A crisis brewing for the healthcare system and a crisis already happening for our students

Working in medicine has always been a stressful job for a number of reasons. Long hours, dealing with life and death situations day and night, lack of time to build personal relationships and stressors related to work-life balance contribute to personal stress. This is compounded by putting oneself second to the needs of others combined with changes in practice of medicine, technical advances and changing patient expectations among other factors. Furthermore, organisational and institutional pressures and structures can add to the burden of practising medicine. Medical students (doctors-in-training) carry with them a number of stress-inducing factors. First and foremost, they are in that vulnerable age group where two thirds of psychiatric disorders begin. Secondly, stressors of all types can contribute to the development of mental ill-health. The history of medicine tells us that doctors would often work hard and in relative isolation, but enjoyed extremely high social status and other rewards. This social contract with medicine has shifted significantly over recent decades, with doctors almost ubiquitously working in teams with other doctors, nurses, social workers and others. Indeed, health care overall is becoming much more collaborative and patients themselves are increasingly seen as a crucial part of the overall team in their care. This is undoubtedly welcome. At the same time, societal and financial rewards for doctors have lessened in many places alongside marked changes in patient expectations and changes in laws with clear emphasis on health as a commodity which can be bought and sold and patients being consumers who have greater understanding and can communicate widely using social media and other methods.

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