“You’re a medical professional, how can you be ill?!”

If people can’t even believe that doctors, nurses, healthcare workers can’t have physical ailments, now imagine the awareness surrounding mental health, or the lack thereof.          

Mental health has always been an insidious disease that has preyed on many of us in the healthcare community, and I specifically chose the word ‘insidious’ because of the treacherous nature of this combo: Mental Illnesses + Toxic workplace culture. This gradually and cumulatively crumbles our mental state, our well-being, and our ability to pick ourselves up in adversity, which happens literally every other second in the hospital FYI.

What makes this problem even harder to tackle is that doctors are notoriously bad for admitting that they are susceptible to illnesses and mental pressures. It is considered to be a herculean task for many to even disclose their symptoms, to seek timely professional help, which leads to late diagnoses by which time, the condition might have become more serious.  And the joke is on us because these are the very things we berate our patients for!

Why? Why is it an unspoken rule in the hospital that we have to turn up unless we are sicker than our patients? Why are we forced to work past our shifts and told to think of it as our moral responsibility? Why do we not acknowledge the elephant in the room when one brave colleague steps up to admit they are suicidal? Why does this colleague get transferred to some unseen ward for inexplicable reasons?

I blame the healthcare system for unloading its burdens onto our shoulders that we have been silently bearing. Yes, some governments have been trying to be proactive to implement guidelines to aid in relieving these burdens. The UK initiated a working-time directive that seeks to limit the maximum working week to 48 h, which gives staff limited time to hand it over to the next shift, and this has resulted in medical error-caused deaths in 407 out of 1635, due to clinically important delays. Singapore has set up training courses in conjunction with the hospitals and the Healthcare Academy, to teach medical professionals how to handle crises and self-care. This is a step in the right direction, but barely half a step. How would this be sufficient as a one-time course, which barely has any follow-up from the staff and an existing healthcare system that continues to suffocate us?

We are haunted everyday about problems like accessibility, medical litigation, caseload, exams, and insurance policies, lack of healthy food and sleep, as well as emotionally demanding work. 74% of physicians have reported burnout according to a recent study, physician suicide rates is double that of the general population and highest amongst all professions. This does not stem for a lack of awareness, we live, breathe, eat, and sleep medicine. Surely we are able to self-diagnose, and “doctor” ourselves?

In a paper entitled “Illness Doesn’t Belong to Us,” McKevitt and Morgan interviewed physicians with a recent history of illness to further understand why this idea that doctors don’t get sick exists. Physicians cited embarrassment, guilt, and a sense of failure that they as a doctor succumbed to illness. When asked about the reasons why doctors “may not” get sick, physicians noted the importance of coping with pressure, stress, and illness that is instilled within them during medical training. “The idea that you have to soldier on is very prevalent while you’re training.” They discussed difficulty with coping with illness, eluding to an unstated belief among physicians that “illness shouldn’t affect them as badly as it does other people, and that they should ‘work on.’” And most physicians in this study did work on it. They worried about the burden their absence would place on their colleagues, as well as judgement from their colleagues from being ill or being perceived as weak.

This guilt has been especially prevalent in these COVID-19 pandemic frontlines when the caseload has been overwhelmingly high even at full capacity. With doctors succumbing to the virus, to violence against healthcare professionals by frustrated patients, the workplace has become increasingly toxic and yet, mental health frustratingly remains a taboo topic. Hospital staff continues to struggle with silent desperation, too exhausted to fight the system that has been relentless and cruel to these frontliners, too afraid of the stigma that follows if they seek psychiatric help, too fatigued to fill out forms and choosing to dip their hands in the drawer to self-medicate instead.

It is no wonder that depression, anxiety, substance abuse are a few of the many ailments HCWs are afflicted with. The ‘burnout epidemic’ is a pressing matter that cannot be neglected especially in these times. The first step is to recognize that the problem exists, mental health is still a concern, no matter how functional doctors and healthcare staff appear to be in the workplace.

The change will only start if we break the chain. Only if we learn to put on our own oxygen masks, be it through seeking professional psychiatric help or through mindfulness practices. If each one of us recognises the issue at large and show some compassion, we would be able to cancel the toxic culture of bullying and actually be able to support our peers and colleagues in times of mental health crises. This would build camaraderie, teamwork, and a positive work environment where we can feel safe to voice out our concerns, where we can work together to correct the fallacies of the existing system, where we would no longer be exploited for our impeccable work ethic (working through illness) to allow institutions to profit. Perhaps we can correct the gaps in medical school training when dealing with patients with psychiatric disorders. We would learn how to effectively calm down an autistic child having a meltdown, or what to say to someone who confesses to being suicidal, instead of giving in to excuses like “you’ll learn it on the fly” and “this kind of wisdom comes with experience”.

We need to know acute psychiatric interventions, and we need it to be as relevant as CPR, with certified training and regular refresher courses. This is by no means a replacement of psychiatric treatment, but merely a crucial initial intervention in an emergency situation, that could very well save a life.

I know it seems like a daunting task, to try to change the system and culture from within, but if we remember medicine’s oldest adage: primum non nocere, and stop the self-harm in our medical community, we can make a difference together.

LAGOM

Vyshnavi

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One response

  1. Thanks for talking about the elephant in the room aka health struggles of HCPs themselves! It’s super important for more people to be aware of this topic and for HC systems to not only take initiatives to address this but follow up with them. Health struggles among HCPs need to be normalized as they are also human after all.

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