Jane: It was New Year's Eve. It was a Friday, usually on a Friday they always started late, so there was no great rush. So we had a very relaxed morning. Geoff said about going down to the fireworks that night, New Year's Eve, it's a tradition to go to Kirra for the fireworks. And he kissed me and went to work.

Ann Arnold: Geoff Perkins was an anaesthetist at the Gold Coast Hospital in Queensland. It was New Year's Eve 2010. His wife Jane:

Jane: I had an appointment that morning. I came home and Geoff's car was on the driveway. And I was really surprised, you know, he was home quite early. And it wasn't parked very neatly. In fact I had trouble getting in the other garage. I started putting things away and sorting out the girls' lunches, and one of them ran upstairs and came down and said, 'The bedroom door's locked.' Which was very strange, I thought it was just stuck. Then she went up again and came down and said, 'And I can see Geoff, he's on the floor.'

Ann Arnold: Geoff Perkins had taken his own life.

Jane: So he'd taken a very fast-acting drug and he'd had an awful death, an absolutely awful death, which I didn't know at the time. Anaesthetists know how to die well. I assumed he had died well, had a good death. But he didn't. It was obviously very spontaneous, something he had done very spur of the moment.

Ann Arnold: Doctors are a vulnerable group. For decades, depression and suicide have been a source of sorrow among doctors that has been rarely spoken about, even amongst themselves. In 2013, a landmark Beyond Blue survey of doctors found that one in ten had reported having suicidal thoughts in the previous 12 months. For medical students it was one in five. In the general population, the rate was one in 37.

Now the spotlight is again on doctors' wellbeing after four sudden deaths of young doctors in Melbourne last month.

Helen Schultz: Unfortunately the first registrar I heard about I did work with, and that was very devastating for me to hear, even though I haven't seen him for a long time. I remember him from the beginning of his training, and I couldn't help but feel absolute sorrow for him, for the people that worked with him, obviously for his family;

Ann Arnold: Psychiatrist Dr Helen Schultz coaches and mentors registrars. Three of the doctors who died were psychiatry registrars, or trainees, all in different public hospitals. The fourth was an intern, so just out of medical school.

It's not publicly known how or why these doctors died. The deaths are to be investigated in the Victorian Coroners' Court. But grieving colleagues and peers say workplace pressures can't be ignored. And there are many.

Helen Schultz: The times when I was most stressed and most upset was when I was asked to work outside of my role, and that happened quite a bit with regards supervision.

Ann Arnold: Helen Schultz graduated from registrar status five years ago.

Helen Schultz: And the responses really were that, you know, you've got people on the phone to help you if you're out of your depth. So the thing that really annoyed me and got me the most upset was that somehow putting your hand up and saying, 'I don't feel comfortable doing this, this feels wrong to me, I feel really vulnerable,' was very quickly turned to 'you have a problem with competency'. And I think that's what a lot of us registrars struggle with. It's like, well, 'just put your hand up if you need help, we're on the other end of the phone', but junior doctors in particular are very nervous about calling senior doctors.

Ann Arnold: Long before these recent Melbourne deaths, some medical leaders were urging their peers, of all ages, to acknowledge mental health risks and to seek help early. But it's a massive cultural shift.

Ian McPhee: It's one of the more distressing elements of being part of a professional group that is always seen to be or expected to be robust, together, making decisions on the run, critical issues being addressed in a timely manner and acted on. And to be seen as vulnerable is not part of the deal. But we all are.

Ann Arnold: Ian McPhee is an anaesthetist, and a rarity because he has been open with his colleagues about his history of depression.

Doctors are typically perfectionist high achievers who don't cope well with failure. They work long hours in a competitive environment, in roles that can be emotionally draining, and within a culture where there is a reluctance to seek help.

Many doctors are now saying there's another reason not to tell anyone how they're feeling. Mandatory reporting requires doctors, including those who treat other doctors, to report a colleague's perceived 'impairment' to the Medical Board of Australia. It was brought in four years ago, as part of a suite of new laws for doctor regulation. There is debate about interpretation of the law—exactly when reporting is necessary—but it has created a climate of fear.

Western Australia exempts treating doctors from reporting, and the WA Minister for Health, Kim Hames, has told Background Briefing that doctors are travelling from other states to his state to get treatment.

