Things That Doctors Do Terribly

At the same time as articles hyperventilating on the robot future that will replace squishy humanoid doctors appear as regularly as each new moon, it has never been more apparent to me that I will be seeking personal interactions in my own care for a long time yet. When I visit a doctor I value the recognition of all of me that is beyond my ailment just as much as their accuracy in guidance and diagnosis. I hope I offer the value of shared humanity when I care for patients too.

The robots we have just don't seem that caring. [via flickr.com]

The robots we have just don’t seem that caring. [via flickr.com]

The need for humanity as we look out for each other was driven home by an entirely different story this week. The death of Robin Williams and the ensuing grief and reminiscence has brought much to light. The need for a deeper understanding of depression has been a recurring theme in coverage. And when I read this coverage I am embarrassed at how poorly I understand something that is so common. Anyone with medical training should leave their undergraduate training with a deep and useful knowledge with which to provide help to those in need. I’m pretty sure that is not the case. I’m sure because doctors don’t even look after their own who are struggling with mental health issues.

 

The Invincible Doctor

A culture of denial of health problems or any form of weakness is a big hurdle to doctors seeking help when they need it.  But more and more evidence points to significant issues with anxiety, depression and substance abuse in doctors everywhere, including Australia. A survey released by Beyond Blue in 2013 revealed around 10% of doctors responding had suicidal thoughts in the preceding 12 months. Doctors reported substantially higher rates of psychological distress than the general population and other Australian professionals. The difference was most marked in doctors under the age of 30. That’s our next generation of healers in distress.

This is not unique to the Australian medical landscape. Similar problems are being reported in the UK. Medical training is no defence against the grim dog of depression or any other mental illness. It does not guarantee insight into what is going on. Nor does the medical training of those around you guarantee that they will understand what it might be like to be drifting inside that cloud. I have heard too many doctors make the mistake of expressing depression as just a matter of ‘getting over it’. Point them at any other disease and those doctors would try to understand the underlying pathology that leads cells or systems to malfunction. Until physicians truly accept that this is a disease like any other that inflicts real pain and disability in all its terrible manifestations, how will we get close to making our responses better?

 

Big Hurdles

The barriers to doctors seeking help are easier to understand. The stigma attached to mental illness clings just as stubbornly inside medical circles as outside. Doctors voice fears that their career will be over if they confess to mental health issues, a worry made all the more pressing as you imagine what would happen if patients or colleagues found out. Add a temptation to self-manage and doctors are just as likely to need multiple approaches to seek help as any other affected individual.

What is steadily improving is access to help. Most societies and specialty colleges provide resources addressing this and guidance as to what can be done. It is not hard to find confidential help and treatment from groups like the Doctors’ Health Advisory Service. From medical school onwards, the importance of having a relationship with a general practitioner is strongly emphasised.

But we’re failing each other. At a personal level we’re not doing a good enough job of helping colleagues who need help. I sat down and counted. Almost every year of my professional life I can recall a story circulating of a health professional in distress. Too many of those stories have ended with suicide.

We’re too often failing colleagues and we’re too often failing patients. So it is well and truly time I tried to gain some of the understanding I should have left university with.  I plan to start by listening to those who can teach me. I aim to absorb as much advice as possible from those who have been there. And then I hope to be ready to help every time I can. It is surely the least a human doctor should do.

 

More reading:

In trying to explore this, I’ve found all of the following bits of writing (in addition to the link above) extremely helpful. I’d be very happy to be shown more. 

http://www.kingstribune.com/index.php/weekly-email/item/2070-quarantining-depression

http://blogs.telegraph.co.uk/culture/jamesrhodes/100075913/robin-williams-dies-depression-is-a-cloak-of-lead-a-toxic-second-skin/

http://junkee.com/we-need-to-talk-about-mental-illness/39402

http://hyperboleandahalf.blogspot.co.uk/2011/10/adventures-in-depression.html

http://www.lettersofnote.com/2009/10/it-will-be-sunny-one-day.html

 

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4 thoughts on “Things That Doctors Do Terribly

