The darker side of being a doctor

医生的阴暗面

By DrEricLevi · 5 min read 作者：DrEricLevi · 阅读时长：5分钟

I’m a surgeon. I’d like to think that I’m resilient and well adjusted, having gone through medical school and rigorous surgical training. I’ve been a doctor for 13 years and much of that period has been spent training to be as good a surgeon as I could ever be. I have great family support, a physician wife who understands my work and I’ve never been diagnosed with a mental illness. 我是一名外科医生。我愿意认为自己是一个坚韧且心态平衡的人，毕竟我经历过医学院的磨砺和严苛的外科训练。我当医生已经13年了，其中大部分时间都花在如何成为一名尽可能优秀的外科医生上。我有很好的家庭支持，我的妻子也是一名医生，她理解我的工作，而且我从未被诊断出患有任何精神疾病。

The suicide death of Dr Andrew Bryant, a Brisbane gastroenterologist last week hit a raw nerve. His wife wrote this honest and courageous letter. 上周，布里斯班胃肠科医生Andrew Bryant的自杀身亡触动了人们敏感的神经。他的妻子写下了这封诚恳而勇敢的信。

Although I’ve never had serious suicidal thoughts, I – like many other doctors – have been through many dark seasons. Depression, anxiety, burnout, suicidality, hopelessness, lethargy, anhedonia, feeling flat, worry, and the like are all different flavours of the same phenomena: the negative human response to internal or external stressors. Of course, the causes are always multifactorial. It cannot and should not be oversimplified to family history, genetics, behavioural deficiencies, bad environment or poor social support. 虽然我从未有过严重的自杀念头，但像许多其他医生一样，我也经历过许多黑暗时期。抑郁、焦虑、职业倦怠、自杀倾向、绝望、嗜睡、快感缺失、情绪低落、担忧等等，这些都是同一种现象的不同表现：即人类对内部或外部压力源的负面反应。当然，其成因总是多方面的。它不能也不应该被简单地归结为家族史、遗传、行为缺陷、恶劣环境或缺乏社会支持。

When I carefully dissect my dark seasons, some common themes often emerge. Work is often the critical exacerbating and perpetuating factor in those dark times. Because as a surgeon I spend the vast majority of my lifetime at work, what happens there influences all other aspects of my life including my marriage, family and social life. 当我仔细剖析我的黑暗时期时，一些共同的主题往往会浮现出来。工作通常是这些黑暗时期中加剧和持续恶化的关键因素。因为作为一名外科医生，我一生中绝大部分时间都在工作中度过，所以工作中发生的一切都会影响我生活的其他方面，包括我的婚姻、家庭和社交生活。

Here are 3 common things that have thrown me into some dark pit of despair: 以下是三件常让我陷入绝望深渊的事情：

1. Loss of Control

1. 失去掌控感

I have lost control of my days. I had worked in a hospital where I was oncall 24/7, 12 days out of 14. I had fortnightly weekends off. When I was preparing for surgical exams, I’d be working and studying from 6.30am to 10pm everyday, seeing my family only on the weekends for lunch. I had worked in a hospital network that covered 4 campuses and drove 500kms a week when covering these sites. I had worked in a hospital where I didn’t get home for days at a time, sleeping overnight in hospital quarters, outpatient clinic benches and in my car. I used to have my sleeping bag, toiletries and change in the boot of my car because I didn’t know if I was going to make it home some nights. Plans change every single day at work because of emergencies. I can’t even be sure what the next hour will bring when I am on call. You might ask, why can’t you work less? It’s not as easy as that. If I decide to work less, who is going to cover the hospital? If the hospital aren’t employing other doctors, we can’t allow patients to go uncovered. I accept the fact that I have a duty of care to be on call. The intensity and personal damage of these on call periods are often forgotten. 我失去了对自己日常生活的掌控。我曾在一家医院工作，那里要求我24/7全天候待命，14天里有12天在值班，每两周才能休息一个周末。在准备外科考试时，我每天从早上6:30工作和学习到晚上10点，只有周末午餐时间才能见到家人。我曾在覆盖4个院区的医院网络工作，为了覆盖这些站点，我每周要开车500公里。我曾在一家医院工作，连续几天无法回家，只能睡在医院宿舍、门诊长椅或车里。我曾经在车后备箱里常备睡袋、洗漱用品和换洗衣物，因为我不知道有些晚上是否能回家。由于突发状况，工作计划每天都在变。当我值班时，我甚至无法确定下一个小时会发生什么。你可能会问，为什么不能少工作一点？事情没那么简单。如果我决定少工作，谁来负责医院的事务？如果医院不雇佣其他医生，我们不能让病人处于无人照看的状态。我接受我有值班的护理职责这一事实。但这些值班期间的强度和对我个人的伤害往往被人们遗忘。

Not only that, we are losing control of health care in general. Everyday, there’s a new form, a new guideline, a new protocol, a new health software, a new policy all dictating, restricting and modifying clinician activities. Some of these policies are written by people who do not see patients. There’s a whole paid industry dedicated to restructuring what doctors and nurses do to reduce costs and increase output. 不仅如此，我们正在失去对整个医疗保健的掌控。每天都有新的表格、新的指南、新的规程、新的医疗软件、新的政策，都在规定、限制和改变临床医生的工作。其中一些政策是由根本不接触病人的制定的。现在有一个专门的付费行业，致力于重组医生和护士的工作流程，以降低成本并提高产出。

