Issue 18 / 14 May 2018

Doctors’ wellbeing: learning from Richard’s death - Featured Image

Richard and Kate Harding

I HAVE recently been catapulted back to the UK from New Zealand in the wake of my intensive care consultant husband’s death. My children and I are still reeling from Richard’s suicide, which took place 6 months ago, at home, while my daughter and I were walking the dog.

Richard and I met as junior doctors in Brisbane, and have also worked in Perth, Dunedin and, latterly, Whangarei, after 10 years back in Herefordshire, England. We shared a deep love of both Australia and New Zealand, and chose to return to the latter in 2016. It had been increasingly difficult for British doctors to find intensive care consultant posts in either country in recent years, and when a job came up in Northland, New Zealand, and we became aware of the area’s incredible natural attributes, including the world-renowned Tutukaka coast, Richard felt compelled to apply.

Just as we prepared to make the journey across the globe, including packing up our possessions into a shipping container, making arrangements for our two dogs to fly out to join us and selling our house, Richard received the letter all doctors dread – notification that a complaint had been made against him to the General Medical Council (GMC).

This effectively put our plans on hold indefinitely and caused us months of stress. Camped out in a holiday cottage, living out of suitcases, we sent our children back to the school they thought they had left for good, and returned to the jobs we had resigned from. Finally, the complaint resolved in Richard’s favour, we left the UK, assuming that our emigration would be permanent, and we were determined to put the GMC investigation and all the associated anxiety and uncertainty behind us.

Unfortunately, the effects of a complaint – even one statistically highly likely to be found in the doctor’s favour, as in Richard’s case – last far longer than the period of investigation. Richard did a lot of soul-searching during those months. He had always been known for his sound clinical judgment and for his decisiveness at work, for his steadiness under pressure, for his relaxed and calm manner and his sense of fun – he loved to banter with the nurses and doctors he worked with and had an open and forthright manner with everyone he met.

This sense of having been born to do the work that he did was something he exuded effortlessly, and I envied him this, having always questioned my own place within medicine and my choice of general practice as a career.

In the aftermath of the complaint, however, he talked to me much more about the ethical dilemmas he faced at work, all of which cropped up in intensive care, rather than during the course of his anaesthetic work, which continued to come easily and naturally to him. He began to question his decision making. He began worrying about cases that previously would have caused him no concern. He brought his work home in a way that I hadn’t seen him do before.

By this time, he had settled into his new role at Whangarei Hospital and was enjoying getting to grips with a new system, despite the challenges of adapting to a new country and different ways of working. He was popular with his colleagues, and his direct communication style went down well with his patients, who appreciated his warmth and his honesty. He enjoyed learning about the Māori culture, and would give me and the children impromptu tutorials on Māori word pronunciation, having been inspired to make headway in this area by some powerful and thought-provoking cultural awareness teaching at the hospital.

At home, however, it was clear to us both that his mood was slipping downwards, and it seemed that the long months of anxiety and powerlessness in the face of the GMC complaints procedure, coupled with a move across the globe, were catching up with him.

Doctors’ wellbeing: learning from Richard’s death - Featured Image

Richard Harding

Richard did well on antidepressants and weaned himself off them after 6 months, with his doctor’s blessing. He threw himself into our new coastal lifestyle: running, cycling, diving and fishing. He frequently had his morning coffee in the sun while gazing at our astonishing view, which took in the gleaming blue of the harbour waters, Mount Manaia in the distance and the shimmering greens for which New Zealand is famous. He deeply loved his new environment, and we often walked on the beach together, marvelling at our good fortune in having landed in a place so heart-stoppingly beautiful.

The illness then recurred some 6 months later, slowly taking hold, fuelled by his on-call rota and the associated sleep disturbance that, constitutionally, he had always found difficult, but which this time took a disproportionate toll on his mental health. He went back onto his medication, but this time, agitation was an increasingly prominent feature of his illness, and it became clear to us both that he was on the wrong drug; that, this time, he needed something different. He was 3 days away from his first appointment with a psychiatrist when he took his own life.

