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I DISCOVERED CrazySocks4Docs Day – held annually on 1 June – only [in 2018]. The day aims to “encourage conversations about mental health and help reduce the stigma for doctors experiencing mental illness”. When I discovered the day thanks to my burgeoning Twitter obsession, I experienced an incredible and overwhelming reaction.
Almost exactly 30 years before, as an intern in the central Queensland city of Rockhampton, I had tried to kill myself. Three decades later, I am now President of a specialist college, but I had kept the entire episode to myself and tried to forget it. I am deeply ashamed of not learning from my own experience and using it to help others.
I hope it isn’t too late.
Perhaps by fate I was introduced to cardiologist Dr Geoff Toogood, the incredible and inspiring founder of CrazySocks4Docs, at a College meeting a couple of weeks ago. The meeting was so unexpected and so overwhelming I choked and could barely speak, but it made me determined to take something positive from my own experience all those years ago. Hence this article.
I have a strong feeling that my own experience mirrors that of many doctors around the country, but it is worth explaining. I hope it will help others understand why I have been silent and have not taken the actions I should have. When I heard that Rockhampton junior doctor Frith Footitt had taken his own life on New Year’s Day this year, I could not bring myself to read any of the details. The tragic outcome could easily have befallen me.
My internship was a very bad year. I had found medical school difficult – I was not a natural academic like so many others in my year – but hoped that my intern year might prove better. I was wrong.
Halfway through 1988, it seemed clear to me that I was making even more of a hash of internship than I had of many subjects back at university. To make matters worse, Rockhampton was a long way from my family and my junior doctor colleagues all seemed to be more capable and were thriving.
As I reached the halfway point in my internship, I felt overwhelmed with inadequacy. I had a patient die and felt responsible. My ward work was just barely adequate. My consultants and registrars were not exactly glowing in their feedback. I had an all-pervasive sense of failure, that so many years of struggle at medical school had been a complete waste and that I was little short of dangerous. I could see no way out.
So, one night, I made careful plans to kill myself. I won’t go into detail but suffice to say that I wanted the end to be painless and clean. I stole some supplies from the wards – standards of drug security were much slacker 30 years ago – and set about writing letters. Luckily, I had few personal affairs to put in order.
Incredibly, a work colleague arrived unexpectedly and began knocking on the door of my small hospital unit. That person – I won’t reveal the gender – knew I was in because my car was parked just outside. There were knocks and calls, “I know you’re in there …”
It was completely distracting. I had inserted a cannula in my left hand, so took it back out and threw the tubing and bag of intravenous fluid in the bedroom. When I answered the door, I must have looked very flustered and suspicious.
I will never know what made this person visit me unexpectedly. Perhaps my emotional state wasn’t as well disguised as I thought. Perhaps it was just plain good luck. Perhaps it was something else.
I spent quite a while talking to the person, though not about my plans for the night. Enough, however, to make me take a step back from the brink. To reconsider. To think about other options. Looking back, that person probably had an inkling that I was about to do something dramatic. That impromptu visit saved my life.
I won’t pretend that I had an epiphany or that I suddenly was better. I did seek help, although I didn’t completely disclose just how close I was to suicide.
Rather than put my career, for what it was worth then, further in jeopardy by talking to one of my hospital colleagues, I made an appointment with a GP in town. I started in a roundabout way, and ultimately confessed that I had made elaborate plans for kill myself.
To this day, I can remember the GP’s advice. Under no circumstances tell anybody or see a psychiatrist (I only knew of one in Rockhampton at the time, and was about to become his intern for a 3-month term!). If I had a record of suicidality or mental illness, I would never be able to buy income protection or life insurance, and I would probably never get a good job. Indeed, don’t tell anyone …
I was bonded to the Royal Australian Navy, with the hope of spending time as a seagoing medical officer. The advice I had received was startling – what if I was rejected from serving and had to pay back my return-of-service instead? I couldn’t afford it. There was no way I was going to risk my Navy job – what if they were so worried about me jumping overboard that I was banned from the fleet?
I elected to try antidepressant treatment, but I remember it being very unpleasant. The options were more limited 30 years ago. The GP warned me that if anyone found out about prescriptions for antidepressants, I might be in trouble with the Queensland Medical Board, perhaps struck off until I could prove myself.
The episode left me with two key messages, both of them very wrong. This first was that not thriving as an intern (or being “a-copic”, as one of my registrars disparagingly put it) meant I would never be appointed to a training program. The second was that seeking help was a sign of weakness, something to be ashamed of and hidden.
Today, I am President of my College. I have had a good career and, on balance, have done more good than harm to the patients I care for. In the end, there was some light at the end of the long, dark tunnel. I just couldn’t see it at the time.
Why shine a light on my own past, 30 years later? Why speak about this so publicly? I have had a good career and achieved most of the things I had hoped to. Why rake up the past? Why not stay silent as I have for three decades?
If a person who has reached the highest point in their specialty still feels ashamed of events 30 years ago, and is reluctant to admit it, how must those who are going through things and feeling disempowered now feel? I am determined to use my own example to point out that mental health problems are nothing to be ashamed of.
Today, I am not ashamed of how I felt or what I did 30 years ago. I am ashamed and disappointed in myself that I have not used my position to advocate more strongly for colleagues in difficult emotional circumstances. I am ashamed that I was embarrassed and ashamed.
Doctors commonly are under pressure, are more prone to mental health problems, and often have access to the means of killing themselves. These are occupational hazards. In the same way that pilots are exposed to simulated decompression and hypoxia so they recognise the warning signs, we should recognise the warning signs and the debilitating and potentially lethal effects of psychological decompression.
When trainees of the College of which I am President took their own lives, I stayed silent.
When a junior doctor took his life while working at the same hospital that I did when I tried the same thing, I stayed silent. When I met Geoff Toogood, I stayed silent. Even after the shock realisation that CrazySocks4Docs day was almost exactly 30 years after I tried to kill myself as an intern, I stayed silent.
Enough silence.
It is absolutely vital that each and every one of us is honest and acknowledges the pressures and strains of our profession; that we see mental health issues not as sources of shame, but as potential occupational hazards that put not only ourselves at risk, but the patients we care for. I should have spoken up sooner.
For every doctor, especially our juniors, it is important to understand that mental health and emotional issues are nothing to be embarrassed about or ashamed of. They are important and need acknowledgement and treatment. We need to support each other and make this message abundantly clear.
If I had not been interrupted, I would have died 30 years ago. Luckily for me, that didn’t happen. Now I find myself a College President. If you feel now the way I did 30 years ago, seek help and support as soon as you can. Speak out. Who knows where you might end up.
Professor Steve Robson is former President of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and is a member of the Australian Medical Association Federal Council.
If this article has raised issues for you, help is available at:
Doctors’ Health Advisory Service (http://dhas.org.au):
NSW and ACT … 02 9437 6552
NT and SA … 08 8366 0250
Queensland … 07 3833 4352
Tasmania and Victoria … 03 9495 6011
WA … 08 9321 3098
New Zealand … 0800 471 2654
Medical Benevolent Society (https://www.mbansw.org.au/)
AMA lists of GPs willing to see junior doctors (https://www.doctorportal.com.au/doctorshealth/)
Lifeline on 13 11 14
beyondblue on 1300 224 636
beyondblue Doctors’ health website: https://www.beyondblue.org.au/about-us/our-work-in-improving-workplace-mental-health/health-services-program
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That was hard to read, horrifying and shocking to have potentially lost someone that has contributed so much to humanity. Thank goodness for your friend. I would like to mention an organisation that I volunteer for that provides free trauma aware yoga for Frontline personnel, including Doctors and Nurses. Please share with everyone and anyone you know, that yoga can help and it is free. https://frontlineyoga.com.au/
Thank you for sharing, for taking away the shame and stigma.
Hi Steve, thankyou for your article. There is an iceberg of mental health issues out there.
I myself have been through the AHPRA wringer from a MDE . It was excruciating. At all stages one is made to feel like a criminal (even the legalistic language looks like it’s lifted from the criminal code).
One’s life is dissected and exposed like a cadaver in the classroom. Protecting patients they say.
So once they had a ‘notification’, I had to stand back (and down from work) and get better, but always with the threat of AHPRA and all it’s implications for return to work looming.
The experience stays with you for life. It is requested in every application for a job, registration, not to mention insurance, and income protection is denied.
There needs to be a massive paradigm shift which may take a generation to evolve, but you have certainly let the light in and I shall endeavour to follow your example.
Many thanks
My concern is about the recommendation to seek help from the Doctor’s Health Advisory Service. As a medical practitioner myself, I contacted the Queensland DHAS after my medical practitioner brother had taken a life threatening overdose about 5 years ago. His psychiatrist in Brisbane refused to see him and suggested I call the DHAS. The person I spoke to eventually (a psychiatrist) said there was nothing they could do to help. I rang the doctors who had previously cared for him in another state, one was overseas and his locum (who knew I had permission to talk to him) refused to answer my calls. Eventually after three days of multiple phone calls I was guided to a wonderful psychiatrist and he is slowly recovering. I hope the process is now easier. Please don’t give up seeking help if you need it.
In Veteran Mental Health, particularly in the USA, there is a recognition now of “moral injury” as a cause for crisis (not new, but possibly not explored that much in the psychiatric/psychological fields because of previous religious overtones ). In my work with those feeling suicidal, I am struck by how aptly “moral injury” applies to their exploration of what may have caused their decision. Indeed, it is as applicable to the abused child as the war veteran and I think certainly would be identified by some of those caught in the stresses/ traumas/decision making of medicine.
https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp
What heartbreaking stories! Tears as I read it in October and again today. It’s such a difficult path, getting through the horrendous expectations that we know everything about illness, when young and exhausted and isolated and terrified of making a mistake in often life threatening situations. it’s a wonder anyone gets through it! I had to take a week off in my intern year, 1973. and at the end of the year left hospital, never to return. Managed to get GP recognition without exams as we did back then. Then began another path of education, about how to create wellness without drugs. Depression is a deficiency of (often) serotonin not a deficiency of SSRI, and it can be raised by eating more protein TDS, by adding tryptophan or 5HTP, for example. Many other types of depression eg low zinc:copper ratio, MTHFR gene defects etc. Mine was undiagnosed coeliac disease until age 30. Many of my depressed patients (1/3 of them!) have had their lives changed by stopping all milk protein – wake up after 3 days feeling light and alive and able to think clearly about the stresses of life, and able to go through the stages of grief without staying stuck in depression and hopelessness. I agree with Rosemary Jones that hormones are wonderful. Natural progesterone is life-changing for PMDD, which is due to high oestrogen:progesterone ratio in the luteal phase. (not progestins). If you can find a colleague who does this type of medicine (eg through ACNEM.org.au) you won’t need a diagnosis of depression as it will be something else less career and insurance threatening. Drugs can be wonderful if needed but should be secondary to a biochemical path of discovery for each individual.
I feel impelled to respond to Anonymous (posting 131).
.
I feel so angry that premenstrual problems are being treated with antidepressants (c.f. O&G Magazine response) when it is so blindingly clear that this is a hormonal problem that requires a hormonal solution. I have that solution but nobody wants to listen except for my grateful patients. Why not publish? The ‘paradigm of understanding’ is just that and the data is soft but the results are universal.
I understand that to direct people’s attention to to my writing on this subject in this blog might be inappropriate but I would be most honoured if you were able to trace me and correspond privately. Maybe the webmaster may respond to my request that my email address may be sent to you.
The fact that you wrote at 2.19am speaks volumes to me.
Like many of these correspondents, I am a gynaecologist who on one occasion at least actively considered suicide. This was for complex situational reasons rather than depression as such. My individual contribution is that I struggled the whole of my life with gender dysphoria that was finally resolved when I finally transitioned at the age of 69. I congratulate myself that I maintained the strength to keep going and am still happily working at the age of 80.
