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Care for yourself, and each other

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World Suicide Prevention Day, 10 September

In our small town in Queensland, we are reeling from the recent suicide of a colleague. Tragically, every year too many doctors die at their own hand.

What is it about our profession that makes suicide a particular risk?  Is it the paradox of a “healing” profession harmed by the very nature of their work?

Below are what I think are some of the contributing factors.

Overwork and exhaustion. This is coupled with burnout, sleep deprivation, trying to valiantly do handle an impossible workload with insufficient time, resources, and support. It is a form of external and self-abuse. We are working longer hours and are on call longer and more frequently than our urban colleagues. Cut yourself some slack, do not strive for perfectionism.

Stress. Conflict at work, depth of responsibilities, financial worries, relationships, loss of autonomy – there are multiple sources of stress. With every morbid outcome we witness we are at risk of post-traumatic stress. And we feel alone. We are discouraged from showing stress. Do not convert this stress into cynicism; remember the high ideals that brought you to this career.

Substance Use. In a 2013 beyond blue survey, doctors in rural and remote areas reported higher levels of risky alcohol use than their metropolitan colleagues, and those who said they were under significant stress reported even heavier use. In dry communities, this behaviour is literally under the table – people have to hide their drinking and often feel shame. Just for today, say, no.

Lack of balance.  Do we spend our downtime working? Go to the toilet when you need to, eat meals, sleep, exercise – the rest of the world does. Get away from your rural isolation, make a trip to the big city or do some four-wheel driving away from the community. Bushwalk. Take a swag.  Fishing? Stargazing? No mobile signal? The flip side of no ADSL is the ability to get out of mobile telephone range. Milk this. The outback has much to offer.

Mental health issues. A quarter of doctors surveyed by beyond blue say they have considered suicide, and 2 per cent have actually attempted it. As a profession, we are clinically depressed at a rate higher than the general population.  Also, as a profession, we need to totally remove the stigma surrounding mental health issues affecting ourselves and our colleagues. They are illnesses that require looking at. Like any other illness, there are preventable risk factors, causes, diagnoses and management. We must support and look out for each other. We do it for our patients and families. We need to do it for each other.

Our resilience is high, but so are the barriers to seeking help, like issues of privacy, AHPRA’s mandatory reporting regime, embarrassment, and career development fears. Take the time to see a consultant who does not reside in your own head. Do not self-medicate. Consider meditation, mindfulness or explore spirituality. Five telephone counselling sessions are provided free by your College, and video specialist visits are available not just for your patients, but also to you. Every State now has a confidential doctor’s support program.

Medical error or near error.  The shame, the hiding of uncertainty, the fear of incompetency. We in the outback are generally GPs, which means we are not specialists in a defined area of expertise.  So yes, at times we are working out of our comfort zone. Find a mentor, it is scary here. To my urban colleagues, I ask that you develop a tolerance for a rural doctor who is not superhuman

Criticism. This comes from colleagues, patients, employers, even strangers. It can be demoralising.  Journal the criticism. The bullying, the snide remarks, racist/sexist comments, even a simple unsupporting “hmph” cuts us.  Report abuse, talk about it. The greatest of these criticisms is the dreaded letter from our medical governing body: a subpoena to appear in court to defend our medical actions. Can our governing bodies find it in their hearts to empathise? With every letter calling us to defend our actions to the Board, can there also be a list of doctors willing to mentor a distressed colleague? Show us a registry of good outcomes, not just the bad ones.

The doctors around me in this small town are slowly coming out of their state of disbelief regarding the loss of their friend. I see their eyes humbly looking at each other with a deeper look.

I wish them a path through their confusion. I feel privileged when they talk to me about their pain.

I hope we can continue to talk about the fatal act as a form of prevention, and to help with the healing.

This year, 10 September is World Suicide Prevention Day. Let this small article prevent even one suicide.