I have written elsewhere about finding Richard dead, trying to resuscitate him while knowing it was entirely futile to do so, helping the children to say goodbye to him, watching the paramedics drive him away, knowing that I would never see him again. Fielding the policemen’s questions, thanking the neighbours for their help, shutting the door on them and at the same time on our old life, unable to imagine how our new life could possibly take shape without him. Suffice to say that we did – somehow – survive those early days, and that our new life is unfolding without him, though it still seems incredible sometimes that such a thing should be possible, or even allowed.

We have returned to the UK, to the security that comes from living near family and old, dear friends, though I have made friends for life in New Zealand and will never forget their kindness in the aftermath of Rich’s death. We are adapting to life as a unit of three, rather than four. I have returned to work, compelled to do so as soon as possible by my new status as sole breadwinner, and by the absence of any life insurance pay-out. I am taken out of myself and my troubles by my hospice work, and am well supported by my work colleagues, many of whom are close friends.

Richard’s mental health troubles were, in comparison with those of other doctors who have taken their own life, short-lived and intense. He had had one previous episode of depression in his early 20s; there was no recurrence for 23 years, until the period following his GMC complaint and our emigration. He was open about being investigated (probably in part because he was confident that he would not be found guilty of poor clinical judgement, on which count he was correct) and found his colleagues to be uniformly supportive and reassuring. He still died.

It is hard to predict who will succumb to suicidal thoughts both during and after an investigation. He would not have been on anyone’s “one to watch” list. It is debatable how much of a factor the GMC investigation was in causing his death, since his suicide occurred 22 months after first receiving the “letter of doom”, as we called it. I personally feel that its effects were insidious, that a complaint, however minor, has deep and long-lasting ramifications for doctors, who tend to be sensitive to any suggestion that they are not looking after their patients properly. Of course we make mistakes. Some of us even commit crimes. The vast majority of us are just trying to do our best, however. We genuinely want to help our patients, do some good in this troubled world, go home to our families feeling that we made a difference – however small, however temporary.

Here in the UK, I am working with the Association of Anaesthetists of Great Britain and Ireland, which is looking into the suicide rate among anaesthetists. This is well known to be higher than average, due in large part to their easy access to lethal injectable drugs. Of course, many suicides have nothing to do with complaints. Some are substance misuse-related, others associated with long term chronic health conditions, physical as well as mental (although the distinction between the two is artificial and not always helpful).

One of the goals of this work is to put in place ways of trying to reduce the risk of suicide for individual doctors, while equipping hospital departments to offer better support to those affected by such tragedies when they do occur. Colleagues are hit hard by the loss of a doctor in their midst to suicide, and the remorse and guilt that I feel as Richard’s wife are felt by his friends and workmates too.

I am no expert in the field of doctor wellbeing, and am learning as I go along. I am grateful to those who are teaching me, and allowing me to play my own tiny part in the work that is being undertaken in this area. Richard’s death was simply unimaginable to me, knowing as I did – do! – how much he loved his family. I have to live with the consequences of this failure of imagination every day, as do my children and everyone else who has been affected by his death.

I miss him desperately. I miss our life in New Zealand, our enchanting peninsula, the greens and the blues. I long to go back, but, for now, I belong here in Britain, lashed by rain, Brexit a constant background rumble of discontent. Richie is with me wherever I am, as is the grief – a deep dark central weight within. Not for one moment do I doubt how much we were loved by him, not for one moment do I think that he knew what he was doing to us by leaving us. Sometimes that helps; more often, it doesn’t.