I had outed myself at a State Conference of our College and although I had been beside myself with trepidation the result was highly successful; I felt accepted more or less. I celebrated by dropping into a local winery whose sparkling white had won all the prizes and bought a whole dozen. As I drove homewards in a state of elation I composed the following,
WHEN YOU CONCLUDE THE WAR IN YOUR HEAD, YOU ARE FREE TO MAKE PEACE WITH THE REST OF THE WORLD.
Says it all for me and I have survived. Bless you all.
Rosie
The value of the example and leadership that Steve (and others) show cannot be overstated. I think that overall ‘the system’ is moving (sometimes glacially) in the right direction.
As a current medical practitioner (specialist) who has been dealing with my own mental health issues for the last 30 years or so of my life (yet only with awareness and consciously for about the last 5-7 years), I too have struggled with the spectre of mandatory reporting to AHPRA and the potential consequences of seeking help to my career, and can unequivocally confirm that these fears (whether or not such fear is ‘justified’) can delay and prevent the seeking of help and treatment.
Having finally begun to get help, I can honestly say that I have not regretted the decision to do so. To others who are also struggling, I would suggest that you reflect that while the current ‘system’, including the mandatory reporting system, is far from ideal, (and I would strongly advocate needs to be changed for the good of both the health professionals and our patients) that you will likely be better off with the help and support that can be provided from those around you – both family and friends, as well as a good GP and other professionals, rather than attempting to go it alone.
Take care of yourself / help yourself first and foremost – then worry about whether or not your career follows exactly the path you had mapped out for it.
Best wishes to all.
Dear Steve and Kate
Your story has reached UK via Archivist in Arch Dis Childhood. Thank you to both of you. You are warm, caring and honest human beings. I identify with all you say about 1980s/90s medicine and the wear and tear on us and resulting. depression. I do hope that your private conversations will leave you both happier and more resilient and allow you to believe that you are loved and valued as people, not doctors.’. Im off to look up CrazySocks4Docs to spread Geoff Toogood’s excellent idea (perhaps Arch Dis Child will contact him?) and e mail my GP about my BP and antidepressants, which I was putting off.
Thanks and take care
How can we as doctors get help without our income protection getting wind of it and then cutting off all insurance for mental health problems in the future? I am struggling with PMDD and have been on an antidepressant for it. As a result I am now not covered for ANY mental health issues in the future. What do I do?
I feel my condition is worsening and I am afraid to get help
Thank very much Dr Robson for sharing your story. I am a GP registrar in Melbourne. Your words have inspired me to take better care of myself as well as my patients.
For young doctors out there, if you are struggling, please get help. Feel free to see your GP without fear. If the first GP you go to is not the right fit, please see as many GPs as you like till you find the right one. Like Dr Robson, you too will be able to see the light at the end of the tunnel again. Don’t give up!
Thank you Steve. for your honesty, courage, leadership and, not least, for your change of mind both 30 years ago.
You HAVE done good. The world has been better for you having stayed in it.
Best wishes.
Suggest reading “House of God” by Samuel Shem a few times. Only way for me to understand the problem. Inexpensive on Amazon.
My wife is a patient of Dr Robson and we have to report his skill, compassion and effective care saved her life. We are very blessed to have him here in Canberra. I have read this outpouring of love and cry for better ways to protect our medical people. I am a retired lawyer aged 75 with experience of medical life by living and working with the profession when at university and in legal practice. It is time for all of us to support those who care for us. The ACT Government has a current panel to investigate and report on the Culture of ACT Public Health. I have made a submission personally in confidence and contributed to a submission for older Canberrans who need our doctors. I hope some readers of this experience pass information to the panel so they make recommendations for improvement.
Unfortunately the stigma has not changed in the United States in the 40 years since I graduated from Medical school. We desperately hide any sign of “weakness” because careers and relationships are destroyed by the hint of anything less than perfection. Treated depression, and indeed many psychological conditions, do not preclude our ability to provide excellent patient care. The empathy they foster probably even gives us an edge on generating trust in our patients and dedication to patients. If narcissism, intolerance and prejudice were acknowledged as the personality disorders they are perhaps those pointing the fingers and destroying careers would eventually gain better understanding and we all could lead happier lives getting the support we need. I have no doubt that all patients would benefit
Very good article, I am very happy that I came upon it. I immediately shared it in my network. As a last year resident in psychiatry, this story really sheds a new light upon the work we do. I have seen some colleague doctors who requested help, and indeed had to find solutions to keep their anonymity as much as possible to avoid what you mentioned.
Go on healers, you can do it !! And don’t take all the responsibility for yourself, the patient is the one who is sick in the first place, and it is the financial system that is requiring the hospital to manage costs and the staff to long work hours. We can’t always do our job right in this situation…
Good luck!
Frith Foottit was my brother and best friend, and there isn’t a day that goes by that I am not confused how we lost such a vibrant intelligent and spectacular human. Reading these posts gives me hope for change and simultaneously saddens me that in such a respected caring profession deprevation and degradation begets same. That senior doctors and hierarchy can scorn the domestic violence and child abuse they see in their care, yet cannot feel the compassion for their own charges.
I had no idea that it was so difficult being a doctor. That suicide was an epidemic. The silence is deafening to me now.
I wish with all my heart that I could have knocked on the door during Frith’s time of despair. That he answered the phone, or ambled across the road for a chat. He was an amazing problem solver, he was always building and creating and restoring. He was deeply thoughtful and constantly questioning. So many useful medical developments and insightful aids died with this doctor of engineering, medicine, and life. He had so many things he wanted to do.
Please come together as medics and support each other and change from within. Stand together and be united for each other. It’s not hopeless.
I know that I have zero knowledge of the difficulties of medical life, with all my expertise being vicarious experience over a few wines with Frith (and Scrubs). But I know its a big problem when my cruisy Doc Marten wearing dread lock bearing dapper dressing quirky brother, with double doctor intelligence and caring bedside manner, got so lost in the haze, that he didn’t make it home.
Thank you Dr Steve for pointing the way, bravery to speak up is the true north required to get everyone home through the darkness.
Thank you for both this thought provoking article, and the wonderful heartfelt responses it has generated.
I think it’s time a radical new approach was suggested, because although the lines of communication and access to treatment are opening slowly (with the setbacks of mandatory reporting getting in the way of real progress) they are not opening fast enough to stop deaths and real distress from happening.
What if we accepted that our jobs, although rewarding, are really stressful, with life and death in the balance, with high stakes decision making often left to junior staff (with phone back up if they are lucky), with real PTSD inducing horrific experiences of blood, gore, and deep emotions? What if we acknowledged that as a group we have a high tendency towards perfectionism, self-flagellation and the anxieties and risks that our typical medical personality type induces, not just to us as individuals but to those who we teach and train, and treat?. What if we accepted those things as the baseline and that most of us will experience at least some level of work related distress at some point in our careers?
If we did that, and we positioned ourselves as healers for doctors, then we would most likely recommend mandatory, universal counselling for all medical professionals working in patient facing roles, intensifying in periods of known stress such as internship, after witnessing horrific accidents, before and after specialty exams, when being investigated for misconduct or after patient complaints, and we could throw in for good measure the other life events that every human faces.
That might make a real difference.
Thank you Steve for this article.
Earlier this yr my husband, a health professional, was suicidal but refused to seek help for fear of AHPRA ramifications. Thankfully he is still here and my children still have their father.
As a trainee of your college I ask you, someone who is in a position of power and influence, to take it to AHPRA to remove mandatory reporting for healthcare professionals. So we , as healthcare professionals, can get the help we need without fear of ramifications to our career.
Steve,
I just wanted to let you know that the colleagues who “all seemed to be more capable and were thriving” were struggling just as much as you were, and not talking about it to an equal degree. Please don’t believe that you were unique in feeling inadequate and lost and that your degree had been a waste of time and money. We were all in that boat, and I’m sorry we were not aware of the seriousness of your situation.
I also think we used alcohol to deflect and ignore as much as possible, but that’s another whole issue.
I’m so glad to hear you have survived and thrived.
Steve your honesty takes courage and leadership. I am the 47 year old daughter of a doctor and nurse. My mother was suffering mental illness and I intervened and took her to a psychiatrist 3 years ago. She was diagnosed with bi-polar after suffering in silence for 40 years. My father is a retired GP and has been married 3 times. His brother took his life at 22. I have observed my father suffering depression after his marriage break downs and after the death of his father (also a GP) and his mother. He has suffered in silence for decades. At the age of 47 I took myself to my GP to seek treatment for anxiety and depression. I don’t wish to spend the rest of my life suffering in silence like my medical parents. I also want to be a positive role model for my teenage daughters. It is ok to seek help. We are human, not invincible. We are not perfect and that’s ok. We must exercise self-compassion and be the best person we can be with support systems in place. That takes courage and leadership. To all the doctors out there who have children, please I urge you to be positive role models for the people closest to you. Otherwise your children become collateral damage to your mental illness that is not being treated. We are all here on this earth to support one another.
Above extrapolation should read,
6% of current depressed Australian doctors
Words such as “burnout” are often employed by medical institutions or surveys which can be used to shift blame to doctors for their emotional distress while deflecting attention from unsafe working conditions.
PTSD is a very real risk on the front line.
Holmstrand,et al 2015:
preamble:
In a meta‐analysis of follow‐up mortality studies, the lifetime suicide risk, was estimated to be 6% in affective disorders, 7% in alcohol dependence, and 4% in schizophrenia.
Two other studies showed the overall suicide risk in general populations to be 2.4% in affective disorder and 3.5% in depressive disorder.
Study findings:
The long‐term suicide risk in subjects with no, one, or more mental disorders was 0.3%, 3.4% and 6.2% respectively.
For individuals with only depression, the risk was 6.0%, only alcohol use disorder 4.7%, and only psychosis 3.1%.
However, when individuals had additional disorders, the suicide risks were 6.6%, 9.4% and 10.4% respectively.
In a long‐term perspective, among men with alcohol use disorder and depression there was a very high risk of suicide (16.2%).
My comment:
Lifetime risk is very significant…….and doctors have the means…..with higher than general population use of medication/”poisoning”.
Extrapolation:
If lifetime risk translates to, say, 6% of depressed doctors dying by suicide this is ~1000 doctors who suicide eventually. Add in alcohol and substance abuse and other mental illnesses and the number will be far higher.
This is a request not a comment
I wrote a long article Nov 3 11.09am
It is registered anonymous
Can you change it to “Frank”
I’m contemplating adding my full name but not quite there yet… but with a “name” on it I can at least direct a couple of people to it more easily.
If you can’t change it that’s fine
Over 115,000 medical practitioners are registered in Australia 2018. Biggest age groups are between 25 to 50; peak in 30s.
If 1 in 7 will suffer depression in their working lifetime = ~16,500 will suffer depression. If 1 in 21 of total registered have active depression in any given year = 5,500 depressed this year and every year.
and if 75% don’t seek help = over 4,000 untreated depressed doctors in any one year.
As the number of doctors increases, so do the numbers. Depression is high in medical students and junior doctors, and depression incidence/prevalence is a major problem throughout careers. For every physician who attempts suicide, many others are struggling with burnout and depression. One recent US survey found that 42% of U.S. physicians are burned out, with rates of 38% among men and 48% among women. Such distress manifests in other ways as well, such as alcoholism, substance abuse and poor patient care.
Extrapolation to doctors from figures on RACGP website:
Every day in Australia, it is estimated that:
*around 1000 people think about suicide
*approximately 250 people make a suicide plan
*around 200 people attempt suicide (more than one new attempt every 10 minutes)
*almost 8 people die by suicide (accounting for 1.7% of death from all causes)
( This would translate to at least 5 doctors of 115,000 registered in Australia think about suicide EVERY DAY, IF same rate of depression and suicidal ideation as the general population, which is likely an underestimate.
This would translate to 13 doctor suicides/year if SAME rate as general population!
But US data suggests medical profession suicide rate is twice the general population. Our local stats will underestimate as a doctor must be actively working at the time to count as a medical practitioner suicide.
So APHRA demands reporting despite knowing the stats and devastating consequences of untreated depression in doctors. Head in sand high-mindedness which is guaranteed to lead to failure in fixing the problem. But these rule-makers can go to sleep feeling righteous and moralistic. While more die and suffer needlessly. Self-defeating, sanctimonious, pious madness.