2. Loss of Support.

2. 失去支持。

Just imagine. I start my days at 6am. I wake up to an email alerting me of the number of discharge summaries that haven’t been completed and the various computer based modules I have to complete (hand washing, privacy, lifting patients, etc). Round starts at 7am. I see 15-20 patients with various travel forms, certificates, scripts that need completing. All to be done via the electronic health system, clunky, not user friendly, takes a long time to log in. Then I start an overbooked operating list at 8am. There are 7 cases booked. I have no say on who gets on the operating list and the order of patients. The first patient haven’t been checked in. The diabetic one is hypoglycaemic. The infant is cranky. The autistic child is running away. The interpreter is not here yet. The computer is still not logging in. The password is expired. I used to be able to arrange the operating list because I know that some operations take longer than others. But now, the bookings office determine that that all my tonsillectomies take 14 minutes because that’s the average time recorded on the computer. The moment I scrub in, the timer starts. The moment I unscrub timer stops. Click. Click. Click. Because the theatre bookings does not take into account the interpreter time, pre-med period or transfer to ICU, the list is running late. The nurse in charge is breathing down my neck to finish on time. I still took about 14 minutes on each case, but the team is delayed by external clinical reasons. The theatre team is anxious to finish, everything is rushed, and mistakes are bound to occur. 试想一下。我早上6点开始一天的工作。醒来时，邮件提醒我还有多少出院小结没写完，以及各种必须完成的电脑模块（洗手、隐私、搬运病人等）。早上7点开始查房。我要看15-20个病人，处理各种需要填写的旅行表格、证明、处方。所有这些都要通过电子健康系统完成，系统笨重、不友好，登录还要花很长时间。然后，我在早上8点开始超负荷的手术列表。预约了7台手术。对于谁能进入手术列表以及病人的顺序，我没有发言权。第一个病人还没办理入院。糖尿病患者出现了低血糖。婴儿在哭闹。自闭症儿童在乱跑。翻译还没到。电脑还是登不进去。密码过期了。我以前可以安排手术列表，因为我知道有些手术比其他手术耗时更长。但现在，预约办公室认定我所有的扁桃体切除术都只需要14分钟，因为那是电脑记录的平均时间。我一刷手，计时器就开始了。我一结束，计时器就停了。点击。点击。点击。由于手术预约系统没有考虑翻译时间、术前准备期或转入ICU的时间，手术列表总是延误。负责的护士催促我按时完成。我每台手术确实只用了14分钟左右，但整个团队却因为外部临床原因被耽误了。手术团队急于结束，一切都匆匆忙忙，错误注定会发生。

In the mean time, I field 12 phone calls from ED, GP and other units. By now there are 3 patients waiting for me in ED and 1 being flown in from another hospital. The operating list is finished late. I rushed to ED, and gulped down a cup of instant coffee. Then I arrive late to the afternoon clinic, which again is overbooked. Clinic nurses are not happy. I see 8-10 patients while taking more calls. I try to discuss complex surgeries with patients but I keep getting interrupted by calls and paperwork. Then I run back to theatre for an emergency case. By this time I’m set up for failure. I’m tired, cranky and my head is full of jobs to do. I do the afternoon round, see more consults, admit more patients and dictate letters. I have taken up to 70 calls on a 24h on call period. By 6pm I’m totally exhausted. I grab a packet of chips, ginger beer, and start working on the papers I was meant to write up. I review the case notes for the next couple of days. I get home between 7-8pm. Grab dinner and put the kids to bed. I get called back in and I take a patient to theatre for an emergency procedure. I come back just after midnight and sleep. I get called four more times between midnight and 6am. 6am. Repeat. 与此同时，我接了12个来自急诊室、全科医生和其他部门的电话。此时，急诊室有3个病人在等我，还有1个正从另一家医院空运过来。手术列表完成得太晚了。我冲进急诊室，狼吞虎咽地喝下一杯速溶咖啡。然后我迟到了下午的门诊，门诊同样超负荷。门诊护士很不高兴。我在看8-10个病人的同时还要接更多的电话。我试图与病人讨论复杂的手术，但不断被电话和文书工作打断。然后我跑回手术室处理紧急病例。到这个时候，我已经注定要失败了。我累了，脾气暴躁，脑子里全是要做的工作。我进行下午查房，看更多的会诊，收治更多的病人，口述信件。在24小时的值班期间，我最多接过70个电话。到下午6点，我已经精疲力竭。我抓了一包薯片、一瓶姜汁啤酒，开始处理我本该写完的文件。我查看接下来几天的病历。我晚上7-8点到家。吃完晚饭，哄孩子睡觉。我又接到电话被叫回去，带病人进手术室做紧急手术。午夜过后我才回来睡觉。在午夜到凌晨6点之间，我又被叫醒了四次。凌晨6点。重复这一切。

I have lost control of my days and I have lost support. When can I ac 我失去了对自己日常生活的掌控，也失去了支持。我什么时候才能……