Troubled sleep, change in mood, intrusive memories, feelings of isolation, excessive worry, changed appetite, difficulty in enjoying what you normally enjoy, hopelessness about the future. Does any of this sound familiar? PTSD is more common in medics than you think.
When you embark on your career of medicine it’s difficult to picture how it will be. There can be glamorous ideas of saving lives, rushing around the hospital in packs of smart doctors, and really making a difference. What you may not envision is the hard days, the paper work, night shifts, overtime and emotional distress.
The thing that I was especially unprepared for was dealing with negative patient outcomes. When you’re a student you believe that every person can be saved, and that hospitals will fix everyone that walks through their doors. What you don’t realise is that this isn’t always the case.
Dealing with negative outcomes
Sometimes there is no cure. People can go suddenly or slowly. More distressingly there are times when patients have a harmful outcome due to medical negligence or error. Usually due to an overwhelmed public health system these errors can leave doctors traumatised for a long time after the fact.
Nearly 80% of doctors have experienced a distressing patient event in the last year, and many go on to suffer from depression, anxiety, and PTSD (1).
In the middle of the work day you’re not always aware or able to process these events. Sometimes during a busy set of shifts you may not really understand how you feel until you’re on annual leave or a day off.
Personally, I had no idea how to face adverse patient outcomes because I had zero previous knowledge. Mixed with long hours, navigating the new role of internship and trying to gear up for your next transition it can be really hard to care for yourself in these situations.
Recognising the signs and symptoms
- Intrusive thoughts and memories
- Nightmares
- Recurrent unwanted memories of the event
- Reliving the traumatic event – flashbacks
- Distress if something reminds you of the events
- Avoiding things that remind you of the event
- Negative changes in thinking and mood
- Feeling of hopelessness
- Detachment
- Loss of enjoyment in usually enjoyable activities
- Memory trouble
- Changes in physical and emotional reactions
- Difficulty concentrating
- Trouble with sleeping
- Easily startled
- Irritability
- Guilt and shame
- Self-destructive behaviours
My own struggles
Near the end of residency, I found myself a nervous wreck. I couldn’t sleep through the night and woke up with my heart racing at 3am, suddenly terrified that something bad had happened or reliving those hard memories of previous traumatic experiences. Nightmares were common…
My appetite was shot and I had severe gastritis, leading me to be on two medications to treat it (at the age of 25). At one point, I even had a gastroscopy (paying $1400) for weight loss and severe symptoms….the diagnosis: work related stress.
Even the slightest thing could remind of the events I wished to forget. Driving past the hospital I worked at was enough to send me into a panic, even for months after I’d finished working there.
My concentration was poor, and I felt so down. Without any hope for a better time ahead.
Needless to say, I was in a very bad way.
I finished residency and took a few months off. I went back to work as a locum in the emergency department, but the first day back I started experiencing those dreaded feelings again. It was as if the time off had did nothing to help.
Ultimately, I decided to leave clinical medicine for my own health.
When I was living in those dark days I felt a lot of shame and guilt. Why couldn’t I handle it? Did I just not ‘have what it takes’? Am I weak? It felt like I was leaving medicine with my tail between my legs. My negative self-talk was at an all time high.
But none of that is true. Being vulnerable is strong. PTSD, anxiety or depression in medicine is widespread. Sometimes, what’s right for someone else just isn’t what’s right for you and it’s never shameful to hit the reset button.
This may not be the answer for you, many people can stay in clinical medicine and heal in other ways. For me, this was my way to care for myself.
What else can help?
Caring for yourself is key. Both physically and emotionally. Care for your basic physical needs: hydration, food, good sleep hygiene, exercise, vitamin D. Then tend to your basic emotional needs: love, hope, meaning, and control.
If you’re meeting these needs you can better deal with difficult situations, and have stores to energise yourself with.
When it gets too much
When you’re already feeling struggling with PTSD, taking the time to exercise, make healthy meals and get a good night’s sleep seem near impossible.
This is when we need to call in the reinforcements.
We can:
- Speak with our loved ones
- Engage with trusted colleagues
- Talk to our GP
- Get support from Employee Assistance Program, Education Supervisors, and Doctors’ Health Services for our state/country
- Find a good psychologist, counsellor or other mental health professional
- Take time for ourselves
Look into your local resources, for those in Australia click this link for 24/7 hotlines you can call. For more resources click here. Feel free to send me a message, know that you’re not the first and only one that has had difficulties during medicine.
(1) Paturel, Amy. “When physicians are traumatized.” AAMC, 13 August 2019.