Dear Steve,
I came upon your cathartic article in the pages of The Sydney Morning Herald yesterday. I applaud you for being so frank and honest about what must have been a period in which you felt such grave insecurity. That you have overcome those dark days and achieved so much is a credit to you and an example of human resilience. That you have spoken up, even after thirty years is not a reason to feel ashamed.
I was fascinated also to read in that same edition of The Sydney Morning Herald, the response by Kate Tree.
I have now found the original article in Medical Insight. I have been absorbed by the many responses. What strikes me particularly is the number of them whose authors feel it necessary to be anonymous. I don’t criticise them, but there is something seriously amiss with a system which encourages, even demands that writers on such a topic should choose not to disclose their names.
The blame for this secrecy must be sheeted home to our society and to the institutions which thrive in that society. We are I suspect all complicit in our attitude and to perpetuating a stigma.
I have been fortunate in my career not to have been subjected to debilitating humiliation or bullying on the part of my superiors. I hope that I have in turn not subjected my juniors to such stresses. Seniors must be seen by their juniors as guides, philosophers and friends, not as instruments of hostility.
Sincerely,
David Oliver
Dear Steve
Thank you so much for sharing your story. Its so important for doctors to lead the way in reducing the stigma that surrounds mental health, particularly in the medical workforce. As a GP i have seen countless medical professionals who struggle to not only open up about their mental health issues out of fear of being seen as incapable or weak by their superiors, but also out of fear of implications for insurance, registration,etc let alone finding time in their busy schedules to attend office appointments with psychologists. We, doctors, need to lead the way in breaking down the barriers to getting help and this starts by sharing stories like this so people realise they are not alone and yes these issues are all too common in society, and medical professionals are not immune to mental illness. We also need to place pressure on insurance companies to change rules for covering mental illness as this is overt discrimination and Ahpra as a start….once again thanks for your open honest article you have helped a lot of people already.
Thank you Steve,
your story and support is one more chip away at the negative implications that still occur–although less than 30 years ago.
I had 2 colleagues commit suicide–both well thought out and meticulous.
In those days there was no institutional support mechanism.
Again, thank you
Thank you Steve, for breaking your silence, and thank you too Kate for your words, it’s amazing to see what people notice and do around us.
As a medical student I have faced challenges.
I have faced depression and come out the other side, this was initially triggered by over hearing colleague discussing my diagnosis of ADHD in a negative manner after a lecture where a child psychiatrist decided it was appropriate to put a joke in their presentation, the only one they used, about ADHD.
I have bore witness to a female colleague who was sexually harassed by her preceptor, and left stunned when a senior in the region tried to brush this behaviour under the carpet, and then as a solution thought it appropriate to replace one female student with another female student.
During my studies, I was involved in a serious car crash where I some how walked away almost unscathed. All of 10 minutes later another car crashed in front of me and as the only person there, I proceeded to perform first aid on the driver (they were ok) until the ambulance arrived. However this was a Sunday and the next day was the start of my final rotation before exams, so I managed to find a lift from a friend and went to hospital the next day. There I experienced all the text book signs of PTSD, for 2 weeks I fought myself, finding space and time to allow myself to come down and get on with my day. For all of this I was offered 2 days off. I managed, I struggled but I found a way through. There are a small group of my peers who may not know the impact of their words and actions in those days.
It is so frustrating, angering and disheartening to experience such emotionless and tactless displays from colleagues and seniors as well as from the profession as a whole. A profession where we apply ourselves, we hope, to the betterment of humankind. This field allows no time for a person to recognise their emotions, their accomplishments, their failures, it is simply pick up and go on.
What happens next year? What happens in the years following? We, as soon to be juniors, are looking now at the challenge of internship, and at our future impacted by the short sighted creation of a bottleneck of applicants for specialist programs. We still see/ hear of bullying at all levels of this field. No it is not what it was 30 years ago, I don’t believe any one would argue that. There is a different stress that exists and its impact is real.
What we all ask, as people who are now at the top of your respective professions, please continue to strive for change to improve this field. It’s working, we can see that, but don’t stop. For every program, article, contact that exists, there is a conversation that is started. This article created one between a group of peers and myself at dinner 2 nights ago. The power in that, that saves lives.
I must say I love medicine! I wouldn’t leave this profession for the world.
So I have put in place a number of strategies and created a number of relationships so that I hope I will either avoid falling back into this trap or if I do, I will have immediate help to prevent me falling further. I will strive to be present and aware of my colleagues as we move forward,
Thank you Steve, thank you Kate, and thank you to everyone who speaks out for the betterment of this industry. You don’t know how many lives you touch, but your impact reverberates.
Depression is the leading cause of disability worldwide. Over 3 million Australians are living with depression or anxiety at any time. In Australia, it’s estimated that 45 per cent of people will experience a mental health condition in their lifetime. Only 35 per cent of Australians with anxiety and depression access treatment. Men are less likely to seek help with only 1 in 4 men accessing treatment.
So the system makes it unpleasant and punitive for the thousands of anxious and depressed doctors to seek help. Go figure!
The National Coronial Information System revealed 153 suicides among health professionals between January 1, 2011, and December 31, 2014. But doctors who are not actively working are not counted, so those who are “off sick” with depression, or taking time off, or who retired early or changed careers because of depression aren’t counted, so the numbers are a fraction and a very poor reflection of reality.
There are depressed doctors throughout the system at every level, most afraid to seek formal active help for fear of the reporting system. Many abuse alcohol and other drugs. They self-medicate, or may see a private psychologist outside the system. The system stinks. These people are practicing, so any risk to patients is happening anyway. Most actually do their job well, but in a fog of pain. Depressives function…even if not optimally. APHRA needs to allow them to seek help. Colleges and Hospital administrators need to be supportive and allow time off without punitive repercussions with overt or subtle prejudice (“sorry, you just didn’t make the cut this year”.)
I identify very strongly with Steve’s article and experience. Many years ago as a medical student and JMO I struggled along with severe depression. Being a doctor is rewarding but challenging emotionally and socially. The hours are long, the work stressful. I was unsure of myself though outwardly appeared confident at times. We hide well in view. I would arrive early and working late doing countless unpaid hours to check results and avoid mistakes. But I still made some, as all doctors do especially in training, and the guilt was/is extreme. An off-the-cuff put down from a senior can be devastating, and sometimes was. I doubt the seniors had any idea of the pain they caused, or how close to the edge they pushed. But it wasn’t just that…I lived on the edge, self-judging and self-critical. Suicidal ideation was there a lot, niggling at me, but I looked at it dispassionately as much as possible, like it wasn’t really meant for me. I took risks, driving, climbing, high-risk sports, jumped out of planes, often challenging myself on my own. Thankfully I always got through and wasn’t after a mistake found at the bottom of a ravine or cliff, and it would have been an accident. I felt the distress of patients and relatives acutely, and was aware how often I wasn’t able to deal with it, though I tried desperately hard to show compassion, most of the time; sometimes I emotionally checked out and ran, but usually not. Death and disability. Trying to stop it, sometimes unable to as no-one could, but…did I miss something? Could I have done more? The judge and jury always there in my head. Sometimes probably I could have, but at least gave myself a break now and then, and excused my inexperience. At least friends had the same faults, some of the time, and that softened the blows.
I lived with an aching chasm inside, my brain sometimes immersed in a fog. But I pushed along. I was best when busy and challenged. Frantic was bad but good. No time to think, just keep working, doing, living, interacting. Worry about the less-than-perfection later. Nights were awful if not busy. The time between 2am and dawn was SO painful…..emotional quicksand. I so liked the sun reappearing…desperate for it. Literally life-saving light from the darkness. I so needed those social occasions with friends. Medical ones to have a shared experience, to laugh about the insane job we do, the awful historians, the crazy workloads, the bully-bosses who were clinically hopeless and didn’t know it yet acted God-like, with chinks showing in their emotional bravado. I really needed the occasional escape time with the non-medical friends and acquaintances who couldn’t appreciate the insanity of my job, the stress level, the workload, my need to study at all hours and read up on cases and drugs and side effects all the time so I at least knew what I was supposedly doing, so I wouldn’t kill anyone else, hurt anyone else, then the study workload on top, so no point mentioning….just escape and experience normal life away from the sick and dying and hospitals. Their lives seemed so different…so normal! And trying to find love…experience the joy, then the despair of failed love, the guilt of safe-emotionally-half-there love, the one-night stands and remorse or enjoyment of them, then another attempt at more, then more anguish.
I took a break before specialist training. Travelled, worked part time, tackled my demons to some degree, but also waited for them to shrink away a bit. It was a great idea, but not really a choice…I would have gone under had I pressed on…maybe. And the demons shrank. I saw a psychiatrist once who laughed when I said I felt a failure. He seemed patronising and unsympathetic; maybe I got him on a bad day, and we all have those, though we should be able to at least play the sympathy game. Sure I had a successful academic resume from school and uni, and was considered an excellent doctor, but that was irrelevant. I “knew” the reality of my failure inside. Maybe his was the right reaction in a sense, and I could see the funny side or incongruity, but the fog and doubts remained. And the pain was still there.
Psychologists have helped along the way. I don’t know the answer to how I muddled through but I did. I matured a bit, OK a lot, managed to forgive myself a bit, OK a lot, friends and family were still there for me, and I am so appreciative of that, because I wouldn’t be here without so many, often little interventions. Just knowing someone cared and would be hurt if I self-harmed. I seemed to have a value in other lives. Some senior colleagues showed their human side and were supportive and that was fantastic, and probably very important. A bully may have crushed me. I fell in love with an amazing person who loved me back. I had found a loving, incredible life partner to support me and support back. Life expanded. I specialised, and survived the rigour of a training scheme. I have a wonderful, fulfilling, loving family. Life goes on and is good. Medicine has been and is a great career. Should I have done something else…who knows….I am quite good at it. Life has been and is a big positive.. it’s great. I have periods of being down (OK, I should call it depression, and it can be severe at times, but it goes away for a while, sometimes even years. I still sometimes try to trivialise it to myself. It is just something that can be there, sometimes foreground or preferably and more often background or inert. That’s life, or mine anyway. I know where to find help now.)
But can I stop a colleague’s or JMO’s suicide? I have known doctors who have, mostly not close contacts or confidants. Has my sympathy or contact ever made a difference? Could I have done more ever? I don’t know. But life IS worthwhile. It can be so amazing. We only have one. However bad you feel, there are people who care…always…family, friends, colleagues, friends you’ve yet to meet, counsellors who can and want to help. Hang in there!!!
Dear Steve, you are not alone in your experience and I admire your courage for speaking out.
I am glad you are here to tell your story.
As a depressed and anxious medical student I sought treatment from a psychiatrist who psychologically abused and sexually exploited me over a long period of time, without providing me with any treatment. I eventually found the help I needed and finally gained the strength to make a report to AHPRA. This turned into a 4 year disaster with what seemed like an investigation about me (now a doctor) and not the offending doctor.
The system is a complete failure in so many ways. There is often not a lot of support to be had and doctors are left to struggle along as best they can. Psychiatry betrayed me , and the process with AHPRA has been actually devastating and retraumatising. At times I wish I had not come forward, but we all have to speak up, as doctors, as patients, as humans we have the right to compassion and kindness and treatment.
Best wishes.
Dear Steve, Thank you so much for writing this. I am a psychologist and the same thing is happening to our profession, whether it’s bullying by our colleagues, AHPRA, or our professional society. I appreciate your bravery and one day I will to write About the epidermic of bullying in psychology
Steve, thank you for having the courage to finally share your story. I am encouraging all my junior staff to read your story, your words are very powerful. The comments show how these problems have affected so many of us in so many ways. I hope that the doctors of tomorrow will be able to seek help without fear or trepidation.
great story, it is a sign of strength, not weakness to admit that you’re not perfect and you need help.