Kim Hames: They clearly do that because they're scared of being reported. So they come here for that anonymity and for getting treatment early when they think they might have a condition. Sometimes you don't even know how bad you are and what the problem is, and it takes others to recognise it. It's really important for people who have a mental illness particularly to seek early treatment and management.

Ann Arnold: Kim Hames, Western Australia's Health Minister, and himself a doctor.

In January, before the deaths of the four Melbourne junior doctors were in the news, the tragedy was just starting to become known among medical networks. Dr Helen Schultz hosted a discussion in her psychiatry rooms in Richmond, so colleagues could talk about it.

Helen Schultz: Some of the people in the room had some relationship with the doctors involved, some were friends of friends, some were colleagues, many didn't know who they were, and in some ways that was of a concern to me as well because there was a blanket statement from the college announcing the deaths, and I suppose that led to a lot of uncertainty and conjecture amongst the registrar population about who they were actually talking about, whether their friends were safe, who it actually was. But there were some people there that were there because they'd been affected in some way, yes. We all came together with big question marks, but what the big question that came out of it was that we're not going to give up on this until we find out why.

Ann Arnold: Doctors form a tight professional community where reputations and referrals are important. Very few are prepared to speak publicly about sensitive issues that affect them, such as mental health. That's particularly the case with young doctors, who are trying to win approval from their senior colleagues as they build their careers, and fear being judged negatively. Helen Schultz, who has written a book and blogs about psychiatry, is more outspoken.

Helen Schultz: I suppose now that I am a psychiatrist I might be able to speak a little bit more about life as a registrar without fear of repercussions. Acute psychiatry, acute mental health, it's about as raw and as acute as you can get, particularly nowadays with the rise in the use of methamphetamine and ice, a lot of our patients are a lot more aggressive when they're brought into emergency departments. So all of these issues have to be a part of this in the sense that if you already have something going on in your life, whatever it might be, and then you're exposed to all of this without sometimes adequate supervision, there's got to be a breaking point.

Ann Arnold: Helen Schultz.

The medical community, and particularly the psychiatry community, has been rocked by the deaths. Professor Mal Hopwood is the president elect of the Royal Australian and New Zealand College of Psychiatrists, which is now renewing its focus on its trainees.

Mal Hopwood: These are a key part of our current workforce and a key part of the specialist workforce of the future, as well as just good young people who need to be looked after, for goodness sake. So it's certainly hit all of us hard and given us a resolve to be looking at everything we can do to help our trainees.

Ann Arnold: There has been criticism though, hasn't there, of the college since these deaths occurred, the suggestion that the assessment processes are too demanding.

Mal Hopwood: Our pass rates, in fact, have been consistent over a period of time. I think drawing a direct link to recent events at this stage would seem premature to me, I must say. It's also worth acknowledging, of course, medical practitioners are people for whom passing exams has been a big part of their identity. So it's a situation that is almost certainly going to cause tension from time to time.

Ann Arnold: Professor Hopwood says the deaths are, however, a reason to look at systemic issues, such as the financial strains on public hospitals, and the extra workload for psychiatrists since recent changes to Victoria's Mental Health Act.

Helen Schultz is concerned that grieving colleagues will now be under greater stress themselves.

Helen Schultz: So I would imagine what's happening at the moment is that the psychiatry registrars and the consultants that are grieving at the moment, who worked alongside those who have tragically passed away, will be expected to fill the backflow of work and to fill the vacancies that have been left unfortunately by the passing of these doctors. Now, these same doctors that are going to be asked to take up extra duties will also be the doctors that are grieving at the moment. There's a calling to be a doctor. There's a calling to help people, but who really helps us?

Ann Arnold: The challenges are there for doctors from the very beginning of their careers.

Jim Greenwood: The evidence is quite strong that mental ill health is greater amongst medical students than amongst any other group of students at the university.

Ann Arnold: Jim Greenwood is associate professor of psychiatry at the University of New South Wales. He studied medical students' mental health and says there are many reasons that students might struggle during their degree.

Jim Greenwood: To get into medical school is very competitive and people are expected to perform at a very high level to gain entrance. This tends to select for people who are fairly anxious, tend to be obsessional, and very conscientious and very hard working.

The university interviewers tend to look for people who are caring, who are concerned, who are sympathetic, who show empathy for the wellbeing of other people, but it could be that people with those personality characteristics are also more vulnerable to emotional and psychological problems.

