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 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?
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.
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.