Mental Health and Medicine
At the beginning of his or her career, every doctor or medical student naturally searches for role models within the field. Unfortunately for me, the only name I could think of on my first day of university was House, the world’s most famous television doctor.
He is cold and calculating, a lone wolf and an uncompromising clinical genius. In short, House is everything a doctor should not be. His evident skill in making clinical diagnoses does not make up for his disrespect and cynicism towards his patients and colleagues.
If we picture ourselves walking into a room of successful doctors, we naturally expect them all to be experienced and qualified. We know they have saved lives in the past. If we were to collapse in the middle of the room, we would expect every one of them to put down whatever they were doing and rush to our aid. The patient always comes first.
The medical community has worked especially hard over the years to build a rapport with its patients. We trust doctors enough to share our concerns with them and we expect that they will listen to us.
But behind the label of their profession, it is easy to forget that doctors have pressures of their own to deal with. Medicine is a stressful occupation, and the wellbeing of doctors and medical students themselves has become a cause for concern.
Mental illness in Australian doctors and medical students
A 2013 survey by beyondblue showed that doctors and medical students in Australia experienced significantly higher rates of mental illness and distress than the general population. Young doctors and interns in particular were more susceptible to mental illness, while female doctors reported higher levels of distress, depression and anxiety than male doctors.
Figure 1: Levels of very high psychological distress by gender in doctors, the Australian population and other Australian professionals aged 30 years and below
Work-related stress may play a key role in this. The study found high rates of burnout in doctors, often associated with high responsibility, high workload, and long work hours. Young doctors were more likely to experience burnout, which suggests that inexperience may contribute to dissatisfaction and a feeling of being ‘overworked’.
Figure 2: Burnout in the domains of emotional exhaustion, cynicism and professional efficacy, by age group
The 2013 beyondblue survey was one of the first large-scale studies done on mental health specifically within the medical profession. While further research is needed to reinforce these findings, the survey only adds to the growing evidence that mental illness is a problem within the medical community.
The doctor becomes the patient
The National Mental Health Survey found that while doctors were generally able to cope with high levels of stress and seek therapy when needed, stigma was common. Prevailing attitudes included the belief that doctors with a history of depression or anxiety are ‘less competent’ (40.5%), or that their mental illness is a ‘sign of personal weakness’ (44.8%).
Stigma is arguably the single greatest obstacle to overcoming the mental health crisis in the community, and the medical profession is no exception. The central problem here is an underlying, traditionalist belief that doctors who are struggling to cope should simply ‘suck it up’ and carry on. The idea that mental illness is a sign of incompetence and weakness is dangerous, especially for young doctors, who are most vulnerable.
The culture of the medical community is one of self-sacrifice and resilience. It is a culture where young and inexperienced doctors may feel like they have to endure personal distress without letting it affect their work. It is a culture where good doctors are expected to always be at a patient’s call. The patient always comes first; the doctor’s own problems are secondary.
This philosophy has been the pillar of medicine for over a century. But it may be doing more harm than good.
The attitude of putting your own mental health aside may work for a handful of brilliant clinicians who are experienced and are well-renowned in their fields. But for the average medical student, intern or junior doctor, self-sacrifice alone is not an adequate coping mechanism. Many, if not most, will be faced with levels of stress and emotional upheaval they have never experienced before.
Providing a safe space for doctors and medical students to talk about their problems is essential; it is the only way that we will break down the myth that doctors who experience psychological distress or burnout are less capable than others. Young doctors and students may also require extra support in the early stages of their career.
Ultimately, the medical community must learn to treat the welfare of its own workforce with the same level of commitment that it delivers to its patients. Failure to do so represents a failure of the medical profession, and brings irreparable harm to both doctors and their patients.
If we truly want our doctors to be able to help our community, this is something we simply cannot afford, and we must work hard to prevent such a failure, before it’s too late.
The views and opinions expressed in this article are those of the author and do not necessarily represent those of the Doctus Project.