Ann Arnold: Psychiatrist Jim Greenwood.

When Helen Schultz was still a junior doctor, she experienced one particularly bad night in a large teaching hospital. She and another junior doctor just out of medical school were in charge for the night.

Helen Schultz: Myself and another resident were carrying pagers that covered the whole of the major teaching hospital for medicine. The pagers were going off, and my poor colleague walked into a general medical ward where he found a very tragic situation involving a patient who had died. He was first on the scene, and had to deal with the trauma of trying to revive the patient at the same time as setting off a code blue, which we all attended. It was a tragic outcome. This was so unexpected, it wasn't a cardiac arrest, for example, or a respiratory arrest. It was something completely different, and we were first on the scene.

Ann Arnold: Dr Schultz says the nurses were stood down for the night, and relief nurses were brought in, because the incident was so upsetting. But the doctors had to keep going.

Helen Schultz: And rightly so the nurses were stood down, but we weren't and we kept working, and our pagers kept going off. And the next day, I took it to my seniors and I said, 'I'm really, really worried about my friend, is he going to be okay?' And...

Ann Arnold: Because he was the first to find...

Helen Schultz: Yes. Does he need help? And he was very resistant to getting help, he didn't want anybody to know that there was any way, shape or form that he wasn't coping with this. And it was turned around to, 'But what about you, are you okay?' But in the way, the terminology and the way that I was being asked was, in a sense, you know, 'Are you competent enough to manage that sort of extreme trauma?'

Ann Arnold: 'Because if you're not okay, there may be a deficiency in you.'

Helen Schultz: Absolutely, and that was something that was really highlighted as one of the key findings in the Beyond Blue recommendations, was that most doctors perceive if they say that they're not coping it will be seen as a sign of weakness.

Ann Arnold: Melbourne psychiatrist Dr Helen Schultz.

On the far north coast of New South Wales, at Tweed Heads on the Queensland border, another medical community was shocked four years ago when they learnt a colleague had taken his life.

Ian McPhee: We completely out of the blue heard of the suicide of one of our senior colleagues. And it really took us all aback.

Ann Arnold: Dr Ian McPhee is an anaesthetist at The Tweed Hospital. His colleague who died worked there some of the time but was mainly at the Gold Coast Hospital.

Ian McPhee: It was one of those circumstances where we really did not expect that this individual was in as much turmoil as he obviously was. He was extremely capable, very knowledgeable, extremely attentive to the details of his work and patient welfare. And I guess some of us would argue that while that's a general character within anaesthesia (a little bit of the obsessive compulsive is in all of us), he was perhaps focused a little more than the average, a little bit more intense. But to the best of our knowledge he had a vibrant life outside.

Jane: My name's Jane. My husband Geoff Perkins committed suicide on 31 December 2010. Geoff worked as an anaesthetist at the Gold Coast Hospital and sometimes at Tweed Hospital.

We had children living with us at the time of his death, they were just 7, two girls. They were my daughter's children, so they were our grandchildren. And Geoff had two children by his first marriage. But younger medicos work very long hours, so he really felt he missed out on his own children. With these two girls he did everything.

As soon as they could ride a bike, well, before they could ride a bike be bought bikes, took the pedals off, took them to the park where there was a little slope and let them learn to ride. Before very long he bought them really good bikes, and took them off on the roads.

Ann Arnold: And there was bushwalking and skiing and…

Jane: Oh bushwalking, he went out of his way to find the perfect spot to take small children for bushwalks. Not too long, very interesting, waterfall at the end. And then he had another grandchild, his own daughter had a baby. He was sent pictures of the scans and photos of her all the way along. So he was very excited about having another baby in the family.

Ann Arnold: Jane is a retired theatre nurse who met Geoff while working at the Gold Coast Hospital. She'd stopped working six years before Geoff died. Jane has since tried to piece together what happened that day. It seems things started to unravel as soon as he left home in the morning.

Jane: It must have been pretty much as soon as he got in the car, he got a phone call from somebody at work, the floor manager, asking where he was because the patient was there, waiting, and the surgeon was there, waiting. And he wasn't, where was he? So he said, 'Well, I'm on my way.' And apparently he swore, which surprised me.

Ann Arnold: The operating theatre start time had been brought forward and Jane says Geoff hadn't been told. He arrived to find the first patient was a man in his 90s with dementia and a broken bone. He hadn't, in Geoff Perkins' view, been fully prepared for anaesthesia.

