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DURING the break between the 2016 and 2017 Australian Football League (AFL) seasons, players and coaches at the Richmond Football Club engaged in a daring team building exercise: they shared stories about themselves, sharing their vulnerabilities.
It worked. It bonded the player group into a close-knit unit and contributed to the ultimate life bond: an AFL premiership. Sporting teams around the world have been embracing similar ideas with great success.
Yet we, in medicine, are seemingly unwilling to embrace our vulnerability.
Recent discussions and articles (here, here, here, here and here) have, for me, brought back a haunting past, especially the stigma and discrimination.
The stigma around mental health starts early and continues throughout medicine. The flippant remark about not knowing a sane psychiatrist is but one example.
How easy is it then for us to embed false thoughts about mental illness.
My initial help-seeking was delayed because I feared deeply the potential repercussions for my career if word slipped out about my mental health issues. We all know how the medical grapevine works if a colleague is ill, let alone with a mental health problem. I feared this, often unkind, grapevine.
I was also ashamed. I had seemingly failed by becoming ill. As a doctor, I had come to feel that we needed to be bulletproof, especially in the case of mental health. Why was I the only one failing?
The comments that I received – that I was not able to cope, or perhaps had chosen the wrong career, that I was not resilient, that it was my choice to feel this way, that at least I have a good job, or we all feel sad sometimes – were not helpful. If anything, they pushed me closer to that cliff, as I was, at the time, intensely suicidal.
Arriving at my GP’s rooms, I had a deep fear of seeing someone I knew who might recognise me. I feared that they would know I had a mental health issue, that I had in some way failed and wasn’t tough enough for the job. I walked in, sat down and hid my face behind a newspaper until it was my turn.
I did the same at the psychiatrist’s office, fearing that in either situation I would be spied by another doctor or a patient, and that my diagnosis would be shared.
Perhaps it seems strange to have been worried about this, given I have been very public about my illness, but in the initial stages of any serious illness, especially mental illness, privacy is paramount. It allows time to seek help, get support and start getting well.
My GP and other specialists were and have been fantastic about maintaining my privacy and, as I stopped working to get treatment, not subjecting me to the potentially awful pathway of mandatory reporting.
I did, however, get asked about what was happening at a number of workplaces. I was not well, and at the time I probably shared much more than I should have or was actually required to. I was trusting of my medical surrounds, trust that was broken.
That was something I regret, because over time, I have come to realise that, behind the scenes, a number of people saw my illness as weakness and they exploited it.
Perhaps they were the same doctors who yell at others in meetings or mock those with mental health issues.
However, out of that came something good. The crazysocks4docs day was born directly out of behind-the-scenes muttering and comments about my mental health.
The day was started to create awareness but especially to challenge stigma.
Indeed, out of that awful time in my life comes both post-traumatic stress disorder, but also post-traumatic growth, and in my mind, the latter is winning. It’s entirely possible for both to coexist.
Patients
I have had amazing support from my patients. They will drop in articles about me, in case I missed them, share social media posts from media articles I am in, and, of course, they ask about the socks and, indeed, give gifts of these.
They embrace the vulnerability and the fact that I have learned about my illness the hard way, because they realise that I have seen medicine from the other, very dark side of the moon.
The medical profession
Sadly, it’s a little different when it comes to my colleagues. The stigma and discrimination is far greater from within.
I have been put through more hoops than others. I have had questions such as am I still on medication, when my last appointments were, am I in regular follow-up; told that prolonged periods of sick leave would not look favourable at reappointment. Some of these questions don’t even come face to face. Some come by SMS.
I can only assume other doctors with other medical conditions are asked the same kinds of questions.
Many simple day-to-day things – a spelling error in a document, for example – apparently infer failing mental health. And I have little doubt some have targeted me. This creates hypervigilance, for fear of looking “crazy” again.
It has been suggested to me that I have been playing the victim, engaged in learned helplessness. No.
Am I the only one? I don’t think so. I receive many messages of support when I speak, from doctors or relatives of doctors who thank me for my public advocacy. The underlying tone in messages, particularly from younger doctors, suggests that I have a voice they do not have, and that they too are battling their own demons.
This kind of stigma is deeply destructive to doctors, to patients and to safe care. We delay seeking help, with often fatal consequences.
Should we expect better behaviour from ourselves and our colleagues? Of course we should. We should set the medical standard and community standard, especially around mental illness.
We are also responsible for change. Think about your own comments, actions and behaviour, because the stigma stops with each of us. It’s the stigma within us and around us that is lethal.
