Doctors who commit suicide
A reader points towards a worrying article in Newsweek
The unsettling truth is that doctors have the highest rate of suicide of any profession. Every year, between 300 and 400 physicians take their own lives—roughly one a day. And, in sharp contrast to the general population, where male suicides outnumber female suicides four to one, the suicide rate among male and female doctors is the same. (Newsweek)Most people who commit suicide are depressed and doctors suffering from depression are reluctant to seek help. And once they decide to commit suicide, they are usually successful. They know how to do it.
Why do doctors get depressed?
It is the peculiar strains of the job. Doctors feel responsible for their patients in a way and at a level that other carers cannot understand. When a patient dies, most doctors feel a moment of guilt and responsibility, even though their management of the patient has been faultless. Difficult to describe the sinking feeling you get when, on a Monday morning, your secretary says "could you phone the coroner - there has been an unexpected death."
Morale in the UK medical profession has dropped to an all time low. We are generally reviled by the national press and by right-wing pressure groups, such as the Taxpayers' Alliance, both of whom portray us as lazy and over-paid. This suits the government who is in the process of introducing a lower level of quasi-medical care throughout the NHS. It is hard to be told that a job for which you trained for ten years can be better done by an HCP who is educationally and intellectually inferior and has no real medical training. You feel devalued. You know that, however "nice" and "caring" the HCP is (and they are) the patient is being short-changed. You know, also, that the great and the good and the privately insured will see doctors, not HCPs. To those of us committed to the principle of a decent standard of health care for all, that is wrong. But if you try to express that wrong, you are deemed to be politically incorrect and are shouted down.
Most of all, though, the low morale is due to the doctors' inability to discharge their personal responsibility for the management and welfare of their patients, a responsibility that cannot be delegated, and a responsibility that is peculiar to doctors. The constant need to fight an impenetrably inefficient, dumbed down NHS to try to get a decent level of care for your patients is a receipe for low morale.
Pass the Prozac
Morale in the UK medical profession has dropped to an all time low. We are generally reviled by the national press and by right-wing pressure groups, such as the Taxpayers' Alliance, both of whom portray us as lazy and over-paid. This suits the government who is in the process of introducing a lower level of quasi-medical care throughout the NHS. It is hard to be told that a job for which you trained for ten years can be better done by an HCP who is educationally and intellectually inferior and has no real medical training. You feel devalued. You know that, however "nice" and "caring" the HCP is (and they are) the patient is being short-changed. You know, also, that the great and the good and the privately insured will see doctors, not HCPs. To those of us committed to the principle of a decent standard of health care for all, that is wrong. But if you try to express that wrong, you are deemed to be politically incorrect and are shouted down.
FORTY years on, Orwell's Newspeak is finding its apotheosis in New Labour's modernised National Health Service (NHS). However, whereas the original form of Newspeak restricted the range of words in order to limit the expression of dissent, the contemporary form deliberately distorts the meaning of words in order to mislead and manipulate. The Changing Workforce Programme of the NHS Modernisation Agency is planning the development of a new category of health professional...Nonsense says the government, intent on saving money. Nonsense say the hubristic HCPs
...the core GP task of providing a first-line medical diagnostic service, without recourse to excessive, unnecessary, and potentially harmful investigation and referral, is not one that can be delegated to anyone who does not have a full undergraduate medical and postgraduate GP education. (Iona Heath)
Most of all, though, the low morale is due to the doctors' inability to discharge their personal responsibility for the management and welfare of their patients, a responsibility that cannot be delegated, and a responsibility that is peculiar to doctors. The constant need to fight an impenetrably inefficient, dumbed down NHS to try to get a decent level of care for your patients is a receipe for low morale.
Pass the Prozac
Labels: low morale, suicidal doctors
55 Comments:
Don’t forget MMC and MTAS, which was/is so crazy that most members of the general public don’t actually understand or believe the issues or effect of the chaos. Families divided, careers arbitrarily destroyed and years of postgraduate training and qualifications disregarded.
The bodies supposedly representing doctors such as the BMA and the colleges were clearly complicit with the governmental design to create a base level of medical unemployment in order to mandate salary cuts and force compliance with the dumbing down programme. This is a prime recipe for 'learned helplessness' which is a key factor in depression.
an HCP who is educationally and intellectually inferior
Educationally, sure, but intellectually?
Just read the Newsweek article. I didn’t realise that these were numbers from the US. OK OK MMC is probably not the cause of the yanks killing themselves.
Are the figures known for the UK.
It's a bit of shame you have managed to move away from an interesting look at MEdics, suicide rates and exploring the potential causes of this to bang on about your hobby horse.
