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This article was first published as a comment on an MJA InSight article written by Professor Steve Robson on 22 October 2018, which we suggest you read first. It is reprinted here with the permission of Dr Kate Tree and Professor Robson.
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 felt 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 about 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 okay”, 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 intravenous cannula. This was the world before mannikins, 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 electrocardiograms because I was terrified of missing something crucial. You projected such outward confidence, which I saw – yet, it seems you skillfully 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 second 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. Not to mention the charming culture of bullying and sexual harassment 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 wellbeing.
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 of more help to you, and that I contributed to letting you be caged by the silence.
POSTSCRIPT: Steve Robson courageously revealed his story, hoping to promoting cultural change in attitudes to mental health within the medical community. Steve has received many responses, including from the surviving partners of doctors lost to suicide, from doctors confronted by their own mental health challenges, and from individuals who feel that silence remains a doctor’s safest option.
My reply was a personal message to Steve, yet perhaps provides a glimpse into the socio-cultural context of the 1980s Queensland hospital work environment.
Doctors face compassion fatigue, emotional burnout, vicarious trauma and workplace bullying – while working in situations that make it challenging for them to reach out for social support or medical help, in competitive environments that promote rather than discourage maladaptive perfectionism. We take bright caring young people then subject them to institutional traumatisation and see who survives.
Cultural change in attitudes is possible, it happens, it takes time – perhaps intergenerational change – but it also takes effort and it takes activism.
“You must be the change you wish to see in this world,” said Mahatma Gandhi.
How can we collectively, as a profession and as a society, promote cultural change to better protect, support and help doctors in distress, doctors with depression or burnout or with mental health illnesses or challenges?
“When you come out of the storm, you won’t be the same person that walked in,” said Haruki Murakami.
Silence is a risky strategy and not a long-term solution.
Dr Kate Tree graduated from the University of Queensland in 1987. She is a partner in a general practice in Murwillumbah in northern NSW.
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
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or MJA InSight unless that is so stated.
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Doctors continue to have good reason to fear reporting mental health conditions. I became unwell after having been bullied into performing non-evidence based procedures on children. Following an initial review by the Medical Board (which I instigated, to ensure I was fit to practice), the service in which I was a registrar (for having the temerity to then speak up about poor practice) decided that I needed to be ‘managed’. So they sent me back to the Medical Board for review if I took a few weeks off on sick leave (you don’t need to be seen by us, you are taking care of your health condition well). Each time I was reviewed by a different Medical Board Appointed Psychiatrist, with a different diagnosis each time (none of the reports utilised a DSM 4 diagnosis, or sought a decent corroborative history, or had a formulation…sheesh), none of which were correct. My advice: MAKE SURE you speak to DHAS, and have your GP/Psychiatrist understand that if you manage your condition appropriately, there is no need to be referred to the medical board. It was a mistake for me to want to be ‘cleared’ by the board to be ‘safe’ in the first place. I had no idea the prejudice and stigma that would result, and how much being re-referred would demoralise me and worsen my condition. Finally, if you are in an unsupportive health service, seeing poor practice, no matter what it costs you – leave. 99.9 TERs with hundreds of thousands of dollars, fine minds and valuable skills need to be better treated.
Dear Kate and Steve,
Having attended the same event, I must confess my ignorance at the time. Looking back, I feel a sense of regret for not being more perceptive. The ‘intervention’ group left a profound impact on me, and although I was a bit older and theoretically more experienced, I wonder if I would have been any less lost in such a situation. I can rationalize my lack of awareness by noting that I wasn’t very socially connected with the intern group, held a slightly more senior role, and had recently entered into marriage.
I’ve pondered whether this challenging period for you unfolded during our shared term of work. Regardless, I extend my sincere apologies for not recognizing any signs and not reaching out to inquire or offer support. To Kate and your colleagues, I apologize for not being more approachable, even though I doubt I could have been as effective as your group was. Undoubtedly, you must have needed support yourselves—before, during, and after.