Jane: So that would have made Geoff very angry, and he went down and spoke to the director of anaesthetics.

Ann Arnold: Who he already had a testy relationship with.

Jane: Oh very testy, very testy. Geoff avoided talking to him. But he went and saw him, in the theatre suite, and was very angry and said he would not anaesthetise this patient. And what's more, he'd had enough, he was fed up, he was out of here, and that was it. He left the hospital. He went home and he committed suicide.

Ann Arnold: Jane would later make a workers' compensation claim through the Queensland Industrial Relations Commission. The claim was unsuccessful. The commission found that Geoff Perkins' employment was not a significant contributing factor to his death.

In those proceedings, a statement was provided from the Gold Coast Hospital director of anaesthetics, Dr Kerry Brandis, who Geoff Perkins had clashed with. This is a reading from his statement:

Reading: Geoff could be a prickly individual. In the past there were frequent complaints about his behaviour and rudeness by staff.

Ann Arnold: In the statement, Dr Brandis said that on that fateful morning, Geoff Perkins had sought him out and made a heated complaint about the anaesthetic plans for the elderly patient.

Reading: This didn't actually take long, maybe a few minutes. Finally he backed off and said something like, 'Well, that's it. I'm sick of this place and what happens. I'm sick so I'm going home.' I remember he kind of threw up his arms in the air a little and walked straight into the change room.

Ann Arnold: Geoff Perkins' widow Jane struggled to reconcile accounts of Geoff at work with the man she knew at home. She said he was never demonstrably angry, but had been quieter in the year or two before his death.

Jane: I was unaware that Geoff was depressed. After he died I spoke to a lot of people that I knew. I just couldn't understand what had happened. And I was told by a lot of colleagues that he was depressed at work. They all knew. They all knew not only that he was depressed but one of them even told me that in the last year he hadn't coped with all the changes that were taking place in preparation for moving to the new Gold Coast University Hospital, a new big site. He just wasn't adapting to the changes. They knew that. But nobody did anything. Nobody said he's becoming depressed. Nobody thought to ring me or ask me if I had noticed any difference.

Ann Arnold: Jane believes the hospital should have been addressing mental health issues for staff all along.

Jane: It was never talked about at meetings, that anxiety, depression, upsets, stress, they can all gradually get you down. And they needed to make sure that they knew they could talk to somebody, find somebody they could talk to. And if it became apparent that that wasn't enough, something else should have been done. Somebody should have approached him. Or me. The brakes should have been put on somewhere. Because I would have thought Geoff's mental state was very relevant to an anaesthetist who is putting people to sleep and waking them up.

Ann Arnold: A Gold Coast Hospital statement to Background Briefing said that the hospital has an Employee Assistance Program offering free counselling, and they now an annual R U Okay Day.

At the smaller Tweed Hospital, where Geoff Perkins also worked, there was a more direct response to his death. Fellow anaesthetist Ian McPhee, having had his own experience of depression, instigated a get-together.

Ian McPhee: We got together, as I guess Australians do, at the pub for a drink, and just acknowledged where we all were in life. It was very heart-warming I've got to say. I was very touched by the emotion that was generated across the clerical staff, the nursing staff, the medical staff. It was quite something.

Ann Arnold: And all people who are normally focused on looking after other people.

Ian McPhee: Correct. Often to their own detriment.

Ann Arnold: Soon after this, Dr McPhee says, the new resolve to look out for each other was put to the test.

Ian McPhee: Very encouragingly one of my more senior registrar colleagues came to me with a concern about one of our registrar colleagues from another discipline, saying that she was worried that this young fellow was essentially on call 24 hours a day, seven days a week. And I think as a mother herself she could see that this young fellow was losing out on contact with family and friends and finding himself completely isolated to what was a very cold clinical environment.

The outcome was that I alerted the head of department and the executive of the hospital to the circumstance, both grateful of having this called to their attention. And within a week things had changed. Rosters were altered, there was time made available to him to fly to Melbourne and catch up with his clan. He was a fellow working a two-hour flight away from family and friends.

Ann Arnold: But he was working around the clock.

Ian McPhee: Around the clock.

Ann Arnold: The Beyond Blue study of doctors' and medical students' mental health found that the biggest barrier to doctors seeking help was the potential loss of confidentiality and/or privacy. 52% of the 12,250 doctors who responded to the survey cited this fear. Little wonder there are concerns about mandatory reporting.