Again, to echo most people’s responses, very courageous to write this article, Dr Robson and absolutely amazing, in particular, to hear Dr Tree’s response… the online community can be dangerous at times, but in this case, the reunion online was incredible to witness! Epitomised also, how our own perspective of what’s going on can be so distorted, especially when our mental health is down. Or even when it’s not, how easy it is to blame ourselves and feel like a failure. But whilst there are still ongoing issues with discrimination against mental health in the medical workforce, I think the culture IS changing, the conversations ARE happening and this gives way to hope for a more compassionate health system. I am proud of pioneers and people who put themselves in vulnerable positions to bring about this change. As a 5th year medical student, I sought the help of the Victorian Doctors Health Program, and was admitted to a private psych unit. One fellow medical student, Dr Nicky Dobos, knew and put herself out there, despite the stress of exams looming up, to check up on me. Over the last 5 years, I have been a patient at a parent-infant unit in the same region that I work at as a GP obstetrician. It has been humbling, a perceived fall from grace, and then completely enlightening and an incredible experience of relative freedom to allow myself to be a patient, rather than hiding behind the stress and the perceived shame. It has taken me a while to get there though. At first you just feel like a failure, then you feel like a failure for failing to get yourself out of feeling like a failure, and on it goes, as each cumulative toxic layer threatens to completely overwhelm you. I will never forget those brief moments in my life that felt never-ending, and whilst I do not wish to experience them again, I am now much more willing to lean into discomfort, and I am grateful for the humility and the life lessons they have and continue to teach me. So, next time, black cloud, if you decide to come for me, I am learning to not fight so vigorously against you, but to accept and see what you have to teach me this time.
I think in our medical profession, NONE of us are immune from the, at times, high stakes game of life and death, and feeling responsible. In some ways, our profession is as high risk as the military for post traumatic stress, yet it is often unrecognised, poorly understood and accepted. The coping mechanisms may be variable in expression and severity, from depression to drinking to humour to desensitisation and depersonalisation to cynicism. Failure to recognise and address these issues not only puts individual medical professionals at risk of burnout, mental health issues and suicide, but also threatens patient care via disengagement, fear tactics, bullying and toxic work cultures.
To prominent leaders in our medical profession whom I have had the privilege to hear their story – to Dr Vijay Roach, to Dr Toogood, to Dr Richard (and Lucy) Mayes and now to Dr Steve Robson – thank you for paving the way, for your clinical courage (I can imagine, Steve, that you still might have felt like deleting this article as you were writing it!) – I have no doubt that you will be preventing multiple suicides in having spoken out.
In finding a colleague in whom you can confide DO NOT make the mistake of choosing one who works with AHPRA. Listed here
https://www.medicalboard.gov.au/About/State-and-Territory-Medical-Board-Members/The-ACT-Board-of-the-Medical-Board-of-Australia.aspx
Thank you for your courage and leadership in writing this, Steve. It can not have been easy, but it is such a powerful story.
It may be helpful to persons deeply troubled by painful and recurring thoughts and memories to seek help with psychotherapists familiar with EMDR, a very effective way of clearing the mind of disturbing thought and an excellent method of treating post traumatic stress disorders. There is a place in all of us, beyond our limited thoughts, fantasies and imaginations that is rooted in fact, and perception, that is a limitless energy, call it love and compassion, a clarity that if we can see it is beyond the limitation of thought that will give us freedom from divisiveness from what we think is the solution to our problems. The answer is not to seek answers but to be in the action and movement of non thought of a quiet mind which is freedom from ego and trying to achieve and living in comparison and judgement, all of which is the cause of mankind’s psychological unhappiness.
I watched my Husband go through intern and residency in the 80’s. I watched the incredible hours he then did the the UK for his dip in obstetrics. I then watched as he did anesthetics before going out into rural general practice where he did 14 yrs. I can almost picture in my mind Kate’s description of the unfolding story.
I read it with tears but it was a story that needed to be told. We need to keep talking about it so that more dr’s both young and old stop dying.
Thank you Cate. I really appreciate that.
FROM THE EDITOR: Renae, on behalf of the MJA and MJA InSight, please accept our condolences on the loss of Frith. Thank you for adding your voice to this debate. All strength to you and your family. CS
Thank you Steve. The doctor you spoke of, Frith Foottit, was my husband. Thank you for honoring him, and bringing his story to light. I’m so glad you survived your darkest days. Let’s hope this initiative helps others survive theirs.
Hi Steve,
Thank you for writing this. I think many of us have stories from our junior doctor years that we’ve never told people. It’s such a stressful, tiring, lonely time. For those of us without family or partners it’s incredibly isolating. I think during the notorious “week of nights” the only people I would speak to were hospital staff and patients.
Thank you for your lovely care during my own pregnancy and (almost) delivering my last baby! He’s almost two now and going gangbusters with his brothers!
I can’t say how much I appreciate you writing this and really saying how bad it can get. We need to hear more of these stories and feel free to talk about things like this more in our profession.
Thank you Steve for sharing .
Also, thank you Kate for sharing as well.
Thank you Steve for sharing your very personal and inspiring story. From my limited knowledge, you have been a great advocate of those who are not easily visible and struggle to be heard, be they our First Peoples or migrants. Thank you for shining a light and giving a voice to the many doctors and medical students who struggle with mental health. Best wishes and thanks for being our president.
Dear Steve
A big thanks for sharing your story.
I had a similar experience, which was a few years ago when I was working as a junior doctor. Being an international Medical graduate getting a RMO job was very difficult I got my first job, which was in a different state away from my partner after a long struggle.
The hospital never gave me a full years contract. It kept giving me 3 monthly terms after every end of term report. Therefore, I was always at the edge, doing a bit extra to prove my self again and again.
I could not sleep. I had panic attacks. I blamed myself for a death of a patient. I had flashbacks of my interactions with that patient. I saw my GP and was diagnosed with clinical depression.
I told my supervisors and medical administration about my illness. My supervisors told it was an adjustment disorder and that it would be very difficult for me to get an emergency medicine term to get General registration as the medical administration knows about my mental illness and emergency medicine is very challenging.
My depression worsened to a stage when I started googling on “easiest way to suicide” I was not taking the medications prescribed.
I had a minor car accident whilst driving to work one morning so my partner didn’t let me drive to work as he was aware of my googling, I started taking cab for work.
One evening in winter I decided to drown myself in one of the beaches, which was 15 km away from where I stayed. I called my regular “cab driver” to take me to the beach. He was suspicious about my plans. He spoke to me and said I needed to talk to some one and he took me to his home and I met his family, his grown up kids and grandchildren all under one roof. This reminded me of my family overseas and I had a change of mind but still somehow regretted having called the usual cab driver as my intentions were shattered.
I shared this to my partner who worked interstate. My partner and my family forced me to resign in the middle of the term. I decided to leave medicine. I went back to my home country for 6 months, I was forced by my parents to see a Psychiatrist and take anti-depressants.
When I returned back to Australia, I got a years supply for my antidepressant from overseas. Don’t know why but somehow I started applying again for RMO job and immediately secured a years contract in the same state where my partner lived. I got 2 emergency medicine terms and my previous supervisors words haunted me “ that emergency terms are challenging” I tapered myself off the medication and did well in all my rotations.
Exactly a year later my interaction with the cab drivers family, “Thank you for making a difference in my life ” he had already retired by then. He called me on my mobile and we had a conversation about life.
And now after several years as a General Practitioner, I feel so passionate about my work. I do not regret the past; because of my past experience I understand my patients and am able to have more meaningful conversations with my mental health patients. . I am happy and content.
Bullying by senior staff is a recurring theme throughout these posts, but you should stop for a moment and realise that those who bully are frequently suffering from feelings of inadequacy and the “impostor syndrome” themselves. They feel their ability does not match their position or the respect they are given so they take it out by bullying their subordinates to conceal their own shortcomings.
Bullies at work are seldom unpleasant within their own families, where there is no similar pressure.
Perhaps bullying should also be recognised as the symptom of a mental condition that could be cured by patient counselling and understanding.
Dear Steve
Thank you for sharing in such a personal way. Well done for shining light on these issues. I salute you.
Dear Steve,
Thank you for sharing your story. It reminds very much of my own story. I feel that it is happening to many people around us. We all have personal challenges to go through. We all here to help each other to sail through the difficult situation. I hope we all can work together to support new generation during their dark tunnel voyage. Thanks again.
Dear Steve,
I want to add to the list of thankyous for sharing your story. I am a junior registrar of your college and your post was very timely in That I myself have taken some time off for my own health. It is extremely reassuring to see the support of our president in encouraging recognition when personal challenges arise and the encouragement to seek help and undertake measures to address these. I hope your words can give other junior doctors the strength to reach out.
Just clarifying – I was actually NOT the person who knocked on Steve’s door – as Steve and I both know.
Steve chose not to name anyone, therefore I did not name anyone either : it is Steve’s story, not mine.
I was merely someone who knew this episode had occurred, not the person to whom Steve opened the door.
But I knew, I most definitely knew, and if those few of us who knew had not felt obliged to help maintain the (supposedly protective) culture of silence, then Steve would not have lived for the past 30 years without realizing for all that time that his friends were actually caring and wanting to help.
Steve, I have known you long enough to appreciate your courage and your determination to help others. I am therefore not surprised that you have told your story in this way. Clearly it will help many people who are suffering just as you have in the past. I was an intern (junior resident) at the Royal North Shore Hospital in Sydney in 1971. That year was the worst year of my life. The systematic bullying and intimidation that I suffered led me to cry myself to sleep on many nights. At the end of that year I got as far away from that place as I could. I went to the UK and thus began a long and satisfying career in obstetrics and gynaecology. My mission in life as I approach retirement is to make sure that the junior doctors who I am helping to train do not have to go through that type of trauma. They need (and deserve) our support, our care and the best teaching we can give. Congratulations on a splendid article.
thank you Steve and Kate for your courageous end to the 30 years silence. This world and this life are far from perfect, but I am greatly encouraged by the lengths to which you have both gone, to strive to do what you think is the right thing, throughout the 30 years and today. The many comments show varying degrees of agreement and disagreement with your thinking and your actions. Discerning the right thing to do is difficult. Striving to discern the right thing is the first step. Doing it is the next. And who can say which is the more difficult?
I’m not a physician, but a minister in the church. The pressure to not admit to any form of mental illness is very similar.
Dr Steve’s suffering and these responses document an emotionally challenging chronicle of the importance of our human concerns for others. A near tragedy and perhaps other real tragedies that dod occur may have hinged on the fortitude of those concerned and their willingness to appear foolish or intrusive by speaking up.
As a psychiatrist my heart aches thinking that my field is not one that anyone with emotional stress would turn to for relief and restoration of wellbeing. Targets for intervention are all here. To live is to suffer and face disappointments, uncertainty, and stresses. To be a friend is to be available to another who feels unanchored, it is at the worst of times that one most needs friends. If there is a medical speciality that treats disorders of the mind or spirit, then it must be one that is a real friend to anyone in need, such that one naturally reaches out for help.
I find these tales tragic because friends find it so difficult to possibly make a fool of himself or herself and say “Steve I am terribly worried about you. You know I am a friend who loves you and I cannot face the thought that you are upset and do not think we are as upset as you are. Let us help. We have all had terrible times. You have been there for us. Now its our turn to be there for you.
I find it tragic that how we psychiatrists present ourselves to colleagues and the public, we are not regarded as real friends who are on your side in the worst of times.
Let us get real. We have some work to do so these experiences of no where to turn are no longer part of our societies and our medicine.
To Steve Robson:
You live about as far away geographically from me as is possible on earth, yet your story hits close to home. Something which helped save my life was a Physicians’ peer support group. This allows for confidentiality without secrecy, if I may split hairs.
To Kate Tree:
Thank-you for saving Dr. Robson’s life.
– – Francis Newman
Of 82 responses so far, there has only been one from a medical administrator. The silence emanating from RACMA is deafening. The one response, while very welcome and worthy of some encouragement, seemed to contain mainly platitudes. The College needs to lift it’s game on this issue after at least 40 years of being complicit. Get serious! This issue is ENTIRELY within your remit. Push back against Health Departments, design systems that anticipate difficult patients and families. Listen to your staff and act on suggestions to improve workplace safety. Failure to act will eventually see you facing personal litigation for negligence.