On a different note, congratulations to both of you for your remarkable achievements in your medical and wellness careers and lives.
Best regards,
Hasnain Ahmad
What an incredible demonstration of humanity. Kate and Steve have displayed the life experiences and values of so many doctors, who are humans doing their best to use their skills and knowledge to help people and each other.
An important conversation on an often overlooked topic. Addressing the mental health of our healthcare providers is crucial. Thanks for initiating this discussion.
Helping medical colleagues with depression and suicidal thoughts and feelings can be more difficult than helping those who are not in the caring professions. The current systems of notification of impairment and supporting troubled doctors, especially in the public sector, are not working well and can make help seeking and help accepting harder. Accessing effective psychiatric help confidentially and in a timely way is difficult unless it is anticipated, facilitated, tenacious and resistant to initial rebuff. When suicide occurs, it is frequently associated with unhelpful generalisations on the value of psychiatric intervention among colleagues that makes others less likely to seek help or believe that the ‘the help will help’. The needs of the children of those who take their lives are often overlooked.
My experience is that while most of us are capable of criticizing ourselves into depression, there are a huge number of narcissistic bullies in our profession that will do it for us. They are to be found principally although not solely in large teaching hospitals where they thrive on intense competition, or conversely, believe that they need to behave atrociously in order to maintain their self esteem and position in the pecking order. Believe me, they are not all male either!
My advice to trainees today is to seek training positions in smaller, rural hospitals. It is disappointing to hear that there are some notorious hospitals in Australia. In my day, many of us sought out Australian training posts precisely in order to avoid the inhumane treatment of us in NHS hospitals.
Two of my most useful learning posts were O&G on the Isle of Man and ED in Darwin. Hours were humane, and personal support given by strong consultants.
I was driven to find posts outside of the UK by the bullying and criticism I received from the consultant in my first SHO position in Leicester UK. Believe me, had I not been married to a very supportive wife (and dog) I doubt I would have survived.
Nope, nothing has changed in QLD.
I suffered a severe depressive episode and was off work for ages (because of QHealth’s antics)…and guess what QHealth did?
They rang me to ask how I was going?
Nope. They subpoenaed my medical records.
I am a psychologist of almost 30 years’ experience. I read, with such despair, at the state of your governing bodies and ethos of your superiors. To ignore the mental health of those in the medical profession is an abomination. If they want doctors to care about others, then surely leading by example is obvious?
Additionally, it is worth reminding doctors of all specialties that Telehealth is an excellent, private and convenient medium via which to access a psychologist. Having moved from Victoria to Queensland, I was able to continue therapy with clients and when new clients, particularly medical professionals and those in emergency services, were unable to see me during my clinic hours, they could access me at their (and my) convenience.
Just as you are there for the sick and infirm, please remember that a psychologist is as close by as you need them to be, to support and guide you through the struggles with your mental health.
What can we do for our colleagues? Do what Kate & colleagues did for Steve … care:
“We cared about you, Steve. We were unskilled, untrained, perhaps totally unhelpful, but we cared and we tried to help.”
“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.”
We cannot control the outcome, but we can choose to care and try to help.
This stream of articles popped up via my Facebook page. I worked in the Dental Clinic at the Rockhampton Base Hospital around 1983, and became involved with the Dr’s Club for a short time. It was Party Central, and through that I got to meet a young registrar, with whom we had some excellent fun.
I moved to a capital city, but the night before I left my doctor friend thanked me, saying I was the only person who had introduced him to “real people” outside of the hospital. I had a bunch of engineers and the like as friends – they were intelligent and fun and I see now, a distraction from the pressures of the hospital (quite different from the pressures of the Dental Clinic – which mainly involved playing several hands of 500 over morning tea and chatting up the female staff!).
I have thought that a worthwhile endeavour might be to set up some links into the outside community so that doctors from elsewhere can have a life outside of work. And having had quite a lot of doctor friends over the years, I realise that the medical profession itself is a little weird. You go on a date with a doctor, your partner falls asleep at the movies because she’s worked 3 nights straight); often your only friends are doctors facing the same pressures and frustrations.
