I was a junior doctor when I experienced my first episode. The strange thing is, that despite my medical training (I may have bunked off a few of the relevant lectures in medical school), I didn’t recognise the symptoms.
I had lost my appetite and had lost weight. I wasn’t sleeping and was irritable, angry and tired most of the time. Most disturbing to me was a feeling (despite being surrounded by work colleagues and friends most of the time) was that I felt emotionally cut off and removed from people. I had also become cynical and decidedly detached from my work responsibilities and, truth be told, had lost all empathy with my patients. Not a good combination for someone working in healthcare.
It took a conversation over coffee with a good friend of mine who is a psychiatrist to make me realise that I was depressed. Although of course it is obvious to me in retrospect, I had no idea I was depressed at the time. Like many people, I had no clear sense of my mood on a day to day basis. Like most other doctors I just kept on going.
What’s ironic about the code of silence is that a significant proportion of doctors have experienced mental health problems. Up to a quarter of doctors will meet the criteria for a depressive illness by the end of their first year in training and other studies suggest that up to 51% of (female) doctors have a lifetime history of depression. Substance and alcohol abuse are common, burnout is common and suicide rates are higher than in other professions. Medicine is not as glamorous as it sounds.
In a recent UK article a survey was conducted of 1122 medical students, 343 of whom were suffering with mental health issues. There were a number of astounding figures that highlighted how rampant mental illness is among medical students. Firstly, 80% of the 343 students stated that the support they received was poor, if they received any support at all. 167 out of the 1122 students admitted to contemplating suicide during their time at medical school. Figures regarding smoking and drug use were also revealed with 15.8% of the 1122 students admitting to smoking, 25% engaging in binge drinking, and 10.9% using illegal drugs. Legal highs and drugs to help aid revision were tried by 8.3%.
What shocks me is the number of students who feel that they need to use drugs to cope with the stress of medical school. Obviously not all students who use the above are doing so to alleviate stress or to cope with mental health issues but a proportion of the students are and this, I find, is very worrying. If there are issues now what will happen to them in the future when they become doctors, being moved across hospitals and regions, working long shifts, having to cope with the emotional demands of talking to patients and relatives?
Let face it, being a junior doctor is not easy. When on call you may have to walk away from battling and failing to save someone’s life and tell a family that their loved one is dead. The cruel thing is that the culture in hospitals mean that as a junior doctor on call, you have to shrug off or bury the emotion deep before moving onto face 100’s of patients. There is no support from superiors, no time to take a moment to absorb the emotion, just pager beeps and an unending stream of angry or desperately sick patients. Top it off with a cocktail of 24 hour calls or a week of nights, and I ask you – how can we expect competent diagnosis and mentally sound doctors?
Mental illness is, for many affected doctors, a shameful secret. One that can affect how other doctors perceive your reliability as a clinician and also one which could affect your career. To admit to not coping in medicine is to be weak, to somehow let your community down, and to go against the macho code of invincibility that we have imposed on ourselves.
For the last 20 years, I’ve been on the receiving end of medical care from GP’s, psychiatrists and psychologists. I’ve learnt a lot about mental illness, its treatment and how to look after myself better. I have also learned a lot about the stigma of mental illness in medicine and how to cope with it. Largely, it has to be said, by keeping quiet about it.
At present, thanks to the medical care and advice I’ve received and the support of family I’m doing well. Most of the time. I’m more mindful of my own moods and more forgiving of myself when I make mistakes. I recognise the warning signs of an imminent crash and feel better equipped to deal with the symptoms when they come. I have learned to say no (and not feel guilty about it) and also to give myself the odd pat on the back and remind myself that I’m doing some good.
However awful I sometimes feel, I know that it will pass eventually. I also know, that on my worst day, I’m still a conscientious and caring physician. I also firmly believe that my experience of dealing with depression has made me a better doctor; It has helped me understand the healthcare system from a patient’s perspective and also helped me empathise more deeply with patients (as another patient) and to be a more compassionate.
It has made me much more attuned to psychiatric symptoms in my patients (even when may not be aware of them themselves) and to develop a language that allows me to engage them in discussions about their mental health in a non-threatening way. Although I have a better understanding of how an illness like depression can colour and skew patient perceptions of certain physical symptoms, I think I am also less likely to over-diagnose psychiatric illness in a patient who’s symptoms don’t easily fit into a neat medical model.
A Support Mechanism:
Depression is something that is without boundaries. For medical students coming through now, there are no safety nets in place, no emotional respite from the traumatic things they deal with on a daily basis. It is seen as a rite of passage to leave junior doctors to run the wards, and learn to “deal” with life in hospitals.
In medical school, we need to teach the next generation of doctors, coping strategies or mechanisms to deal with stressful situations. An appropriate support infrastructure has to be put in place to help junior doctors who find themselves suffering from depression and anxiety.
Workplace stress is a leading cause of depression and demotivation. A junior doctor who is sleep deprived, anxious and emotionally detached cannot provide the best level of care to patients. We are putting the lives of the nation at risk by not supporting the primary carers of our population.
Irrespective of any existing hospital culture or rite of passage, we need to start to preserve the mental health of those that we rely on to keep the hospitals of this country running.