Being reported to the regulators—the Medical Board and AHPRA, the Australian Health Practitioners Registration Authority—could lead to suspension, or to conditions being placed on a doctor's practice. This information, in general terms only, goes on the AHPRA public website. Mandatory reporting of medical colleagues was brought in after some high profile cases shook public confidence.

Lawrence Springborg, opposition leader [archival]: There is no doubt that Queensland Health and the Beattie government knew in 2003 about Dr Patel.

Toni Hoffman, whistle-blower nurse [archival]: I just said to him at that time that we have to do something about this, we cannot let this happen any longer.

Ann Arnold: In 2010 Dr Jayant Patel was found guilty of unlawfully killing three patients. He was initially sentenced to seven years jail. After an appeal, Dr Patel was retried and found not guilty.

Following Jayant Patel, there was Dr Graeme Reeves.

Journalist [archival]: He was known as the Butcher of Bega, and today there was a further development in the horrific allegations against the banned Dr Graeme Reeves. Five of his alleged victims spoke publicly about their suffering…

Ann Arnold: In 2011 Graeme Reeves was found guilty of assault on a patient in southeastern New South Wales. She was one of dozens of women who had complaints against him dating back 20 years.

Australian health ministers agreed on a range of new national laws and systems for doctor regulation. Mandatory reporting was one of them.

Dr Joanna Flynn, chair of the Medical Board of Australia, which oversees doctor regulation, said when it comes to doctor behaviour, there's no question mandatory reporting is important.

Joanna Flynn: In relation to doctors who have engaged in sexual misconduct or who are unprofessional or whose performance is very poor, the mandatory reporting issue, I don't think it causes problems, and it's an important public protection.

Ann Arnold: Dr Flynn, who's a general practitioner in Melbourne, says that reporting an impairment, however, is nowhere near as clear-cut.

Joanna Flynn: In relation to impairment (that is a doctor who may be because of a health problem not performing as well as they should), there is absolutely no doubt that if they're placing the public at risk they should be reported. But the fact that there is mandatory onus to report does create anxiety on the part of any practitioner who has got a health problem, at times dissuading them from seeking help in a way that is unfortunate.

Ann Arnold: An article published late last year in the Journal of Law and Ethics has been widely discussed in medical and legal circles. It argued there was no evidence that mandatory reporting of an impairment improves public safety, and that its introduction was a purely political response to some extreme doctor behaviour. The chair of the medical board Dr Flynn agrees with that point.

Joanna Flynn: The context that that article describes is correct. It was a political response to a concern that the public was not being adequately protected.

Ann Arnold: There is no quantifiable data that doctors are being deterred from treatment. But Dr Flynn said she is aware of and greatly concerned by the anecdotal reports.

Joanna Flynn: Absolutely. Because ultimately a doctor who is not in good physical and mental condition can't do as good a job as they would want to do and as the community deserves.

Ann Arnold: Ironically a system brought in, mandatory notification, brought in to protect the public may in fact be doing the public a disservice if doctors aren't getting help to get better.

Joanna Flynn: I think that's true. Mandatory reporting potentially is something which may aggravate the problem because people don't seek help.

Ann Arnold: A review of mandatory reporting and the other national regulations brought in four years ago has just been completed. It's not been made public. It will be tabled at the COAG Health Council meeting in April.

But there are many in the medical world hoping that the rest of the country will revert to the Western Australian model, where treating doctors don't have to report their doctor patients.

Back in 2010, the Western Australian Minister for Health, Kim Hames, accepted the argument put strongly by the WA branch of the Australian Medical Association, that it was important for doctors to feel safe in seeking treatment.

Kim Hames: Now, the difference that that makes is that we are getting doctors coming from other states who don't want to go to their doctor because they're fearful of being reported.

Ann Arnold: Do you know how frequently doctors are coming from other states for treatment in WA?

Kim Hames: No we don't, and it's all anecdotal because doctors aren't allowed to talk about their patients, but we do have doctors saying to bodies like the AMA that they have had doctors coming across for treatment, without being more specific than that.

Ann Arnold: The national mandatory reporting law was not intended to apply to doctors simply seeking treatment. It's only meant to apply when a health problem presents a clear risk to the public. But critics say the law is unclear, and that's why there's a prevailing fear of it.