I have a lot to thank my doctor friends for – encouraging me to go to university, and all the great times in Rocky, Longreach and Mt Isa. But I was sucked into the whirlpool of depression too – I sometimes wonder where the party-animal went to – am I the same person? The “harsh self-criticism” leads to friendships being dropped.
Well now I have doctors and others to thank for my recovery from depression – following firm instructions from my wife (my best friend, incidentally), I sought medical help. The anti-depressive drugs got me on an even keel, and then some Duromine combined with exercise helped me start on some weight loss. Gradually my outlook improved and then I had an epiphany about these self critical thoughts. The vast majority of them are very misguided. Saying something stupid 30 years ago is not a reason to kill myself, it’s a reason to say “sorry” and move on. Likewise making a bad stock recommendation for a client (in the context of hundreds of good ones!). The times I should have done this, or should not have done that.
The constant chatter throws up these challenges, and then something unhappy happens (in my case, the death of my brother, the birth of a disabled son, the GFC, a death of a parent, a challenging business environment – life has been nothing if not eventful!). Our minds bind all these “reasons” like a causal bridge to the unhappy event. For a while I even became obsessed with the order I put the bins out, lest I attracted more “bad luck” – obviously that is causality gone haywire!
Now, the drugs don’t prevent these thoughts but they do slow the responses – I liken it to a horse sleeping standing up – you can function but part of your mind is asleep. And as I lost weight and got into some exercise (nothing major, just Parkrun and a few other bits and pieces), I realised I could challenge these thoughts. I can say “now look, I dealt with that 30 years ago”, or “that’s rubbish, I did my absolute very best at the time”. And you know what? The deliberate act of challenging of these thoughts sends them scurrying away. They come back less and less. Soon positive thoughts start to slip in. Occasionally I get a glimpse of the feelings I had before chronic depression (which I see now, has been a feature of my life for decades – that is a reason for hope. It’s a small joy just to report that to you.
This week a work colleague asked me to show her a photo of a fun time in my life that I was relating (I was pretty “creative” with my hair – long live Duran Duran). I dragged out the old photo albums. For years I have been afraid to look at them – they are associated with some of “the thoughts”. But, in my recovering state of mind, you know what I found out? That there were hundreds of fun times – and I was right in the middle of them. My friends did not desert me for sometimes being silly, or for making mistakes, just as my clients have never deserted me for the odd stock recommendation that did not work out. It was only me that never forgave myself.
I only deal in people’s financial situations (although that can be broader than might be apparent at first glance), but I do care about what I do, as do I am sure most doctors. Sometimes we say the wrong thing. Sometimes there are mistakes – with proper systems they are most often caught before damage is done. More often – the dying child brought in too late, the unforeseen rupture, the failure of a stock in the GFC – things happen because there was, really, no possible way through to a perfect (or even good) outcome.
Practical person that I am, perhaps the medical profession needs to look at how its members can better participate in “normal” society. A start to that might be some sort of friendship group for those new to town. In Central Queensland, my first effort would be to take new doctors to Five Rocks and Keppel – good healthy fun as far away from the rigors of the formal heath system as you can imagine! And as a profession (other professions take note), maybe there is a place for a formal structure of “light (mental) duties”, so that doctors facing depression can “step out” for a few months or years, while continuing with less demanding work.
Hi to all those blasts from the past – I think about you all almost every day!
I like being a psychiatrist and even though I’m 65 I can’t bring myself to give it up just yet. But I hate and fear the public health system which bullies doctors into providing inadequate or even harmful care and holds them responsible for the outcomes. And I feel that I am often in conflict with colleagues who justify the system to juniors while expecting them to continue to show their enthusiasm as they jump through the hoops of specialist training.
Am I self-righteous? Don’t we all have to deal with “the real world “? Never be afraid to speak your truth, even if other people disagree with, Gandhi said. So here goes.
