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JUNIOR doctors and medical students believe they may be labelled as failures if they seek help for stress or mental illness, but the medical culture is gradually changing for the better, according to groups representing junior doctors.
Robert Marshall, president of the Australian Medical Students’ Association (AMSA), says one of the barriers to seeking help is the fact that the doctor a medical student could turn to for help was often the student’s assessor and future colleague.
“People don’t want to be tagged as someone who is not coping,” Mr Marshall said. “Medical school is generally collegiate, but there are a lot of A-type personalities who want to achieve, and want to be seen to be achieving.”
Dr Michael Bonning, chair of the AMA Council of Doctors in Training and a board member of beyondblue: the national depression initiative, agreed that some young doctors unfortunately believed that seeking help is an “admission of failure”.
Their comments come in response to an article in the MJA, which describes a support program for junior doctors at Royal Melbourne Hospital. The program, which was introduced after the suicide of a surgical registrar in 2006, aims to identify “at-risk” young doctors and refer them to appropriate specialists. (1)
The authors, from the Royal Melbourne Hospital, wrote that one of the key lessons they learned in implementing the program was that “junior staff are extremely reluctant to seek assistance for fear of harming future career prospects”.
The AMSA says there is a need for more education on student health and wellbeing in medical schools, and has released a guide that aims to provide practical advice on wellbeing. (2)
The guide was created in response to AMSA research that found 55% of medical students believed there was a stigma associated with experiencing stress or distress, and 72% perceived a stigma around mental health. (3)
The AMSA said there was a body of research which showed that although medical students exhibit similar psychological wellbeing to other students before medical school starts, this lowers during their studies.
Despite the challenges, Dr Bonning believes the stigma associated with seeking help is gradually reducing, especially as doctor wellbeing and work‒life balance has become a cause du jour for many medical organisations. “That makes it a bit more of an approachable issue for people,” he said.
Dr Bonning said that doctors who spoke out about their workload or stress issues encouraged others to do the same. “I’ve seen with my colleagues that it often takes one or two people to be a ‘lightning rod’ to encourage other people to talk about the pressures they’re facing,” he said.
He said the culture of medicine is also changing for the better, with more doctors of all ages seeking a work–life balance. He called for more research on the impact of reduced work hours, particularly on patient outcomes. “We are an evidenced-based profession so this should be based on evidence too, not just opinions,” he said.
beyondblue has also developed a specific Doctors’ Mental Health Program because research had identified high rates of mental illness within the medical profession. (4)
– Sophie McNamara
1. MJA 2011; 194: 466-469
2. Keeping Your Grass Greener, a guide to medical student wellbeing NOW!
4. beyondblue Doctors’ Mental Health Program
Posted 2 May 2011
I’m extremely heartened to see Australia’s medical culture taking a more proactive stance on the mental health and well being of students and junior doctors. During the late 90s, I was in a same-sex relationship with a University of Western Australia med student. There were many stresses within our second-class citizen lives. Not least was the verifiable fact I was being victimised and tortured by personality disordered homophobic employees of a business which was adjacent to my home — the place where my med student boyfriend and I conducted our relationship.
I commend the activiites of Australian Medical Students’ Association (AMSA) and Beyondblue for creating the med student guide, “keeping your grass greener” and initiating a doctor’s mental health program. The reason I am writing is because of the dehumanising way in which my partner dealt with the stresses of smalltown Perth’s “kill the OUT gay man” homophobia… He went into complete denial and pretended he had never met me. This appears to be the only way an A-type personality could deal with a horrible situation, alone. Fears of being labelled as a failure and negative impacts on his career prospects stopped him from discussing the stresses of his relationship. So I’m happy to know the Australian medical culture is changing for the better. And that all those gay and lesbian medical students out there don’t feel alone like my ex-partner did during the late 1990s.
@Chris: I’m glad your coming out worked out well, but I know of another colleague who was “unwell” and was known to be sick, but because it affected his behaviour, not only did he get no support (or even a referral to the Medical Board), he was, in effect, kicked out of his position at the hospital where he worked. I’ve also seen similar cases where individuals weren’t performing, were punished in some way, and were later (too late) found to be sick.
It should be routine that when otherwise high-achieving individuals (ie doctors) are not performing in some way, they should be referred for assessment, for the good of all concerned.
I suffer from obsessional problems, in particular repetitive noises (such as an olive-backed oriole (bird) that chorused every morning outside my bedroom) drive my crazy. Initially I was terrified that someone would find out that I sought psychiatric advice, but soon learnt that this was not so and many colleagues came up to me with their own stories when I presented myself at a medical conference. I encourage anyone with psyche problems to come forward. You will be universally treated with respect and sympathy.
It is my observation of the experience of a close friend of mine that whilst hospital administrations are supportive of junior staff’s mental illness issues the speciality colleges are not. I have only the observation of my colleague’s experience of their illness and the attitude of the RACS. The RACS offered minimal support and no willingness to allow a break in training which more than likely resulted in a further deterioration in their illness and subsequent dismissal from the training program. That college could not comprehend that a mental illness might impact upon an individual’s job performance.
At least insofar as that speciality college is concerned the development of a mental illness during training will negatively impact upon trainees’ career prospects.