A junior doctor in Sydney writes about the crushing pressure experienced by doctors in training.
In the year it has taken for me to complete my training as a junior doctor three of my colleagues have killed themselves.
These are just the ones I've heard about.
I've read articles that refer to suicide among doctors as "the profession's grubby little secret" but I'd rather call it exactly how it is – the profession's shameful and disgusting open secret.
Medical training has long had its culture rooted in ideals of suffering. Not so much for the patients – which is often sadly a given – but for the doctors training inside it. Every generation always looks down on the generation training after it: no one ever had it as hard as them, and thus deserve to suffer just as much, if not more.
This dubious school of thought has long been acknowledged as standard practice. To be a good doctor you must work harder, stay later, know more, and never falter. Weakness in medicine is a failing and if you admit to struggling it's thought that you simply couldn't hack it. In the cut-throat, brutal culture of medicine, many junior doctors stay stoically mute in the face of daily, soul-destroying adversity. In these worst cases, their loudest gesture is deafeningly silent. The thought of years of knowledge and training being used for such purposes is not only sickening, it is heartbreakingly sad.
Extremely long hours, little financial remuneration (particularly while training), discouragement to claim overtime, and extreme shortage of training places leave many doctors of my generation feeling as if we don't have many options.
Colleagues compete with one another because it's how we have been conditioned to behave – we all know one bad mistake or disagreement with an important superior is all that it takes to end a career you've already devoted seven-plus years of your life to, and you haven't even really started yet.
To not "specialise" is seen as a cop-out – anyone who openly admits to wanting a more lifestyle-friendly medical career path is more often than not looked down upon. You're left feeling much of the time that whatever you do it's simply never going to be quite good enough.
When I asked my friends who are not doctors whether three people in their cohort had killed themselves in the past year, they looked horrified. There would be some kind of inquiry, they said, an investigation, some action. Some kind of introspective analysis into their workplace that tried to find some kind of answer for what had occurred. Doctors tend to receive an email from our management with a link to a counselling service, and then we go to work and pretend as if nothing has happened.
No doctor I know, particularly juniors trying to pass exams and get into training programs, would ever voluntarily seek help, because they are afraid of being labelled as weak or not coping.
Junior doctors are called the backbone of the medical profession, but at the same time it feels all too often as if we are its collective punching bag. We are told from day one we must always be extremely polite to nursing staff – whom I have witnessed belittling interns and residents without consequence. We are expected to work well beyond our rostered hours. We are told we must pay thousands of dollars for courses and exams and further our knowledge – but we are all too often humiliated by our seniors in high-stress environments because, for all the things we know, we can never know enough.
When I think about all the things I have learnt at the end of my training, one stands out very clearly. There is something rotten inside the medical profession that has been festering for a long time. There is no realistic cure. The statistics about doctor suicide and mental health have been clear for years and yet our responses and solutions feel perfunctory at best and shameful at worst.
Most junior doctors feel the same as me – that things won't change and that there's no point in really trying.
I don't want to get "doctor suicide fatigue" where another death is not a tragedy but rather an unpleasant expectation. When a patient dies unexpectedly at my work there is an investigation and a debrief and somebody writes a report and steps are put in place to ensure this doesn't happen again. Where is this investigation when a doctor dies?
Junior doctors deserve better than what we are being given. It is time for the medical profession to look deep inside itself and fix the cancer that has been growing for far too long. If they don't, the cost is simply too high.
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