I like being a doctor and even though I’m 65 I can’t bring myself to give it up just yet. But I hate and fear the public health system which bullies doctors into providing inadequate or actually harmful care and holds them responsible for the awful outcomes. And I feel that I’m often fighting with other senior colleagues who seem to justify this system and who demand that juniors don’t complain, while at the same time making them jump through the hoops of specialist training. I feel self-righteous as I write this, but I’m only trying to speak my truth.
I have little faith in institutional reform. The status quo seems supported by too many players. I can only think of making an individual difference.
I finished medical school in Queensland almost 15 years after Prof Robson began work at Rockhampton Hospital and at that time it was renowned as a notoriously difficult place to work. Intern places around the state were allocated on a ballot system and it was well known that doctors who were allocated to Rockhampton would frequently decide that they would simply rather not work in Queensland at all. Rather than address the problem, the health officials announced that any doctor that withdrew from the ballot would be blacklisted from ever working in Queensland again. I hope that things have improved in the 15 years or so since!
Saddened and enlightened to read all these stories. I was an Intern and House Officer in the early 1980’s
in 2 large regional Qld hospitals and for whatever reason I was never subjected to the long untenable hours that so many of my colleagues mention. Perhaps it was a better culture or better Medical Superintendents but we were made to take our fatigue leave – sent home. Sure there was some gender bias and lack of support at times from male chauvinist registrars and consultants but even in tears I felt strong enough and supported by others to stick up for myself. I guess I am fortunate that I do not have a mental illness and my hope is that anyone struggling with the demands of a medical career will find the support without the discrimination. I write this mainly to reassure medical students and young doctors that although there are too many of our colleagues who struggle that it is not inevitable and for the majority a medical career is a wonderful thing. I do not want to make light of the struggle or the too high rate of suicide in our profession but I do not want to discourage young people from pursuing their dreams to study medecine.
Dr Tree, Prof Robson and others (inc Junior Consultant in a Regional Hospital),
Thank you for sharing your stories.
I am an anaesthetist and pain medicine specialist working in a regional hospital. 18months ago after less than two years as a consultant I was close to suicide in the context of depression.
The pessimist in me (I’m working on it, but nearly 30yrs of negativity doesn’t change overnight) despairs of the situation.
The good news is things have changed.
In the last two years the only voice saying that I should keep quiet and not seek help was my own!
I have been encouraged to seek help and been supported in doing so. Over the last 18 months that encouragement and support has come from my friends, colleagues in three states across both specialties, local colleagues who didn’t know what had happened but shouldered additional work to cover my very short notice leave (and to this day I have not heard a word of complaint about it) , an excellent GP who manages the difficult task of simultaneously encouraging me to be a patient and yet not ignore the mental health knowledge that comes with being a pain medicine specialist, the NSW DHAS who bent over backwards to organise an appointment with a psychiatrist less than 48hrs after I contacted them, and a psychiatrist who is happy to treat a colleague and managed to make space for me at very short notice!
The bad news is we (doctors) are still burning out, we’re still dying (as an Australian anaesthetist I can expect to lose AT LEAST 10% of my colleagues to suicide… no that is not a typo, 1/6-1/10 anaesthetist’s lives end in suicide), we’re still terrified of the professional and personal consequences of seeking help, we have regulations that are too vague and make seeking help risky (except in WA) ironically putting the public at more risk when we continue to work without seeking help or taking leave for fear that either will ruin our lives, we have seen a significant increase in rates of litigation over 30yrs ago, and a significant increase in lack of control over our work.
It is my hope that people like Prof Robson, Dr Tree and myself can help out with progressing the conversation. We need some of us who have been there to be able to put our hands up and tell our stories. We need to be real people who have dealt with mental illness and/or facets of suicide be it in ourselves or our colleagues, not anonymised vignettes, so that the conversation is not abstract. We need to hear from real live people, as well as hearing about our colleagues that mental illness has killed, because those of us who are still alive (even if we are still living with mental illness) are proof that there is hope.
