Doctors need more freedom
The article you published addressing the issue of medical doctors who struggle with depression and even suicide is quite likely surprising to most readers (“It is time to listen better to doctors who struggle with depression,” March 25, page 9).
After all, doctors tend to be accorded near god-like status in most cultures and especially so here in Taiwan. Some parents have dreams for their children to become doctors for a whole host of reasons, including the high salary, fame and prestige that go along with the profession.
Hence, the immense stress and pressure that accompanies such lofty ambitions — whether it comes extrinsically from such children’s parents or is intrinsically self-imposed by the children themselves — begins at an early age.
Getting through pre-med studies and medical school is tough, even for the brightest and most highly motivated students. Those who make it that far are then thrust into intense internships and residencies where they are forced to work and/or be on-call for insanely long hours, which makes them sleep-deprived and in many cases nutritionally deficient, since they seldom have time to eat wholesome and healthy meals, but rather need to subsist largely on snacks and junk foods for weeks and months on end (“Resident doctors’ weekly working hours cut to 80,” March 28, page 3).
To cope with the immense stress loads, a significant number of doctors turn to smoking and/or drinking, even though one would think that doctors, of all people, ought to know better. Many even get hooked on highly addictive sleeping pills or other drugs, as their work environment and position in hospitals and clinics provide them with easy access to prescription medications.
The writer of the March 25 article is an oncologist and factors specifically related to oncology could be a clue as to why doctors in this specialty are potentially at greater risk of depression and suicide.
Aside from the high salary, fame and prestige mentioned above, it is probably safe to assume that most doctors enter the profession with an underlying altruistic desire to do everything they can to help their patients recover their health.
However, oncologists frequently need to deal with the death of their patients, quite likely more often than in most other branches of medicine.
They also need to deal with the emotional shock and trauma of family members when they inform them that their loved one has developed cancer and, in more serious or advanced cases, that they cannot offer them much hope.
On top of that, in most developed and especially Western countries, oncologists are limited in regard to what treatments they can offer to cancer patients — primarily chemotherapy, radiation and surgery.
Depending on the laws of a particular country, state or region, an oncologist who even suggests an alternative treatment that they think could be more efficacious and less dangerous or damaging to a patient’s body compared with one of these “big three” conventional treatments could run the risk of having their medical license revoked, which essentially equates to getting fired and being unable to get another job.
Yet, oncologists know (even if they fail to openly communicate to their patients) the inherent dangers and serious “side effects” associated with these conventional treatments.
For instance, more than one study has shown that the vast majority of oncologists would never give the same chemotherapy drugs that they routinely prescribe for their patients to their own family members and would not take such drugs themselves if they were diagnosed with cancer.
That should be an eye-opener.
However, the point here is that moral dilemmas such as this undoubtedly cause guilt and depression in a lot of doctors — that is, on one hand they want to do whatever they can to help their patients, but on the other hand the regulations and confines of the system they work within largely prevent them from being able to.
As Ken Murray, a physician, wrote in a 2012 online article in the Guardian: “Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent [...] I suspect it’s one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields.”
By its very nature, the medical profession subjects physicians — some more than others — to intense stress, with depression being a major by-product. Depression is almost certainly higher among doctors who are more likely to have patients with higher mortality rates.
Doctors, given their professional training and knowledge, should have greater freedom to prescribe treatments that they truly believe — and that are supported with sound, unadulterated empirical evidence — can benefit their patients the most.
At the same time, they should not be forced to choose between their jobs and prescribing a treatment — even a long-standing treatment approved and sanctioned by the medical establishment, but one that doctors know, and which research shows, can do irreparable harm to their patients — that they do not feel comfortable about and cannot administer with a clear conscience.
After all, the quintessential rule in medicine is primum non nocere, or “first, do no harm.”
Wayne Schams
Pingtung
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