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. ...continue reading →
Amy Gajaria is a third year resident in the Department of Psychiatry at the University of Toronto
Last week was the first snowfall of the season in Toronto. Usually, the first sight of fluffy white flakes collecting on city streets would have me dreaming of strapping on my cross-country skis. This, year, however, the first snow left me huddled inside, frightened of slipping on ice.
Towards the end of September I badly damaged my ankle when attending a charity event. In a few moments I went from an active 30-something to someone unable to stand independently. After the paramedics got me to the nearest hospital, the first thing that popped out of my mouth was not “pain medication STAT” (that was the second thing), but instead “I’m a doctor. I hate being a patient.”
I later told myself that this was because I wanted to speed up communication and avoid unnecessary explanations. ...continue reading →
Dr. Sabine Ziegler is a general practitioner with an interest in palliative care, practising in Ettlingen, Germany
For readers from Canada, a "mother land" of physician health, my reflections on physician health in Germany may surprise; the structures in Germany are not nearly as well developed as in the USA, Canada or Great Britain.
Doctors in Germany can prescribe and self medicate without any consultation or assessment by a colleague- which means drug misuse, including benzodiazepines, is possible. Long working hours, high professional responsibility and little recreational time lead to a large percentage of doctors feeling physically and psychologically affected. On top of that is the constant confrontation with suffering, fear and death. Doctors also often crumple under the high demands they create for themselves. It doesn't fit with a doctor’s self-perception to seek help for their own problems. Yet when a sick healer tries to cure himself most of the time it doesn't work. Every year around 150 German physicians end their lives. ...continue reading →
Professor Dame Carol Black is Principal of Newnham College Cambridge, Expert Adviser on Health and Work to the Department of Health, England, Chair of the Nuffield Trust, and Chair of the Governance Board of the Centre for Workforce Intelligence. She was a keynote speaker at the recent International Conference on Physician Health
Whatever the nature of their work, whatever skills they bring to bear, however strong their calling and dedication, employees come under the influences of their workplace and of those who employ them. It is as true for doctors as it is for the drivers of tube trains, the builders of Olympic stadia or civil servants in Whitehall. The evidence, gathered painstakingly over many years, in such different arenas of work, is consistent and strong. It leaves no doubt about the characteristics that we look for in identifying good work and a good workplace.
The effects of workplace influences are felt and measured to varying degrees in ways that are clear. First is the personal health and wellbeing of employees – their physical health and their mental health, the former often measurable declared, the latter often masked and hidden.
Second is the performance of the group, the team, and ultimately the institution for which they work. In health care such performance is measured in terms of the quality of patient experience, the safety of care and health outcome.
These measures correlate with features common to organisations which have achieved success in promoting staff physical and mental health and well-being. ...continue reading →
Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
“It was the loneliest I’ve ever felt,” said my consultant surgeon colleague as he described lying in his hospital bed the night before cardiac surgery. Even with all his surgical experience, familiarity of the surroundings, knowledge of his own hospital, and utmost confidence in his cardiac surgical colleagues and anaesthetist, he was scared. Despite what our patients might think, being a doctor is no defence against illness and doesn’t make coping with illness any easier.
But, we are our own worst enemies. We put immense pressure on ourselves and don’t want to let our medical colleagues or patients down. I once listened to a single-handed rural GP who had recent chest pain and was awaiting an angiogram. His greatest worry was that he could not get a locum to cover his patients ...continue reading →
People sometimes ask me whether doctors are any different from other people when it comes to their mental health. Do they suffer more or less? Do they have different disorders and distress? The truthful answer (as with so many human questions) is a bit like, “Yes and No”.
Of course doctors can have physical and mental health issues, but this fact is often hidden from public view. Mental suffering in particular is a clandestine experience, and disclosure is especially hazardous for doctors, since it adds professional jeopardy to their burden of shame and guilt.
Awareness of doctors as human beings with real personal problems and stresses is not widespread ...continue reading →
Trisha Greenhalgh is Professor of Primary Health Care and Dean for Research Impact at Barts and the London School of Medicine and Dentistry, London, UK
The Professor of Trauma Surgery texted me: “Can I come and see you today please?”
I had started work at 8 am and it was already 4.30 pm. I had four more meetings in my diary. But he had never asked before, so I decided it must be important. I texted back: “6.30 in my office, if you’re still around.”
He was early. I buzzed him in, and asked wearily, “How can I help?”. We overlapped on a committee so I assumed he wanted to talk business.
Dr Andrée Rochfort is Director of Quality Improvement at the Irish College of General Practitioners, Dublin
I frequently wonder how we can best prepare young doctors for their future medical roles and responsibilities, and how we can best support those already doing the doctor job.
We set out to care for others, to help others, to help others recognize their options and choices. We are set apart from patients during training. We learn to feel the expectations that “others” have of us; our peers, other health professionals, managers, professional bodies, medico-legal bodies, media, patients, patients’ relatives, our own relatives and non-medical friends. To this mix add in our self-expectations of ourselves. Combine these ‘perceived pressures’ then add our intrinsic sense of perfectionism and our pledges to others to do everything possible and we have a recipe for internal conflict! We feel guilt and failure when we cannot deliver perfect care with the selflessness we believe is expected of us. In reality we have to remember we are ‘human’ and we cannot work miracles. We do not have a magic wand. ...continue reading →
Declan Fox is a Family Doctor in Tignish PEI (that's Prince Edward Island, Canada, for international readers)
How did I get here?
With apologies to Talking Heads, I wonder sometimes, myself. How DID I get here? Resurrecting this family medicine practice in Tignish, PEI, is what I'll be doing for the next few years. At the ripe old age of 59 I'm taking on something I wouldn't even have attempted 25 years ago. And I'm doing it 2500 miles away from home in a health service that is very different from the UK NHS I once loved with a mighty passion.
So what's so great about moving to Tignish? A little history might help. 17 years ago this month I was mooching around home, three months after a suicidal breakdown due to my second bout of major depression. ...continue reading →