Thank you Dr Steve for your story,it will save so many other people from taking lives.It also shows that our tomorrow shall be better if we don’t quit.
My husband was a fantastic medical doctor, he died recently of cancer. Most of his life he took medication against depression and anxiety, and he lived a succesful and happy life with a well controlled depression. He was a very empathic man, with many friends and colleagues that knew about his condition and to which he could turn for support, which he frequently did. I have always thought that these characteristics were linked. Prone to depression, very empathic, and being a very good doctor. Medical professionals should be encouraged to take care of their mental health, and they should be actively supported in doing so during their training and their professional life. In fact, mental health is important for everyone, and I would expect that all medical doctors receive sufficient training to recognize the symptoms and act upon them in patients and colleagues.
If the medical profession would realize that MD does not mean”Medical Deity”, the whole ptofession would be much better off. Doctors are human, just like the test of us. I have a PhD in molecular immunology. I worked in a medical school as a research scientist. As a woman & not an MD, I was frequently ridiculed as not “good enough” to be an MD. Why would l want to be an MD, if this was how they behaved? The whole culture of medicine needs to enter the 21st century for the good of doctors & their patients.
Society sends mixed-signals about men showing emotions. I am very liberal and saw amongst very like minded people the mocking of men that cry or show emotion.
Recently over in America, feminists writers were saying Supreme Court Justice Kavanaugh was unfit to be a judge because he was emotional and cried during confirmation…even going as far as pretending to drink male tears.
Sorry but we can’t talk out of both sides of our mouth. Praising men for sharing feelings but mocking the ones that we don’t like for the same.
Bravo Steve. Bravo.
Thank you for this.
My daughter is in her 3rd year of her nursing degree. As a result of an attack by a previous partner she had to take time off to heal. Her physical injuries have healed but mentally ? No, not yet but with the help of her wonderful Uni team, she has been given time off. Through her GP she has been seeing a psychiatrist and working it out. She has also moved back home with myself and her older sister. To top it all, she’s just been diagnosed with fibromyalgia. Her Uni team have just rescheduled her placements to take this into account as well.
Support is there in some places and it has been worthwhile so far. Not my old daughter yet but a new older, wiser version is emerging. I’ve had many a chat with her, trying to offer support anyway I can ( her mum is just very dismissive of this- one reason we’re divorced) and i hope she is recovering.
However, as someone who suffers depression episodes myself, I know how easy it is to put on a brave face. All I can do is be there for her and listen. Sometimes she wants advice, sometimes she just needs to get it off her chest.
So far, apart from the delay in qualifying, this hasn’t appeared to affect her career. She still has 2 offers of full- time scrub nurse at 2 different hospitals, both have put them on hold stating that once she has qualified, then she can choose. Signs that some places are changing , even if it’s just at local level. Hopefully the support will continue to be available for her as she progresses.
Anyway, just want to say thank you to all mental health professionals for the work you do and look forward to the time when time off for this is given the same understanding as time off for a broken leg. Just because there are no visible symptoms doesn’t mean the person isn’t hurt.
Dear Steve,
Your story brought tears to my eyes. Over the New years’ week, I was on call as acting Executive Director Medical Services for Central Queensland Hospital and Health Services (CQHHS includes Rockhampton Hospital). Early on New Years’ day I received the terrible phone call advising that one of our most senior and respected Orthopaedic registrar had taken his own life. I was severely shocked and emotionally shaken. As the news spread, the resident and senior medical staff were in disbelief. He had friends across the organisation who were shocked and unable to understand. He was a great teacher and helped all who asked. Rockhampton Hospital and CQHHS are determined to provide a safe and supportive working environment to all our staff including our junior doctors. Your personal experiences and your courage to be so open will help all at Rockhampton Hospital to understand the need to search for ways to understand better, how our colleagues are feeling and give each of us greater courage to ask for someone to listen.
Deepak Doshi
Thank you Steve for sharing your story! I see a lot of people commenting on here about how it is mandatory reporting or their GP or colleagues etc. who have kept them silent. As a final year medical student in NSW who will be leaving clinical medicine after this year, I can firmly say the problems still remain in med school too. I have reached out to our faculty on three occasions when I was feeling as I put it ‘situationally depressed’ – once for being bullied my a supervisor, once when my grandfather died, and once because I was forced rural for an extended period of time and removed from all my supports. Each time I was essentially told that these things would prepare me for my future in medicine and that I should treat this as a learning experience, even though they were sorry to hear I was struggling. In the end I didn’t feel there was anyone to turn to, and that if this was the start it was only going to get worse. I have made the decision to move into business instead, and whilst I will earn less than my colleagues I am hopeful that I will be happier for it. Sometimes I question this decision, but everyone’s comments on here have made me feel much better for it so I thank you all!
Dear Steve,
Thank you for sharing this story. It is particularly important to me, as you feel that you have let other colleagues in distress down by not telling this story until now. But sharing is not the only way to help. Let me tell you how DID help me.
You were my registrar when I was a highly anxious, highly neurotic 6th year medical student doing my obstetric rotation in Rockhampton. You were a fantastic teacher. But more importantly, you spent alot of time talking to me. Chivving me along. Being kind. Being comforting. I thought you were just a good guy. Looking back, I suspect that you saw things in me that you had seen in yourself and tried to make it better. And you did.
For my own part, I talk now freely to my juniors and my patients about anxiety, perfectionism, vagal dysfunction, meditation etc etc. I have never used medication, but have no shame in admitting that some rather serious therapy has substantially improved my life.
It is no surprise to me that you have ended up as President of your College. Amazing then. Amazing now.
With thanks and love.
Thank you for sharing your story. One thing not mentioned is income protection insurance etc. will have a clause to say any mental health problem will not be covered – even if you have only seen a GP for work related anxiety in the past.
As a RANZCOG trainee within sight fo finishing, it has been good to see the training support unit has appeared and I really wish it had been earlier, although I’m not sure how to use it. The college demands and expectations are hard to meet at times and actually doing the job is the least stressful part by far for me.
I have found it difficult to be reading this, as I am having to apply for special consideration this week to be allowed to stay on the training programme, as I have not met a certain requirement by a specified time. I have never been a problem trainee clinically or inter-personally, but certainly my mental health took a nosedive for a few days when confronted with an email saying I could be removed from training. Oh, and none of my training of the last 6 months counted, and anything subsequent will continue not to count.
As the rules for applying for special consideration are so limited (do not include work related stress and anxiety, pre-exisiting illness etc.), I’m actually lucky that a close family member was very ill in the last run so that I can use that as part of my application. Indeed the RANZCOG wording is such, that to apply for special consideration on mental health grounds, a trainee would have to be sectioned or suicidal. It would be great if people could be supported in training with the recognition that we all have different strengths and weaknesses, and that suffering burnout and stress impacts that.
Thankyou Steve,
As a Specialist I am concerned about the way we train our registrars. Recently we had a registrar who we were informed by his wife confidentially (without her husband’s knowledge) prior to him starting that he was being admitted at the end of his previous run for the first 2 weeks of his new appointment to a private psychiatric hospital in another state. This was his first position as a trainee in our college-the candidate having had bullying issues with the previous training programme. The candidate never mentioned his problem to the director of training or the head of department in the whole time he was with us and eventually left at the end of the year.
I cannot emphasize how important it would have been to start a dialogue about his illness. Because we were not supposed to know about it we couldn’t bring this up with the candidate directly. The candidate interpreted his poor performance comments negatively-while that could have been the depression, I suspect he was really struggling with the job and just day to day functioning which was under par. The college could not be informed and therefore no quarter could be given, and I think this is wrong. In another time with good control of his disease he may have been perfectly fine. He wasn’t reemployed as the majority of the department felt he was not engaged. I think he got sold short.
I think it also points out the degree we really rely on having a fully functional registrar in a training position and how stressful it is for persons without extra problems. It is a hugely stressful time, the information curve is steep, and the stress of learning more in a short time is huge, with the exams on top. Our current college has a 5 year time limit to complete training and I think this needs to be subject to special consideration for persons with extra challenges.. Selection panels need to be more sensitive to persons who take time off to recover not penalise them for it. Its in everyone’s interest to have healthy staff and make the workplace a better place. Instead of helping this registrar he had a negative experience in our department and didn’t come back. How much better would it have been to let him get well and not put the pressure on until he was well enough to deal with it.
This case also highlighted to us the issue of evaluation. The candidate in question interpreted any attempt to evaluate his learning as bullying and refused to engage in active on the run learning. This was possibly too confrontational for him but again I suspect was a indication of the illness. To dismiss this person as inadequate when he was under the influence of a mental illness was not fair to him-but again was not something we could address without his agreement. This is a really difficult situation for both parties-I think there needs to be trust on both sides, and also integrity that the right thing will be done. The employer needs a fair job for a fair wage, the individual needs job security, dependability at a time of unrest, support and help to get well. Maybe what we really need is a code of ethics and guidelines or standards when dealing with impaired health professionals that APHRA, the colleges, the employers and individuals need to adhere to. The first principle is patient confidentiality, the second is fairness. After all-if you broke your hip no one would ask why you need 3 months off work-why should they for mental illness. No-one would also query when your local doctor would say you were ready to return.
Thank you for your courage and compassion for others ,Steve, by telling your stories.So many others have added their stories and have told of sharing these stories to many others. It is so important that are not silent any longer.
Margaret
Thank you to Everyone for being part of a conversation resonating with so many when you consider the ripple effect. Inspiring to read such thoughtful and personal comments in a professional forum generating a good deal of cognitive dissonance while contemplating such a range of experiences.
My thoughts are with those present and past who have been there when they could not be heard.
Lifestyle factors are increasingly seen as crucial to potentially preventing and managing diseases of our time. In this respect my education started after 1988 when my schooling finished.
From observations made over years while seeking to understand my personal and family journey the following recurring themes have played a part in how I strive to live and reach my potential ..
.. Connection .. Nutrition .. Exercise .. Sleep .. Be
In context of what has been said in previous posts one’s needs may differ depending on genetic tapestry, bio-individuality and options life may present at a given time. We can no longer accept barriers that contribute to our very own who for good reason feel uncertain about seeking help.
Why not take the best of our current paradigm while harnessing the talents and efforts made by courageous colleagues who dare to think outside the box. What if we became catalysts moving from a disease driven to a wellness based healthcare system starting with ourselves? .. Just imagine ..
Those of us with bipolar disorder whose lives have been saved by caring friends are, indeed, fortunate.
Hi Steve,
I’ve known of you, your dedicated work and effective leadership of RANZCOG and now I read of a story both brave and articulate. Thanks for your generosity and humility; perhaps more senior doctors in our hospitals still need the cognitive skills to empathetically care for juniors. A significant improvement would come if there was no further bullying from doctors AND some administrators….we should address these issues as they are perhaps more amenable to being improved than are the thorny politics of external structures of governance. We are part of a caring profession, hopefully with the guidance of such fine people as Kate and yourself, we may show by example to our junior colleagues what it means to care,
warm regards,
Chris Halloway
I am not a doctor, but worked as a Nurse and Midwife for many years , sometimes in country hospitals.
My husband is a practising medical specialist in a capital city, our son is a medical student in another state.
This wonderful ,powerful and brave article is exactly the type of discussion we need to be having in the medical field, which is unique in it’s extreme pressure and unrealistic expectation of nothing short of perfection and excellence.
I applaud your courage and insight Professor Robson.
I have printed this article and sent it to my son …I will encourage him to get his 3 med student housemates to read it, and pass it around their faculty in the hope of highlighting to the new generation of medicos the perils that exist and the discussion that needs to happen if they are to improve.
I wish you continued good health …you are an agent of powerful and necessary change.
Steve, thank you so much for speaking up. I am a GP who has had episodes of depression regularly since my teens. I am currently well, but struggle to seek help through “usual channels” when I need it. What you are doing is very important.
Thank you Steve, such a powerful article. Kate’s response (30) actually, unexpectedly made me cry – what a beautiful, eloquent comment. How Steve perceived himself, through the veil of depression, is so different from the perception those around him.