I mean, blaming suicides on the government's drive to "Quackery" is specious. Not that I love the government, you understand....
I must make time to read 1984.
Yeah, it is a paper from America, but it is a problem in the UK too.
Hobby horse?
I have to accept that - it is something that occupies me a lot. It is a major issue for doctors, particularly in hospital, but because it is not politically correct to say it, not many do. I am not politically correct, so I do say it. And if you could look at all the rants on Doctors.net you would realise that I am a paragon of moderation.
I am not for a moment suggesting that the rise of the HCP is making doctors top themselves. It is not as simple as that. But it IS contributing to very low morale.
John
It's funny that you say that, there may be rants on doctors.net (note to self: have a look over there).
But so far, in my experience, the hospital docs I work with haven't said a thing, and the GPs I work seem to be employing them! (Well some are, opinion seems to be divided on this, depending on the practice)
I wonder if it doesn't just seems worse from where you are sat, not actually working with/employing these HCPs? (Not meant as a dig, but in my experience polemics often arise from a distorted view arising from ignorance due to separation.)
But understand this, I don't entirely disagree with your "horse", but I certainly do not agree with this very polarised position either.
I wish I could articulate these arguments better (note to self: take English class)
It's interesting that this report is from America, where none of the problems of "dumbing down" and underfunding seem to exist. You post would have been far more meaningful if it was backed up by statistics from the UK. Without figures to back up Dr C's treatise, his argument doesn't really hold much water.
I've known two GPs who committed suicide; interestingly they were depressed but sought solace by drinking too much, probably the worst cure for depression there is!
Cornishgiant,
I take it you are not a doctor - in which case DNUK will not be accessible to you.
This is emphatically not a "one-person" view, but something which is essentially endemic across the whole profession.
Juniors feel powerless to speak out against these noctors, who frequently poach valuable training opportunities away from future "specialists".
Juniors are increasingly left hung out to dry by a conspicuous lack of consultant back-up - often unwilling to rock the boat over an initiative that has heavy management support. And besides, juniors rotate every 6 months, and are therefore dispensible.
The current generation of junior doctors are incredibly demoralised by pisspoor training (often because of noctors) and uncertain future job security which typifies MMC.
We are trapped in a closed box - unlike lawyers/accountants/dentists, we are reliant on a single organisation for accredited training and, essentially, payment.
This is not a problem in itself - it never bloody used to be - but a state monopoly must pledge to provide the highest quality of training to its medical staff.
Until society recognises the uniquely difficult situation we are in, I cannot see how things will ever improve for the good of everyone.
Chris BSc MD MRCP(UK)
dumbing down doesn't exist in American Health care?
Dear god, they invented it.
Take a look at:
The Center for Nursing Advocacy
http://nursingadvocacy.org/media/tv/er.html#SeriesPortrayal
(always one of my favourite sites when I need giggle)
One of their "important" roles is to monitor TV programmes to make sure that nurses are not portrayed as subordinate to doctors. This on ER
""ER" has generally depicted nurses as competent, caring professionals with technical training who contribute to patient outcomes. Unlike many shows, it has resisted portraying them as Nurse Ratcheds, sex objects, or mute ciphers who appear occasionally to execute physician commands. It has shown some nurses to be men and members of minority groups, though all three of the major nurse characters have been straight white females. It has even shown nurse managers, though these depictions have been problematic.
Unfortunately, the show's limited efforts to highlight the work of nurses have been overwhelmed by the physician-centric vision that has dominated its first 267 episodes. This includes the hopelessly lopsided nurse : physician major character ratio, the regular portrayal of physicians doing and getting credit for exciting, important work that nurses do in real life, the frequent suggestions that nurses are physician subordinates, the intense focus on physician training while nurses' professional development is virtually ignored, the disproportionate emphasis on the one major nurse character's personal life, and the mishandling of slurs against nursing."
Get a life, girls
John
Just popped over to doctors.net, to find I am not eligible to join.
Probably because I am "educationally and intellectually inferior"
I was going to go away and look up some big Dr C-esque words to describe the above assertion. But I couldn't be bothered, and realised that calling it "the biggest bag of utter pissy wank-shit that I have ever heard" is an entirely suitable and on the same intellectual scale as the cooment.
You talk of us HCPs having "hubris"?!
No, cornishgiant - not because you're "educationally and intellectually inferior" - because you ain't got a GMC number.
