WHY DOCTORS COMMIT SUICIDE AND WORKPLACE TOXICITY
The past few years have shown a steady rise in the number of suicides by doctors. The month of April '20 was particularly horrible; 6 suicides in total in a tertiary care institute like AIIMS of which 4 were either doctors or medical students.
The underlying reason in each case is different, but encompassing them all in one broad category boils down to the existence of a high pressure environment ever since your days as a medical student. Multiple factors are responsible for this atmosphere. Some apply positive pressure and facilitate personal growth; while others if left unchecked can very quickly lead to disasters.
Society generally associates being a doctor with certain protective attributes like high status, career and financial stability and a generally well rewarding job. However, the negative aspect of being a healthcare professional is very casually overlooked. They are just as exposed as anyone to early traumatic life events, bereavements, relationship breakdowns, genetic predisposition to disorders etc. There is also the constant risk of exposure to various diseases, a higher prevalence of mental trauma and PTSD and often sacrifices in social and family life.
From a very young age, aspiring doctors are competitive, driven, compulsive, ambitious and individualistic. It is these qualities that make the foundation for their successful career ; but these features may go into overdrive as a doctor gets stressed. They work harder and often blame themselves for events beyond your control. As a result, to survive a lifetime in medicine, healthcare professionals often develop psychological defences like "depersonalization and dissociation" . Such defences often make it tricky to detect or diagnose changes in one's psyche, be it by a trained professional or whilst evaluating yourself.
In the aftermath of a disaster, doctors are at a far greater risk of post-traumatic stress, substance abuse and clinical depression than the average civilian. It is seen that doctors are more likely to die as a result of suicide than other professionals and are more than twice as likely to take their own lives than the general population. Suicide rates among female doctors is said to be even higher; reaching a mind numbing four times higher than the average rate. Yet seeing themselves as vulnerable is disruptive — antithetical even — to their self-concept. They are the healers in this equation, not the ones who need to be healed.
On 10th July 2020 Dr. Anurag Kumar, a junior resident in the at AIIMS DELHI allegedly committed suicide by jumping off the 10th floor of the hospital. He was working as a trainee psychiatrist himself and had been admitted after a major depressive episode.
On 10th August 2020 Vikas, a second year MBBS student at AIIMS DELHI allegedly committed suicide by jumping off the roof of Hostel 19. It was later revealed that he was undergoing treatment for depression at the same institute.
40 year old Dr Mohit Singhala was found hanging in his rented apartment in Delhi. He was a budding researcher in the Department of Pediatrics at AIIMS DELHI.
A Dental Resident Doctor at AIIMS DELHI allegedly attempted suicide in April 2020 due to repeated caste based discrimination and sexual harrasment by a faculty member from her department. She had made multiple complaints about being singled out and harrassed for being a Dalit; but no action was taken.
All of this from just one institute in a span of a mere 4 to 5 months. As of 21st of May 2020, there are 542 medical colleges and 64 stand alone PG institutes in India recognised by the MCI. What must be the stats taking all of these into account?
In the cases presented up till now, the doctor in question chose to end his/her life after struggling with a mental illness, immense pressure or harassment. Let us move on to another equally disturbing entity - one that has resulted in its fair share of mental health issues and related suicides- 'A toxic workplace and coworkers'. This poison has been coursing through the veins of our noble profession for a long, long time now!
The Payal Tadvi Case:
Dr Payal Tadvi was a Resident Doctor in the Department of Gynecology at BYL Nair Ch. Hospital and TNMC. She was allegedly harassed by her seniors Bhakti Mehare, Ankita Khandelwal and Hema Ahuja for being a Tribal-Muslim candidate. She was banned from seeing OPD patients, she was not allowed into the OR and was forced to complete all the clerical work. Routinely abused with casteist slurs and not even allowed to take a break till these seniors deemed fit, Dr Payal had faced enough. A Gynecological Resident barred from seeing patients, her academic life as a budding doctor was destroyed. Pushed to her limits, she decided that ending her life was easier than continuing to endure this torture. On May 22 2019 she wrote a note apologising to her parents and explaining in detail why she took this decision, before committing suicide.Click here to read the full note and try to wrap your mind around the magnitude of the entire saga.
