The year is in full swing and the speaking invitations are tumbling in, many from schools and universities.
“Come and talk to us about your career in medicine. Tell us what it’s really like.” The students are dreamy, the way I once was. The faculties are prudent, keen to ensure that I understand the pressures facing their charges, who regard entry into medicine as the ultimate badge of honour.
At primary schools I bat away talks of “I just want to be a brain surgeon” and tell the children to read widely and be kind. I urge high schoolers to detach sense of worth from course selection. Pre-med students I advise to take their time deciding whether medicine is really “it” and I puzzle with medical students over why it’s hard to find meaning in our “helping career”.
After 25 years in medicine, I still love it. To do a ward round is to see discoveries in action, including some cancers turned into chronic illness. Add to this intellectual feast the intimacy of the doctor-patient relationship and the sanctuary that good medicine can provide to both parties. If there is a “power element” to being a doctor, it is the power of advocacy.
For years I have spoken to audiences about the sheer joy and privilege of being a doctor and have briefly touched on the challenges. Until I read an essay by my friend Rick and was forced to reflect on my message, which has always been, “All things considered it’s a winning career.”
The essay describes the suicide attempt of a doctor, who turns out to be his daughter, a surgical resident working unfathomably long hours and edging further away from acts of simple self-care like eating and sleeping until she seeks refuge in a fistful of antidepressants.
It is any parent’s nightmare to be confronted by the fact that the child you brought into this world should seek to find solace through suicide – but the aftermath is appalling too. Her training institution grants her little slack and seems to turn its back on a deep-seated problem with medical culture. She is sent a link to a policy manual. There are two messages here. One, the roster comes first. Two, when in trouble, read the fine print.
But the most painful and telling response came from her coresidents, administrators, and educators: nothing. Beyond one text from one coresident, radio silence. The community abandoned her.
To me, these are the most harrowing lines of the essay, an indictment of a profession that aims to serve humanity while damaging its own people bit by inhumane bit.
This story may be from the US but make no mistake, the story of this doctor could be, and is, the story of any doctor.
Psychologists recommend having a “best friend at work”, someone whose support can help us navigate the place where we spend so much of our lives. Yet just two out of 10 people can claim to have such a friend – and doctors are no exception. We work in teams, yet many relationships are fickle and transactional. Beneath the veneer of professionalism there lurks a tired, if not outright, disregard for others. By not caring for our own, we are the undoing of ourselves. And our patients will be harmed, not so much by our absence but our half-hearted, damaged presence.
What might change look like?
One: train senior doctors how to communicate sensitively with people who are not their patients, thus correcting a serious flaw in how people are promoted to leadership positions. Accountable, emotionally intelligent leaders can make the difference between life and death – not only for patients but also for doctors.
Two: stop blaming individuals for the failings of a culture, usually headed by people who invoke “back in my day” and are blind to modern reality.
Three: replace the euphemisms, name the problem and spread the figures. Doctors are twice as likely to die of suicide than the population average. Australia loses an average of 34 health professionals (half of them nurses and midwives) every year to intentional self-harm; the UK and the United States lose 10 times as many. Figures from countries such as India and China with millions of professionals are more unreliable but the problem is undeniable.
A growing number of doctors privately report being harmed in various ways by the profession but their voices fall silent due to the enormous cost of speaking up. So now I can’t help wondering if medicine’s moment of reckoning with that harm may be hampered by physicians like me, whose public comments have focused on the healthy side of a rotten culture.
It is time to let people see behind the glossy images of proud students and fulfilled professionals who couldn’t imagine working elsewhere. Let’s be honest about the problems ranging from mismanagement to misbehaviour. Sure, it might invite more commentary and even ridicule about using our privilege to sound precious, but I think that patients would respect us for acknowledging just how broken we are and see that our calls for change are motivated by the knowledge that our work affects the public interest.
Which “inspired” student in my audience is now paying the true price of becoming a doctor? Which parent wishes their child had never attended my talk?
If we demand honesty from the public, it’s time we returned the favour. Part of that course correction may be to help young people process the troubling evidence, say to parents that their concerns are real and consequential and join hands in mapping a better way ahead.
If this is what it takes, every doctor I know would be prepared to play their part.
Meanwhile, I am holding my friend and his daughter in my thoughts.
In Australia, the crisis support service Lifeline is 13 11 14. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In the UK, Samaritans can be contacted on 116 123. Other international suicide helplines can be found at befrienders.org
Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. She is the author of What It Takes to Be a Doctor. Her latest book is called A Better Death