The inferiority complex is all yours... oo arr
Chris BSc MD MRCP(UK)
I quoted the Newsweek article because that is the one that has just been published. Suicide is, I can assure you, a problem amongst UK doctors, partiuclarly female doctors (women now outnumber men at medical school)
Try these for starters:
http://jech.bmj.com/cgi/content/abstract/55/5/296
http://bjp.rcpsych.org/cgi/content/abstract/168/3/274
CONCLUSION. In all studies the suicide rates among doctors were higher than those in the general population and among other academic occupational groups.
BMJ 2001;322:945 ( 21 April )
News
Stresses on women doctors may cause higher suicide risk
Roger Dobson, Abergavenny
Suicide rates among women NHS doctors in the United Kingdom are twice that of the general female population, new research has found. It also found differences in suicide rates between medical specialties, with anaesthetists, community health doctors, GPs, and psychiatrists of both sexes having significantly higher rates than doctors in general hospital medicine.
(BMJ - http://www.bmj.com/cgi/content/full/322/7292/945/a)
http://www.guardian.co.uk/society/2001/apr/10/nhsstaff.health
High suicide rate in female doctors and GPs
+++++++++++++
there is lots of data on it.
As to the comment about two GPs who committed suicide who were heavy drinkers - of course. People who are depressed drink heavily and people who drink heavily are depressed. Why do you think that some doctors drink so heavily? STRESS
John
Cornishgiant you will have difficulty taking a look at Docors.net it is written by Doctors for Doctors and unless you are a Doctor you won’t get in. Dissenting opinions would not be welcome.
The main reason why the suicide rate is so much higher for Doctors than for the general population is not because of the malign influence of HCP’s or the dumbing down of the health service in gerneral and the medical profession in particular (although these may all be factors). It is because like Vets and farmers (who also have higher than average suicide rates), Doctors have the knowledge as well as access to the means to put a quick and relatively painless end to their lives.
Intent+ planning +access to lethal means = high risk
Suicide in doctors.
There are surely additional factors that self-select for a medical career. e.g. the personality types that go into this field? What is their motivation and does reality meets what they were seeking?
I am not a medic, but I do know of some who clearly have sought that field in order to "be someone", and the status/role etc has not met the depth of need.
I also know of medics who are so used to being very able that they have not learnt skills of dealing with errors.
Intellectual...
You surely agree that there are many people who are intellectually equal to doctors and who are not doctors. I like your blog, but there are times when it sounds like you think that doctors have the monopoly on intelligence. I accept that doctors are at the upper end of the intelligence range - but so are a percentage of the rest of the population...and some of us are HCPs.
I am worried by NHS "dumbing down" - some of the problem seems to be inadequate training - i.e. clear enough red flags to tell an HCP when to refer on.
Hi Cornishgiant
Brilliant comment. Don't worry about the lack of long words. You made your point brilliantly. I take it then that, on balance, you are not persuaded that doctors are better educated and more intelligent than HCPs. Or even hospital porters. Talking averages, of course. There are always exceptions. Ludwig Wittgenstein worked as a hospital porter for a while. (No, he was not a doctor, he as a philosophical philologist)
John
PS let me have your address, and I will sent you a Thesaurus and Dictionary for Xmas.
There are surely additional factors that self-select for a medical career. e.g. the personality types that go into this field? What is their motivation and does reality meets what they were seeking?
++++++
Now that is much more interesting. Doctors are more intelligent than most, but they also tend towards obsessional perfectionism. They are trained to analyse and solve problems, and are at their happiest when they are diagnosing. Unless they have read Balint and understand the collusion of anonymity, their brains tend to fuse when there is not an a diagnosis. Hence the problems and aggro with ME patients. Doctors can't diagnose them, so assume they are all mad. Some are. Many are not.
John
John,
You have courage to open the ME chestnut again!
Don't tell me that ME patients are driving GPs to suicide???....murder perhaps??
Dr C,
Whether or not I agree or disagree about "average" intellect, it was a display of arrogance of the highest order.
Pllease send the Thesaurus to (don't worry about the dictionary, I ain't arsed 'bout spelling)
Fucking thick Pharmacist
Doctors are God House
All bow down
Inferiorville.
It'll find me ;-)
Dr Chris - no inferiority complex here, thanks for the concern!
I'll miss this tomorrow when I'm on the plane to Spain for the yearly golf jaunt.....!
I give the example of a classic area where doctors do NOT perform well because ME is a problem that does not always compute with medical training. This is a comment on doctors, not on ME sufferers
John
Dr C,
Whether or not I agree or disagree about "average" intellect, it was a display of arrogance of the highest order.
Pllease send the Thesaurus to (don't worry about the dictionary, I ain't arsed 'bout spelling)
Fucking thick Pharmacist
Doctors are God House
All bow down
Inferiorville.
We'll also add ungrateful to your CV.