The Dr Payal Tadvi case was a very unadulterated and immaculate form of this poison. But it may not always be this apparent, this visible. A toxic workplace stems from a myriad of reasons.
In an article titled 'A Very Real Taboo: Toxic Culture Threatens Everyone' by Jim Katzaman, Dr Jaifred Christian 'Jim' Lope says and I quote-
“Toxicity means having to live a life where seniority is emphasized at the expense of professional respect and dignity,”
He further says "Part of it comes from the chain of command, which is important. It just happens that ego and pride get into the mix.”
The chain of command:
Often used as a military term, the chain of command has its medical counterpart too. It extends from the Intern to the Attending Physician, with multiple personnel falling in between. This hierarchy exists for the clear demarcation of one's responsibilities and duties and allows a junior to seek guidance and train under the watchful eye of a superior.
A toxic environment manifests when a junior is made to feel irrelevant or as if he/she does not belong. Excluding them from the decision making process, making them the scapegoat for the smallest of incidents and in general burdening them with work while stealing the credit for yourself - these are some of the characters of a toxic senior. This issue may run even deeper with sexist, casteist discrimination thrown into the mix.
A lot of this stems from the feeling of "If i have suffered, so shall the ones after me" . In the past there were multiple instances of seniors burdening the JR-1 with too much work, berating him/her constantly and all in all making their first year of residency an absolute hell. All because they were in this exact same scenario a few years back. And thus the cycle continued.
A toxic senior does not suddenly appear out of thin air in your residency, these traits are apparent in the UG days too. A senior who berates you every chance he gets, refuses to help you with academics, harasses you based on your religion/caste is someone you should steer clear of.
Make no mistake, this has nothing to do with senior-junior interactions from when you were a freshie. You meet the people you're going to spend your next 3-5 years with and it helps you settle into a new place and a new environment. You go to them for help with academics, party together after exams and often make bonds that will last even when you're both old, tired doctors with white hair and an illustrious career.
The worst part about toxic seniors is that they repeatedly justify their behaviour and tendencies by saying that it is a way of bonding, or a norm in the industry. The effects of a toxic workplace are more or less the same in every field. These include physical symptoms like sleeplessness, weight gain/ loss of appetite, deterioration in personal relationships and absenteeism- among others. Emotionally, they become discouraged, stressed and lose confidence, which may eventually lead to depression. However, there is a critical difference between the ill effects of a toxic workplace in the healthcare industry compared to others : it puts patient care at a risk too. Recipients of toxic behaviour from co-workers or seniors are often seen making clinical errors as a result of stress, display hostile outbursts towards patients and are more prone to make poor decisions regarding patient care.
HOW CAN YOU TRY TO DEAL WITH TOXIC PEOPLE AT YOUR WORKPLACE OR EDUCATIONAL SETTING?
1. You cannot expect a person like this to wake up one day to realise the error of their ways and have a 180- degree attitude change. This is precisely why you should try having an open, honest and candid conversation with them. Try giving productive feedback and ask for feedback on your behaviour as well.
2. Practise healthy coping skills. Dealing with a toxic coworker or senior can take a serious toll on you. Take care of your mind and body. Eat good food and try to get adequate sleep and exercise.
3. If possible, try distancing yourself from the toxic person - mentally and emotionally. Surround yourself with positive people who lift you up and give you energy.
4. Put your foot down. Know your boundaries and make sure others are clear about that too. If the toxic person has crossed the line and is now abusive and unprofessional, put your foot down. Try talking to a higher person in charge about your problems.
5. Seek help when necessary. If you start seeing signs of worsening mental health as the effect of a toxic workplace, try talking to a counsellor or a therapist.
Suicide is never the answer! Things may be bleak- completely dark for you even, but it will surely end. Never forget that as an individual you touch the lives of all your friends and family, but as a doctor you touch countless more.
"If suicide ever crosses your mind, just know that i would rather listen to your story than a eulogy"