Postscript from Kate (17 May 2018):

I am so touched by your responses and will re-read them in the coming days, because so much of what you have said – collectively – is so thoughtful, and profound, and deeply helpful to me. I am really moved by the support that I have received in the aftermath of Rich’s death, both in person from my army of friends (both in the UK and in NZ) and my family, and ‘through the ether’ from people like you who have taken the time to respond to what I have written. I have been particularly struck by those of you who confirm that Richie was in no way himself when he took the decision to end his life. I guess I knew this to be true already, certainly rationally it MUST be true, but it helps to have it confirmed. I don’t know if it will be possible to fully come to terms with the guilt that I continue to harbour about his death. Perhaps it has to be come to terms with, accommodated, made space for, rather than eradicated – surely that’s too ambitious a goal. I take comfort from the kindness and understanding that I have been shown. Mainly, I keep going. Get out of bed every morning, take a deep breath, get through the day. Repeat. Try not to go round in pointless circles in my own head. Focus on the moment. Raise the kids. Walk the dog. Trust that it will All Get Better, sometime in the indeterminate future. Hope that the colour will return to life, a different life, a life I wouldn’t have chosen, but have no choice but to embrace.

Dr Kate Harding is a hospice doctor and part-time GP now working in Herefordshire, UK, following the death of her husband Richard. She lives with her two children and her cavalier King Charles spaniel, Mo. She can be found on Twitter at @KateJH1970.


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32 thoughts on “Doctors’ wellbeing: learning from Richard’s death

  1. S. Rolfe says:

    I had the privelage of being treated by Dr Hope for several years in grafton st and my last appt in April at bella vista just b4 he passed.Hearing of Dr Hopes passing shook me to the core as he was the only Gastro I would go to and be treated like a human. Dr Hope was an amazing man and my heartfelt condolences go to you Kate and ur children.

  2. Shagun says:

    Dear Kate, you are a very strong woman it comes out through your words and a very compassionate person. I am really sorry for your loss and will say a special prayer that you and your children will heal and find every happiness in life again. Its people like you who shine a torch of hope on readers like me who might be reading to make meaning of suicide and suicidal tendencies in people they encounter closely.

  3. Anonymous says:

    Thank you Kate for your profound story. Thank you Richard – you live on.
    As one who is still in the cycle of wanting to “ quieten “ the mind and wanting to be brave and soldier on, I feel allmof your stories. My heart always sinks when I get to the bottom of the story and find the contact details if beyondblue, etc. You see, I have tried this, I have alao contacted the college and asked for counselling . I gotvthe “help” that is supposed to be given when you ring or call these people, went to the psychologist and one of the things that stuck in my mind was the advise that I should take vit b12. I came out of that meeting worse than ever and to some extent determined to finally do something , maybe go to sleep a little longer. What I am trying to say is that I feel these things do not help us doctors however the good intentions are. We know and we can predict what they are going to say. It does not go to the innermost being in all of us. Thank you.

  4. Garry Barron says:

    Like Paul Sparks this brought a tear to my eye. This is tragic on so many levels, particularly as it can affect children. This month is the 4th anniversary of one of my colleagues passing away in similar circumstances. I tried reaching out but to no avail. The first step is recognition of this problem so common in our profession. Open and frank discussion will lead to steps to prevent this. My heart goes out to you Kate/family/friends and applaud you for your openness.

  5. Christy Wilson says:

    Very brave of you to share. Your expression of the taking of one’s life as “lack of imagination” is, to me, profound. While many others here comment on the challenges of
    the profession, which are real, I, for one, am concerned that you take care of YOUR mental health. Don’t, in the long run, let there be multiple victims. You are strong. Take time each day to focus on the good and be grateful, because there is still good among the pain. Good and gratefulness will help give you the perspective to heal. Best to you and your children.

  6. Peter Bradley says:

    Very sad story indeed. I absolutely feel for Kate, and thank her for her brave and frank story. However, even sadder is the knowledge ‘there will be more’. This will happen again, for sure. So, what are we going to do about it..?

