In the last few months I have been involved in teaching medical students because in the next 10 years I would like to give back some my learning through clinical experience back to the next generation of students and doctors. My wife and I are both doctors and we have looked back on our younger selves with compassion in relation to our witness of suffering, sickness and death of our patients. I feel a need to protect doctors from the future trauma they will face as hospital doctors.
The assumptions are that
1. Medical school selection has chosen the people who will cope with human suffering and decision making whilst exhausted from lack of sleep.
2. Doctors and medical students will be able to get help when the time arises
3. Doctors and medical students are in some way above it all.
We are seeing about 30% morbidity with depression in doctors and medical students. In the medical news in the UK there are reports of hundreds of doctors consulting with their GP each week about depression and anxiety each week. At this rate virtually every doctor will be having this important consultation. When people have thoughts of suicide, they often want something to change. With the prospect of financial crisis in the UK and the prospect that government will not be able increase resources in mental health, it is down to us to learn how to remain healthy at work. This shared responsibility in the medical profession needs to be thought about and talked about at work and in training.
Harvey, Epstein, Glozier at al 2021 in The Lancet have reviewed the matter of mental illness and suicide among physicians.The teaching point here is that in adult suicides the male to female ratio is 4:1. However for the suicide of doctors the ratio is actually 2:1. This information is important because it highlights some vulnerability for women. how do we understand this matter? Furthermore there is no data on near misses which lead to doctors seeking help or a change of life away from their current job.
Themes I want to pick up on here are
1. Impotence in a political sense, with managerial and admin dominance
2. Burnout and moral injury
3. Conforming doctors to the tasks of the production line model, such as prescription writing
4. Devaluing doctors whilst overvaluing less trained professionals
5. Emphasis on process and rules, whilst overlooking the relationships, such as the consultation with patient and with each other professionally