Doctors must learn to handle work traumas

“How do doctors and nurses cope with the trauma of handling patients in dire conditions? I have visited hospitals for many years and I wonder how they deal with such lots of mental strain”

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One of the best kept secrets in the world is that doctors are also human. Both doctors and their patients live in the collective delusion that the former are made up of some special (mostly unbreakable) fabric. This is not a new delusion. Growing up at King George the Sixth Hospital in the early 50s, I was aware of the arrival, from Makerere, of some of the sharpest medical brains to have walked the continent. I was also aware of their close contact with alcohol and most tragically early death. With only a few exceptions, they died before they were 40 and most died of what I now recognise to be stress related complications.

In most cases, they were well trained as doctors but were ill equipped to live the life presented to them, in colonial Kenya. They were doctors by name and training, but were also Africans who lived as third rate citizens who could not enjoy the privileges they expected from their educational achievement. Education did not liberate them from the colonial yolk. Their working conditions were at best atrocious.

Other professionals might have gone though similar challenges but the doctors were the most visible to my impressionable mind. The situation did not change much over the years, and when we joined the medical school 51 years ago, we still had some teachers who had what was clearly significant mental illness in today’s definitions (we also had many excellent teachers).

Today, the situation might have improved somewhat but doctors still lead a miserable life in many parts of the world. From the third year of medical school, young students lose their power of empathy and to a large extent become cynical, and detached from the pain and suffering they encounter in their patients, as a method of coping. That way, one can come from a deadly tragedy in theatre and still be able to eat a steak.

This sense of detachment is believed to originate from the not so subtle cues that one gets from their teachers, to the effect that the patients come first and that in the pecking order, the young doctor comes last! For that reason, one must for their patients, postpone such things as sleep, rest exercise and even such basic biological needs as going to the toilet! Many young doctors have been told to continue working even when they themselves have high fever, just because there is nobody else to work on that day. Like most doctors, I am witness to having worked in a surgical ward as an intern for more than 36 hours and collapsing under the weight of sleep and anaesthetic coming from the patients’ breath!

The statistics might frighten you but they are worth stating so that when you next see a doctor you can begin to understand his suffering.

It is estimated that 25 percent of doctors have significant anxiety/depression. In one study, 15 percent had Post Traumatic Stress Disorder (PTSD) and six percent had significant burnout. Sadly, doctors are some of the loneliest people, with some frightening statistics. They are 25 percent more lonely than their patients and 20 percent worse off than people with PhD’s meaning that the problem is not high educational achievement but something else.

Worse still, suicide rates among doctors are above those in the general public. Anaesthetists, psychiatrists, and general surgeons were the worst off in one study. Female doctors do worse than their male counterparts in this respect! This is the bad news. There is some good news which is that most regulatory bodies including the Medical Practitioners and Dentists Council in Kenya have very robust programmes for physician health in recognition of the challenges that the doctors go through. Professional associations including the Kenya Medical Association and the Kenya Psychiatric Association are fully seized of the challenge posed.

Perhaps not surprisingly, the health tips for the doctors are no different from those of their patients. Eat regular full meals, chew, do not gobble your food even if you are going to theatre, and remember exercise is the best drug for anxiety and depression. If you do not sleep adequately you will scream and shout at theatre nurses and you will make mistakes that you will regret.