    It appears to me that we need to consider the analogy of matter, and anti-matter, and create the comparable situation with respect to the bodies that handle complaints against Drs, be it AHPRA here in Australia, or the GMC in Britain. We therefore need each country to set up an organisation, called (for example), SDUI = Support for Drs Under Investigation, or similar. Totally dedicated to investigating the incident, coming to a conclusion as to how it all evolved, then providing unconditional support to that Dr, not the patient, and to the hilt, in terms of their morale and mental state, irrespective of whether there was a failing on their part or not. Not trying to duplicate what their Medical defence fund are meant to do, but complement it.

    These official bodies like the GMC and AHPRA, appear to see their role quite simply as protecting the public against poorly performing Drs, and to some extent I suppose it is expecting too much, and creates a conflict of interest, for them to be expected to concern themselves over the plight of the Dr concerned as well as the patient. Similarly, (as I can personally attest), the various medical defence organisations we pay high subscriptions to, when it come s to the crunch, tend to take a pragmatic view of the likelihood of a win versus defeat, and what it will all cost, so will often just not defend a case purely on those grounds. I guess that the fact that both AHPRA, and the local State body, in my case quite quickly came to a ‘no case to answer’ conclusion, spared me what would have made that incident much more stressful, and countered the disappointment the defence organisation ended up saying technically I missed a diagnosis, rare though it was, and masked by another more obvious and common one, and elected to not defend.

    Clearly neither the official govt bodies or the defence organisations are in place to provide the unequivocal support a Dr in the situation of a complaint requires for their mental and emotional support. This glaring gap needs to be addressed.

  7. Anonymous Coward says:

    It is a hallmark of our vocation that we learn from life and death. It is genuinely beyond the norm to share our most personal traumata to further understanding, so that is an expression of the character of Kate as a doctor through and through.

    Anaesthetists rank highly amongst us for suicide. The subject is not for fools. The effects of decisions are quickly borne out, the mechanism and means to death well understood. The isolatory and highly vigilant nature of the work lends to introspection and that can be a bitter harvest when things go wrong, when doctors are traumatised by what happens. ICU is another level and some of the finest minds in medicine are found there.

    Usually when things go to custard, suicidal thoughts are countered by the thoughts of the effects of the suicide on our loved ones. Unfortunately, Richard may have undervalued himself, even when his family clearly loved and valued him, as well as the fact of numerous lives saved as a reality of his daily work for many years.

    As doctors we want to prevent harm, but it cannot be said for our media, who seem to revel in it.

    I think we should change this, given it is a serious catalyst to suicide.

  8. Anonymous says:

    Dear Kate, I too am not one to comment online, but you moving story, and the work of the MJA in highlighting issues surrounding doctors suicide – both in junior doctors and doctors under investigation has prompted me to respond. As a mother and a wife, my heart goes out to you as you face what has been , and the future to come. I applaud your courage in bringing this often taboo subject out in the open. As a Medical Superintendent in rural Australia, I see the impact on clinicians of our current health system, and societal expectations around what modern health care and doctors can provide. Our systems of Clinical Governance need to not only to protect the public, but also the Medical Officers who turn up to work every day with the intention of providing high quality medical care to the patients that they see. As a profession we need to be united in ensuring that when adverse outcomes occur – as they inevitably will when dealing with human factors – that our response is focused on opportunities to improve, and not opportunities to punish. We need to have the courage to recognise and support our colleagues in distress, and learn how to better manage those difficult conversations. My warmest wishes to you and your family.

  9. Anonymous says:

    I am so sad to read this, i remember hearing about it when it happened. Im a nurse who used to work with Richard, he was such a lovely man always making people feel at ease. I remember doing ward rounds with him and it would feel fun and light hearted. He was always full of so much energy and dedication. My deepest condolences to you all.