At least two submissions to the review of national regulatory laws, seen by Background Briefing, argue for the national law to change to Western Australia's model.

Doctors can speak freely to their medical insurers. Two medical indemnity companies, Avant and MDA, have said in their submissions that doctors are reluctant to seek treatment for fear of being notified to the Medical Board. They advocate the rest of the country adopt the WA model.

The decision for the health ministers will mean weighing up both doctor and patient safety. WA's health minister Kim Hames says that's not easy.

Kim Hames: I have to say that at the time it wasn't just an easy choice to make. I was torn myself as a doctor between looking after patients and making sure they were protected and making sure doctors were prepared to seek treatment.

Genevieve Goulding: If you're not well, you can't possibly be delivering optimal care.

Ann Arnold: Dr Genevieve Goulding, an obstetric anaesthetist in Brisbane, is president of the Australian and New Zealand College of Anaesthetists. In the mid-1990s she co-founded a welfare committee for anaesthetists.

Genevieve Goulding: They have a public duty to be as well they possibly can, and that is physically as well as mentally, and emotionally resilient so that they can deal with the stresses of their working life and give optimally to patients, so that they don't harm patients. So it's turning it around from not what's best for…well, it is what's best for you, but in the long term it's what's best for patients.

Ann Arnold: But, Dr Goulding says, doctors make terrible patients themselves. They too often self-diagnose and self-treat. All doctors these days are urged to have their own GP, but that doesn't sit easily with some.

Genevieve Goulding: Most doctors are used to being in control, being assertive, making the diagnosis. You then have to put yourself into a more submissive position and put your trust in another person, and I think that proves quite difficult.

Ann Arnold: Genevieve Goulding is one of several senior doctors who chose to talk to Background Briefing about their personal experiences, for the benefit of other doctors. Dr Goulding developed a panic disorder some years ago, and it had just started to affect her work when a colleague stepped in. She had spotted Dr Goulding's distress at taking a commercial flight, and suggested she get help.

Genevieve Goulding: So she would ring me every few days and say, you know, have you been to see so-and-so yet. I'd say no I haven't got around to it, all the usual excuses, you know; I'm on nightshift, I'm too busy, I've got this and that to do. People make excuses. So I put it off and put it off and then finally did so and it was very rapidly managed and controlled.

Ann Arnold: Dr Goulding is urging doctors to accept help when someone does intervene.

Genevieve Goulding: So if you get a tap on the shoulder, it should not be seen as a criticism, it should be seen as someone trying to help you because you can't really look after yourself and treat yourself.

Ian McPhee: What happened was that I became unable to function. I was mentally and physically crippled. I knew that there was something wrong, I didn't know what it was. I had to stop work. I recognised that myself. And I reached out to the only source that I was aware of of support and that was the Doctors' Health Advisory Service. That was a lifeline.

Ann Arnold: There's an anonymous doctors health advisory line in each state. Anaesthetist Ian McPhee was referred by the New South Wales service to a psychiatrist.

Ian McPhee: One of my psychiatrist colleagues was kind enough really to make a diagnosis of depression. It later transpired that there was a bipolar element to that too.

Ann Arnold: Ian McPhee reported himself to the then New South Wales Medical Board. And, he says, the experience of being monitored and having conditions placed on his work was a positive one.

Ian McPhee: I was placed very appropriately in the impaired registrants program of the New South Wales board. There is a huge commitment made by the board to impaired registrants. There is a regular schedule of meetings, they establish a mentor locally to refer to. And they keep a watch on how things are progressing for as long as it takes to have an individual regarded as fit to return to practice.

Ann Arnold: Ian McPhee's treatment included ECT, or electroconvulsive therapy. After that, he needed to be retrained at a major Sydney hospital where he'd worked previously.

Ian McPhee: Because one of the potentially disastrous effects of ECT was a complete loss of short-term memory. And when I say short-term it was a good three years of my life were literally removed from my memory. So I found myself walking into a hospital that I'd helped design for a rebuild, not knowing where my office was. It was a very, very distressing time.

Ann Arnold: Were you about to start work again at that point and realised, hang on, I can't?

Ian McPhee: No, I'd recognised that I would need to get back to familiarise myself with the fundamentals of anaesthesia.

Ann Arnold: So you had to learn the drugs all over again?

