Embracing our vulnerability in medicine

DURING the break between the 2016 and 2017 Australian Football League (AFL) seasons, players and coaches at the Richmond Football Club engaged in a daring team building exercise: they shared stories about themselves, sharing their vulnerabilities.

It worked. It bonded the player group into a close-knit unit and contributed to the ultimate life bond: an AFL premiership. Sporting teams around the world have been embracing similar ideas with great success.

Yet we, in medicine, are seemingly unwilling to embrace our vulnerability.

Recent discussions and articles (here, here, here, here and here) have, for me, brought back a haunting past, especially the stigma and discrimination.

The stigma around mental health starts early and continues throughout medicine. The flippant remark about not knowing a sane psychiatrist is but one example.

How easy is it then for us to embed false thoughts about mental illness.

My initial help-seeking was delayed because I feared deeply the potential repercussions for my career if word slipped out about my mental health issues. We all know how the medical grapevine works if a colleague is ill, let alone with a mental health problem. I feared this, often unkind, grapevine.

I was also ashamed. I had seemingly failed by becoming ill. As a doctor, I had come to feel that we needed to be bulletproof, especially in the case of mental health. Why was I the only one failing?

The comments that I received – that I was not able to cope, or perhaps had chosen the wrong career, that I was not resilient, that it was my choice to feel this way, that at least I have a good job, or we all feel sad sometimes – were not helpful. If anything, they pushed me closer to that cliff, as I was, at the time, intensely suicidal.

Arriving at my GP’s rooms, I had a deep fear of seeing someone I knew who might recognise me. I feared that they would know I had a mental health issue, that I had in some way failed and wasn’t tough enough for the job. I walked in, sat down and hid my face behind a newspaper until it was my turn.

I did the same at the psychiatrist’s office, fearing that in either situation I would be spied by another doctor or a patient, and that my diagnosis would be shared.

Perhaps it seems strange to have been worried about this, given I have been very public about my illness, but in the initial stages of any serious illness, especially mental illness, privacy is paramount. It allows time to seek help, get support and start getting well.

My GP and other specialists were and have been fantastic about maintaining my privacy and, as I stopped working to get treatment, not subjecting me to the potentially awful pathway of mandatory reporting.

I did, however, get asked about what was happening at a number of workplaces. I was not well, and at the time I probably shared much more than I should have or was actually required to. I was trusting of my medical surrounds, trust that was broken.

That was something I regret, because over time, I have come to realise that, behind the scenes, a number of people saw my illness as weakness and they exploited it.

Perhaps they were the same doctors who yell at others in meetings or mock those with mental health issues.

However, out of that came something good. The crazysocks4docs day was born directly out of behind-the-scenes muttering and comments about my mental health.

The day was started to create awareness but especially to challenge stigma.

Indeed, out of that awful time in my life comes both post-traumatic stress disorder, but also post-traumatic growth, and in my mind, the latter is winning. It’s entirely possible for both to coexist.

Patients

I have had amazing support from my patients. They will drop in articles about me, in case I missed them, share social media posts from media articles I am in, and, of course, they ask about the socks and, indeed, give gifts of these.

They embrace the vulnerability and the fact that I have learned about my illness the hard way, because they realise that I have seen medicine from the other, very dark side of the moon.

The medical profession

Sadly, it’s a little different when it comes to my colleagues. The stigma and discrimination is far greater from within.

I have been put through more hoops than others. I have had questions such as am I still on medication, when my last appointments were, am I in regular follow-up. Some of these questions don’t even come face to face. Some come by SMS.

That prolonged periods of sick leave would not look favourable at  reappointment

I can only assume other doctors with other  medical conditions are asked the same kinds of questions.

Many simple day-to-day things – a spelling error in a document, for example – apparently infer failing mental health. And I have little doubt some have targeted me. This creates hypervigilance, for fear of looking “crazy” again.

It has been suggested to me that I have been playing the victim, engaged in learned helplessness. No.

Am I the only one?

I don’t think so. I receive many messages of support when I speak, from doctors or relatives of doctors who thank me for my public advocacy. The underlying tone in messages, particularly from younger doctors, suggests that I have a voice they do not have, and that they too are battling their own demons.

This kind of stigma is deeply destructive to doctors, to patients and to safe care. We delay seeking help, with often fatal consequences.

Should we expect better behaviour from ourselves and our colleagues? Of course we should. We should set the medical standard and community standard, especially around mental illness.

We are also responsible for change. Think about your own comments, actions and behaviour, because the stigma stops with each of us. It’s the stigma within us and around us that is lethal.

The lived experience is the way forward. We must embrace vulnerability in medicine.

Dr Geoffrey Toogood is a cardiologist and a long-time advocate for mental health. He has swum the English Channel. He came up with the idea of crazysocks4docs day.

If this article has raised issues for you, help is available at:

Doctors’ Health Advisory Service (http://dhas.org.au):

NSW and ACT … 02 9437 6552
NT and SA … 08 8366 0250
Queensland … 07 3833 4352
Tasmania and Victoria … 03 9280 8712  http://www.vdhp.org.au
WA … 08 9321 3098
New Zealand … 0800 471 2654
Medical Benevolent Society (https://www.mbansw.org.au/)
AMA lists of GPs willing to see junior doctors (https://www.doctorportal.com.au/doctorshealth/)
Lifeline on 13 11 14
beyondblue on 1300 224 636
beyondblue Doctors’ health website: https://www.beyondblue.org.au/about-us/our-work-in-improving-workplace-mental-health/health-services-program

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