  10. Ali Mazhar Rizvi says:

    Hello Kate, I had the privilege to work as a registrar/inter national fellow with your husband in area A Intensive care at Queen Elizabeth Hospital Birmingham. If it bring you any comfort he was a wonderful doctor and a great human being, taking time to explain and counsel his complex subset of patients and their attendants. He was very popular amongst his colleagues n juniors. I am shocked with this news and share your grief. May his soul rest in peace. You’ll definitely be missed Richard

  11. Paul Sparks says:

    Dear Kate
    I’m not one to spend much time clicking on MJA articles and certainly not one to post comments, but tonight I find myself typing through tears after reading your essay and the comments that everyone has left……the wider public really has no understanding of the disproportionate effect a complaint can have on an already stressed medical professional who, for the most part, is trying to do their very best under usually very trying circumstances. Unlike our lawyer friends, we take complaints incredibly personally and our defences just don’t seem good enough or practised enough to be of much help. I hope our medical councils, our legal colleagues and the wider community have the opportunity to read your heart wrenching piece and perhaps we might all reflect a little differently on how medical complaints could be handled in the future. I hope you have all the support you need to get you through the next little while…..

  12. Sue Ieraci says:

    Thank you for the courage and insights expressed in your essay, Kate. After so many years of the Quality and Safety movement, it seems that we have not improved enough at either complaints management or human management. Ironically, it is often people who care the most who also suffer the most. We need to by much more conscious of the effects that intense investigation, delay and uncertainty can have on a person, despite eventual resolution.

  13. Anonymous says:

    Dear Kate,
    Thank you for your honest and open letters. I offer my heartfelt condolences to yourself, all your family, and all those affected by Richard’s passing (ourselves included, if I may be so selfish). Please do not blame yourself in any way.

    I am a retired consultant/specialist in Anaesthesiology, having spent most of my practising decades in the operating theatre, and also much contact with, and time in Intensive Care.

    If I may be so vain, although I was a moderately excellent student, my post-graduate years have been very demanding, and, at times, very difficult (as they can be for us all). I chose to retire slightly early, mainly to look after my family and loved ones, however I have suffered fairly troublesome depression for some years now, for which antidepressants continue to be taken. I am also on a variety of medications for other medical problems (I am not young any more), and find myself considering passing on not infrequently. Your emails may have helped to delay this.

    Indeed, what a terribly demanding, difficult, and unforgiving profession is ours.

  14. Kate Harding says:

    I am so touched by your responses and will re-read them in the coming days, because so much of what you have said – collectively – is so thoughtful, and profound, and deeply helpful to me. I am really moved by the support that I have received in the aftermath of Rich’s death, both in person from my army of friends (both in the UK and in NZ) and my family, and ‘through the ether’ from people like you who have taken the time to respond to what I have written. I have been particularly struck by those of you who confirm that Richie was in no way himself when he took the decision to end his life. I guess I knew this to be true already, certainly rationally it MUST be true, but it helps to have it confirmed. I don’t know if it will be possible to fully come to terms with the guilt that I continue to harbour about his death. Perhaps it has to be come to terms with, accommodated, made space for, rather than eradicated – surely that’s too ambitious a goal. I take comfort from the kindness and understanding that I have been shown. Mainly, I keep going. Get out of bed every morning, take a deep breath, get through the day. Repeat. Try not to go round in pointless circles in my own head. Focus on the moment. Raise the kids. Walk the dog. Trust that it will All Get Better, sometime in the indeterminate future. Hope that the colour will return to life, a different life, a life I wouldn’t have chosen, but have no choice but to embrace.

  15. Anonymous says:

    You write very movingly and I just wanted to let you know I am touched by your story and love for your husband. I wish you and your children healing and calm and a bright future. What a horrible critical brutal profession we work in .

  16. Catherine Sellu says:

    Very moving and humbling Kate.

  17. Anonymous says:

    Dear Kate,

    You are one strong, brave and beautiful person. It is how one responds to adversity that is truely defining and what you have written is testimony of this.