Yet we also need to be careful that those who have/have had mental illness or have been suicidal do not feel that they are shamed for choosing not to speak up. Prof Robson’s choice was his choice. A choice made initially in a different era perhaps, and a choice he now chooses to change, but neither he nor anyone else should feel ashamed for not making their story public. Our stories are not easy to tell, and we cannot presume what it might cost someone else to share theirs.
The pessimist might despair but the doctor in me longs for no one else to ever know the awful dark place where taking my own life seemed like not only an option, but absolutely the right thing to do.
Thank you for sharing your story Prof Robson.
My comment is not going to be well-written as I am passionate about this topic and barely managed to wait till I read all the comments before I speed through writings mine.
I am a RANZCOG trainee, and one of my training years was, and will hopefully be, the one worst year of my life! During that year I was discriminated, bullied, victimised,… the list goes on. To make matters worse, I went through a pregnancy loss and was diagnosed with a serious medical condition. Let me give you an example of how “supportive” my workplace was. I called my immediate supervisor, crying hysterically, having found out about the diagnosis, to ask for a half-day off. This was to have imaging to check for metastatic disease. I was asked by my specialist (who worked in the same hospital) to have it done that Wednesday, in the same place as my previous imagings. This was to liaise with the oncology team and commence Chemo before the end of the week. The response to my request was “but Wednesday’s clinics are really busy! It just doesn’t work. Can’t you do it another day? Or just do it at another radiology outside of hospital, at a different time?” Can I also add that I call in sick a maximum of two days a year and on that day had 320+ hours of sick leave and 800+ hours of AL accumulated. That conversation made be believe what I was told for many years….”as a JMO, to the hospital, you are a replaceable object”.
Gradually, I felt the accumulation of bullying, discrimination, physical and emotional stress escalating. Reaching a level that I felt I could no longer be providing care to patients safely. It didn’t feel right to continue. One day I closed my eyes and imagined just having had hand over of an afterhour shift, where the consultant is not on site. I was called to the emergency department where a pregnant women had been brought in with multiple trauma, and I was required to perform a perimortem CS to facilitate resuscitation. I asked myself: “do you see yourself capable of coping and going through this kind of scenario?” I always loved what I did and was a confident doctor before that. If I would ask myself the question any day preceding that year, the answer would have been “YES” , but this time my brain said “NO WAY”! This is when I knew I need to stop, atleast for a while. So I decided to tell my supervisor about it. The details of my encounters with my training supervisor are so painful that I don’t want to even ever think about them, let alone type them, but I can give an example of the response when I told them what was happening and how I felt. When I said I have decided to take sometime off. “Well! you are not a banker giving home loans away! Are you? You shouldn’t come to work if you’re not feeling up to it!” I could write a book of the encounters alike.
I am going to stop before I tell about the days I thought about driving off the bridge, on the way home from work. I am telling my story becuase I want to ask, beg, the people in the position of power to help us. People like the presidents of training colleges, to please consider junior doctors vulnerable little human beings coming to you for help. Sometimes see them as own younger siblings. Please care, ask more and try to help when we come to you telling our stories, raising concerns, begging for help, asking for reconsiderations and special circumstances. One extra hour of your time, looking into our circumstances, might well mean saving our trainings, our dream careers, our families and sometimes our lives.
Thank you
I was at the Redcliffe and District LMA meeting two nights ago where the president of the AMAQ (Dr. Dilip Dhupelia) gave a presentation on what the AMA has been doing for doctors. I sadly learned that COAG had recently rejected out of hand and with no evidence, improving the (mandatory) reporting to APHRA criteria of impaired doctors to the West Australian model. This model does not have the same crushing effect on doctors who are temporarily impaired.
Therefore, the time has come for civil disobedience so as to stop this senseless loss of life by suicide by our colleagues who quite rightly afraid to seek help!
Wow, what a powerful response to an already powerful letter. A truly remarkable tale of survival and compassion. Thanks for sharing with all of us.
The hours are too long.
