Suicide has been making headlines in recent weeks, but when we all move on to the next issue, the factors that contribute to the deaths of so many people persist, writes Dr Anthony O’Connor
In the last year, two doctors that I taught as undergraduates and subsequently worked with have died by suicide.
The story was picked up by the Sunday Independent newspaper on Sunday, 9 December. The hospital where the doctors had worked had organised memorial services and counselling for the friends and colleagues of the deceased, who the newspaper told us were medical and surgical senior house officers.
The hospital then sent those same colleagues back to work the 32- and 56-hour shifts that their fallen comrades had done at the coalface.
Business as usual.
The Sunday Independent carried another story about junior doctors the following week. Under the banner of “€266 million top-ups are paid out to HSE staff” it described “a bonanza in pay increases, top ups, on-call and overtime payments” and that “junior doctors will share a pot of €97 million in overtime payments”.
Business as usual.
Depression and suicide are a scourge of our times. I have long held the view that there is a silent epidemic of undiagnosed, untreated depression amongst our colleagues. This disadvantages patients in a very significant manner and is catastrophic for doctors and our families.
Rheumatologist and blogger Dr Ronan Kavanagh had the courage and eloquence to pen a wonderful piece on his own experiences with ‘the black dog’, a subject Dr Garrett FitzGerald of another parish has also broached with skill and insight. Ronan’s blogpost, which should be required reading for every aspiring doctor, argues that having lost empathy with patients during his first attack, his experience with overcoming depression made him a better doctor. The challenge is to equip doctors of all ages with the skills of empathy and self-care, without needing a depressive illness as a tutor.
I knew I needed help a couple of years ago when, in spite of an overwhelming sense of sadness, I was incapable of feeling anything enough to cry while driving to work to go on-call, having been up writing a paper until 3am that morning. Luckily I never felt suicidal, but I remember that morning thinking it might be nice if I was involved in a medium-sized accident where I broke a leg or an arm to get me out of call for a few weeks. I texted my team to say I was ill and would be late and sat in the hospital car park for nearly an hour just feeling numb and unhealthy, listening to the bleep going off and ringing back from my mobile. With the help of an amazing woman, a good GP, a great counsellor (which I am extremely grateful to my employer for providing) and some medication, I slowly got through it. I have no intention of ever going back there, although I know it could happen. I do everything I can to prevent it.
What cannot be avoided in evaluating depression in young doctors is the effect of long hours, burnout, the pressures of work, exams and research, public vilification, financial worries and dismal career prospects. Some of these are unsolvable, but we owe it to those who have died to create a set of working conditions
that are more conducive to good mental health. Unfortunately, the prevailing wisdom is ‘Well, it was worse in my day’. This argument, presumably equally popular among whichever chimney sweeps survived to their twenties in the 1840s, is not good enough on any level. I suspect those who propose it would not dare whisper it to the heartbroken families of those young doctors who did not live long enough (nor would they have anyway) to patronise their juniors with such claptrap.
This problem can be ended by two institutions – health service employers and training bodies. I call upon both to immediately enact policies to limit the hours worked by junior doctors to 24 in a consecutive sitting and 60 in a week, as of today, with a view to complying with relevant legislation within five years. There will be old ráiméis from those who erroneously think themselves well-served by the current system about “quality of training” and “continuity of care” that should be loudly and consistently ignored by all right-thinking people. If hospitals can’t provide good continuity of care while rostering doctors for shifts twice in excess of all other workers, then they are incapable of providing safe care to their patients. If training bodies can’t train people adequately in 60-hour weeks over eight to 10 years, then they are unfit for purpose as educators.
The deaths of these two young physicians are no less of a tragedy than that of Savita Halappanavar. The deaths are equally complex and multifaceted, with no one individual factor or institution to blame. They are comparable also in that they raise uncomfortable questions about how we do our healthcare business in this country, and the legal, moral and ethical framework that guides it. All three deaths may have been avoidable, all will inevitably happen again, but we have a responsibility to act to make them as infrequent as humanly possible. They all deserve equal political attention and scrutiny. Regrettably, my two former students appear to have been quickly forgotten by the powers that be and the public they served for all too brief a period. May they Rest in Peace.
Business as usual.