    If it helps at all, I can assure you that Richard was almost certainly dissociated mentally and/or spiritually at that critical moment in time. There is no way he was of sound mind when he left you. Although I didn’t know him, from what you wrote and comments made in response above, his entire being was that of a selfless, giving, engaging person who was very good at what he did best – critical care doctor and family man.
    I can say this as I am currently going through a very similar situation whereby days before Christmas “The Medical Board” suspended my registration. There was no risk/harm to patients nor any poor outcome. It was due to a complaint from speculation without any proof. This, amongst many other life factors, crescendoed to a VERY serious attempt on my own life in the midst of severe depression. Mental illness and disease labels are difficult to define. We are merely scratching the surface of mental health.
    There is so much work to do to address this. Suicide is not covered by Income Protection whereas an AMI/CVA is. However, depression is just as much a disease as Cardiac or Cerebral Pathology (or cancer even) and yet it is not recognised as such when it comes to the end result. It is time for the Insurance companies to accept this. We all pay them enough and they certainly make more than sufficient profit.
    I agree with prior comments about how “The Board” is currently handling complaints. As Wayne(14.) said in his comment, once accused a practitioner tends to withdraw.
    I withdrew, so, for “The Board” to hide behind the safety net of – seek counselling – is not realistic. I understand “The Boards” duty to the public but what about its duty to its registrants! It needs to protect and look after its doctors. It seems we are Guilty before being proven Innocent and the rug is pulled from beneath us which is devastating when life is stressful enough with family mouths to feed etc. When a mental illness is involved and we start talking about “triggers”, then that is unchartered waters…

    Now having come out the other side and stabilised (but not yet registered again – investigation still pending… Time line unknown?) I would like to say that I would never choose that dark path again and can remain strong but depression can be a relapsing lifelong disorder. Prevention is certainly better than cure and the work that you are doing in Richard’s memory is commendable to say the least.

    As a Profession, perhaps we can appeal to “The Board” to be more insightful to an accused doctor’s health and needs rather than purely a bureaucratic perspective on patient health and safety.

    As far as you and you family goes – May the fondest of memories prevail forever!
    Good luck with your pursuits…

  18. Fiona Jazayeri says:

    Dear Kate,

    Thank you so much for posting your deeply moving and personal experience of what you have been through. I am sending you my prayers and hopes that you will get through this, and that there may be a time when that dark weight is lifted from you, or will become easier to bear.

  19. Wayne Cunningham says:

    Kate, your writing is an absolute treasure, and I’m sure that no-one reading it could fail to be moved by what has happened to you and your family.
    Tragically, the impact of complaints on doctors continues to be dreadful. I have researched this and one of the outcomes in NZ was the development of a counselling service for doctors. This has been reported and it appears to have been useful. The reference, for any interested reader, is
    Cunningham W, Cookson T. Addressing stress related impairment in doctors. A survey of providers’ and doctors’ experiences of a funded counselling service in New Zealand. NZ Med J 2009; 122 (1300).
    Several respondents to Kate’s article have commented on a need for a response from the College or other medical organisation. Respectfully, may I suggest some ideas about doctors’ responses to complaints that might be helpful.
    Firstly, doctors are often shamed by receiving a complaint. Their response is of withdrawal, wanting to hide, often being barely able to seek help. Secondly, doctors’ responses are both emotional and intellectual, at the same time. They seek to understand the complaint, their practice, the circumstances and so on ‘intellectually’, but often do so in isolation. Whereas a counselling service is fantastic to help support doctors emotionally/psychologically, I have yet to see any organized response by the profession to have a respected, trusted colleague sit down with a doctor in receipt of a complaint and objectively assess what happened. Finally, my research suggests that although well-meaning, families and colleagues are often not equipped to provide adequate support, and neither should that responsibility be expected. It is the responsibility of the profession to unconditionally support doctors in receipt of a complaint.
    The complaints system is unlikely to change. What we can change is our profession’s response.
    My heart goes out to Kate, Richard and her family. My mind goes out to our profession- it is time to act.
    Wayne Cunningham, Professor of Family Medicine, RCSI Bahrain