Mind you, if I was a tablet counter, I'd have the right hump.
ha ha ha!
People have forgotten the simple honesty of calling a spade a spade.
John says "nurses are educationally and intellectually" inferior to doctors.
People (including me) look at this and think 'how inflammatory', but why should we? The statement is, by definition, true.
As has already been hinted at, this is about averages. The Dutch are taller than the Japanese. A 6'4" Japanese man will find this annoying as he is taller than most Dutchmen, but the statement is true.
A 5'7" Japanese man will be annoyed by this statement, as no one wants to feel he belongs to a community deemed 'inferior' (conflating height and superiority here - and I'm a shortie), but nevertheless he must accept the initial statement is true and he - like most Japanese men IS shorter than most Dutchmen.
By the average A-level requirements and results, competition ratios, examinations and job duties, doctors are - bluntly put or not - intellectually superior to nurses.
This is not an inflammtory comment. I'm not saying Dr Crippen does not make inflammatory comments, but this is not one.
It is hard to be told that a job for which you trained for ten years can be better done by an HCP who is educationally and intellectually inferior and has no real medical training.
Or, y'know, just doesn't have the benefit of Daddy's money, but wants to work in healthcare anyway?
A person's job has never been a great predictor of their intelligence. I worked in a shop to put myself through Uni, so arrogant customers believed I was thick. Many students work at the likes of McDonalds if they don't have a gold-plated Daddy Fund to get them through their degrees. Are they 'intellectually inferior'? One of my closest friends is educated to PhD level, he's a wonderful guy, has churned out some stellar research, but because of his disabilities he's given up academia for dog grooming. He loves it. It doesn't automatically strip him of his achievments, or render him 'inferior' to you.
Oh and suicide rates among doctors have always been high, before the 'dumbing down' of which you speak. Farmers have similar suicide rates, it's a wonder they manage it, what with being so 'intellectually inferior' to the mighty Crippen.
I came to this post expecting to see some interesting new take on this perennial problem. Sadly I was let down.
I think it's a pretty low blow to exploit such a sad social/psychiatric problem to do a bit of political posturing on your favourite topic. I'm actually not sure who should be more offended, the specialist nurses or doctors with depression.
Doctors are more intelligent than most, but they also tend towards obsessional perfectionism. They are trained to analyse and solve problems, and are at their happiest when they are diagnosing. Their brains tend to fuse when there is not an a diagnosis.
If I were a doctor I would have to take the attitude that there are still some things that are not known, and live with it. Otherwise if I could not live with it I would have to switch to doing research myself.
(BTW WRT to ME diagnostic test, last I heard from London is gene expression divides into seven subtypes)
K
Looking at my last post I realise it sounds a little unsympathetic coming after the main post about depressed doctors. I did not mean that.
K
"John says "nurses are educationally and intellectually" inferior to doctors".
True but irrelevant. What is getting up the noses of the nurses who visit this site (myself included) is Dr C's assertion that Nurses are:
a) unprofessional
b) playing at being Doctor
c)unable to recognize the limits of their competence
d) Responsible for all the failings of the Health Service
Christ on a bike we are even being blamed for Doctors killing themselves now. (I know this is hyperbole before someone calls me paranoid).
His high handed, superior, holier than though, and at times frankly paranoid rantings do not endear him to many who might ordinarily agree with much he has to say. Telling someone that the only thing someone is good for is to clean out bed pans is not calculated to endear them to the point you are trying to make.
I, for one, could never do your job and think you are not valued or paid enough . I am a psychologist and ( although it is very politically incorrect to say so in psychology company )I also feel we and the patients we see are being subjected to dumbing down. Why have someone who is trained to doctorate level when a nice nurse with a few months' CBT training or better still a dinky computer programme will do? It's one way to cut down waiting lists of course ( the bain of my life!). I often wonder who helps depressed medics ( ie. not for medication which I assume is prescribed by colleagues or psychiatrists )
"E",
John's assertions are true! Some specialist nurses are playing doctor, and this is facilitated by management acting on HMG dictats.
I cannot presume you are angered by this for any reason other than that you are a first-rate nurse, interested in doing nursing duties of the highest quality for the good of your patients.
Duties like bed pans and feeding, although unglamorous, are instrumental in a patients recovery/rehabilitation, and should not be treated as anything less - and I'm a doctor!
I therefore cannot see your problem with Dr C's moans - you both seem to be playing for the same team.
Speaking as a junior doctor, I have this to add.
Suicide among doctors will always be higher than in the general population because of the very nature of the job. The long and short of our job is that other people's problems become our problems and we get paid to solve their problems. Often, we can but sometimes we can't. Hospitals can be emotional pressure cookers and there have been times when I've felt I've had the world on my shoulders.
