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Junior Doctor Stress and What Can be Done about It

Junior doctors [and residents in the US] do a valuable and sometimes life-saving job for patients. They are the future in medicine and can bring enthusiasm and fresh ideas into the profession. Despite the importance of their role to society, junior doctors have sky rocketing stress levels and many have an appalling state of mental health.
The Shocking Suicide Rate Among Doctors
It is totally shocking that in the 21st century, so many bright young doctors fall prey to depression and around 400 US physicians intentionally end their own lives annually. This means that every year in America, a million patients lose their doctor to suicide. The chance of dying by suicide is greatly increased for those in the medical profession compared with ‘lay’ people. For instance, male doctors have a 70% increased risk of dying as a result of suicide, when comparing the death rates with men from the general population. One of the reasons there are more completed suicides – ironically – may be as a result of doctor training. Doctors know the human body intimately. They know about drug dosages, they know more about the effects of drugs on the body. They know how to save a life and because of this, how to take one. A determined doctor can calculate a fatal drug dose expertly or know where to cut that would be catastrophic. They also have access to powerful, death dealing drugs that are only available on prescription to the rest of the population. This may be why there are so many successful doctor suicides each year.
Reasons for Doctor Depression
But why do so many intelligent medical professionals get so depressed? There is no single answer to the complex question. Reasons may include huge caseloads (the average family doctor has almost two and a half thousand patients each), long working hours (while an American junior doctor’s working hours should be an average of 80 hours a week, a ‘lay’ person’s average full time quota is only 40 hours a week), insurance company headaches, debt worries as a consequence of medical school and the effects of dealing with high pressure, life or death scenarios. If a painter and decorator makes a mistake at work he can just paint over it. If a doctor makes a mistake, it can result in a patient’s death and a possible lawsuit for the hospital. Therefore, being a doctor today means you have to have nerves of steel and respond well to stress. Some of the most talented doctors may underestimate the rigors of training when they begin medical school and may find the unrelenting pressure and lack of sleep takes the shine off their career.
Accidental Deaths
These kind of stresses don’t just cause intentional suicides, they have also resulted in accidental deaths. The issue has received a great deal of public attention in the UK recently with junior doctors striking over changes in their contracts, including more NHS services being available seven days a week, increased working hours and a cut in pay. These proposals have caused the first pickets since 1975, with trainee doctors arguing that the new contracts are unsafe for patients and unfair to doctors. The public is largely behind them and so is research that shows that cutting hours back to 80 hours a week does not adversely effect patient safety.
The walk-outs weren’t the only time in recent years that the issue of overworking junior doctors was brought to the attention of the public. In 2011, junior doctor Lauren Connelly died after crashing her car on the way home from work after she had worked over 90 hours in just 10 days, followed by a 12-day stretch in which she had worked more than 107 hours. The exhausted doctor veered her car off the road and was killed after returning from a gruelling shift. She was only 23 and had only began working as a doctor seven weeks earlier.
Student doctor Paul Robertson, who was conducting research into Parkinson’s Disease at the University of Oxford and was just a few months away from being awarded his doctorate, was found dead in his student flat with a used syringe in his right arm. A spoon and other equipment used for preparing heroin were found near his body. The promising scientist had been having problems with stress at work and was finding it hard to cope with the pressure placed upon him. He had began using heroin recreationally to ease stress and help him sleep but had accidentally taken too much. Levels found in his blood were three times the fatal level. It is clear that more needs to be done to look after the mental health of junior doctors.
How to Manage Stress at Work
1. If you’re worn out, just carrying on isn’t a good coping strategy and will increase the risk of burn-out and depression. It’s also dangerous to patients, as a tired doctor makes mistakes. If you don’t already have them, ask your supervisor for resting facilities you can use either during a shift or afterwards. If you believe you are becoming depressed, you are entitled to ask for time off to recuperate or seek therapy. Taking time out to spend with family and having the time to discuss work stresses with a partner or spouse can reduce emotional stress.
2. Getting physical exercise also lowers stress levels. This may be because exercise stimulates the production of feel-good endorphins that reduce aches and pains and help you feel great.
3. Having an activity that you enjoy outside of work can help you to separate from work issues while you are not there. This can give a much needed break from the pressures of your job.
4. If you have noticed a colleagues mental health is deteriorating and you think this is impacting on their ability to practice, for their safety and that of patients you should report this to your supervisor. There may be doctor support groups available that they can attend for counseling and to form friendships with other doctors with depression.
5. Recent research looking at how to reduce suicidal feelings among new medical interns found that providing access to an online cognitive behavioral therapy program helped reduce these feelings. Why not ask your department if they are up-to-date on doctor mental health research and if they intend to implement such a service?
6. Get a massage! Some hospitals provide a massage therapy service for doctors. As doctors work long hours, are on their feet all day or night and have to lift patients, they often suffer from backache or tension headache as well as exhaustion. Increasingly, medical trusts are recognising the benefit of massage in relieving stress, aches and pains and offering their own in-house massage service for doctors and nurses. Why not make use of yours or ask your supervisor to consider providing such a service? Happy and healthy doctors make good doctors.

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Anne Caler is a freelance writer with a healthcare background. She is also a mother and changed careers to suit her lifestyle.