So You Want to be a Doctor: on stress and suicides

We doctors are the best when it comes to suicide; we are among the most creative at it, too. We also have the highest suicide rate compared to other professions.¹ It's no surprise, really. In learning how to heal, we indirectly learn how to kill. Armed with the knowledge, we only need the proper motivation. And stress can be a powerful motivation indeed.

Every so often, an almost brave house officer--Americans call them interns, I think--writes to local newspapers about the amount of stress they face at work.^{2, 3} Almost brave because they don't reveal their identities in said letters/articles, which is wise because they'll only be targets for further bullying. I do not use the term 'bullying' lightly because this reflects badly on my colleagues--and perhaps, even myself.

But our general response to these open letters of complaint is laughing at the article and giving snide comments, because, let's face it, we've been through the same process. As house officers, we had experienced working seven days a week, over forty-eight hours at a stretch, and we had experienced being yelled at by senior medical officers and specialists in front of nurses, students and patients. It's a rite of passage, we say. It's something we all have to go through as doctors, so buck up and shut up.

We doctors dive head-first into a world of death and disease. Among the first things senior house officers teach fresh ones is how to react when a patient collapses. One of the most vital steps is to call for help. Unfortunately, speaking from personal experience, help doesn't necessarily come--not on time, at the very least. During such times, even the most arrogant house officers will be humbled at how professional and quick-thinking nurses and other support staff can be. However, no matter how quick we are, no matter how good we are, we cannot defeat Death. We can't even defeat diseases, sometimes. Several of my friends have contracted tuberculosis even though they have taken all necessary precautions when treating patients.

Shit happens.

Don't get me started on dealing with patients' difficult relatives.

I love working, and this is partly due to the excellent working environment. The whole department is like my extended family, and we share laughter and commiserations. I usually don't feel the long hours, and sometimes I still come during non-working weekends to check up on my patients. Still, no matter how good the environment is, sometimes it gets too much. Especially when patients you've come to care about passes away, or complications you cannot control happen during surgery.

Imagine how it feels when superiors treat you like scum, and your support staff treat you like a snot-nosed infant whose incompetence fills them with contempt.

This example may not be relevant, but I'm going ahead and use it anyway. When I started doing surgery some long years back, we used old and tired bone cutters (which are still in use today), and to do a craniotomy (sawing off part of the skull) alone would take me almost twenty minutes, making the total surgery time longer. I heard that before my time, they used a manual saw, and surgeries took way more hours than I would have been comfortable with. High-speed drills were for surgeons only. Now that the old craniotomes are dying off, we get to use the high-speed drills and an uncomplicated surgery only takes up slightly over an hour for me. Junior medical officers start their career in Neurosurgery using these high-speed drills, and the old craniotomes are an urban legend for them, just like the manual saws are an urban legend for me. We're moving toward a better future.

Still, I count myself lucky for working at the heart of the service. Other centers still use the old craniotomes and sometimes the manual saws.

What I'm getting at is that as the generations move along--one doctor-generation is around 5 years, so don't get any weird ideas on how ancient I am--we get better. We teach our junior better and more efficient ways to treat patients, and we are also armed with better tools for the job.

So why do we slam house officers who want a better work environment with reduced stress levels? Why do we keep on saying "we've been through that. These house officers are such babies."? We've been through it, and it was hell. We know how terrible it is to work for more than twenty-four hours straight, and we sure as hell know the mistakes we tend to make when sleep-deprived. When we hear about a doctor committing suicide, we wonder if we knew that doctor, we wonder how he or she did it, and that's about it. We've been so inundated with extreme stress levels that we now believe that extreme stress is the norm, and is expected.

Maybe a better pay will help. Maybe shorter hours will help. Maybe a full day's rest after a twenty-four hours shift will help. Maybe even a mandatory one-week leave will help. That last one will definitely help, in my opinion.

All of the above are rendered useless if the work environment is toxic. No amount of compensation will matter if senior doctors believe that in order to build good junior doctors, you have to break them first.While it is true that fresh house officers start off their careers with a certain amount of arrogance--after all, we are among the brightest over-achievers--we don't have to make them hate their jobs. Humility and humiliation are two vastly different things, and to be honest, I think we have lost sight of that.

Being a doctor is stressful enough as it is. To ensure a better future for the younger generations, why not show our support instead of shooting them down? Why not show solidarity in securing a better life for all of us in and out of the workplace? And even if the authorities will do nothing other than write an empty response letter, why can't we create a healthy work environment?

Don't let a hard life make you just as hard. The next time we think about laughing at an article of complaint written by a house officer, why not think about the hell we've been through, and feel a little compassion toward these juniors. The people who voice out their concerns and complaints are courageous people who want a change for the better. These people should be lauded, lot laughed at.

Though I have to admit, with certain people, no amount of love and attention will make a difference.

_________________________________________________________

¹ Ilan Shira. The Occupation With the Highest Suicide Rate. The Narcissus in All of Us, Psychology Today; August 1, 2009.

² Houseman, Kuala Lumpur. Stressed From Still Working Long Hours. The Star Online; January 8, 2013.

³ Loh Foon Fong, Lim Wey Wen, P Aruna, Shaun Ho. Housemen still being overworked and bullied, sending some into depression. The Star Online, April 14, 2012.