  20. Dr Michael Austen says:

    Thank you for sharing this
    There is little ability to control the process, the timeframe nor anticipate the outcome of any complaint.
    It is the complaint itself that is the issue that we need to address at a College/Faculty level in terms of support and collegiality.
    I would like to think that in the future there should be no need to place our lives on hold – being on hold is what currently happens at many levels and the effects travel with us.
    We need to take control of this as a profession

  21. Amanda Newman says:

    I think this letter will be a treasure for your children in years (decades) to come. Thank you for sharing it.

  22. Anonymous says:

    So brave to bring this terrible thing out into the open
    None of us know what anyone else is thinking or feeling
    Our work in the NHS is incredibly tough .. we do our best to do it right with compassion compounded by long hours and poor conditions
    There are often more complaints than praise
    It only takes one unfair criticism to hit you in the gut
    It through you off course
    Support from colleagues is usually brilliant as we all know but the seeds of self doubt are sown for some and it’s hard to climb out of
    Some don’t make it but not because they don’t try or want to
    My heart goes out to you and your family .. and of course to Dr Harding

  23. Anonymous says:

    Kate,I don’t know you but,in your grief,you write so bravely and wisely.
    Richard would be so proud of you.
    Together,you may have already saved other doctors’ lives.

  24. Anonymous says:

    My great mate and a terrific GP suicided after a complaint to AHPRA .
    There was a history of depression ,well controlled , but this was
    “the straw that broke the Camels back ” In my humble opinion
    innocent of a vexacious complaint

  25. Anonymous says:

    Heartfelt condolences to Kate, her family, and Richards wider circle who were left with the devastating impact of this all too frequent tragedy. You have reached an amazing level of understanding when you say that ‘not for one moment do I think that he knew what he was doing to us by leaving us’. As a recently retired Anaesthetist, I have stood by helplessly throughout my career and watched and mourned as far too many of my colleagues have taken this tragic step. Many of these have been trainees who have failed to gain their examinations. I’m afraid that the Colleges must do a better job at their systems for passing and failing people, and if they feel compelled to fail someone, they should be automatically enrolling those clinicians into a program where they are closely mentored, monitored and watched over until they succeed with their exams. For how many deaths will it take till they know that too many people have died?

  26. Dr John Stokes says:

    Thanks Kate for being so brave in writing this. This is a tragedy and we know this is happening more frequently. But there is little consolation in saying that. At our next HPARA (Health Professionals Australia Reform Association) on the Gold Coast in two weeks we will be discussing this issue again. Two Senate recent enquiries in Australia have highlighted these issues and yet AHPRA, our regulation body regards the effect of notifications and wrongful complaints as a small problem based on their inaccurate numerical analysis. As an Intensivist and Anaesthetist myself who has been vexatiously reported I know of the heartache and anguish he and his family would have suffered. This issue was highlighted in the national Australian magazine only one week ago.
    John Stokes – Chairperson HPARA (

  27. Harold George Burkitt says:

    Kate’s heart wrenching letter highlights the consequences of a system in which the work of doctors is now just another service to be consumed with very little left of the doctor-patient alliance which was so much a feature of medicine in former years. The current complaints system is a logical extension of this construct with medical administrators treating doctors as cogs in a machine of service delivery rather than dedicated professionals doing their best in an inadequate system and where so many clinical decisions are based upon a large subjective component. Complaints are far to easy to make and complainants are rarely if ever held to account. The “consumer is always right” philosophy means that the doctor essentially has to prove his/her “innocence” yet the complaints system denies due process and natural justice. Suicides are just the tip of the iceberg of the distress that results. Knowing that if you seek medical help in that distress, your registration may be compromised dramatically compounds the problem.
    Of course there has to be a complaints mechanism but at very least, complainants should be required to make a statutory declaration in lodging complaints.
    Thank you Kate for your courage in opening up this subject for the long overdue proper consideration that it deserves.