I'm a happy person, but if I think back over the last few years to the times I've felt really low, the vast majority of the time it's been because of something that's happened with a patient at work.
I really think that people (the general public) don't really understand what we do. This is especially true of anaesthesia but i think it applies to doctors in general. Many a time I've spoken about something to my family but you can tell that they don't really have a handle on my level of responsibility so they can't really empathise with me. They say things like "things will get better" "it's not your fault" or "tomorrow's another day" but it's hard to believe them when I know that they don't really know what I'm talking about.
(On that note, MMC hasn't helped because I now live hundreds of miles from my family and have only seen them three times this year. Constantly being moved around the country makes making good friends really difficult, especially if you're the quiet sort).
It's often a very lonely job too. Sometimes you're lucky and you work with people you really get on with. Sometimes, however, you don't gel with your colleagues and the fact that we work such long hours means that there's little opportunity to escape and have some fun. Often you finish work and you have no energy to go out or visit people and all you have to look forward to is doing the same thing again the next day.
Of course I appreciate that other jobs have their own stresses but, in my opinion, the constatn worry of another human being actually dying because of something you have (or haven't) done can really get you down.
- Michael
"As to the comment about two GPs who committed suicide who were heavy drinkers - of course. People who are depressed drink heavily and people who drink heavily are depressed. Why do you think that some doctors drink so heavily? STRESS"
This comment by Dr C really worries me. Any doctor who has a serious drink problem should not be practising medicine at all. Their professional judgement is bound to suffer with grave consequences for patients.
Anonymous 12.01am
I would guess the same could be true with 'just' the depression anyway.
The use of alcohol because of depression may not be that common, at least not according to this web site, http://www.netdoctor.co.uk/diseases/depression/alcoholanddepression_000486.htm
On the subject of suicide, have any of the studies taken into account the possibility that at some of the difference in suicide rates, and possibly even most of the difference, can be accounted for by doctors being more successful at suicide? How do attempted suicide rates compare between doctors and non-doctors? Not having access to the full articles, I've not been able to check myself.
I think working hours may have had something to do with it too. I used to be almost clinically insane at times after a 40 hour shift, I would cry while driving home at night, and that is quite dangerous! A surgical SHO working in the hospital with me one weekend (I was on Friday 8am-Sat noon and then Sunday 6pm to Monday 6pm before then heading into my normal working week) had been rostered on, as was the norm for her specialty, from Friday 8am-Monday 5pm with NO scheduled break for sleep at all. She left Monday evening, checked into a hotel and killed herself. She was 26, a second year Surgical SHO. I remember wishing I had spoken to her or had a cup of tea with her during the weekend, but in the end of course it wouldn't have done any good. Often after extended shifts under high pressure and sleep deprivation, people are just not responsible for their actions anymore. Another girl I knew to see, a medical SHO, (also 26) was found in her bed after overdosing, a year or two before the surgical girl killed herself. Again after an extended shift, which I don't think is a coincidence. Many docs I know have felt so desperate they have admitted they wished they could die during/after one of these ridiculous, dangerous shifts. When will people learn? Granted this is not an issue in the UK from what I hear, the EWTD is implemented to the extent that most get sleep at some point every 24 hours I believe. But it certainly contributed to at least two suicides in young doctors that I knew, and God knows how many more I didn't.
The EWTD should help resolve all that.
There will (I hope for my sake) be no more 40 hours shifts.
However the thing that worries me is that the "official" times don't match the "real" time worked.
I have a friend who showed me her "official" time, 48 hours. She had actually worked 87 hours that week.
Then i hear of people being told to go home and they are "inefficient" because they are still working after 5pm.
Ah well just so you know its not us deciding to run off at 5 so you can't see your Dr its us being told by the managers to leave or face a disciplinary.
Consultantphysysician,
It is more the way he makes his point than the point itself and the way he tars all senior nurses with the same brush. Some senior nurses may be playing at Doctor (Some Doctors play at being God), I don’t doubt it, but most of us are not and while emptying bed pans and feeding patients is without doubt a core nursing duty and a very important one at that (although I hesitate to call it a skill) to suggest that is all I am good for is insulting.
Dr.Jane doe
With their “expert knowledge” and access to lethal combinations of medications I would expect Doctors to be making more successful suicide attempts than most. On the question of working hours Dr C (and others) appear to think the long hours worked by junior doctors is at least in part a good thing (“working 100 hours a week, it was hard but we learnt some medicine”) reducing the hours worked by junior doctors will of course require nurse practitioners like me to take up the slack. Just saying is all.