I have had episodes of depression throughout my medical career. I have had very little time off work. Some has been handled well by my employer and some has not……
For those still struggling, I am now in my 40s and my depression is well managed. I am glad I didn’t decide to die.
Thank you for writing this article.
I am worried about my colleagues and myself. Some of my friends are sitting their specialist exams for the 3rd/4th/5th time. I can see the constant tension before the exam, the crushing disappointment of failing and the depression of gearing up for another attempt. I’ve missed a whole year of my kids’ lives but at least I passed.
It’s not just the exam, there’s an unremitting anxiety that there aren’t any consultant jobs at the end anyway. It’s almost black humour, talking about our careers because to be honest, none of us are confident we’ll find a consultant job without leaving where we live. And we’re all in our 30s and 40s, we don’t want to leave our house, our elderly parents, our kids’ friends, our partmetr’s job….
Then we watch our colleagues go through coronial inquiries or litigation and I really wonder if medicine was really worth it. I know three senior colleagues, both of whom I have the utmost respect for, who were dismissed/lost their position because of a bad outcome. Why? Is this how we treat our colleagues?
No wonder there’s an epidemic of depression.
Sitting here in tears admiring the courage and bravery of Steve, his colleagues and others directly impacted.
Reading this post because a small portion of Steve’s story was shared in church this morning. His story was conveyed in a dignified, respectful and honourable way that piqued my interest.
I firmly Believe that their is a fine line between our mental health breaking us or healing us. So grateful for the public sharing. I have known people who have lived out brilliant medical careers with underlying mental health issues. I am not sure of the level of awareness by medical boards etc. I do know if they had been blocked because of their medical status we would have lost some truly gifted medical professionals.
Healing comes when we are no longer afraid to be who we are meant to be.
Many, many Blessings for your openness and honesty.
???
An “age handicap”???? Holy crap — if that doesn’t say a mouthful about attitudes within medical education, then I don’t know what does. Wow.
To the PHO working in Bundaberg Hospital. I started work as an orthopaedic surgeon in Bundaberg in 1988 . I remember there was a highly skilled and experienced PHO of mature age working in the A/E dept. who had no higher qualifications, this was probably you. If it was me who hurt you I am deeply sorry. Please be assured it would have been in no way a reflection on your abilities but concern that you might be setting yourself an impossible task to be accepted into a specialist training program while carrying an age handicap. My heartfelt congratulations on your achievements through your guts and determination. Philip Dupre.
Thank you to Steve for reminding us all that depression/anxiety/self-doubt can happen to us all, particularly in the early stages of our careers when sleep-deprivation, poor or no supervision and punishing work loads can distort our perspective on life. Next there are the punishing, often arbitrary and always expensive exams which face our junior doctors, not to mention the quotas for training places in all disciplines. However, at all stages of our careers there is the pressure of judging ourselves with the Retrospectoscope when we review our diagnoses. We beat ourselves up over diagnoses when new facts come to light, long after we have had to make the initial call based on our clinical examination, our knowledge that medical diagnoses are based on probabilities not facts, and the pressure not to order too many expensive tests!
Thank you to Kate for reminding us all, including Steve, that our colleagues do care for us, within the confines of respecting the privacy of the individual, with spectre of AHPRA hanging over us. You have inspired us to be more caring, with antennas finely tuned, when interacting with our colleagues.
Thank you to Jane, for sharing her very personal story with us all. It is a heartfelt reminder of the great cost of keeping one’s own counsel. For those who did not know Jane’s husband, John, he was our role-model GP in Canberra for many years. John’s death deeply affected all who knew him, and it still does. We remain inspired by Jane’s bravery at continuing her life as a GP and single mother, and by her wisdom in understanding the particular circumstances leading to John’s death, circumstances which could affect any one of us at any time.
I am a physician in the states and I was first diagnosed with depression during my undergraduate education. I started medication which helped, but it was a bit of trial and error to find the right regimen. I still excelled in college and was accepted into medical school where I also excelled. My depression was very well controlled and had never affected my academics. I was accepted to my first choice for residency, which is a large academic program. I was required to apply for a permit with the state medical board and on the application they ask about mental health. The application is very clear that if you are not honest, you can be disqualified from obtaining a medical license in the future, so I was honest and reported that I was taking a low dose SSRI for my depression. The permit was delayed, they wanted additional information about the depression. The questions were quite redundant, asking exactly how the depression affected my life. I told them that I was well controlled on medication and that my grades never suffered. Unfortunately, this delayed my obtaining the training permit even though I responded to them immediately. I was called by my angry program director prior to starting residency asking what was the problem with my training permit. His understandable concern with the delay was that I would not be able to start on time which causes major staffing issues. I proceeded to explain that I was on the lowest dose of a common SSRI which is what delayed the permit. I had no red flags… never hospitalized, maintained mostly A’s during undergrad when first diagnosed, so was accepted to med school and a reputable residency; however, I still faced, what I felt was unnecessary, discrimination from the medical board. This discrimination forced me to disclose private medical information to my director and boss which I did not want to share.
I have found that a lot of medical residencies (and medical schools) like to report that they have psychiatric support available to all, and “focus on well being”; however, if you actually utilize these resources, you are discriminated against.
I am lucky that I was able to get care and treatment when I first noticed my symptoms… I think I am lucky it happened before med school.. not everyone is that lucky and we are losing lives because of the stigma that med schools and residencies like to “say” they don’t have. Perhaps the problem is not actually with the med schools and residencies, but once you are done with training, you are facing a very discriminating medical board.
Hi Steve, thank you for sharing your story, it has come at a very opportune time. I am a final year medical student who has been struggling more than usual for a while now, whilst still keeping up appearances. I went to talk to someone about it for the first time the other week and received the similar advice – don’t tell anyone how you’re feeling, it is in your best interests if you don’t discuss this again. I have been feeling a bit lost since then, but this article made me feel less alone. Thank you!
Thanks so much Steve! You know me personally but I have chosen to remain anonymous because of fear, judgment and potential issues with AHPRA. My new diagnosis is too raw and I am still too “sick” to feel safe with open disclosure.
I have been self-treating/prescribing for unipolar depression for about 28 years. For my 52nd birthday this year I finally saw a psychiatrist and was diagnosed with a Bipolar Illness (after an “intervention” from colleagues and relatives). It has been an extreme roller-coaster since then as I had to be dropped into a depression first in order to remove the hypomania ( which was not enjoyable – it was irritability, agitation, anger etc). I am just slowly climbing out of this depression, but have a way to go. And like most doctors I am self-employed, the main income earner and can’t take time off of work unless things are disastrous.
And guess what? – the general advice from psychiatrists and GPs is STILL to keep quiet – until you are well. Because AHPRA and other colleagues don’t know how to deal with us whilst we are not well. And the sad thing is I UNERSTAND THIS!!!! – how, what and where do we assess a doctor’s competence to continue working with a mental illness??? We can see a fractured bone, chest infection, rheumatoid arthritis etc. but we can NEVER EVER see inside someone’s brain to work out whether they are fit for duty.
What’s the answer????? Blowed if I know, but at if we can start a dialogue we can progress in one way or another at least. So thank you Steve!!!!!
Hi Steve, From one midwife who has worked with you ,how proud of you I am ,for sharing your journey and understand what courage that takes ,you wil be an inspiration to many .
Steve, your story has been widely shared and I am reading and writing from Canada where it has been shared in a forum that I moderate. Thank you for your honesty, bravery and humanity. I think it is clear that how you perceived yourself is not at all the sensitive individual that you are. We need to take care of ourselves and take care of our own. Once again thank you opening up your experience with overwhelming stress and suicidal attempt with us. It humanizes and normalizes the epidemic of Physician Burnout and Suicide that is now rampant.
Thank you Steve for your brave and bluntly honest article and it has been inspiring reading all the comments and opinions. Proud to have you as our president.
This shows the gravity of the short coming. Our profession, despite dedicating our lives to help and care for people, has not had a great track record of looking after our own well being!
There are many circumstances that may trigger depression in health professionals, but instead of looking for cure for depression, should be looking at removing situations which may make the ingredient recipes for isolation and depression! This should be at social and professional level.
I found this story and Dr Tree’s response so brave and moving. It reinforces the idea that whilst there are bullies and psychopaths amongst us, most of our number choose to support and understand. It is a very lucky doctor who is never touched by mental illness. We work in a hierarchical system dealing with life and death, and the culture is still dictated by old men who are not empathetic to many modern issues. Things are changing, albeit slowly, and any doctor out there struggling should ask for help. A good psychiatrist will discreetly support you. You will not be reported and your condition will be confidential. Thanks again Steve – you’re an amazing human
Thank you for sharing your narrative Steve. Finally the mental health of doctors is being discussed and we can start owning this space. Our next issue is to change the system such that all doctors are supported at every stage of their career. Psychologists and psychiatrists have mandatory debriefing which doesn’t affect their life or income protection insurance, I’ve bever understood why we all shouldn’t have this.
Perhaps if the support process started at Medical school, and became part of Business as usual, we would not needlessly lose so many lives.
Glad you are still around to share and destigmatise mental illness in doctors.
Physician suicide still remains very taboo. When I went through this last year, I approached 3 different physicians. One patted me on the back and said to let them know if there was anything they could do. This physician was also what I thought was my best friend but never called me again even though we beforehand would socialise outside of work at least twice a week. The other two were GPs, one my own gp. They both suggested I take a week’s vacation. The truth is that we as drs are still very uncomfortable dealing with colleagues and mental health issues. I do not blame them. They lacked the proper tools. I jjust dont think they will ever realize how close I came or how let down I felt at the time.
thankyou for this, as someone who has been struggling for awhile, dealing of the shame of not being able to improve things on my own and have now sought help despite the fears of AHPRA ect it is this is beyond brave and wonderful to read.
In 1988, as an older doctor, I was working in Bundaberg Hospital as a PHO (Registrar level), and saw the patterns of bullying from the hospital executive affect many. I too had depression and psychiatric care, but was honest about the diagnosis. I was not reemployed but told I was “only fit to be a GP”.
Mentally well I have done well across many fields. I have a post graduate degree and two College Fellowships – driven in some way to prove to myself that the callous surgeon was wrong.
A colleague did not professionally survive the bullying and I saw reported later a deregistration for pethidine addiction.
Subsequently I have also discovered that being a rural primary care doctor is far harder than that surgeon imagined.
Thank you for your very difficult and truthful story.
And thank you to Kate Tree for you response and the intervention that was staged by your fellow interns.
As a fellow of your college I am very proud of my president to be so open about his own mental health issues and the fear of retribution associated with it.
The issue will still remain the stigma associated with mental health and the absolute fear that AHPRA at watching us like Big Brother.
I had a very confronting and difficult time adjusting to my mothers terminal illness and eventual death that I developed crippling anxiety and depression. I chose to seek help and commenced medication as soon as I could. To this day no one at work had any idea of how difficult it was every day for about 6 months and I never missed a day of work or had any issues with my clinical workload or patient care.
Unfortunately the general public is very misinformed with regards to those that are receiving treatment for mental health issues as my own brother asked me, “ are you allowed to work as a doctor when you’re on anti- anxiety medication”.
I hope this very public statement and story will help to limit the stigma associated with mental health and supposed impaired physician rhetoric.
I’ve often wondered how doctors manage and it makes no sense to me that more care isn’t taken of them throughout their training and subsequently. The carers need care too!
I heartily applaud your courage in speaking out and I sincerely hope it’s the catalyst for change throughout your profession. I know that if I was to be taken to hospital in a critical state I’d like to think the doctors and nurses caring for me are not over-tired, distraught, depressed or unsupported.
Thank you for sharing your story. I think everyone in medicine would be able to relate to it in some way. It certainly helps to know others have felt the same, and people years ahead of you have been through it and made it nonetheless.
Similarly to post 43, last month we lost a colleague in our network and many of us have wondered how we did not see the signs, why he had not disclosed his feelings to anyone, whether any of us could have prevented his suicide?
