Micaela Abbott spoke to medical students at AMSA's national conference about her sister Chloe Abbott's death. Credit:Daniel Munoz "My family had really detested the term 'resilience'," Ms Abbott said, recounting her sister's fortitude as a champion swimmer who represented Australia in international competition. "That's not something you can do without resilience," she told the crowd of students about to join the profession that Dr Abbott's family and colleagues believed contributed to her death. Dr Abbott's family is pushing for system-wide cultural change and the introduction of safe working conditions for junior doctors who are saddled with gruelling shifts and a heavy study load. "It's absolutely devastating that this conversation was only generated after the loss of my sister, but we need to get these important changes in place," Ms Abbott said. "Chloe's death can't be a waste."

Dr Chloe Abbott (left) died in January, one of several recent junior doctors to commit suicide. Convening the panel, psychiatrist and National Mental Health Commissioner Ian Hickie said the current focus on building resilience ignored the deleterious culture of medicine and dangerous working conditions to which junior doctor were subjected. Professor Ian Hickie said resilience was a "con" that distracted from meaningfully addressing dangerous work conditions for doctors. Credit:Steven Siewert "It's this con of individual resilience that is part of the problem," Dr Hickie said. "We operate on a collegiate system that has been unregulated but has demonstrably failed to move into the 21st century."

He drew parallels with the aviation industry that had industrial safeguards in place so that pilots did not fly while fatigued. "Why should doctors treating patients be any different?" he asked. Mr Hazzard flagged overhauling legislation that required doctors to report colleagues who had a health condition that put patients at risk, over concerns the law was stopping doctors with mental illness seeking help. Currently, all registered health practitioners must report a doctor to the medical regulator if they believe the doctor is "placing the public at risk of substantial harm" due to a health issue, including mental health. But junior doctors believed any mental health problem could be reported, Mr Hazzard said.

"But that's not the way junior doctors generally interpret it because of the fear inculcated in the profession," Mr Hazzard said. "The constant fear [is] that 'I am not going to achieve to move forward in my profession if people know I've got this issue.' "We may need to change the legislation because of this perception," Mr Hazzard said. Dr Tessa Kennedy is chairwoman of the AMA NSW doctors-in-training sub-committee and said system-wide and cultural change was needed to improve the mental health of doctors. Credit:Louise Kennerley Ms Abbott, 25, said her sister didn't tell anyone she was struggling because she was terrified it would jeopardise her chances of getting into a highly competitive endocrinology training program. "When you make medicine your life, which she did, there was a huge fear that, if she asked for help, it could cost her her career," she said.

"A doctor in NSW should be able to see another doctor for their mental health problems and not be afraid that it will be reported to their boss. Everyone should have that right." All panellists agreed the culture of medicine and the "intense pressure" on doctors-in-training were of greater concern than reporting laws. Untenable working conditions, long hours, unrealistic expectations and gruelling study regimens were a danger to doctors and patients, chairwoman of the AMA NSW doctor-in-training committee and paediatric registrar Tessa Kennedy said. "We also need to look very hard at our culture," Dr Kennedy said. "Bullying and harassment remain endemic in our profession. "The sense I get is that doctors-in-training have a lack of confidence in the system to deal with bullying and harassment."

But the general attitude of some senior doctors also needed to be redressed, she said. "Whenever I flag with senior colleagues that I'm really excited to have a day off after I worked 65 hours in last five days … they scoff and say: 'Five days? In my day, I did 13 days in a row, 48-hour shifts.' "[I would think] well, thank you for invalidating my fatigue … I love my job but are you saying you need me to work in an unsustainable, unsafe way? "They have all these horror stories of them falling asleep cannulating people ... that's not a good thing. That is not something to be proud of … it's a dangerous thing." Dr Geoff Toogood spoke candidly about his own struggles as a doctor seeking help for his mental health issues. Credit:Daniel Munoz

Geoff Toogood said "a precious few" senior doctors were speaking up about the issue. "But dare I say we tend to get squashed by our colleagues," he said. The senior cardiologist, who has publicly shared his own experiences with mental illness, said within a week of taking leave he was getting emails from his workplace asking when he was coming back. "Mental health awareness is terrible among doctors," Dr Toogood said. "We need to be well ourselves to help others be well." ❏ Support is available for those who may be distressed by phoning Lifeline 13 11 14; Mensline 1300 789 978; Kids Helpline 1800 551 800; beyondblue 1300 224 636.