Ian McPhee: Not from scratch. It's the most curious phenomenon, I was able to be drawn back to recollections but they weren't spontaneous. I had to actually sit with a colleague, watch what they were doing, and then it was as if a light bulb went on and I could see, yes, that's what I used to do.

Ann Arnold: Was your name on a website that said you were impaired...?

Ian McPhee: Yes, it certainly was.

Ann Arnold: It didn't say what your impairment was, just said that there was a health issue?

Ian McPhee: Yes.

Ann Arnold: And that it was a conditional registration for the time being.

Ian McPhee: Exactly right, and my conditional registration was maintained for some years, until I was able to undertake an exit interview and I was released from the monitoring program. But I think that was the right thing to have had happen.

Ann Arnold: And did you feel humiliated?

Ian McPhee: Not at all. I was never made to feel humiliated by what was going on.

Ann Arnold: Anaesthetist Ian McPhee, from Tweed Heads in northern New South Wales.

Dr Mary Langcake is head of trauma surgery at St George Hospital in southern Sydney.

Mary Langcake: I myself as a trauma surgeon in one four-week period last year had to sit down with three separate families and tell them that their loved ones were not going to survive head injuries. That leaves a little part of you behind every time you do that.

Ann Arnold: Dr Langcake is president of the New South Wales Committee of the Royal Australasian College of Surgeons. She organised a forum late last year for fellow surgeons to discuss and learn about mental health issues. Mary Langcake says in her own case, she has been fortunate to have empathetic supervisors.

Mary Langcake: I had suffered from depression since I was in my early 20s. I went into surgical training in my 30s. In my second year of surgical training my marriage broke down, for a number of reasons, not all of it was related to the surgical training but certainly the hours and the stress contributed. And that triggered an episode of depression. And I spoke to the consultant with whom I was working at the time, and he sat me down and said, 'What can I do to help?' The way I approached it was to say, 'I'm struggling at the moment, this is what's happened in my personal life. And I have tried to keep going but I think it's important that I take a step back. I don't want it interfering with the job that I'm doing.' And he was kind enough to say, 'Well, we hadn't noticed,' which is always something that one worries about.

And then he sat down with me and we looked at what would be the right way for me to deal with this, and so some time off was arranged. And when I came back, one of the other consultants would bring me lunch. He would get his wife to make two lunches and we would sit and have lunch together. On another occasion he had a young son and his wife would bring his young son down to the beach one day a fortnight so that he could catch up with the pair of them, and he said, 'Come on, we're going down the beach,' and I was invited to go and have lunch down there with him. Little acts like that of support were quite surprising initially but really very welcomed.

Ann Arnold: In her current position, Dr Langcake has a particularly understanding boss, who has been able to recognise when she has been unwell.

Mary Langcake: For me I look very tired, and I actually tend to stutter and I normally don't stutter. I think she picked up that perhaps I was just slightly more edgy than normal. In addition, she knows that the end of the year marks the anniversary of my father's death some years ago and that that can be a difficult time, so I think she is always got an extra eye on me around about that time.

Ann Arnold: So that is a privilege, in a way, to be working with someone who knows you so well and knows that history. A lot of doctors wouldn't have that.

Mary Langcake: I think that's absolutely right, I am lucky in that regard, and that's why I say that other doctors ought to look at what they can put in place, absolutely necessary to have a good GP, perhaps necessary to have a friend as a confidant. The fact is that episodes of depression and anxiety and other mental illnesses occur and then may not occur for many years. So it's not like we're talking about doctors and/or surgeons who are constantly in this state.

Ann Arnold: Dr Mary Langcake.

The Melbourne psychiatrist Dr Helen Schultz who coaches and mentors trainees, urges young doctors to find those people who will be there to support them.

Helen Schultz: From what I've learnt through my training, the people that really know me as a person and all my secrets, vulnerabilities, et cetera, are people that I've very carefully sorted out and sought out, and that's been the lovely thing, I think, about getting to a senior registrar role and a consultant role is that those people are with you for the rest of your career, and they're the ones that matter. And they will be there for you; they'll be there for you for, I can guarantee, 15, 20, 30 years.

Ann Arnold: Background Briefing's co-ordinating producer is Linda McGinness, research by Anna Whitfeld, technical production by Leila Shunnar, the executive producer is Chris Bullock, and I'm Ann Arnold.

transcript of this program will be made available by the Tuesday following the broadcast.