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This morning I was doing an ECT list. Yes, I am one of those people the scientologists despise. The anesthesiologist consultant asked me if was wearing Crazy Socks. I did not know about the campaign. So she showed me some tweets and clued me in. She has had three  close friends suicide.

This is the infographic that is trending at the moment. I reflected on my own experience. The worst time in my life, the most despairing, was not a divorce and a three year custody battle. It was dealing with a vexatious litigant of a lawyer who took me to every authority and tribunal that exists in NZ, and then accused me of perjury. So I hinted that.

Within an hour I was instant messaged from my GP. Who was wearing Crazy Socks.

My MPH thesis was a survey of psychiatrists and GPs, looking at adverse experiences from patients and their families. It was a numerical exercise, now published well over a decade ago. I still remember reading the descriptions some colleagues had added to their form, about patients hounding them to the medical council, the health and disability commission, the privacy commission, and going to the press. Some have even set up advocacy groups.

They do not understand the cost is not merely the loss of doctors. It is that the ones remaining do not have the confidence to do the job, as they are afraid that they will be the next one to go through the grinder, and have their lives examined by those who do not understand the job.

Dr Wendy Potts was a 46-year-old mother of two and a general practitioner in Derbyshire. She also suffered from bipolar disorder. Dr Potts wrote about her experience with depression on an online blog. In it, she wrote openly on how fluctuations in her mood affected her and her life in general. It is reported that a patient complained after reading her blog, questioning whether she should be able to practise as a general practitioner. She was suspended by her practice and National Health Service (NHS) England, and referred to the General Medical Council (GMC). In November 2015, Dr Potts hung herself.
Gerada C. Doctors, suicide and mental illness. BJPsych Bulletin. Cambridge University Press; 2018;:1–4.

I may have read her blog. Complaints against doctors can kill.

Medicine is stressful. There have been attempts to train people to be resilient, but that does not help… when the stress is overwhelming. Many junior doctors do not have the backup they need and work very long shifts. I recall working over a hundred awake hours — on the ward — a week: we were keeping logs for industrial action. The situation in NZ changed because my generation of junior doctors went on strike (And yes, I was in the union and on the branch executive when this happened). But managers think they can educate their way out of this problem.

“My family had really detested the term ‘resilience’,” Ms Abbott said, recounting her sister’s fortitude as a champion swimmer who represented Australia in international competition.

“That’s not something you can do without resilience,” she told the crowd of students about to join the profession that Dr Abbott’s family and colleagues believed contributed to her death.

Dr Abbott’s family is pushing for system-wide cultural change and the introduction of safe working conditions for junior doctors who are saddled with gruelling shifts and a heavy study load.

“It’s absolutely devastating that this conversation was only generated after the loss of my sister, but we need to get these important changes in place,” Ms Abbott said. “Chloe’s death can’t be a waste.”

Convening the panel, psychiatrist and National Mental Health Commissioner Ian Hickie said the current focus on building resilience ignored the deleterious culture of medicine and dangerous working conditions to which junior doctor were subjected.
Professor Ian Hickie said resilience was a “con” that distracted from meaningfully addressing dangerous work conditions for doctors.

Professor Ian Hickie said resilience was a “con” that distracted from meaningfully addressing dangerous work conditions for doctors.
Photo: Steven Siewert

“It’s this con of individual resilience that is part of the problem,” Dr Hickie said.

“We operate on a collegiate system that has been unregulated but has demonstrably failed to move into the 21st century.”

He drew parallels with the aviation industry that had industrial safeguards in place so that pilots did not fly while fatigued.

“Why should doctors treating patients be any different?” he asked.

Mr Hazzard flagged overhauling legislation that required doctors to report colleagues who had a health condition that put patients at risk, over concerns the law was stopping doctors with mental illness seeking help.

Currently, all registered health practitioners must report a doctor to the medical regulator if they believe the doctor is “placing the public at risk of substantial harm” due to a health issue, including mental health.

But junior doctors believed any mental health problem could be reported, Mr Hazzard said.

“But that’s not the way junior doctors generally interpret it because of the fear inculcated in the profession,” Mr Hazzard said. “The constant fear [is] that ‘I am not going to achieve to move forward in my profession if people know I’ve got this issue.’

Kate Abussion, Sydney Morning Herald.

The figures in the infographic are taken from a beyond blue report. They are Australian, and fairly robust. They are also from 2013.

Five years ago, I was at a memorial. Another suicide. Our third doctor in 18 months.

Everyone kept whispering, “Why?”

That was when I decided I had to find an answer.

So I started counting dead doctors. I left that memorial service with a list of 10. Today I have 757 suicides on my registry.

And I began writing and speaking about why doctors die by suicide and why it’s so often hushed up.

When doctors commit suicide, it’s often hushed up.

The response was huge: So many distressed doctors (and medical students) wrote and phoned me. Soon I was running a de facto international suicide hotline from my home. To date, I’ve spoken to thousands of suicidal doctors; published a book of their suicide letters; attended more funerals; interviewed hundreds of surviving physicians, families and friends. I’ve spent nearly every waking moment over the past five years on a personal quest for the truth of “why.” Guilt, bullying, exhaustion are big factors. Here are some of the things I’ve discovered while compiling my list and talking to so many people:

High doctor suicide rates have been reported since 1858. Yet more than 150 years later, the root causes of these suicides remain unaddressed.

Physician suicide is a public health crisis. One million Americans lose their doctors to suicide each year.

Many doctors have lost a colleague to suicide. Some have lost up to eight during their career — with no opportunity to grieve.

We lose way more men than women. For every female physician on my suicide registry, there are seven men. Suicide methods vary by region and gender. Women prefer to overdose and men choose firearms. Gunshot wounds prevail out West. Jumping is popular in New York City. In India, doctors have been found hanging from ceiling fans.

National Institute of Mental Health director Joshua A. Gordon explains some of the latest research surrounding suicide rates in the U.S. (Monica Akhtar/The Washington Post)

Male anesthesiologists are at highest risk. My registry also shows that most of these doctors kill themselves by overdose. Many have been found dead in hospital call rooms where they are supposed to be resting between cases.

Lots of doctors kill themselves in hospitals. They jump from hospital windows or rooftops. They shoot or stab themselves in hospital parking lots. They’re found hanging in hospital chapels. Physicians often choose to die in a place where they’ve been emotionally invested and wounded.

“Happy” doctors also die by suicide. Many doctors who die by suicide appear as the happiest, most well-adjusted people on the outside. Just back from Disneyland, just bought tickets for a family cruise, just gave a thumbs-up to the team after a successful surgery — to mention only a few cases from my list — and hours later they shoot themselves in the head. Doctors are masters of disguise. Even fun-loving docs who crack jokes and make patients smile all day may be suffering in silence.

Pamela White, Washington Post (archived)

This is not an Australian or American problem. It is a problem, as the article about Dr Potts (and others) notes, when the public and regulators forget that there is a human behind that MD and that white coat (I don’t think I have had a white coat for thirty years). It is when people and societies wish for revenge, or the tall poppy syndrome, cuts down the promising. And it is when managers think they can make things more efficient by not using locums, refusing leave, and doubling the case load.

I have lost too many colleagues to suicide. I’m old. And I am now on any committee or speaking in front of any enquiry I can, locally, to make change. Including using my professional accounts to promote a hashtag, something I usually despise.

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