As doctors, we love to think we are intelligent, rational, thoughtful and caring human beings, and we take pride in our profession and the privilege and status it accords. We like to hold our heads high, puff out our chests, speak with authority and convey our hard-earned knowledge acquired over many years of undergraduate and post-graduate study. We like to think we know; we have answers; we can cope; we are strong; we are healthy and perhaps even invincible. After all, it’s patients who get sick — not doctors.
But can we really hold our heads high as a profession, when the rates of suicide are higher amongst doctors than they are in the general population? What does that say about us as a profession?
In an era when we have the best scientific, psychological and medical understandings ever, is it not strange that those who are trained and specialize in those sciences and the understanding of the human person in detail end up worse off than those who are ignorant of such facts? One would perhaps rationally assume that such knowledge, understanding, and awareness would, if anything, enhance one’s ability to stay healthy — not diminish it.
So what’s going on? Clearly, knowledge is not enough, intelligence is not enough, believing we are invincible or won’t get sick is not enough; passing exams and getting a medical degree offers no immunity from mental ill health.
Is it simply down to the nature of the job, the stress, witnessing large amounts of human suffering? Is it that the job is harder, more demanding, higher expectations from patients and staff alike than it was in the past? Is it a result of the drive for perfection with no room for failure or weakness? Is it due to the reports of abuse, bullying and (sexual) harassment by seniors that have emerged in some arenas?
No doubt all of the above can be contributing factors — but are they the start, middle and end of it or is there more to it? Are there factors deeply embedded within the culture of medicine itself that perpetuate some of these ills and which lie at the heart of all of them?
What if the very maxim we all sign up to, that we take pride in, that is drummed into us from day one and reinforced by medical regulators and professional bodies across the globe, is actually responsible for killing us?
A maxim we are all responsible for buying into, for perpetuating, endorsing and reinforcing, not realizing the harm we are doing in the process. We pride ourselves on taking care of our patients and making them our first concern, but how well do we look after our own? How well do we look after ourselves?
If we do not know what it means to truly care for ourselves and our bodies and minds such that we can work hard and be vital and vibrant without getting drained, depleted, exhausted, anxious, depressed, angry, frustrated, needing caffeine, sugar, alcohol or other stimulants, then do we really know how to care for patients? And what quality of care are we giving if we do not know how to care for ourselves?
What if in order to truly care for our patients, to be fully present, alert, aware, vital, vibrant, joyful, caring, compassionate — we first need to know and live that care for ourselves?
Would the true maxim not then be that a doctor’s first concern is to care for him/herself so that he/she has a lived quality of care to give to their patients?
Of course, as soon as this is mentioned many arc up and state this is a selfish way to be and that the public would never accept it. A view I understand, but know is deeply flawed. Consider it is actually more selfish to live however we like, to be irresponsible in our choices, to drink as much alcohol or caffeine as we want, to eat as much food, sugar or junk food as our stomachs can hold, to give vent to our emotional reactions, to live in a way that leads us to being exhausted and depleted — and then to take that quality to our patients.
Compare that to the so-called “selfish” choice of taking responsibility for all those choices so that we eat only healthy food and do not poison our bodies with known toxic foods, drinks, emotions, lack of sleep and more — so that we can be well-rested, alert, vital, vibrant, joyful, present, gentle, steady, consistent, caring, compassionate and actually truly selfless.
Which doctor would you prefer if you were a patient?
And so we are all responsible for physician suicides; every time we perpetuate the message that the care of the patient should be our first concern without first providing that same quality of care to ourselves in equal measure. It is not a case of one more than the other – but a simultaneous unfolding of an ever-deepening relationship of and with care for self and other equally so.
It is only when we engender truly self-caring students and doctors that we will seriously impact the rates of suicide, bullying, abuse, harassment and other ills that currently haunt the profession, and have doctors who are able to work hard and stay sane and healthy despite the outer pressures and demands. Not only that, but a self-caring doctor comes to know who they are and that their worth is not tied up in an exam or pleasing a boss — they hold themselves steady no matter what comes their way, they are empowered and more able to call out abusive ways against themselves and others and to bring about change.
We can keep plucking at the surface weeds and attempt to address the superficial ills, or we can dig deep and remove the roots of this ill in the understanding that self-care is not selfish but is at the heart of care for all and ought to be a mandatory part of medical education.
Imagine, if graduation from medical school depended not only on acquisition of knowledge but also the demonstration of a body and a being that lived in a way that was truly self-caring.
This isn’t just for the benefit of doctors — for this would also enhance and deepen the quality of care given to patients and inspire them to also take more care of themselves. Win-win all round.
We have had many years of putting patients first and ignoring our own needs for food, water, rest, sleep, recuperation and developing a deeper relationship with ourselves so that we are guided more by our inner compass than outer demands — and the results we have before us are of addicted, suicidal, burnt-out, demoralized, demotivated doctors. The definition of insanity is to keep doing the same thing and to expect different results — so the time is long overdue for a complete sea change in our approach to this problem.
One thing is for certain: We have never tried “the doctor’s first concern is to care for him/herself so that he/she has a lived quality of care to give to patients.”
How about giving it a go? It can hardly get worse, and it just might get a whole lot better.
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