The lived experience is the way forward. We must embrace vulnerability in medicine.
Dr Geoffrey Toogood is a cardiologist and a long-time advocate for mental health. He has swum the English Channel. He came up with the idea of crazysocks4docs day.
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 9280 8712 http://www.vdhp.org.au
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 InSight+ unless so stated.
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The medical world is very harsh and judgemental. I never confided in colleagues when I had PND or have been anxious .
Well done Geoff Toogood for using your experience to help others. This shows that you have not need defeated by them. It shows courage insight and kindness, good qualities in a doctor. Best Wishes .
I’m so sorry that you’ve experienced discrimination, Geoff. Your courage in speaking openly is likely to lessen the risk that others will suffer this from their colleagues in future.
I have said this before and I will say it again. Doctors (and nurses ) generally are kind to their patients but can be cruel to their colleagues, anyone that has shown weakness, mental health issues , addiction etc. We hold the high moral ground with our colleagues , and yet understanding and sympathy to our patients no matter what they do. An interesting dichotomy that warrants a lot more study. Lessons in empathy maybe ?
Thank you for taking leadership in this area and embracing vulnerability as a strength, the bedrock of caring and compassion.
I don’t know if Medicine unfortunately attracts people that work far too much who lack self awareness.
As a result i wonder if many doctors do not recognise their own emotional problems and therefore how can they empathise with those experiencing difficulty?
The problem is worse where doctors hold a position of power and hierachy i think where many people appear to have never experienced adversity let alone know what it means to others. There is a reason why we sometimes joke it takes a bit of narcissism to do our job as we see it in our colleagues over and over. The system we work in does not reward empathy and there are no KPIs for humane care, rather administrators care only about numbers of services rendered in minutes.
What is worse is that we victim blame when doctors are “burnt out” when we ought to be acknowledging what many are calling Moral Injury: which is like a PTSD experienced at the “front lines” in Medicine when we can see people suffering, or our desired treatment at odds with competing demands from The System which asks us to deliver best care with few financial, time, and support resources whilst being criticised by bureaucracy either in hospitals or by Medicare and patients all with differing views on what is important.
Thanks Geoff for more great leadership on the issue of the mental health of doctors. As a Sport & Exercise Medicine Physician, this issue is close to my heart and that of my SEM colleagues, as we have previously lost a past-President of our young college to suicide in the prime of his career. Our college (ACSEP) wants to be a leader in this area, both in terms of protecting our own doctors (Fellows and registrars) and helping other doctors. Exercise itself is a very evidence-based way to manage depression and hence great treatment and prevention. Support of all doctors of other doctors is also critical. I liked the AFL analogy to start the article. One day, hopefully SEM will be accepted by the AMA as a medical specialty and we can be considered a full part of the medical team (AHPRA recognition of SEM as a specialty just extended to 2025, which will hopefully help). The high number of professional athletes coming forwards in recent times to publicly discuss their mental health issues (often being co-managed by SEM and psychiatry) also raises good public awareness of the issue and that high-functioning people can and do commonly suffer from mood disorders. Crazysocks4docs will leave an enormous legacy.
Well done for speaking out Dr Toogood and creating the crazysox4docs idea to widen acceptance that healthcare professionals are just as human as everyone else.
As a therapist I have noticed an increased trend in clients being more willing to do exactly that, speak up, and yet less of my healthcare clients arrive with that attitude, at first, than many others.
As a human I certainly needed some assistance too, in the ‘90’s, in learning to be more in charge of my thinking and therefore my emotional experience. In fact it’s what led me to do the study for my much loved joy in this profession with all it can do to help others help themselves.
If I ever need a Cardiologist I would absolutely prefer dealing with someone like yourself, who has gone through their own development experience and come out the other end more able capable and compassionate.
Once again Thank You
Another excellent article, thank you.
Geoff – thank you for holding the candle in this seemingly entrenched culture of caring for some (our patients) but not others (ourselves and our colleagues). There is a lot of work to be done to change this culture – but the Crazysocks4docs is one very visual reminder for us all to stop – at least for 1 day, to look at ourselves and others around us.
Another insightful article from Dr Toogood.
We do need to practice more self compassion and colleague compassion in medicine.
Do we get compassion burnout in the workplace, or just think that it is for others and not ourselves as a group?
Was very interested to hear recently that people who suffer ‘fat shaming’ are very empathic and effective in supporting others with weight issues but extremely self critical and hard on themselves.
Maybe we set unrealistic health standards for ourselves/ and as a group!!