Tutorial with medical students: I don’t want to use the words ‘please don’t kill yourself’

“Neither my emotional availability nor my emotional intelligence is remotely adequate, so I may be of no real use to you, but I will know where to point you for help.”

Admittedly, these are not particularly comforting words when rounding off the end of a tutorial with medical students, but it is always best to be honest when dealing with serious or complex problems. Finishing with the line “I don’t want to use the words ‘please don’t kill yourself’ but I am asking that you please do not kill yourself”, was hopefully sufficiently melodramatic to help those students pay attention to the message.

I am uncomfortable talking about such things, but I am now so amply frightened for our current and future healthcare professionals that I feel it has become an ethical obligation to warn as many as I can of the risks they face and the impact their professional demands will have on them. This concern is shared by many specialists and medical training bodies. There have been recent revelations of the extent of these burdens, with poor work-life balances and high stress rates among doctors being reported.

It feels as if morale has never been lower in the trenches of our creaking, crumbling health service. The huge number of consultant vacancies, combined with and exacerbated by a worldwide healthcare worker shortage, has continued to add incredible pressure on top of staff that were already overburdened and overworked to begin with. Modern healthcare (rightly) demands excellence and the willingness to overlook mistakes has correctly been relegated to the past, to the archaic land of ‘doctor knows best’. While this is the exemplary way to practise medicine, it is fraught with pressure and fear, and requires that doctors be more supported than before when this standard may not have been expected of them. Frustratingly, the requisite supports for these professionals in training have been added at a slower rate than our societal expectations.

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It is very challenging for those working in the health system to admit to illness or difficulty. Fear of professional ramifications, judgement, gossip, or not being able to pull one’s own weight are powerful barriers that look like insurmountable impositions when you’re craning your neck upwards at your vocational Goliath. When the overworked professional is faced with having yet more tasks and responsibilities thrust upon them, it is a rare saint that would not react with evident frustration. Earlier in my career, in the midst of seething bitterness, I adopted the mantra that “everyone is perfectly understanding up until the moment it looks like they may be remotely inconvenienced”.

Staggering workload

This is absurd cynicism, but I promise that it felt perfectly logical at the time. It’s difficult to see past the workplace incivility that is brought forth by the dissatisfaction of dealing with a staggering workload against the backdrop of inadequate resources, especially when these strains are also troubling you. And thus the pressure worsens, our healthcare professionals growing more distressed by the moral injury of the carer becoming so uncaring.

This unrelenting pressure has some terrifying end points: a descent into mental illness, into anxiety, into depression. Until survival instincts are no longer a viable match for this, and the risk of suicide increases dramatically. There is no actual data on the suicide rates for healthcare professionals in Ireland, but many know victims or know of incidents or attempts. It is a cruel irony that the experiences which increase the risk of suicide for these individuals confers the perfect knowledge to ensure that attempts are more likely to be successful or that intervention will be impossible.

The development of supportive programmes and resources is admirable. But it is arguably pointless without a dramatic culture shift that encourages and empowers people to engage with the supports that are available to them. It may seem obvious, but it actually is necessary to inform people working in a hospital that they shouldn’t feel awful all the time. That the effort they are putting into caring for their patients at their own extreme expense and detriment is inappropriate and their own health is as important as the other names on their list. If your colleagues recount that work is killing them, this needs to be flagged as abnormal. I recall an intern that graduated at the same time as I did, who was enabled to dismiss the first few months of a serious metabolic disorder as merely the symptoms of being a newly minted doctor. The incongruity of hospital workers getting sicker because they are within a hospital needs to come to end.

Toxic pressures

It is likely that these toxic pressures will persist for some time. Even assuming that the more optimistic among us will eventually be proved correct and our happy-ever-after will manifest itself; a set of problems as widespread and complicated as the difficulties in our health service will not be fixed easily or quickly.

I hope the general medical population acknowledges their increased risk of depression and suicide in the same manner that their governing senior colleagues have begun to recognise it as an immediate and present danger. All healthcare providers appreciate their responsibility for the welfare of their patients, and while some progress is being made to extend that responsibility to each other – it must happen faster and include ourselves among this cohort to be aided.

The advice I and others have for those who find themselves either in such a state or aware of someone else suffering is disconcertingly simple. Go to your GP (always have a GP, no matter what you do; they are vital to your health in general). Talk to your friends and family. Tell trusted people at work, both your peers and your superiors. Enquire after and avail of any occupational supports that are accessible and acceptable to you. It feels too simple and basic when said out loud; it feels like it is not enough.

Despite this simplicity, it is the only way that such a situation can be fixed. Regrettably, for something so easily said, following through can be incredibly difficult. There is no easy answer to bolster someone through the unease of seeking help.

Just the promise that it’s the better of the available paths, that it’s not a weakness that lowers the esteem of their professional character forevermore, and that it is the right thing to do.

– Dr Mark O'Loughlin is specialist registrar in public health medicine