Medics tend not to want to end up as drivelling idiots in hospices so they put something lethal in a safe place for when the time comes.
Actually e it shouldn't mean you have to take up the slack.
If there were enough junior posts for all then it would be possible to struggle on through in the future.
No offence but even in my limited experience i don't trust the "NP's" as i have seen the variability in ability.
I will still be double checking the info they give/ what the have decided (as i am sure people will be of my work for a few years yet).
"If there were enough junior posts for all then it would be possible to struggle on through in the future."
Well that ain't going to happen any time soon and until it does you will have to struggle on with our help.
re M.E. and GPs
My comment was flippant and open to misinterpretation - I'm sorry. I hear you as being interested and willing to see those "ME" patients as individuals and wanting to be able to find individual answers to help them. If you didn't care it would not be a stress. (or would only be a stress about liability/time and not about letting someone down).
I don't have ME but have had a series of health problems (all medically confirmed) over the last few years so it has made me v aware of patient/doctor interaction. I've encountered a fair number of hospital consultants. The thing I value most, when I meet it, is a willingness to work in partnership i.e. me and the doctor on the same side looking at the condition, not the doctor vs me + condition.
I guess with non-organic "ME" it is v difficult (?impossible) to separate the condition from the patient. The difference in perspective of the patient and the doctor must make honest communication, and dealing with expectations, a gt challenge.
The number of health issues I've been through has meant I try and see the same GP when needed, and am v glad that it is possible. She appears to me to be a v good doctor - she is also likeable and funny. The proposed polyclinic conveyor belt system would be hugely inferior.
Not wanting to join in with the who is superior to whom debate. I have been a senior ward-based sister for over a decade and have many friends who are doctors. I have known colleagues who drank, took drugs (both doctors and nurses) became depressed (not necessarily in that order). Thankfully none of them killed themselves although a few came close. Depression is one of those things that unless you have been there, I don't think you can understand. One thing I have noticed about junior staff and students however, is that medics tend to be the ones who don't want to talk. I always remember my first death on the ward- young girl who'd jumped from a bridge (popular suicide point) a few months earlier and rather than killing herself had ended up as a quadraplegic. Somehow she had managed to try to drown herself (never found out how). She was unsuccessfully resusitated in A&E- very distressing for all concerned as there was no dignity, just futility over what we were trying to do. When the resus was finally abandoned, the senior nurse in the room took us ( student nurses and new staff nurses)to one side and herded us into the staff room whilst anther staff nurse went with the doctor to speak to the family. Sister spent about 20 minutes with us, talking through what had happened and then asked if two of us would help with last offices. The rest of the resus team packed up and left. The new A&E SHO was left on his own in the room until another nurse came in to say that he was needed elsewhere. None of his colleagues said anything to him. That image has always stuck with me. To doctors it seems that death=failure. When we get new doctors on HDU, I try to make them feel part of the ward team (yes, they will even get the occasional cup of tea without asking)and have had a few confide in me about how hard they are finding the job. Most say that they cannot tell their senior colleagues how they are feeling in case it is seen as a weakness. It find this so sad- and I think back to that SHO in A&E. He eventually became a consultant surgeon, with a reputation for eating his juniors alive. Turned into a Dr Romano rather than a Dr Greene (sorry for the ER ref- I also read the Nurses for Reform website, Dr C but on the whole am a big fan of ER and how it shows nurses- certainly better than the way our shows do ) I think that doctors find the whole "team" thing a bit harder...ward nursing teams tend to be tight little units (although for those who do not fit in, this can be just as bad)a good ward sister will make sure that the team supports rather than implodes. HAving always worked in critical care, I have always had to deal with patients dying and not always in the pretty way that TV likes to show. You cannot help getting attached to some patients more than others and it is upsetting when they die....why nurses seem to be able to cope with this better? We spend more time with them maybe, our training doesn't centre around "fixing" or even "curing" people but on caring for them regardless of the outcome. Or maybe it does come down to personality types- not wanting to sound patronising, most of the medics that I know are over achievers, type As as they used to be called, who seem to only "see" themselves in terms of how their career is progressing, constantly comparing themselves to their colleagues. If you are a staff nurse 10 years after you qualify, no one thinks that you can't cut it- afterall, there are only so many sisters posts out there. Plus not everyone wants to be a sister. If you are a medic on the other hand...
One thing you have ignored.
Jobs with the means to commit suicide eg Doctors, Vets etc tend to have higher suicide rates than ones without eg IT support.
