Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
They found the body. A short paragraph buried in the newspaper. Dr Rose Polge left her hospital shift two months previously and had not been seen since. Her car was found parked by the sea.
A young doctor took her own life. I wanted to write about it at the time but it was difficult to find the words. It seemed to me a tragedy, a great loss of a young life full of potential. But, these words cannot capture quite what I felt. Where have we gone wrong?
It brought me back. I remembered my first year after qualification. It was brutal; a shock. Suddenly I felt I carried all the responsibility. I saw seriously ill patients in the middle of the night and had to make critical decisions. It was a small hospital. I was the cardiac arrest team. The tiredness was unrelenting, the gnawing anxiety continuous. Weekends that stretched from Friday morning to Monday afternoon, watching nurses changing shift, porters going home, and the outside world passing by in a haze. But, I wasn’t alone – my colleagues felt the same. Life would improve and we would change the system for our successors. Life for young doctors would be different when were older.
And now we are older. The life of a junior doctor has improved, but it’s still tough. The shifts are shorter but the work is endless. We looked after patients that we knew, but now junior doctors are expected to provide cover for their colleagues for scores of patients they have never met. While we had some comfort and community with a doctors’ mess, they now rarely have time to rest and often no access to cooked food. And now the Minister of Health in England wishes to impose a 7 day working week. Doesn’t he appreciate that junior doctors already work a seven day week? There is support for juniors from older colleagues but I don’t sense the visceral anger and passionate backing that I believe should be expressed by my contemporaries.
Its more than just a question of junior doctors’ industrial action. Ultimately there will be an agreed solution but we need to explore beyond the contract. We need to rethink how we can support our junior colleagues in the hugely difficult transition from student to clinician. Its not just about providing resilience training, its about redesigning the system. We also need to discuss more openly the pressures and difficulties faced by junior doctors. The general public have a slightly distorted and idealised view. These young doctors do have the world at their feet. And, yes, they do have a job that’s both valued and attracts personal and professional rewards. Yet for most junior doctors it is a difficult and traumatic transition. These are the high achievers who always stood out at school, they were a recognized group at university, and many are socially and educationally privileged. But they are now faced with long hours and the loneliness of critical decision making in the most difficult circumstances. Overnight they take on unaccustomed responsibility and are expected to adapt immediately in an environment where they have minimal personal control. A lucky few adapt easily and most struggle through, but some battle emotional stress, physical exhaustion and depression, and a few simply cannot cope. We need to care for these young doctors and help them to better look after themselves.
We said we would never inflict this life on anyone else – remember?
I had to drop out of Medicine after a couple of years in the late 197Os. I was OK when part of a team but not when left alone for the endless hours you describe, with what seemed to me to be impossible responsibilities. I became severely mentally ill. In retrospect I think lack of sleep played a part too. Rose’s story is terribly sad. As you say it shouldn’t still be happening.
What would have helped me (and did for the short periods when it was possible) was working alongside a more senior colleague, learning and being encouraged and supervised to do new things, and absorbing some of their confidence. Juniors should not be expected to perform a procedure for the first time alone ( as I was with a LP).
Could junior doctors at least have a mentor, or someone to take a kind interest in them, with whom they can talk over their worries and doubts?
Can they always have someone more senior to contact for advice when on call without that person being annoyed?
Could they be given some guidance in their final year about how to deal with the stresses and responsibilities? And could they be told that some people might find that the job is just not for them, and that there is no shame in giving up Medicine and that life doing something else is possible and perfectly OK. After all the decision to study Medicine was probably made in their mid teens.
Could nurses try and be kind – it makes such a difference to receive a bit of kindness rather than ‘well you’re the doctor – get on with it’.
Could there be a helpline for junior doctors who feel in crisis?
Poor Rose. I know too much of what she might have been going through. I am so sorry she felt so alone and unable to tell anybody.