Medicine is tough gig. For so many reasons. Once you’re under, it can be so hard to see a way out again.
I think this article will help many, not to feel better necessarily, but to feel like they’re not the only one.
Thank you again.
Death Toll of Mandatory Reporting
The Medical Profession needs to take AHPRA to task over the issue of the toxic environment caused by Mandatory Reporting as it stands currently..The aim of these laws is to “protect the public”
Every Doctor is also a patient. Doctors have medical ,surgical and psychiatric issues of their own. Every patient should have access to compassionate, capable, appropriate and expert care. There can be no exclusion from this care because you are a member of a profession covered by AHPRA.
The risk to the public is in fact increased if Doctors are forced away from proper treatment guidelines and deny, self diagnose, self treat, avoid professional or family support for fear of Mandatory Reporting. The isolation and improper management is more likely to cause a myriad of avoidable outcomes, including suicide
Thanks to Prof Robson for exposing the issues
Hello Steve –
I so wish my late wife Lara had the benefit of your wisdom, or perhaps had been interrupted in the midsts of her attempt. Sadly, she completed suicide in her third month of residency.
I hope that the people who may be considering suicide and read your article will take a moment to think about those they will leave behind who love them and will never understand their rationale for taking their life. Their pain gets transferred to the survivors, and we are the ones who are left to answer the never ending questions that swirl in our heads afterwards…the biggest one being, WHY?
I wish you all the best in your continued career, and encourage you to continue to speak out to help others who feel they must suffer in silence.
Thank you, Prof, for sharing this part of your life. I lost a colleague last month to suicide and how I wish we had managed somehow to prevent him in that moment from taking his life, and how I wish I’d been able to tell him all the things he is so loved and respected for as Kate Tree has done today. The solution is not straight forward but surely people talking about it in the way you have done is a step in the right direction.
From the editor: Feel free Peter, although they don’t have to be AMA members to read this article. MJA InSight is open access to all readers. Just send them the URL and they will be able to read it: https://www.doctorportal.com.au/mjainsight/2018/41/learn-from-me-speak-out-seek-help-get-treatment/
May I forward this article and Kate’s to our local medical association for members that do not belong to the AMA? Well done on breaking your silences.
Thank you Steve and Kate for breaking your silences and sharing with us. Kate’s response was profound. I’m glad she found Steve’s article in the first place and decided to share her perspective. Apart from the known stressors of the job, I think 3 factors that can literally push someone of the edge are an unfortunate horrible event with poor patient outcome, work-place bullying and dreadful put-your-life-on-hold exams. With the first, some will continue to blame themselves and never get over the guilt. After initial intervention, they will need ongoing support. Work-place bullying is still rife and accepted. The victim goes into a vicious cycle of losing confidence and under-performing leading to more bullying. There is no necessity to bully in order to train juniors. My complaint of bullying was responded with “yes we all know he’s a bully but he’s the professor of blahblah”. Finally, we need to reconsider the way we assess trainees. Preparing for the exams puts one’s life on hold. Failing the exams puts one’s life, career and everything else on hold. Or maybe we just need to change that attitude and perception. In hospitals that take great pride in maintaining high pass rates, the failed candidates often feel marginalised–not overtly or deliberately, but from all the accolade given to the successful ones.
I would like to thank my supervisor who noticed that I had transformed from bubbling enthusiasm to spewing cynicism, in addition to underperformance. Getting marched off to the psychiatrist did me good. But on my part, I learnt that I needed to want to get better and stay motivated to recover.
That could almost have been me six years earlier! but too much inertia to go as far as you had. Experienced some pretty severe consultant bullying for a while. I salute your courage Steve and the way you turned your life around. When I met you in Rockhampton fresh out of the navy I was floored by your energy and felt pretty much a slacker by comparison. It was so clear then that you had found your niche. I have watched your progress with pleasure.
Thank you Prof Robson- this has helped me, as an RACP trainee “in difficulty” (what a label! How dare we fail exams!! Clearly our colleagues who’ve passed theirs are not in any difficulty at all!!!), and as a human today. I am really glad that you wrote this, and shared honestly about your experiences; how common this is, unfortunately, and how extraordinary about your colleagues’ intervention 30 years ago!
Dr Tree, I am gobsmacked reading your story, too!
Please know that just by writing this, you’ve already helped countless people who have struggled or are struggling right now. Thank you again.
As a psychologist supporting doctors all of these stories and responses have bought me to tears. Thank you Steve for adding your voice to this change. There are prevention strategies to grow the skills of well-being. Medicine needs to move its gaze to prevention as well as response to really foster a different culture of care for doctors. This year our Immersion doctor care program has included 2 RANZCOG members. They and all the participant doctors recommend our program with comments like “ this should be compulsory for all doctors”. Skills in self awareness, self compassion, communication, deep listening that bring better patient outcomes and better doctor well being. I’d love to talk with you about it Steve. Thank you again and may you be well.
Sincerely thank you Steve. That is just what we all needed to hear.
Mental health needs to become ingrained in every conversation about health. Beautiful, brave & brilliant
My sincere thanks to Steve for this most important article and to Kate for the frank and touching response. The transition from student to intern can be a terrifying one, in which fatigue and derision from seniors can only worsen outcomes. For people at risk of depression, this is a very vulnerable time. We should all do our best to foster and care for our interns in the way we would want our own children to be looked after in similar circumstances.
Wow, I never anticipated so much interest in my story! I am absolutely staggered reading Kate Tree’s comments – indeed they have deeply affected me. Kate – I will contact you directly to talk… after 30 years!!
Also, absolutely NO disrespect to the GP involved. I appreciated the advice and help at the time, and indeed we remained friends subsequently. The advice was the prevailing sentiment at the time and, indeed, probably the prevailing sentiment still. This is what we all have to work to change.
Thank you all.
Steve
The Colleges have blood on their hands and doctors will continue to die if they don’t change their arrogant positions. More interns in the system, increased competition for training positions and ‘teaching’ hospitals focussed on minimising / flogging staff without any interest in training them appropriately. When specialist exams are failed, the feelings of failure cannot be diluted with open dialogue. Careers are destroyed first, add the financial strain then lives are lost as a consequence. No professional body in the world would be allowed to, or get away with treating their members so appallingly. All of this conducted under the smug guise of training of which they charge upwards of $10k. I can’t wait to find a way out of this profession, it has a shiny veneer yet a blackened, morally bankrupt soul.
Thank-you so much for sharing your story with us Steve. I am so impressed that our President is so open and courageous.
Kate, thank you for posting. Heartwrenching, beautiful, sad, hopeful. All of the above.
Dear, dear Steve,
As one of the very small group of interns working with you in 1988 at Rockhampton, I read your brave and eloquent story. I wept, I could not sleep, and I feel I must respond.
Oh Steve, I had no idea until reading your article that for 30 years you thought it was “just plain good luck” that you were visited at home and interrupted before you could commit suicide. Your “hospital supplies” had indeed been glimpsed, a small number of us were terrified about what your intentions might be, and there was a desperately staged intervention. If you had not opened the door then you would have had visitors climbing through your window or kicking the door down. It was not an impromptu visit. It was not “plain good luck”. We cared about you, Steve. We were unskilled, untrained, perhaps totally unhelpful, but we cared and we tried to help. Please accept my apologies for all the ways in which we let you down. Please accept my sincere and profound apologies that for the past 30 years, you have lived with the belief that no-one cared enough to try to stop your suicide.
Perhaps we could have helped you more without that “code of silence”, and what I heard described recently as “the manbox” – the cultural assumptions as to how a man is supposed to act, the box into which a man is supposed to fit. I was a girl, but I was not your girlfriend, so of course you could not be expected to talk to me about your feelings – in 1988 that was not how a man was “supposed” to behave. If I asked “how are you”, or “are you OK”?, and you looked awful but said you were fine, in 1988 I am afraid that I did not have any effective strategy to turn to next. I hope I would do better now.
All the promises of silence, which was most definitely the prevailing culture of the day, were well-meant and were intended to help you, and yet created a complex web to trap us all.
At the start of 1988, you were so ebulliently effervescently positive and extroverted. You always had a cheerful smile, you would stand and salute when women entered the room – you said you were practicing for being a naval officer, but you always made me laugh! You gave roses to all the female doctors for Valentine’s Day – initially anonymously, until your cover was broken. I still have some photos of you happy and laughing, including up on our roof – because the roof was the best place for a party on a hot night in Rockhampton. And I still remember that my first ever out-of-hospital cardiac arrest came in when you and I were the only two doctors in Casualty, or indeed the entire Rockhampton Base Hospital. You intubated, I did the IV cannula. This was the world before manikins, we only could learn on real people, I had never intubated anyone but you could already do it – I was so impressed. I wanted to be capable, like you were. You seemed so confident and competent, and you helped me so many times when we had a shift in Casualty together on an evening or weekend – I remember showing you all the ECGs because I was terrified of missing something crucial. You projected such outward confidence, which I saw – yet it seems you skilfully concealed your inner harsh self-criticism, in which we were no doubt alike.
As the year progressed, you became quieter, more serious, more withdrawn, and we saw less of you – in retrospect, that would have been the depression starting, but we were young and ignorant and all struggling to cope in our own ways with our own challenges. I would not have recognised social withdrawal as a sign of depression. We were all overwhelmed by the hours, the workload, the responsibility of being the one and only doctor on site overnight in the entire Base Hospital, under constant social pressure to NOT ask for help and to NOT call anyone overnight, by working as interns with sometimes no registrar and sometimes no consultant, if there was anyone more senior they were often only 2nd year out themselves. The interns in Brisbane were paid less than us, but we were working far more hours and scarcely had any supervision or training. Plus the charming culture of bullying and sexual harrassment in the surgical department by “Sir”, but let’s not go into that here…
I was not surprised to read in your article that you had obtained supplies from the hospital with intent to kill yourself – because, you see, I knew about that, way back in 1988. You had not hidden your supplies well enough, someone glimpsed them and leapt to the obvious conclusion. I was told in horror; there was great concern for you and for your well-being. The strategic mission to get into your flat succeeded, but we remained tense that you would try again another time. Later, I was told (“confidentially”, of course) that you were seeing a doctor and being treated, but you did not want anyone to know, so we were never to mention it. And we did as we were told and we kept your silence for you. I was told that your projection of confidence was bravado and a mask, hiding your inner self-criticism, that you judged yourself far more harshly than any of us would. And I was told all these things, but I was told that I had to keep this information silent and confidential. So much silence, to help you save face, to help you stay registered, to help you get to naval officer training after your internship; we kept your silence, and we did not share our own distress.
Steve, for all these past 30 years, I have kept your silence, until you have broken it yourself and bravely made this public knowledge. So now, I have printed out your article, I have shown it to my husband and said, read this, I was there, this was part of my life-story and lived experience too; and I have given a copy to my medical student to read. Sadly, you were not the only medical colleague of mine to have attempted suicide – just the first. I have been to the funeral of a colleague, and I have also helped resuscitate a colleague, when I brought my friend intubated into an intensive care unit with the tears still running down my face. And I have also had male colleagues cry on my shoulder in the workplace, because the 1988-style masks are slipping, the “manbox” is changing, and even well-meant silence is not always constructive, positive or helpful.
Please accept my congratulations, Steve, on having achieved such success in your professional and academic career. I hope that your personal life is filled with contentment and joy. I am deeply sorry that as a 23 year old intern, I did not have either the skills or the knowledge to have been more help to you, and that I contributed to letting you be caged by the silence.
Dr Robson remembers loneliness and isolation 30 years on: “To make matters worse, Rockhampton was a long way from my family”. Comment 9: “I was on a country rotation away from all supports in a grungy, cold flat, working long hours with little sleep and enormous responsibility.”
In today’s MJA Insight ‘Safe Spaces’: “My university assisted me to complete my terms in NSW after I outright refused to ever enter Victoria again. It was really challenging having no peer study networks…”
Some things cannot be fixed. We will always have the time pressures of trauma or acute medical emergencies, and the life-or-death decisions to make with inadequate time to think. Mistakes will be made, and as Comment 18 notes, we will be individually victimised by the entrenched powers in the system. Far better for one doctor to get struck off than the whole government-funded NHS be exposed as a house of cards.