  1. Is there a stigma associated with people suffering from mental health issues because we don’t fully understand how and why the various types of mental illness occur?
    I take your point that graduating from formal education and feeling that you’re properly equipped to factor mental health into your other considerations would be the best outcome.
    I also recognise that it’s hard if you’ve never experienced depression (in particular) to question why people can’t just cheer up – the sun’s still shining, after all. But it doesn’t work like that. The masks people create, the personas they assume to face the world and hide what they’re really feeling inside can be an impenetrable barrier even to people who know them well. Is this a possible reason why more emphasis isn’t given on how to factor in mental health concerns with other medical considerations? Your teachers don’t fully understand &/or appreciate the pervasiveness of mental illnesses, so it’s not adequately covered?
    I heard recently (I think on RN Breakfast) a report that mental health workers are stressed out because they’re far more likely to be attacked at work than pretty much any other profession. If (e.g.) police officers were being physically assaulted to the same extent, there would be a public outcry. I think this story on The Age’s website is basically the same one I heard being spoken about:
    http://www.theage.com.au/victoria/one-in-three-mental-health-workers-attacked-report-20140807-101lg6.html
    Then, of course, there’s drug use – prescription or otherwise – which can further complicate matters.
    I used to wonder why every time someone famous committed suicide the media would say ‘there should be more open discussion about this topic’. I’ve only just understood that they didn’t mean ‘let’s talk about the person who just died’; the message was ‘let’s do something to reduce the stigma, be more understanding and supporting of our family/friends/peers and prevent the next person taking their own life’.
    Thank you, Andy, for being a caring, human doctor.

    • Thanks for the thoughtful response Dayna (and sorry I took a while to respond).

      Momentum is building for the health profession to address these issues better amongst colleagues. I think the broader problem is that it isn’t dealt with well in society. Seeing as doctors and other health types are just people, the same applies.

  2. I have been working as a consulting psychologist for a relatively small rural community for nearly twenty years. Following the retirement of one and the medical collapse of another general practitioner some years back, my closest communities were left with no doctors. On a personal level my father was dying during this period of some 11 months where there was no care available. So I jumped ship from caring for my community as a therapist and took on the challenge of helping another general practitioner heading toward retirement phase to work out how to keep two medical practices in rural Australia going rather than run the risk of seeing those communities lose doctors again.My job is to care for my principle doctor and keep her going and keep the values and care she has given the community for 30 years going….even when she goes. One of the greatest pleasures in my job is seeing her relaxed and happy. It is by no means all my doing, but when I took the job nine months back, that wasn’t something I saw a lot of. She didn’t have time to herself,wasn’t sure about how succession would work, she was first port of call for every complaint, problem and every concern from her staff, suppliers and patients alike. She was on ask for every fund raising and function her community held, grizzled at or about by staff and doctors thinking they were worth more than they were paid or hadn’t been given enough of her time and she had little time to spend with those she cared most for.
    Sometimes we just don’t care enough about the people who do the caring. We don’t see them as people, we see them as what they can’t or won’t give us not as what they do. I frequently would like to tell people to hold on, give the person a break when one more ask or one more issue heads her way. I would like her to be able to go into work and have nothing more on her mind than the total focus and interaction that best meets a patients’ need. I’d like her community to really care and understand that it can’t keep trashing doctors and care workers. That to be cared for means caring how your carers are fairing, seeing when they need a break, noticing what makes it easiest for their day or preferred way of working to happen. So often we slot people into roles or hours or circumstances that aren’t healthy or helpful . We see them do things that we know aren’t how they usually operate and we fail to say how’s life.you look stressed. What can I do to help? When we fail to care for our carers we are in great strife. We give out the PPE gear to protect them from a bug but fail to see the signs of them not thriving in their role.
    Put people around you who share your passion and have your best interests at heart, be caring and compassionate to yourself, love and enjoy your patients and forgive them and yourself for any shortcomings .We need as carers to be the role models others need , we will get tired and frustrated and annoyed at times but we moderate that with skills to sooth, calm, and sort out those frustrations and anxieties. If we can’t do that for ourselves we can’t do it for our patients. Ainslie Meares and Robin Youngson are well worth reading.

    • Thanks for sharing a story from one seriously pointy end and for the more than valuable insights. I’m lucky enough to see plenty of patients and families recognise the work of health staff. Definitely need more work on looking out for ourselves and others. Those are, after all, the ones we spend the most time working with.

      Thanks again.

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