Mental health in the work place II: Medical Doctors

This week and indeed, throughout the rest of the months of October and November, I will continue dwelling on the theme of this year’s World Mental Health Day Celebrations (10th October): Mental Health in the Work Place. Charity, they say, begins at home. So, after last week’s introductory overview, this week will be focusing on the hospital work environment and the mental health of medical doctors.Other health workers, will be covered next week.

Ayodeji was always top of his class in secondary school and everyone assumed he would naturally study medicine. This expectation was expressed by all his teachers and his parents, so he fell in line with the idea. His parents were overjoyed when he gained admission to study medicine at the prestigious University of Ibadan Medical School. He resumed in very high spirits. 100 level was a breeze as he aced the courses in Physics, Chemistry and Zoology. He then resumed in medical school proper with lectures in Anatomy, Biochemistry and Physiology.

Finally, he was on his way to learning how to become a proper doctor, he thought to himself with relish. He confidently sat for the first Anatomy test on lower limbs, but when the results came out, he could not believe his eyes. He had scored 17 per cent. This can’t be, surely there must have been a mistake. Maybe it was over 20 and he had scored 17 out of 20 marks? He was shocked to realise that the scores were indeed, over 100 marks. The highest score was 34 per cent. Despondency set in and he started having self-doubts.

He became reclusive and studied like his life depended on it. His grades started coming up, and soon afterwards, he was hitting the magical number of 50/51 (a pass mark in medical school is 50 per cent, not 40 per cent). His lofty dreams of glory and distinctions (scores of 80 per cent and over, in Ibadan) were by now, ancient memories. The rest of preclinical medical school flew by in a blur, as he managed to consistently score 50/51 to satisfy the examiners. He however noted that a few classmates ended up in Jaja, and eventually the Psychiatry Unit as they simply could not cope with the pressure.

When he crossed to the Teaching Hospital at the end of year three, he was shocked at the tension that accompanied ward rounds and clinics. Lord have mercy on you if you missed an answer from the all-knowing Consultant, or the high and mighty Senior Registrar. The registrars also appeared to relish their turn to humiliate medical students and the House Officers (Interns).

He started dreading going to school, but he soon learnt to disregard the insults while learning to quickly think on his feet and give vague, non-specific answers even when he had no clue. It appeared to him, that it was a mortal sin to admit ignorance. Yet how could he learn and remember everything? In some rotations, the resident doctors were on call every day and almost practically lived on the wards and hospital corridors – perhaps that is why they are called Resident Doctors. But he could see the fatigue and lack of sleep on their faces.

When he was not the target of their harsh words, he could empathize and understand why they are often so irritable and impatient with others. He started wondering if he had not been lured into a wrong career choice. He was not so sure that he wanted to live the rest of his life in this sort of work environment. But it is probably too late now to back out. I will survive, he reassured himself, as he prepared to attend a bed side teaching at 8p.m on a Saturday night.

Doctors: The training of medical doctors, from undergraduate studies, through internship and postgraduate professional training in a given specialty (Residency Training), is often fraught with tension, unusually high expectations of near-superhuman ability, little or no tolerance for complaints or display of weakness – including sickness, not to mention, mental ill health.

Such revelations of ill health when they occur, are more likely to be met with cynicism and viewed as a sign of unreliability, weakness/vulnerability, laziness or a lack of resilience. Thus, physician exhaustion, burn out and mental health issues – including high suicide rates are now very common issues globally. And they start from medical school. The UK and US systems now impose a ceiling of maximum number of on-call hours per week – to prevent burn out and medical errors from exhaustion.

Physician, heal thyself, is apt in this regard. Senior doctors and trainers have to come to grips with the negative mental and emotional consequences of the current work environment. Learning can occur in a more humane and less toxic manner. How do you teach people to develop empathy when you display callousness towards them?