The expectations are inhumanly high
There is never enough cover
It seems I am always doing two jobs
Add to that study and exams
I have saved a few lives in my 6 years as a doctor. I am proud of that. That has been important to me. But now is the time for me to quit. It is too much stress all the time. My life is worth something too.
I am touched and humbled by both Steve and Kate’s honesty and bravery. Thank you for sharing your stories. My pledge is to share this with our local Doctor colleagues to try to break down the stigma. “Its ok not to be ok” but when you are in the eye of the storm it hard to believe this.
Well done Steve and Kate. Really proud of you both. Much love x
Thank you Steve and Kate for sharing your personal stories. You are both very brave . Things need to change. Let’s hope this is the beginning of breaking the stigma. Too many doctors are dying in silence. Lets end the stigma. Take care !
Dear Steve and Kate, I too was at Rockhampton in 1988 – as the medical superintendent. I’m ashamed to say that I was unaware of the difficulties that you, Steve, experienced. I believe nowadays that there are many better systems in place to recognize and offer help to doctors in difficulty – yet clearly there are still young doctors who need help. Kate, and colleagues (there weren’t many of you) thank you for what you did for Steve.
My husband, a final year registrar with two days left before completing his degree. all exams and thesis completed, two days before leave, committed suicide.
I am a health professional and a mental health sufferer myself. The signs my husband displayed I attributed to 7 hard years of registrar training and prep, a final year of exams, thesis, 340hours of work/month and the usual and well known bullying in the work place. He had just the weekend been awarded the ‘I’m sorry’ award for always apologizing for everything. he was a great doctor, a wonderful kind sensitive man – he was not a person to fight back or let others take the fall for anything.
I don’t deny the responsibility I have/had as a wife, best friend and partner to having seen this, stopped it or prevented it. But I feel so powerless in empowering others to prevent physician suicide when it is so insidious and so complex with so many institutions denying their responsibility in investigating cases and advocating for their students, their clients.
I am trying where I live to get institutional support from the university to see what can be done, but I am a grieving widow and ‘idealistic friend’ of lecturers, consultants and registrars at this institution…but there is a resounding – ‘ this is a big systems issue’ . I feel so incapable and unsupported. something has to change (sounds cliché now)
We, as survivors cannot do this alone, where are the institutional voices and government bodies in this discussion, with so much media attention internationally why is there not more institutional support. There are voices rallying together from every continent and more and more exposure around the problem of mental health especially in medicine. Can one institution not take on the dare to be socially responsible to their own registrar or graduate population? See how many papers you can publish, how much money you can make or save, how famous you can become – just please do something…someone
All too familiar feeling when i read both steve and kate’s articles. Not knowing enough, feeling inadequate, not good enough… and generally being too hard on ourselves. I felt that too last year, on top of feeling “but if it was not me, who else will do these things?” Yet at the same time feeling like whatever we do is never appreciated…
Dear Kate,
Thank you for your kind advice.
I am socially isolated as I took a new job in a regional hospital as a new fellow graduate. I was taken by surprise by how easy it is the long stressful work hours (11-12 hours a day, every day for up to 3 weeks at a stretch) with limited support can drive/trigger a person with no history of mental illness to voice out suicidal ideation. With limited local support, one thing that keep me going is a kind ex-trainee supervisor working in another regional hospital 1000+km away, who I could call for advice about work and confide about my working situation.
After hearing the response from medical administrator and HR, I understood one thing: They do not care about us and do not acknowledge the extra effort we put in for work and patients. And if I do not take care of myself and my health, no one will. And so, my plan is to try to improve work, try to have a life after work including exercising, although after long hours of work, all the energy I have left is to be a coach potato.
In the end, if things does not improve, I could always quit, live off my current savings until I find something else to do, as long as I am still alive.
Living is a gift. And there are so many possibilities beyond medicine. I do not want to end it myself when the time is not due.