Dr. C
I know you don't usually get involved in this type of politics but was wondering if you would be interested promoting the very hard circumstances these doctors are facing:
http://zwnews.com/issuefull.cfm?ArticleID=18654
not a doctor -p-
1. many of these HCPs earn more than junior doctors, for significantly less knowledge and understanding. case in point: a nurse practitioner at my hospital earns more than more than an SpR. many RNs earn more than F1s/F2s. I find this immensely demoralising when I've finished a day staying back to make sure that my patients are sorted and well looked after -- and whenever I want to give clear instructions to the nurse, they are on break and I have to either write stuff they'll misinterpret in the notes, or hang around for another half an hour. Nurses don't appreciate that handover kills people.
2. dino-nurse: doctors don't really work in teams. My "team" consists of people that I work for: the SpR, and the consultants. I have a lovely SpR who is very encouraging and has gotten me through the "I want to quit" stages, but I knew him when I was a student; you can't always rely on these structures.
3. raxo: scholarships. I went through high school, medical school, the first year of a phd at an ivy league university, all on scholarships. daddy has no money.
4. drjanedoe: the long hours play into it, but what adds insult to this is the feeling of being underappreciated in the midst of all this. during these shifts, you get work dumped on you by nursing staff who don't understand what it means to stay back and look after a sick patient because it's in the best interests of the patient, whose ridiculous protocols create more work for you, and who won't listen to your explanations of why a bp of 160/80 doesn't need to be treated at 3am. driving home after these shifts, I look at the poles on the freeway and think that they look mighty inviting -- and then I realise that I'd just end up at my hospital's emergency, a place I have no desire to be, and someone I know will be sticking a finger up my bottom.
dhs - 3. raxo: scholarships. I went through high school, medical school, the first year of a phd at an ivy league university, all on scholarships. daddy has no money.
Well done, but with all due respect, those options simply aren't open to most students in the UK. Very few people can afford to end up £30k in debt before they even start their career. The type of scholarships you have in the US are not common here, and certainly wouldn't cover 5+ years. Unlike other undergrads medical students cannot work to support themselves (I had to work full time to cover the cost of my 3 year degree, nearly killing myself in the process) so unless Daddy's cup runneth over, then you're stuffed, basically. People are even avoiding basic 3 year BA/BScs now because of the cost. This government has priced the working classes, and even a good portion of the middle classes, completely out of higher education.
e, I work now in New Zealand, where the longest shift I ever do is only 15 hours long. I don't see any nurse practitioners taking up any slack at all, and indeed how could they, as they could not do our job for us? What I do see is sensible structuring of the medical staffing of the hospital, with 24 hour cover at all levels at all times without anyone doing excessively long shifts. I am doing a 70 hour week this week as I am on Sat and Sun from 08:00-23:00, but it is infinitely more preferable than what I was forced to do at home or lose my job. Incidentally, the EWTD is not implemented in the Rep of Ireland, where I was working, and is not likely to be anytime soon. Irish hospitals appear to feel they are above the law. So the EWTD for us has solved nothing as yet.
e, that docs need to work continuous shifts of 40-50 hours and 100 hour weeks to obtain training of any significance is laughable, and I have discussed this on previous threads with Dr.C. I have become better at my job since I came here, not tired so can take things in, can study at home as not exhausted, can take the time to examine patients more thoroughly, can stay back after my official going home time to learn procedures, go to teaching etc,as my one burning ambition is not merely to get away from the hospital.
I disagree that the reason more docs seem to kill themselves is that we have the knowledge to do so. It can be no coincidence that many I have known, (and being honest, myself included) have thought even briefly about ending it all after or during these continuous shifts. Remember, in the Geneva convention, sleep deprivation is classed as a form of torture. And it is.
Long hours and sleep deprivation are factors certainly but major factors in a successful suicide attempt are planning and access to lethal means. Doctors, vets and I suppose pharmacists have access to the latter.
I would disagree with Dr C's assertion that Doctors are psychologically more vulnerable to low mood and depression because of their personality type, in my experience Doctors are a fairly diverse bunch.
Raxo what you say is just not true.
Nearly all of the medical students on my course will be at least 30K in debt this summer when they graduate.
Professional studies loans are ubiqitous.
The sterotype you talk of no longer exists, ok some people on the degree are rich and get all the help they need but thats true of the uni in general on any degree.
COI: from a poor family where £25 of the folks goes a long way at medical school (well ok not a long way but nearly a whole book).
E i think i will struggle along inspite of your help. From your posts you are likely to be the one giving me grief.
