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Sydney Morning Herald, Saturday November 3, 2018

STEVE ROBSON

I discovered CrazySocks4Docs Day – held annually on June 1 – only this year. The day aims to “encourage conversations about mental health and help reduce the stigma for doctors experiencing mental illness”. This discovery overwhelmed me.

Almost exactly 30 years earlier, as an intern in the central Queensland city of Rockhampton, I had tried to kill myself. Today I am president of a specialist college, but I had kept the entire episode to myself and tried to forget it. I am deeply ashamed of not learning from my own experience sooner and using it to help others.

When I heard that Rockhampton junior doctor Frith Footitt had taken his own life on New Year’s Day this year, I could not bring myself to read any of the details. The tragic outcome could easily have befallen me.

Perhaps by fate I was introduced to cardiologist Geoff Toogood, the incredible and inspiring founder of CrazySocks4Docs, at a college meeting a couple of weeks ago. I choked and could barely speak, but it made me determined to take something positive from my own experience. Hence this article.

I had found medical school difficult – I was not a natural academic like so many others in my year – but hoped that my intern year might prove better. I was wrong. Halfway through 1988, I felt overwhelmed with inadequacy. I had a patient die and felt responsible. My consultants and registrars were not exactly glowing in their feedback. My junior doctor colleagues all seemed to be more capable and were thriving. I had an all-pervasive sense of failure, that so many years of struggle at medical school had been a complete waste and that I was little short of dangerous. I could see no way out.

So, one night, I made careful plans to kill myself. I won’t go into detail but suffice to say that I stole some supplies from the wards.

Incredibly, a work colleague arrived unexpectedly and began knocking on the door of my small hospital unit. That person – I won’t reveal the gender – called: “I know you’re in there.” I will never know what made this person visit me. Perhaps my emotional state wasn’t as well disguised as I thought. Perhaps it was just plain good luck. That impromptu visit saved my life.

I won’t pretend I had an epiphany or that I suddenly was better. I did seek help. Rather than put my career, for what it was worth, further in jeopardy by talking to one of my hospital colleagues, I made an appointment with a GP in town. To this day, I remember the GP’s advice: Under no circumstances tell anybody or see a psychiatrist. (I only knew of one in Rockhampton, and was about to become his intern.) If I had a record of suicidality or mental illness, I would never be able to buy income-protection or life insurance, and I would probably never get a good job.

I was bonded to the Royal Australian Navy. What if I was rejected from serving and had to pay back my return-of-service? I couldn’t afford it. What if they were so worried about me jumping overboard that I was banned from the fleet?

Steve Robson as a young naval officer. He has revealed that he planned to kill himself when he was a medical intern 30 years ago, hoping to help doctors in mental distress.

I tried antidepressant treatment, but I remember it being very unpleasant. The options were more limited 30 years ago. The GP warned me that if anyone found out about prescriptions for antidepressants, I might be in trouble with the Queensland Medical Board, perhaps struck off until I could prove myself.

The episode left me with two key messages, both very wrong. First, not thriving as an intern meant I would never be appointed to a training program. Second, seeking help was a sign of weakness, something to be ashamed of and hidden.

Today, I am president of my college. I have had a good career. There was light at the end of the long, dark tunnel. I just couldn’t see it at the time.

Today, I am not ashamed of how I felt or what I did 30 years ago. I am ashamed that I have not used my position to advocate more strongly for colleagues in difficult emotional circumstances. I am ashamed that I was embarrassed and ashamed.

Doctors commonly are under pressure, are more prone to mental health problems, and often have access to the means of killing themselves. These are occupational hazards. In the same way that pilots are exposed to simulated decompression and hypoxia so they recognise the warning signs, we should recognise the debilitating and potentially lethal effects of psychological decompression.

When trainees of the college of which I am president took their own lives, I stayed silent. When a junior doctor took his life while working at the same hospital where I tried the same thing, I stayed silent. When I met Geoff Toogood, I stayed silent. Even after the shock realisation that CrazySocks4Docs day was almost exactly 30 years after I tried to kill myself, I stayed silent. Enough silence.

