Thursday, September 14, 2006

Doctor Death - or Doctors' Deaths

It was only a matter of time before the papers wrote it up (Young doctors succumb to killing pressures on the ward, The Age 13/9/06) but it concerns me as always that the focus is on working hours (Young doctors' rest-deprived life, The Age 14/9/06). I have written about this before (Doctors get stressed too).

Yes, as hospital doctors we work long hours. Yes, most hospitals have little incentive to reduce working hours (despite the AMA's Safe Hours campaign - potentially flawed as it may be). But don't confuse long working hours with causing doctor suicides. It is a single factor among many others, including long-term responsibilities for patient care; work conflicts with other medical teams and other staff; mixed loyalties to patients, bosses, friends, colleagues, and families.

Personally, I believe that many of these stressors are offset by the rewards: that satisfying feeling of successfully fixing a patient's problem, and talking to a grateful patient and family; being appropriately remunerated for one's services; having a sense of standing within the community; spending fruitful and rewarding time with one's friends and family. I work long hours. I experience stress at work. But I experience the rewards and I do not mind. Some of my colleagues, however, are denied those rewards on a regular basis.

Stressors will not go away. To take them away requires a massive restructuring of our health system which is economically impossible, and despite a lot of empty rhetoric from state and federal governments, is not in their interests. We may whine on about reducing working hours (at the cost of prolonging postgraduate medical training), employing more junior hospital doctors (Where will they come from? Where will they go afterwards? Where is the career path for "hospitalists"?), buying more fancy equipment (equipment is cheap, people are expensive), but at the end of the day, it is all political pseudospeak.

You want to know what the real factor in doctor suicides is? Take a group of motivated, intelligent, organised people. Give them access to lethal drugs and the knowledge of how to kill themselves quickly and painlessly. A small proportion (just like the general community) will develop suicidal ideations. A smaller proportion still will attempt suicide. Unlike the general population, however, every single doctor will succeed. There are no "attempted suicides" among doctors. No random pill-swallowing. No jumping off rooftops. No lying in front of trucks. If a doctor tries to commit suicide, he or she will succeed. Unless they don't really want to.

If you want to make doctors feel better, and discourage them from committing suicide in the first place, then we need to improve the general mental health of doctors. Reducing work stress is part of this, but personally I feel that we need to fix the eroding status that doctors have in our society. We are not commodities to be traded from country to country. We are not bargaining chips to be swapped between government consortia. Talking down our salaries means talking down our value to the community. Make hospital doctors feel wanted, and they will want to stay. Make hospital doctors feel valued, and they will want to live.

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