To Dino nurse,
Its not just the doctors, as a medical student me and my clinical partner were helping in resus with a frail old lady who was lovley. We got fluids up and a chest drain in and generally stayed with her for a while (benifit of being the student). Cme back from A&E asked how she was, "oh she died a bit ago"...he toddles off. Never mentioned, been in ITU attachment got to know patients who die, i got dragged in to confirm death (well be shown how) was still shocked as a newbie to see someone go from talking to dead in a short space of time. Basically just nodded at and left alone.
Have to take it on the chin and move on.
Then again i don't really drink and think cake got me through.
I saw some "hard" mates from medical school sit head in hands and almost cry in the first year. Glad i am avioding certain wards/jobs as the job can really drag you down.
P.s. i have great friends who are more senior and always give me a helping hand.
Dhs, hopefully no-one will be giving you a PR after an RTA, have never worked in ED though! Thinking of that (and catheter insertion) has made me think that if I ever try to top myself it will be miles away where no-one recognises me! :)
Gee, e, I guess NPs would have access to all that stuff too. Wonder why their suicide rates ain't as high?
I would agree with you though, that doctors would not be psychologically more vulnerable because of their personality type. I think it's the constant crap we have thrown at us. My parents and my friends have often been shocked when I tell them what my hours are, with my having no say so in them, when I tell them of the verbal abuse from families, patients, and yes, sometimes nurses, when I tell them of the total lack of job security despite all this work and long hours, the constant exams, the lack of any sympathy even when you watch people suffer and sometimes die day after day. The publics vicious hatred of you just because you are a doctor. Management forcing you to not take your leave. the exhaustion. the constant fighting for every little thing.
The last time I asked for a fucking CT scan in Ireland (at the direction of my consultant) I was subjected to such abuse (by both CT radiographer and radiologist) that I actually felt like turning around and saying "Do you think I want it for myself or something?". I wish now I had. Everything is a huge fight. Why bother? To any students reading this, if you are going to stay in UK/Ireland-just get out-go do pharmacy/physio/financial advising.
It is only going to get worse, not better, so do yourselves a favour and don't fucking bother.
Thanks for the pep talk ;)
I finish medical school in a few weeks....so much to look forward to.
Dr.JaneDoe said...
"Gee, e, I guess NPs would have access to all that stuff too. Wonder why their suicide rates ain't as high?"
I think it depends on which report your read. Nurses weren't covered in the article in question but it doesn't mean that their suicide rates are normal. In fact, it looks as though the suicide rates in nurses are higher than average and have been higher than doctors at times (comparing female to average female rates and males to average male rates).
http://news.bbc.co.uk/1/hi/health/944503.stm
"27 September, 2000
'Suicide risk' for doctors and nurses
Nurses are four times more likely to commit suicide compared with people working outside medicine, figures reveal.
And doctors are twice as likely to kill themselves compared with people working in other professions."
One of the pieces of research quoted by Dr C found that female doctors were at increased risk of suicide but male doctors were less at risk than the general population. It has been mentioned on this blog that the proportion of women to men entering medical school is changing. In 1990 it was 50/50. By 2003 59% of medical school applicants were female. Maybe the increased risk is for females in caring professions rather than doctors?
This information seems to support this theory (my highlighting):
"Several occupational groups in the United Kingdom appear to have considerably elevated risk of suicide. These include, for example, farmers, doctors (especially females), dentists, pharmacists, veterinary surgeons, and female nurses."
http://cebmh.warne.ox.ac.uk/csr/reshighrisk.html
University of Oxford Centre for Suicide Research.
Sorry if this is a bit disjointed, it's a bit late for thinking.
Meidcal school entry is now at just under 70% female.
"Medical school entry is now at just under 70% female."
Maybe, just maybe, there will be less suicides in the future as female medics will be less likely to be bullied by arrogant male colleagues.
Sadly there is some evidence that females doctors are more likely to commit suicide than males
John
Dr's suffer from a range of working practices that make them more vulnerable to suicide e.g. long working hours, high level of responsibility, etc. However research shows that access to the means to commit suicide makes a vast difference. The people most likely to kill themselves are Dr's, farmers, vets and pharmicists.
Farmers can have poor working conditions e.g. very long working hours, BSE, falling profits. However, pharmicists and vets don't have many of these poor working conditions and yet still are in the top 4 of professions most likely to kill themselves.
Other professions who suffer stressful working conditions but don't have easy access to the means to kill themselves, have far lower suicide rates. For example child protection social workers with high levels of responsibility and at far greater risk of murder or serious assault than any other job outside the armed forces.
Strangely enough though, qualified librarians are the 5th profession most likely to kill themselves - but I suspect this is more to do with the types of peopel attracted to this work.
I am not a medic, but I do know of some who clearly have sought that field in order to "be someone", and the status/role etc has not met the depth of need.
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