Fear & Guilt Behind the Stethoscope

Despite the common perception of a white coat, stethoscope, fancy car, and smooth, calm intelligence – today’s doctor is mainly a walking ball of fear and guilt. What’s more he or she has been trained to be this way.

As an Asian, the guilt trip was laid on early in life, along with a dash of fear. “If you don’t study, you will fail” … “all that we’ve sacrificed for you..” …  If you talk to any Asian doctor I’m sure they can relate to this. Not that we aren’t appreciative of our parents and our upbringing. Often there was a lot sacrificed to help us on the way to the goals and dreams our parents and families had for us. Unfortunately this ingrains the fear, and guilt into our psyche, and sets us up to respond with those particular pathways as we go on in our lives. All of this of course isn’t just restricted to Asian families.

Through medical school and our training we’re bombarded with information and expectations to be able to retain it, and respond to situations where if we fail or forget something – someone may often die. Again the fear, the guilt, are slowly etched into our psyche.

The pressures and expectations through a doctor’s training can be enormous. Young men and women, who have just left home are told that they are there to learn – not to save lives – but how not to kill someone or miss something. It’s an important distinction as again the fault and blame is put onto the young doctor in training, further reinforcing the fears, and guilt.

There have always been underlying mental health issues, depression, anxiety, burnout, and substance abuse that have been accepted and even glorified as part and parcel of the career and training. Everyone knows the many hours of work expected, and the intensity, depth and breadth of knowledge/study required. The hours worked, the on-calls, the sleepless nights, the heartbreaks of losing a patient, the guilt, the fear… indeed this is glorified in film and TV in shows from Scrubs, Grey’s anatomy, oldies like ‘Carry on Doctor’ and many more. The light humour in them, along with the comradeship, and the survival through the challenges they face- paint the characters in a warm glow of success and invincibility. This is reinforced by our  own seniors who reminisce about the days when they had to work longer hours, and had to suffer through much worse, all said in tones of wistful fondness, tinged with a mockery of current weak crop of doctors and students.

The result of the glorification of the struggles faced by doctors is to again suggest that if they fail or they’re not coping it is because they’re not good enough. That they’re not working or studying hard enough… contributing to the ongoing cycle of guilt and fear. Importantly it also normalises the traumas that doctors in training go through. This has significant flow on effects – the doctor in question is thought to be abnormal or again failing if they can’t cope, if they seek help, the herd and peer group around them step away from the potential abnormal one for fear of association, and fear of difference. The other important effect of normalising the traumas and struggles is that nothing is done about it, systems aren’t put in place to support or help, instead, incidences where someone breaks down or commits suicide is treated as an aberration in the process of training these guardians of health, and things are quietly dealt with hushed away.

 

 

One other thing that is worth mentioning is the competitive nature of the training and studies. The young people who enter into the medical field are often the best of their classes and schools, they tend to be high achievers, demonstrating excellence not only in academics but also extra curricular activities. They’re used to competing, and winning, and this competitive streak is encouraged through medical school and training – the whole culture of the profession and the training is set to raise the high achiever on a pedestal. Rewarding high achievers isn’t as such a bad thing, but the problem is what criteria you use to measure the achievements, and how you treat those who don’t achieve those lofty heights. Again all this reinforces the fears – fear of failure, fear of not achieving the best, guilt in not having worked or studied hard enough, along with a constant fear and guilt that you may not do enough to save or look after your patients.
The competitive nature, the “Hunger Games” nature of it also has an effect on how these young doctors treat and perceive those who fail, those who are seen as weak. This continues in the cycle of isolating and building a cage of fear and guilt around those that are already suffering in this system.

There has rightly been an outcry over the recent suicides of junior doctors in Australia and indeed around the world. Hopefully this can lead to some change in the systems of how we bring through our doctors. But we also need to look at the whole culture of medicine, of expectation from within and from the public, regulatory and government. This fuel of fear and guilt doesn’t stop at the stages of training but is an ongoing driving force in the career of doctors.

Every day doctors face fears of failing their patient, of the patient being worse off or even dying. This is separate from the fears of the consequences of failing, the complaints, litigation, investigation, regulation, financial costs, and the loss of respect and image. The guilt..  the guilt of failing, the guilt of not doing enough, staying up late at night worrying about what you haven’t done, if you forgot something, that someone might die…. This is a daily occurrence with a lot of medics.

This article isn’t here to offer solution. Most people would agree that these are complicated issues, with a lot of factors but just because it’s hard doesn’t mean we shouldn’t do something about it. So next time you see a doctor or a doctor in training take some time to look behind the TV image you’ve come to think of, and see the fear and guilt in their eyes. Ask them how they’re doing, and if you’re a colleague or senior, be compassionate, and look after your own. 

 

I‘d like to mention the great work being done by a few people recently:

The families of Dr.Chloe Abbott (#Chloeslegacy), and Dr.Andrew Bryant, @Dr.Geoffrey Toogood, @Dr.Eric Levi  and @Dr.Mukesh Haikerwal. These aren’t the only people who’ve done a lot promoting Mental Health in doctors, but they are the ones I’m directly aware of and who have been vocal in their efforts especially on twitter. You can follow the above on twitter by clicking on their names above, and of course follow Serenity @Sernityblog_au.

Useful Links and Resources:

Australian Doctors Health Network – has contact details for each state, you can call get put through to get a GP for yourself near you. Also speak to doctors, and get direct support.

JMO health – has some useful information and self assessment tools to help Junior Doctors

Beyond Blue – www.beyondblue.org.au

To find a psychologist – www.psychology.org.au

Lifeline  13 11 14 (24 hrs) – www.lifeline.org.au

Suicide Advice  1300 659 467 (24 hrs) – www.suicidecallbackservice.org.au

 

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