In the year it has taken for me to finish my medical residency as a junior doctor, two of my colleagues have killed themselves. I’ve read articles that refer to suicide amongst doctors as the profession’s “grubby little secret,” but I’d rather call it exactly how it is: the profession’s shameful and disgusting open secret.

Medical training has long had its culture rooted in ideals of suffering. Not so much for the patients — which is often sadly a given, but for the doctors training inside it. Every generation always looks down on the generation training after it — no one ever had it as hard as them, and thus deserve to suffer just as much, if not more. This dubious school of thought has long been acknowledged as standard practice. To be a good doctor, you must work harder, stay later, know more, and never falter. Weakness in medicine is a failing, and if you admit to struggling, the unspoken opinion (or often spoken) is that you simply couldn’t hack it.

In the cutthroat, often brutalizing culture of medical or surgical training many doctors stay stoically mute in the face of daily, soul destroying adversity; at the worst case, their loudest gesture is deafeningly silent — death by their own hand.

Doctors are trained to examine the mind and body in minute detail — making them ironically experts at not only prolonging life but also at ending it. It is not uncommon to hear the modes of suicide are as precise and measured as drug regimes devised to save sick patients — I know people who have cannulated themselves then self-administered exactly the right doses of fatal electrolytes or medication in order to ensure their last act as a medical professional was to successfully facilitate their own death. The thought of years of knowledge and training being used for such purposes is not only sickening, it is heartbreakingly sad.

Extremely long hours, little financial remuneration (particularly while training), discouragement to claim overtime should you incur the wrath of hospital administrators who have a stranglehold over your career prospects, and extreme shortage of training places leaves many doctors of my generation feeling as if we don’t have many options.

Colleagues compete with one another because it’s how we have been conditioned to behave — we all know one bad mistake or disagreement with an important superior is all that it takes to end a career you’ve already devoted 7 plus years of your life to — and you haven’t even really started yet. To not specialize is seen as a cop out — anyone who openly admits to wanting a more lifestyle-friendly medical career path is more often than not looked down upon. You’re left feeling much of the time that whatever you do — it’s simply never going to be quite good enough.

When I asked my friends who are not doctors whether two people in their cohort had killed themselves in the last twelve months, they looked horrified. There would be some kind of inquiry, they said, an investigation, some action. Some kind of introspective analysis into their workplace that tried to find some kind of answer for what had occurred. Doctors tend to receive a formatted email from our management with a link to a counseling service, and then we go to work and pretend as if nothing has happened.

No doctor I know, particularly juniors trying to pass exams and get into training programs, would ever voluntarily seek help because they are afraid of being labeled as weak or not coping. Instead, too many doctors seek solace in alcohol, drugs, unhealthy relationships and yet on the outside always the facade that we can keep on going. Suicide is an extreme last resort, and undoubtedly there were other components in each case — but there is an undeniable common denominator of the same work environment, the same pressures, and the same timeframe. The whisperings in the hospital corridor have confirmed to me that rather than shock or confusion as to how something this devastating could have occurred — much of the response has been some kind of deep-seated understanding. Which is wrong, and deeply unsettling.

Junior doctors are called the backbone of the medical profession, but at the same time, it feels all too often as if we are it’s collective punching bag. We are told from day one we must always be extremely polite to nursing staff, who I have witnessed belittling interns and residents without consequence. We are expected to work well beyond our rostered hours — but we don’t dare ask for over time because it will flag us as being trouble makers. We are told we must pay thousands of dollars for courses and exams and further our knowledge — but we are all too often humiliated by our seniors in high-stress environments because for all the things we know — we can never know enough.

When I think about all the things I have learned at the end of my residency, one stands out very clearly. There is something rotten inside the medical profession that has been festering for a long time with no realistic cure. The statistics have spoken for themselves about doctor suicide and mental health for years, and yet our responses and solutions feel perfunctory at best and shameful at worst. Amongst each other, most junior doctors feel the same as me — that things won’t change and that there’s no point in really trying. One of my close friends said it best when we were discussing how the doctors who ended their own lives must have felt when he remarked, “Maybe they were just braver than us.”

The only people dying in a hospital should be the sick patients for which doctors can find no answers. I don’t want to get “doctor suicide fatigue” where another death is not a tragedy but rather an unpleasant expectation. When a patient dies unexpectedly at my work, there is an investigation, and a debrief and somebody writes a report and steps are put in place to ensure this doesn’t happen again. Where is the investigation? Where is the debrief? Where is the report? Where are the steps? Junior doctors deserve better than what we are being given. It is time for the medical profession to look deep inside itself and fix the cancer that has been growing for far too long. If they don’t the cost is simply too high.

The author is an anonymous physician in Australia.

Image credit: Shutterstock.com