Thank you Kate, Prof Robson and everyone who kindly share your personal stories,
Junior consultant in regional hospital
Nothing has changed. After disclosing my memtal illness I was bullied out of a job. This was within a mental health facility. Thank you for sharing your story. It seems nothing has changed in 30 years and managment just dont care about your mental health as long as you are at work performing and seeing patients. A very lonely time to be a doctor
As a current working Reg doctor in ED, with constant shift work and ever-changing goals in terms of ‘hoops to jump through’(ie workplace based assessments- let’s make our already busy night more stressful for all, shall we??)… Despite this, I love my job… Most of the time… the remaining time I spend insecure, self-doubting, self-loathing/hatred etc etc very boring.
To those out there struggling; you’re not alone. Maybe we can get together somehow?
Thanks also Kate for the delightful memory of Steve’s valentine;s day roses!
Thank you doctors for your courage to publish your stories. I was in the same situation 10 months ago now. I was spiraling down and getting more depressed everyday without realising it until one night, alone in bed, I suddenly realised that for the previous 2 weeks, I have been putting my “recipe” together to finally keep my mind quiet. The next day I got enough courage to ring work and told them I am off indefinitely. Working with a faceless corporate operator and trying to help patients with medicare breathing down my neck for years and not an ounce of support from anyone and dealing with the effects of cancer was the perfect storm that sent me suicidal. To this day, I am very wary of talking about it especially to my GP and colleagues. I wish I could be brave like you.
Dear “Junior Consultant in Regional Hospital”,
Too many things have already gone wrong! That is exactly why we – as a profession – need a cultural change in attitudes, why we need to care for doctors and their mental well-being as well as physical well-being.
If you need to “cry for help” or you need a “way of coping”, then I hope that you can reach out not only to your family and friends but also to your GP, your psychologist, your psychiatrist – whoever it is that will have capacity to help meet your personal needs. And maybe consider seeing an exercise physiologist for an exercise program while you’re at it, or take up yoga or mindfulness meditation. Or walk in a green space (forest or parkland) or blue space (by river, lake, ocean).
“Regional Hospital” – I don’t know how small that region is, or who is available near where you live, but there is always the option of meeting someone for healthcare from another town in person occasionally, then doing Skype/Telehealth sessions as top-ups between in-person visits. There are apps to help with mindfulness, there is eMental Health (but many folk prefer to also interact at least sometimes with a real live physical presence as well).
And maybe checkout Dike Drummond’s Happy MD website regarding physician burnout – some of it relates more to the USA than Australia, but some interesting thoughts and resources.
I think that hospital management/administration, hospital boards, state health departments, and AHPRA/medical boards, all need to re-consider their responsibility towards medical staff – whether employees, contractors, locums, visiting medical officers, whatever. There has been success with stopping cigarette smoking in workplaces, with reducing (although not yet eliminating) discrimination on the basis of gender, sexual identity or ethnicity or cultural identity. Doctors should not be subjected to excessive workloads nor violence nor abuse nor sexual harassment nor intimidation. Doctors need to be supported in seeking and achieving mental health and well-being.
Yes, I am an idealist, but change is possible; together we can create change.
You matter, no doubt far more than you may realize at times when your workplace situation “gets” to you.
With best wishes
Kate
Dear Kate and Steve
I was there too and had no idea. Of course I feel as though I should have noticed. I am so touched and impressed by the ‘intervention’ group. I was just a few years older and probably should have known more about what to do had I known, but I suspect I would have felt as lost and uncertain as any of you. I can excuse myself by saying that I was not a part of the intern group very much socially, in a (slightly) more senior role and recently married.
I have wondered if this terrible time for you occurred while we were working together in a term as I recall we did that year. In any case my apologies for not spotting anything and asking you or offering support.
To Kate and your colleagues my apologies for not being a more approachable person, not that I could have been any more effective than your groups was! I imagine you could have done with some support yourselves – before, during and after.
