Junior doctors are almost twice as likely to cite very high levels of psychological distress compared to senior colleagues. How can we take better care of those who care for us?
It’s been almost 10 years, but Lizzy still remembers the first major emergency she had in hospital while working as a fourth-year nurse, aged in her early twenties.
“I’d pulled a bed pan out from underneath [my patient] and noticed dark liquid that was about half the pan worth, so a good 5-600mLs [of blood],” she tells Insight’s Jenny Brockie.
As she sent for tests during the evening’s shift handover, Lizzy tried to call doctors for help but support wasn’t readily available.
“I reached for the phone to call for the emergency cardiac arrest [and] he then began to vomit blood and drowned in his own blood.”
After the incident, Lizzy says she felt responsible for the outcome and had trouble coping.
“I felt like it was my fault, that I should have or could have done more,” she says.
“I didn’t sleep, I had nightmares, I had flashbacks … it took a long time before anyone even actually recognised that I wasn’t coping.”
While Lizzy saw a counsellor for her post-traumatic stress and made a full recovery, she’s not alone in struggling with the nature of her job.
A 2016 study of suicides over 12 years found female nurses and midwives had a suicide rate almost triple that of women in non-health professions.
Among doctors too, coronial records show 20 practitioners took their own lives between 2007 and 2016 in New South Wales alone.
Mental health organisation beyondblue surveyed more than 12,000 doctors in 2013 and found those in training were almost twice as likely to cite very high levels of psychological distress compared to their senior colleagues.
Research published in the Medical Journal of Australia in 2009 similarly revealed that 71 per cent of junior doctors were concerned about their physical or mental health.
Emergency situations such as Lizzy’s cause great stress, but for many of the guests on Insight’s Critical Care episode, the everyday pressure of the job takes its toll too.
Fourth-year doctor, Karla, explains how the fatigue that comes from working long hours with few breaks can wear down one’s mental health.
“We usually work, I think between one and three hours extra every day,” she says.
“When you’re tired and you’re hungry … you start feeling resentment. That’s something that I feel really guilty about and then I have to remind myself, actually, they rely on me. I’m the only doctor for these five wards, I have to keep going.”
After her second year as a doctor, Karla began to feel burnt out.
“I was having some insomnia which I’d never had before and I started having what I later found out to be anxiety attacks,” she says.
When Karla met with her training college’s education supervisor about taking a time off, he discouraged her from doing so.
“I was told it would be career suicide, that it would be seen very badly unless I had a legitimate reason such as a PhD. or a master’s [degree].”
While some junior medical professionals say the culture of medicine is unsupportive of their mental health, others feel mandatory reporting laws are also stopping many from getting help.
Currently, national law requires health professionals to report one another to a regulatory body if they believe a practitioner is placing the public at substantial risk of harm – including when it comes to their mental health.
Melanie*, who chose to remain anonymous, tells Insight she feared talking about her thoughts of suicide, which came about after difficulties getting into her specialty training program.
“I couldn’t bring myself to speak to my family. I couldn’t bring myself to make them understand…And I definitely could not tell anybody,” she says.
Melanie sought medical help, but even then, she didn’t share the extent of her struggle to cope.
“I went to the GP who … referred me to a psychologist and with her I actively chose not to mention my thoughts of suicide.”
“It's the culture, it's that you suck it up and you deal with whatever goes wrong. You’re praised for being able to deal with strife and I wasn't dealing with my strife.”
Melanie has since recovered but tells Insight mandatory reporting laws are putting pressure on vulnerable people who don’t have “anywhere to turn.”
But Dr Joanna Flynn, Chair of the Medical Board of Australia, explains there’s a “high threshold” for reporting a medical professional and most cases involve someone who is “actively suicidal or actively psychotic.”
“Either they're so seriously mentally disturbed that they have no insight [in to] what's going on, or they have a record of dishonestly and concealment where they may have been taking drugs or doing something else that they're trying to cover up,” she says.
“Somebody going and telling their GP they’re burnt out, anxious or depressed would not meet the threshold.”
However, Dr Flynn acknowledges not enough junior doctors are fully aware of the criteria around mandatory reporting.
For Karla, working in the hospital system has changed how she now manages her priorities.
“For every young doctor … [don’t] just to try to be a good doctor but try to be a happy doctor as well … I think as a profession we're not very good at balancing our lives with work, so I think looking in and making that a priority for yourself, [is] number one.”
*not her real name
This week, Insight looks at the mental health of junior doctors and nurses | Critical Care - Tuesday 20 June, 8.30pm SBS
If this story is distressing for you, please contact Lifeline on 13 11 14 or the Suicide Call Back Service on 1300 659 467 for crisis support.