  28. AM Cleeton says:

    I am deeply saddened by your loss, Kate. The huddles of anaesthetic circles has lost a champion; patients – a doctor who cared; family – a loving husband, and father.
    The tentacles of unhappiness reach far and wide, triggered by such things as hereditary manifestation, (as in my case) or, (as indeed, in Richard’s case) a mere complaint against his professional conduct.
    That which piqued my attention in your story – Richard’s taking of his own life was within three-days of an appointment with a psychiatrist. It is not known to the reader, of course, how long the waiting time was leading up to those final three days, but in my experience with this branch of medicine in Australia – also as a patient – wait times can be lengthy. But, initial and immediate pre-consultations with specialising junior medical, and senior nursing staff are rigorous and deeply probing enough to eliminate the self-harm probability factor, on a first, voluntary presentation to such a facility. One wonders if, in Richard’s experience, such an initial factor elimination consult was conducted. It is relatively easy in medicine to maintain the facade of privacy. We all know someone who has a practice in one of the many branches. We simply make an appointment and wait for the day.
    Without assuming to know all the circumstances of Richards’ situation, I suspect he may still be around had he simply walked up to the front counter of the mental health unit and sought assistance.
    Very sad indeed, and my condolences, thoughts, and prayers are extended.

  29. Geoff Toogood says:

    Hi Kate

    Thanks for your bravery and honesty and again raising the issues faced by Doctors

  30. kieran forster says:

    What a touching, insightful and courageous essay. There is so much here to be unpacked and because of Kate’s willingness to discuss publicly this tragedy, we can further discuss the nature of depression and suicide. Given the space constraints here, I will pick out one comment. She writes that there was a failure of imagination in foreseeing the tragic scenario that befell Richard. I’ve never seen it describes like this. Although I must reject the inference of a failure of any kind by Kate, I think we all naturally expect the good things to happen. We are trained for optimism. Are we missing something? The second great insight is the insidious effect of complaints. When I received my first angry complaint on the infamous RateMDs, highly suggestive of cluster B dynamics, I was deeply hurt. As Kate says, we all want to do some good. We are often people pleasers and have helped many patients and families. Yet it only takes one critical attack to cause untold pain and self-doubt. After much support from colleagues and the slow buildup of many positive online reviews, I started to see the negative complaint more objectively. Being called the worst psychiatrist ever shd have allowed me to put the abuse in the garbage bin of my mind more quickly. It took time bc we are prone to blaming ourselves and have incredibly high standards for ourselves. I cannot imagine the power a formal complaint has on the mind of a caring, empathic and conscientious dr. So, to return to Kate’s memorable comment that there was a “failure of imagination” to see the tragic scenario coming, I wd suggest there is a high and deeply opaque barrier to prevent us imagining such things. With the reality of Dr suicide increasingly manifesting itself as reality, perhaps we no longer need imagination. Maybe we just need to do something very painful : open our eyes and ears to this dark reality. Then we can deconstruct that opaque barrier and start creating desperately needed support to Drs with depression.

  31. Dr. Gabrielle McMullin says:

    Such a tragedy. I well know the stress that complaints exact though have come to accept that it is part of the job and that no matter what you do there will always be people who are unhappy. There is an increasing view of doctors as the enemy which I find disturbing. I am always wary of people that criticise other doctors when they come to see me. I am so sorry for the loss.

  32. Anonymous says:

    Such a lovely letter with deep seated feeling.. Suicidal thoughts should never be treated as criminal, and sad people should never be treated as criminals and yet the majority of today’s “treatments” are degrading and humiliating, making the overall situation worse. A supportive environment is far more important than any medication or reviews by uncaring psychiatrists who only wish to label patients and prescribe medication creating further dehumanising of the condition.
    Unfortunately the time to intervene in the suicide story is before suicide becomes an option.

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