Congratulations to both of you on what you have achieved in your medical careers and lives
John Buckley
PS I rarely post publicly and would rather make personal contact but wanted to ensure that I reached both of you
I don’t know why I teared up reading this article. But, on careful thought, I think it is because things haven`t completely change since the 1980s. We kept our emotion hidden because we have to put on a brave professional front to deal with the never ending high risk workload which involves critical decision-making. We tell our bosses and our colleagues that we are overworked and need more support and resources. Instead, we were told by administration that there is no money to employ more people, and that we are paid more to work long hours without overtime payment because we are doctors compare to other professionals. Culturally, we are told that we are not expected to finish work on time, just like other 9-5 job. Despite of this, we still continue to work longer hours including weekends for free with the sense of responsibility that has been instill on us to complete the work. Unlike the strong nurse union group who looks after their people, no one tells us to stop for lunch break, and there is no such thing as tea breaks. We are too busy to have time to think about our physical health and our emotions. And when our last bravery of raising our concerns and voices to our superior about the difficulties we faced gets shut down relentlessly without any solution or changes, the hopelessness and depression creep in as the never ending work cycle continues. We are merely working soldiers in a chess piece set to fill a position and easily disposable when we are worn down. And finally, I say out loud without realizing `I want to die and kill myself.` as a way of coping or a small cry for help. Will the whole system and culture ever change or do we need to wait again for something to go very wrong again before anything will be done?
I commend both Dr Kate Tree and Professor Steve Robson for these incredibly open insights into what we, as doctors, know to be true but are often discouraged from admitting to or acknowledging. I have written about doctors’ mental health and suicide rates being higher than their academic peers or the general population in my former work for the MABEL survey (in MJA Insight). It is disappointingly telling that members of our profession still fear stigma and prejudice if they admit to struggling at work and in life, if they need referral to mental health professionals, if they need sick leave.
We have to look after our own and continue to change these attitudes.
I have also seen my fair share of colleagues who have taken their lives and it’s just not worth losing these people.
Well I suppose I’m glad retrospectively that we were all in the same leaky boat, although at the time I thought I was the only inadequate one and that everone else was calm, competent and knowledgeable.
I was terrified as a student and junior resident at Sydney Hospital in the early to mid-1960s – sexual harrassment was expected and endured, and the lack of more senior back-up staff was a constant anxiety. At RAHC Camperdown I was less stressed as a resident and medical registrar because I had supportive colleagues although the above issues still occurred.
My feelings of inadequacy plagued me throughout my career. Memories of “perilous” events and decisions horrify me and inhabit my nightmares to this day, over 55 years later.
It’s ironic (or maybe not) that I should have exposed myself to the last 10 years of a 40 year career working in what most would perceive as the most risky environment – correctional health – but which in fact turned out to be the most rewarding and confidence-building field for me personally and professionally.
Thank you Kate, when I read your response to Steve last week it brought me to tears. It is wonderful to see you joining the movement too. As a psychologist who coaches Doctors I remain grateful to you both for shining a light on doctor wellbeing
What an incredible demonstration of humanity. Kate and Steve have displayed the life experiences and values of so many doctors, who are humans doing their best to use their skills and knowledge to help people and each other. Thank you.
As one who has known colleagues, relatives and friends who have taken their own lives I would like to think that there are no impediments to disclosure but fear that this is not so.
Nicholas Bett
I know – my suicide attempt was interrupted by those who wanted to punish me more
The carers, the true carers in this world, those who truly gain pleasure from helping others – not the five minute consultants who work for money for their own pleasure – are the ones who will always end up being taken advantage of. They work their guts out for the sake of others and often work for free – they are always the volunteers and not the people seeking glory or power. The are taken for granted and yet deserve more praise than the “successful” entrepreneurs that seem to be revered by society. In the end they realise that the world is an evil place and that dishonesty rules over truth and justice. Often official channels let them down by extorting dishonesty and corruption the true carers loathe.
All they ask for is kindness and honesty (the two are intimately linked). By the time the suicidal thoughts arse it is too late – the damage is already done. They have lost faith in humanity.
Prevention is so much better than anything else. We must all start to detest dishonesty and corruption. We must show we care. Be kind to someone today.