Certain memories are perennially and stubbornly etched into physicians’ and healthcare workers’ psyches; the repetitive bleep of the electronic vital sign monitor; the strangest items found in human openings; delivering their first baby; and witnessing their first patient die. These are all rites of passage.
“I’ve found it’s easy to talk about the funny memories, but the disturbing ones are harder to talk about,” says Dr Maureen Mumbe, a Machakos level 5 hospital doctor.
“Even with my closest companions, talking or complaining about the tough moments often feels like passing on a burden that I’m better placed to handle.”
Dr Neema Araka, a psychiatrist, says mental health issues are an occupational hazard for healthcare workers.
A systematic analysis published in August 2018 in the National Library of Medicine says that the suicide rate for doctors has been variably estimated at five times the rate of the general population.
Worse, the risk is twice as high among female physicians than among male physicians. Anaesthetists, general physicians and, counterintuitively, psychiatrists are associated with increased suicide risk.
“In most healthcare systems (whether privately or publicly funded), and across all ages, genders, specialities and seniority, doctors have higher rates of depression and anxiety compared with the general population and other professional groups,” the publication reads in part.
“Doctors are just as exposed as anyone else to risks of mental illnesses including genetic predisposition, illnesses or relationship breakdowns, early traumatic life events, and later bereavements,” explains Araka.
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“Pile those up with the fact that most doctors have certain personality traits that supposedly make for good doctoring, including obsessiveness, compulsiveness, ambitiousness, competitiveness, and some elements of martyrdom.”
Araka says doctors and other healthcare workers see people in their worst times. Besides, the workload is quite heavy, and doctors move rapidly from one emotion to another, which can affect their mental stability.
“Doctors don’t get time to mourn their patients, and contrary to what some may think, healthcare workers tend to bond with their patients. This is because they are human beings,” says Araka.
“One moment they’re required to break bad news to patients or their loved ones, and the next they’re required to put on an excited face to break some good news to the next patient.”
“They do this so many times in a day they start putting their natural feelings away. Sometimes that doesn’t work, and because healthcare workers are surrounded by drugs, some end up getting hooked to opioids and other hard substances,” says Araka.
“Further, physicians can face twice as much stigma for experiencing depression because they’re expected to always know what to do and to be caregivers,” says Dr Samuel Obegi Oroko, a psychiatrist.
He says that most doctors are held in high regard, with jobs deemed to come with career satisfaction, financial security, and high status, which puts even more stigma and pressure on them.
According to Araka, doctors adapt dissociation and depersonalisation as coping mechanisms to survive a lifetime in the hospital rollercoaster environment. “This can make it harder to create healthy bonds to others or even to recognise when the burden of their work becomes unbearable,” he says.
“When people are stressed, their natural personality traits tend to go into overdrive. As doctors work harder, their obsessiveness may cause them to blame themselves for being unable to deliver the care their patients need,” he says.
“They may also feel guilty for events beyond their control, such as losing a patient. Consequently, physicians can suffer a sense of helplessness, imposter syndrome and a persistent sense of failure.”
Oroko says that when physicians finally summon the courage to seek help, they may have to do so at the hospital where they work and could be recognised by patients and colleagues, which can be stigmatising.