce’ in order to get into medical school, and ‘being ‘competitive’ is seen as being a very good thing.

But is this really a trait that is desirable in a physician?!

Being a physician is about being with people. It is about dealing with people, it is about caring for people – it is not about competing with people!

So why is medical school set up in such a way to foster and encourage competitiveness from a young age?

Do we really need to inspire this sense of ‘competition’ in people so that they will learn and do well?

Do we need to inspire people to try and ‘do better’ and ‘be better’ and beat others irrespective of the topics at hand?

Do we assume that people will be too lazy to learn or pay attention unless they need to beat others?!

And moreover what does this mean when these particular traits and characteristics are carried over into medical school and then into physician life once one has graduated and entered the treadmill of life? Continue reading

How at risk of suicide is your doctor?

Did you know that doctors have a higher rate of suicide than the general population? With the highest rates of burnout than any other professional group? 85% of students and 41-60% of doctors.

That’s right, your health care professional is 1.1-5.7 times more likely than you to commit suicide (1).

How is it that our health care practitioners are so distressed that they not only want to but actually follow through and kill themselves?

When you consider the sort of people who start medicine are truly and deeply caring, what goes wrong? What happens?

Do people start out medicine wanting to kill themselves and that’s why they choose medicine?

Surely not……!

Or is the health care system so abusive towards those in medicine that the inordinate amounts of stresses and strains create isolation and distress and pressure that leads to self harming and self destructive behaviour and ultimately the final act, of removing ones self from life?

Much has been written on this subject. People are supposedly ‘unclear’ about why it is that our health care professionals are killing themselves, tending to blame the characteristics of the sort of people who choose medicine for not ‘stacking up’ to the pressure of everything that is entailed in medicine.

Women in medicine are particularly at risk of suicide, at between 2.5-5.7 times higher rate than the general population. (1)

Its easy to victim blame, and to say ‘oh they couldn’t cope’ or ‘oh they were too sensitive’, but instead of victim blaming, perhaps we ought to look at the system that these people are placed in. Continue reading