THE medical fraternity and the public have long been shocked by incidents of suicide among medical professionals. However, the rising number of such cases over the past four years, beginning in December 2020 – starting with four trainee and junior doctors in Penang and Shah Alam – culminating in the most recent case in August 2024 involving a specialist in Lahad Datu, is a justified cause for concern.
The most recent suicide has prompted the Health Ministry to form a task force to investigate the incident. In October, it was announced that the ministry would issue guidelines on how to recognise and address this issue, after several members of the Putrajaya Hospital Board of Visitors acknowledged that it was not an isolated case but rather a reflection of deeper problems within our healthcare system.
Long working hours, decreased resilience, sexual harassment and workplace bullying have long been recognised as significant sources of stress.
A 2023 survey by the Malaysian Medical Association found that 40% of Malaysian doctors had experienced bullying.
Medicine is undoubtedly a stressful profession. It also demands high levels of responsibility as lives are at stake.
Physician burnout has been a continuing issue over the years. Factors such as personality traits, a non-conducive work environment and the pressure to consistently deliver high standards of care can contribute to persistent anxiety and job dissatisfaction among doctors.
Depression and suicidal ideation are serious consequences of physician burnout as reflected in national databases of several countries.
Reports indicate that the suicide rate among male physicians is 41% higher while the rate for female physicians is 130% higher than that of the general population.
Doctors face more work-related stressors than many other professional groups, making them particularly vulnerable to developing depression. These stressors include heavy workloads, increasing job intensity and complexity, rapid changes within healthcare systems, institutional constraints such as discrimination and intimidation, lack of autonomy, limited support, loss of job satisfaction, low morale and the difficulty of balancing personal lives.
Workplace bullying, particularly targeting junior doctors, has emerged as a concerning issue in the medical field. Depression in doctors is often linked to difficult relationships with senior staff, patients, lack of sleep, dealing with death, making mistakes, loneliness, constant responsibility and self-criticism.
Administrators and doctors may forget that a diagnosis of depression does not necessarily impair professional abilities. This can lead to fears of breaching confidentiality, which undermines the openness needed for effective communication.
As a result, affected doctors may be discouraged from seeking help, creating a barrier that makes diagnosis and treatment more difficult.
Healthcare workers need to be more attuned to the signs of mental illness within the medical profession, not only in those under their supervision but also in their superiors.
The common belief that mental distress is a sign of ineptitude or weakness may lead depressed doctors to conceal their illness, from themselves and others. This self-judgemental thinking ultimately hinders their access to care.
To cope, some medical professionals may turn to substances. Self-medicating with alcohol or recreational drugs may temporarily create the illusion that all is well, but
it also introduces an additional risk factor, delaying care and increasing the risk of suicide.
The challenge for all doctors is to recognise depression, not only in their patients but also in themselves and their colleagues, and to overcome the personal, professional and institutional barriers to effective treatment.
Physicians need to facilitate access to proper healthcare, whether in their roles as administrators, colleagues or personally.
While there are eight free suicide helplines available, doctors rarely call them. However, they may be more willing to speak with a colleague. Therefore, it is crucial for peers to recognise suicide risks to detect and intervene in preventable suicides.
Doctors need to acknowledge the various factors behind the complex phenomenon of suicide and the increased risk of suicide among doctors worldwide.
A more targeted approach is needed to address this issue. A good starting point would be to introduce peer counselling – not as therapy, but as a means of providing support and collegiality through conversations with someone who has “been there”.
Physician coaches are available in some parts of the world to support stressed or burned-out doctors, connecting in person or over the phone. They focus on four key areas: leadership skills, major life decisions, disruptive physicians and physician burnout. Many also conduct workshops to further assist doctors.
These endeavours will improve decision-making skills and resilience. The College of Physicians has already implemented leadership training courses over the past few years, receiving positive feedback from participants.
The establishment of peer-support groups is crucial, and we recommend making them mandatory in high-risk areas of medicine.
Interventions within medical organisations can also help reduce job stress, leading to long-term benefits through task restructuring, work evaluation and supervision aimed at decreasing job demands, increasing job control and enhancing participation in decision-making.
Medical departments should be required to display notices outlining the process and benefits of seeking help from suicide helplines and available counselling services, and these services must remain confidential.
Regular awareness training on workplace bullying and workload management should be implemented for human resources departments, with e-modules available for easy access. Evidence suggests that some interventions, including reducing physicians’ work hours, have successfully lowered burnout rates.
Finally, employee assistance programmes need to be instituted and reinforced in hospitals to address and resolve conflicts at the workplace in healthy ways.
Some of the suggestions above may have already been considered by governing bodies, and incorporating those that have not yet been explored could establish a comprehensive protocol for the mental health evaluation and management of medical personnel in Malaysia.
Lastly, information regarding stern action from the Malaysian Medical Council’s disciplinary board on workplace bullying and sexual harassment should be regularly disseminated to reduce the likelihood of such incidents. This, of course, is subject to internal inquiries and, when necessary, the formation of an external committee to analyse the situation.
All doctors are expected to meet the criteria of being “competent and safe”, given their significant responsibility in caring for the public. This duty of care cannot be compromised or left open to abuse.
There cannot be a system where ineffective and disruptive doctors are not addressed due to superiors avoiding confrontation. Ultimately, the Hippocratic Oath must be upheld.
This article is contributed by Prem Kumar Chandrasekaran, Selvasingam Ratnasingam and Thinesh Rajasingam on behalf of the psychiatry chapter of College of Physicians,
Academy of Medicine Malaysia.
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