Most health workers enter the profession with the goal of helping people, but sometimes along the way, that becomes lost just trying to survive the stresses of the job.
How can we support health workers and help them to honour that original intention?
That was my question to the panel of psychiatrists and psychiatry trainees discussing mental health issues in health workers at a recent psychiatrists’ conference in Sydney.
We’d heard stories throughout the week of health professionals being abused in the workplace, sexually harassed, forced to work unsafe work hours, demeaned, racially vilified and bullied while trying to look after their patients.
We know that people cannot do their best work when under stress. Parents with depression need to be well to provide the best care for children; carers need to be supported to be able to look after the vulnerable; similarly health professionals, distracted by worry, cannot do their best work.
Yishay* called me this week for advice.
Although her job is designated “junior doctor” status, she is mature, wise and has had a successful career before returning to university to study medicine. She’d taken some months off work because she could not find a way to fit in the need to care for her child as a newly single parent and work this in with the junior doctor overtime rosters and exam study she was required to do in her training position.
She needed to return to work to stay afloat, but how to find a suitable position? Coincidentally, another doctor, Adriana, called to ask for a reference. She was forced to look for another job because her circumstances didn’t allow her the several hours a day commute to do the next job she had been allocated for six months. There was not sufficient time to permit her to try to relocate her carer responsibilities and then move back with the accompanying uncertainty.
Aidan told me he was resigning. He wasn’t sure what he was going to next or if he would continue to work as a doctor. He had been a top student at school and university and being a doctor was his dream. However, he had had a bad experience, an adverse outcome he had tried to avert but found himself in a situation where he felt helpless to intervene and prevent what unfolded. He was worried it could happen again and there was nothing he could change.
I’ve seen these situations arise, not from malice, but from a system under stress. To the point where individuals spend a large amount of energy worried about what may happen, or what has happened, rather than the task immediately before them, at the expense of their concentration, dedication and commitment to the patient needing their focused attention.
I’ve seen Yishay, Aidan and Adriana’s work and they are good doctors. But they are not at their best and this is not in the interests of their patients, nor for the health system, nor for our community which has contributed six to 10 years on their tertiary education, in addition to their 13 years of schooling to this point.
Nor the personal cost to each health worker who finds themselves reconsidering their life calling. Sure, some people just change their mind and that’s fine. But this is not that. This is the pressure telling them to leave to survive.
Tragically, we know the incidence of suicide among doctors is 1.5 to three times the general population.
Females, junior doctors and minorities are more at risk. This is despite the fact that doctors have 77-80% lower mortality from other causes than the general population.
We hear of junior doctors being told a version of, “The hardship made me better, so you should go through it too.”
Of course, being a doctor has always meant long hours. Some of my senior colleagues had home-based partners who ran the day-to-day household and child rearing, freeing them to invest long days, and years, in their careers.
Some who lacked stay-at-home partners chose not to raise children, who invariably compete for attention from work. Today, we need doctors from all backgrounds and genders, doctors who have working partners, and doctors with time to hang out with their kids and teenagers – doctors who have lived the many ways our community lives.
This reflects the world we live in and makes our decisions – our life-and-death actions, our active listening, our ability to understand the layers of nuance and the needs of those whom we are trained to serve – relevant.
It makes us fit for purpose. So as a health system, as a society, with our changing world, and now Covid, how do we make this work? There was no simple answer to my question to the panel, but it’s one we need to keep asking, for everyone’s sake.
Saretta Lee is a child, adolescent and adult psychiatrist from Sydney
All names have been changed to protect privacy
