Medical training is a tragedy waiting to happen. We shouldn’t be silent about it

Georgina Dent

I don’t want to write about being married to a doctor but complicity in the silence around the pressures of practising medicine isn’t a victory for anyone
A doctor in a hospital
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Tuesday 16 May 2017 00.03 EDT Last modified on Wednesday 17 May 2017 00.25 EDT
My stomach lurched when I learned that Andrew Bryant, a husband, son, father of four and gastroenterologist took his life last week. My heart sank when I read the eloquent and succinct letter his wife wrote to his friends and colleagues about it.
My reaction was visceral. I didn’t know Dr Bryant and I don’t know his family. And yet it felt painfully close to home.
There is nothing remotely simple about suicide but anyone who knows anything about the path doctors walk – and the circumstances that walk so often entails – will know that, on some level, the number of doctors taking their own lives is comprehensible.
Are you a doctor in Australia struggling with mental health issues?
Because so much of what doctors are subject to is incomprehensible. The hours. The pressure. The exams. The culture. The training. The politics. Every single day. It is unrelenting.
For the past eight years I have had a front-row seat to the reality of medical training and a day hasn’t passed where I haven’t considered the brutal toll it takes. I am genuinely astounded that doctors continue to work in hospitals and, if you saw it up close, you would be too.

In eight years married to a doctor I have never before contemplated writing about it.
Not because there aren’t stories to write – there are. There are stories you simply wouldn’t believe. But I have never dreamed of writing honestly about any of them because I too am captured by the lure of discretion that binds medical professionals.
I am held captive by the hierarchy that demands acceptance and I have never wanted to jeopardise my husband’s work.
At times I have thought, in the realm of human suffering, perhaps these brutal work conditions don’t rate. Perhaps they are merely rites of passage, albeit pitiless: the price to pay for a prestigious vocation.
The death of Bryant made me consider otherwise. It made me consider that, perhaps, complicity in the silence surrounding the experiences of doctors isn’t a victory for anyone.
From what I have witnessed of medical training and practice, it is no wonder it breaks so many people. It is a wonder it doesn’t break more. In too many cases, medical practice and training is a tragedy waiting to happen.

Training positions are scarce and the stakes are high. There are interviews, exams, research and courses to undertake on top of working 100-plus hours a week in busy public hospitals where, almost invariably, there are more patients than doctors can see.
By the time a young doctor has decided on a particular speciality to train in, the work required to give them even a whiff of hope of securing a training position in that field necessarily limits their other options.
If all of your work placements, research, study, contacts and exams are for one speciality and you miss out, you will need to start from scratch to establish credibility and experience in another.
It is daunting for anyone who has spent years dedicating themselves to their career, to face the reality of falling short. And yet it happens.
For almost every speciality, there is only once chance a year to qualify. Have a bad interview and it’s another whole year to wait. Fail to pass the primary exam required to get an interview? Another whole year. And another $3,000 or $4,000 for the privilege.
Last year my husband was successful in getting on to the surgical program he had identified as his preference seven years earlier as a final-year medical student.
For seven years he worked with a singular focus: on top of working in registrar positions in busy hospitals developing clinical skills he worked on several research projects, wrote academic articles, presented at conferences, sat numerous exams and undertook mandatory training courses.
It took four years – and three attempts – to be successful. And this is just the first hurdle: there are five years of training to complete now.
To describe the pressure in those years as immense is a gross understatement. The stress was sickening. So was the cost.
We have spent in the vicinity of $20,000 each year for the past four years on his training and courses and exams. None of these expenses are discretionary: without completing the requisite exams and training courses you cannot secure an interview. This is not uncommon for medical trainees.
And yet it amplifies the pressure on getting in.
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None of his peers are poorly qualified: to even get an interview for any training position requires a wholesale commitment to the field. The résumés of medical trainees seeking positions are eye-watering: they have obviously got into – and through – medical school and that is the baseline of their achievements.

There were many, many days and weeks where my husband and I wondered how we had landed here: neither of us were prepared for what this career path required, even before it began.
Neither of us was prepared for the fact that a human being can be so doggedly committed and accomplished and still fail. And yet, it happens.
The stress, for us, was compounded by our decision not to wait to have a family until he qualified. Many doctors do wait and I’d be lying if I said we hadn’t considered the logic of that.
But each year that he missed out, we thanked our lucky stars we hadn’t tethered our family plans to his training. And all of this angst is before he even starts the training.
We are in a “good” patch right now because my husband isn’t working on call. His training position doesn’t commence until August so to fill the time, and earn an income, he is doing a variety of locum shifts.
When I learned of Bryant’s death last week my husband was at work; for the past nine months he has worked either one or two 12-hour night shifts each week. And so it was last Thursday.
He works nights because it pays well but mostly because it pays regularly. Having some certainty over what might be in our bank account is welcome respite.
As a locum working for different hospitals and different surgeons, there is no set pay, no regular pay cycles and there is little we can do about this. Which is why he routinely subjects himself to the torture of working through the night: we know when he will be paid.
And yet – right now – is a good patch. It pales compared with the seven months he worked at an outer-Sydney hospital where he was on call three weekends out of four. He didn’t, as lots of people assumed, get days off in the week because of working weekends.
More often than not he would work from 6.45am until at least 7pm, but often much later, Monday to Friday, and then spend the whole weekend at work. And by the whole weekend I mean doing two 15-hour days. On Monday morning he would front up again at 6.45am.
He would work 19 days straight and then have two days off. He would drive hundreds of kilometres to and from work in a week, with little sleep and immense pressure.
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Three weekends out of four is bad: usually on call is one in two or, if you’re lucky, one in four. Whichever the roster, the result is always the same: an extraordinary amount of time working.
He rarely complains. He loves his job and even when he is in the midst of studying around the clock, on top of working, on top of being a father and a husband, he has never seriously questioned his path.

But we have both questioned the efficacy, the safety and the humanity of what that path demands.
There is no single story or experience for medical doctors; there are different options and pathways. Some doctors will undoubtedly emerge unscathed. But others won’t.
And that is the truth about medicine that we need to confront. At what cost?
• In Australia, the crisis support service Lifeline is on 13 11 14. In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255

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