SYDNEY, Australia — How can I tell you what I have done? Let me start with a doorway. I am looking in at a patient handcuffed to the rails of a hospital bed, arms spread out in a crucifixion pose. The prison guards who have brought the patient to the hospital explain what has happened. I hide my horror behind my calm and neutral doctor face as I unfurl crepe bandages from self-inflicted wounds. Just another set of wounds to add to all the others in my head, the weeping pressure sores of nursing home residents, the gangrenous toes that you can smell from the other side of the room.
The job of a doctor in training is unspeakable. It is hard to find the words to describe what we do. It is hard to work out whom to tell. We cannot speak of these things to people outside medicine because it is too traumatic, too graphic, too much. But we cannot speak of these things within medicine, either, because it is not enough, it is just the job we do, hardly worth commenting on.
When I started working as a doctor last year in a metropolitan public hospital in Sydney, rotating through the emergency department and the surgical and medical wards, as all doctors do in their first year of practice in Australia, my experiences were no better or worse than those of any of my colleagues. Nor are they dissimilar to the experiences of junior doctors around the world. But we are speaking about these things now, where I am from, because my colleagues are killing themselves.
It has long been recognized that physicians are more likely than the general population to kill themselves, especially if they are female. A meta-analysis of studies around the world on doctor suicide found that female doctors were more than twice as likely as the general population to die this way.
Younger doctors are particularly vulnerable. In the United States an estimated average of 28 percent of medical residents show signs of depression during training, making them around three times more likely to be depressed than similarly aged Americans. A 2013 survey of Australian doctors by the mental health nonprofit organization Beyond Blue found that young doctors worked longer hours than their older colleagues, in some cases up to 50 hours or more per week on average. Younger doctors were also more psychologically distressed and more burned out, and thought about suicide more often. Here in Sydney we have lost three colleagues in the last seven months alone.