If you feel the way I did 30 years ago, seek help as soon as you can. Who knows where you might end up.

Professor Steve Robson is president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and is a member of the Australian Medical Association Federal Council.

Changes to mandatory reporting have just been approved by the the Queensland Parliament in the Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2018.

http://www.parliament.qld.gov.au/Documents/TableOffice/TabledPapers/2018/5618T1769.pdf 

The Australasian Doctors' Health Network is particularly concerned to ensure that patients are protected AND that doctors are not subjected to unwarranted anxiety, or deterred from seeking help when needed.

Doctors who treat other doctors also need to know that they are not required to report a colleague whose behaviour does not suggest that they pose any risk to patients.

In Western Australia, the mandatory reporting amendment is clear and evidence-based; it offers a balance between maintaining safety for the public (enabling doctors to be reported when necessary) and ensuring that doctors with health problems can seek timely access to care without unnecessary stress. The ADHN supports the principle of a national approach that upholds these principles.

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March 27, 2018

How safe are older doctors? - Featured Image

 

Older doctors are considerably more likely to be the subject of an AHPRA notification than their younger peers, according to new research.  The University of Melbourne study, which looked at all 12,878 notifications lodged with Australian medical regulators over a four-year period, found doctors over the age of 65 had 37% more notifications than their younger peers, aged 36 to 60.

The type of notification varied substantially between the two age groups. Health-related notifications, covering both physical illness and cognitive decline, were twice as high among older doctors. They were 40% higher for conduct-related notifications and 10% higher for performance-related notifications, compared with younger doctors.  The researchers from the Melbourne School of Population and Global Health said they had identified several “hot spots” of risk for older doctors. One of these was the prescribing, use and supply of medicines.

“Some older doctors are known to maintain registration in order to prescribe for themselves of for families and friends. Whilst this practice is in breach of ‘Good medical practice: a code of conduct for doctors in Australia’, some older doctors have been slow to adapt to evolving professional standards,” the researchers noted.  They also pointed to some older doctors’ failure to keep abreast of new drugs or changes in drug regimens, their reversion to older, more familiar patterns of practice, and their reluctance or inability to follow new protocols.

“Well documented age-related declines in cognition and physical abilities in the general population are likely to be reflected in the health practitioner community with possible implications for safe clinical decision-making,” the authors write.  “Previous research suggests that some health practitioners lack the ability or insight to self-assess competence and may not be aware of a decline in their cognitive ability or skills.”

But the authors note there are no internationally recognised thresholds of cognitive impairment at which a doctor is considered to be a risk to the public.  The study follows reforms proposed by the Medical Board of Australia late last year that would require doctors aged 70 and over to prove they are competent to continue practising. The reforms would require peer review and health checks for these doctors to be incorporated into their CPD requirements. The health checks would include issues such as cognitive function, eyesight and hearing. But there have been no moves towards introducing a mandatory retirement age for doctors.

You can access the study on older doctors and notifications here.

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By David Millett, 16 July 2015

A survey of more than 600 UK doctors, carried out by medico-legal organisation the Medical Protection Society (MPS), found that 85% of doctors reported experiencing mental health issues at some point in their career. A total of 32% said they had experienced depression during their medical career, while 13% had experienced suicidal thoughts. Three quarters (75%) said they had suffered from stress, 49% anxiety and 36% from low self-esteem. The results come as the GMC and leading health professionals agreed that a confidential national support service should be established to help doctors with mental health or drug addiction problems. Respondents to the MPS survey mainly cited heavy workload (75%) and long working hours (70%) as the main drivers behind mental health issues they had experienced.Over half (54%) said the high levels of scrutiny and regulation were affecting their mental health. MPS medico-legal advisor Dr Pallavi Bradshaw urged doctors to seek help ‘as soon as they experience mental health difficulties’.

http://www.gponline.com/eight-10-doctors-experience-mental-health-issues-during-career/mental-health/article/1356309