But are there fixable things? How often do doctors suicide while working in their ‘home’ hospital, the place where they were a student then a junior doctor, and how often is the social disruption of an entirely new hospital a factor? Let alone an entirely new city. Medical rosters interfere with normal social activities like regular sports team membership, but it is well recognised that moving house is a significant psychological stress. Having a spouse with a job which precludes their moving to be with you, adds extra stress to the rural/remote placements.
Does anyone know whether the remote or peripheral rotations have higher suicide risks?
It is an imperative that we look after our junior doctors and trainees. I completely support that. But there are the mid-career doctors and the end of career doctors who can be jaded and worn down by years of tedious bureaucratic governance, patient abuse and the accumulating trauma of the constant exposure to illness and death. That group too needs our attention. There may be sympathy from a quiet disclosure to a colleague, but whilst the regulatory bodies maintain such an adversarial stance towards Drs, full disclosure is likely ill advised.
Absolutely floored by this piece – thankyou for writing it Professor Robson. Such an important message for students especially around examination time. It is so easy to believe that todays struggles will never improve, and your story is proof that this isn’t the case. Thanks again.
Thank you so much for this honest article Steve.
So many of us have remained silent for fear of the stigma. Like you, many years ago I was strongly advised by a senior colleague to keep quiet about my severe anxiety problems as a junior resident because it would adversely affect my career. So I did and managed to have what could be called a successful life in medicine. But at some cost…..
I retire this year but this is the first time I have been open about the health issues I had.
Thank you again most sincerely
Another great story…….
Is it safe to talk about something 30 years ago….
Is it safe to talk about sexual relationships within the workplace!!!
Is it safe to tell your wife / husband / partner.
Is it safe to talk about sexual relationships at work.
Is it safe your boss gives you a reference when you have a sexual relationship with them.
Code of conduct
Dishonest
Not leadership
Oh please
Unfortunately we are a long way off a culture that allows people to speak up. In fact we are cloaked by secrecy and shrouded by innuendo.
May that change.
Let each and everyone one of us contribute to that – one extra kind thought a day from all of us is enough to build momentum. That’s a brief moment for each of us every day, but think of the power that could have to galvanise goodwill.
For those who are stuggling – seek support from those you can trust, a.s.a.p.
Announcing it to the world – leave that for if/when you are ready. It’s always your choice – there is no right and wrong.
Steve Robson – thanks for speaking up.
May others step forward.
A powerful story. I was a GP in Longreach in 1988. You may well have looked after some of the patients I sent to Rocky Base. The advice the Rockhampton GP gave you was, unfortunately, as accurate then as it was in 2014, when my specialist-in-training daughter discussed her depression with her psychiatrist. Both the GP and the psychiatrist were telling the real truth, and there had been no change in over 25 years.
I think it still is the truth, despite the recent press to the contrary.
Mate, you were preserved, and perhaps it is your destiny, as the President of a Royal College, to be placed in a position to where you can do something about it. I don’t think it was your intention, but I’d be grateful if you’d clarify that it was not your aim to bash the GP who told you to look after your career, and eventually contributed to you current position and your ability to do something effective, even if she/he remained as silent as you did.
I do not blame my daughter’s psychiatrist. And she looked after my daughter very well, perhaps, in part, by the very act of remaining silent
Intern bashing, registrar bashing and GP bashing are unholy sports that are rarely called out by witnesses on the spot, at the time. They need to be.
You are now in a position to do something real about it. I admire your courage. Don’t stop now. And please, never, ever, rubbish your colleagues for surviving, rather than changing this awful system. Few of us have ever had your opportunity.
Thank you for speaking out Steve. Too many secrets, too much pain. We need to get better at this.
Thank you Steve for telling your story as a senior doctor and leader in medicine. As a junior doctor, this gives me hope and courage!
Thank you for sharing.
Your GP’s advice still stands “Under no circumstances tell anybody”. Like sexual harassment, unless you are a favoured staff member, complaining about sexual harassment or disclosing mental health problems will not only end or significantly inhibit your career, it will impact the rest of your life. It doesn’t matter all the “People will support you” “We will listen” “No more silence” etc etc platitudes we hear, as previous commentators have said, it generally does not go well speaking up.
I have seen too many examples where people’s lives have been utterly ruined leaving them mere shells just existing. I’m sure many reading would think that better than being dead, those going through life like this know otherwise. Years and years of ongoing misery, dragging themselves through life because they’ve been worn down not to suicide, so that last relief is no longer available to them.
Excellent story, Steve. I see it as a valuable contribution to evolving change in attitudes of and towards medical practitioners with serious mental health problems, which probably includes at least a third of us, over our lifetimes. I fear though that the changes required have a long way to go. My own experience as a junior resident admitting needing help for depression was to have normal superannuation cover denied, and I felt I had to ‘keep a secret’ several further episodes of major depression, over more than half a century, for fear of losing my job. Continuously employed in a teaching hospital, I saw a succession of young doctors killing themselves, often where it was almost expected, and despite efforts to prevent it. I suggest a major area for attention in suicide prevention is in ‘modern managerialism’, whereby individual doctors are identified and blamed for adverse clinical events, without proper recognition of ‘system failures’ and errors of other staff, and without support when most neded. The UK saga of the young Dr Bawa Garba, and a nurse working with her, show just how bad this can be, and this scenario could easily be repeated in Australia. Let’s continue the talk, and to practice ‘Stand by Me’ much more often.
So similar to my own story in medicine, yet I ‘rose’ to become a senior specialist, Vice-President of a State AMA, Patron of the Foster Care Assn of NSW & Federal AMA Councillor. Don’t give up. Find help.
Thank you for sharing your vulnerabilities. We need more leaders like you to show everyone is human.
Thank you Steve for your important words and story.
The one thing that I know is that secrets kill.
The blessing in your story was telling that wise GP about your thoughts, your secret thoughts about suicide.
So often we deal with inner turmoil and deafening and false voices of inadequacy as doctors and share NOTHING with anyone. Confessing and sharing your thoughts was the first step.
I think that professional supervision has an important role in all training programs, not simply Psychiatry. Being able to sit in a judgement free space and share your inner thoughts about the difficulties of being a doctor is crucial to our survival and leaving a legacy.
Thank you again.
Thanks for sharing your story Steve
You are a great leader and disclosing this personal story can hopefully help others to reach out if they are struggling with the pressures of a medical career
We all hope to provide that support for a colleague when they need it most
Our mental health is important
I hope this ensures everyone has their own GP to see when they need help
Powerful important message Steve. Thank you for your courage in sharing this.
Thank you for sharing this. I wish more leaders in our speciality could be so open. I am proud that you represent us as the president of our college and hope that the unforgiving culture of medicine will change.
Steve Thank you. I can relate too well to your story. As an American O&G the stresses of practice in US, personal family problems, and a death of a patient brought me to the brink of jumping from the Ohio river bridge in the early hours of one morning in 2008. Thoughts of the pain I would cause for my young sons helped to prevent me from completing it. I sought help and eventually turned my life around. Now I happily live and work in Australia as a member of RANZCOG. Your article stirs my heart to try to do more while working with our young trainees. Thank you
I am a very fortunate person for 2 of many reasons;
1. I have never known clinical depression and
2. I am a member of a College whose President has made, continues to make and I hope will continue to make a real contribution to Women’s Health, RANZCOG and my practice of O&G.
Thanks Steve.
This article will save lives. I have been at the brink as a junior doctor. Having failed the all or nothing specialist exams the week before, I was on a country rotation away from all supports in a grungy, cold flat, working long hours with little sleep and enormous responsibility. My career was in a holding pattern because of a failed oral exam (anxiety provoked verbal diarrhoea on my part) yet though deemed inadequate a doctor by the examination panel, I was performing all tasks at or beyond my level of experience. Yet I was a failure. I got to the point after two nights on call and about 6 hours sleep over a 72 hr period, I pulled the phone out of the wall and turned off my pager (no mobiles then!). No one could contact me, including my wife who was a 2 hour trip away.
This hospital had 2 senior doctors suicide in the previous years. A colleague of one of those doctors knocked on my door when no one could find me. He may have saved my life. I saw a psychiatrist that day and began the long journey of living with and acknowledging depression as my lifelong partner. I left medicine for a few years, gained additional qualifications and although I continue to practice medicine, I do limit my exposure to it having recognised the limitations of mental health.
A medical career is unforgiving. It is such a specialised qualification that those who wish to leave it find it difficult: retraining, salary drop–at a time when peers in other professions have established themselves.
I would never do a medical degree if I had my time again. Whenever I hear a colleague has died, my first reaction is how did they kill themselves? All too common.
Hi Steve
Thank you for writing
It will help change
And from a college President .great .. leadership
Take care
Geoff
Stunning. Thank you so much for sharing your story and experience. The more we speak up and the more we support one another the more well we’ll be as a profession and as people.
I can relate. I had a depressive and borderline suicidal episode in my late teens, during which I thought of self-harm and considered suicide, but did not form active plans. I told no one, though it showed in poems I wrote, but others did not pick it up from them. It recurred when I was in my early 20s, in my clinical years as a student,as phobic anxiety about heights and going near balconies, plus chronic tiredness and poor study habits. Both lasted about 6 months. Mid way through my internship I reached a point where I could not go on and fronted the Medical Superintendent saying simply that I was exhausted and could not go on. He organised me a week off using days in lieu of public holidays worked, and I bounced back.
Almost 20 years later I relapsed and found myself driving recklessly and considering suicide. By then I was a specialist in private practice and referred myself to a private Psychiatrist I knew fairly well. I’ve been on an antidepressant ever since, as I relapse gradually if i discontinue it. It took a fewtries to find one I tolerated well, but now life is good, and I’ve been well for nearly 20 years. My GP knows my history.
(There is a pattern of depression occurring in my maternal family line.)
We all have dear colleagues who have suicided without our knowledge of their problems. It is a topic to bring up in the tea room of every hospital, preferably in the hearing range of other health professionals and technical staff.
In doing so, sad at the death of an extremely talented anaesthetist, I had a theatre technician come up to me later in the OR. He was seeking advice for a “friend”.
You just never know how much the ventilating of the topic of depression can save at least one life.
Just do it.
Hi Steve. Thank you for your honesty. It makes a huge difference to know others are suffering. I made the mistake of letting my mental health issues come to the fore with AHPRA and at suffering the consequences. Many people never seek help because they will be penalised in a punitive system. It is not safe.
I should add that the situation was so degrading and hopeless that I attempted suicide thinking it would be the best for myself and my family. By that stage I had lost all self esteem – being treated as a liar and being humiliated for no good reason does that to you!
I have suffered at the hands of an uncaring psychiatric team who did not bother to assess me but labelled me with a mental illness. Because of the labelling of convenience they were able to detain me involuntarily away from my family at Christmas time with no feelings of guilt or remorse. Indeed I was humiliated and treated with disrespect in every way imaginable. Not only that, the misdiagnosis has been perpetuated to the extent where, despite my notifications to AHPRA outlining my concerns about the inappropriate treatment and misdiagnosis, AHPRA took immediate action to suspend me despite evidence from four independent health professionals that concurred with my innocence and dispelled any assumptions about the misdiagnosis.
Therefore I urge anyone with any suspicion of a mental illness to keep their symptoms secret otherwise they might find themselves in the same unfortunate situation as myself. It is better to suffer in silence than be subjected to the humiliation and loss of dignity that a misdiagnosis will entail.
Thank you Steve. That is a very powerful story. As a GP whose GP husband succumbed to suicide nearly 10 years ago, I know the pain that goes with the loss, which will always be with me and our four sons. I wish he had sought help but the barriers were huge for him. They were mainly fear of deregistration, fear that I would be (as a practising doctor) compelled to report him if he shared his problems with me, fear of publicity and rejection. As doctors many of us are perfectionists and this is another burden. We are a high risk group that has had too many obstacles put in our way to enable us to easily seek help.