The Hospital Hoax – what does it really reveal about us?
Raj Persaud and Nicholas Morris
In our opinion respect for caring professionals such as nurses and doctors has long been on the slide. The fact a nurse and a seriously sick patient can be viewed as targets for entertainment pranks, reveals how far we have sunk.
A celebrity is also not considered a human being, even when ill, therefore they remain fair game for amusement. The fact the media chose to exploit the pregnant daughter-in-law of the late Princess Diana, is more than just thoughtlessness; it raises serious concerns and reflects wider issues. Public figures remain targets whatever the consequences.
The incident may also be revealing the stress that health care professionals endure, but usually remain tight-lipped about. Perhaps because outwardly doctors and nurses must usually roll up their sleeves and carry on, so the public remain naive about what it’s really like on the front line of clinical care today.
The Bureau of Labor Statistics in the USA recently showed the most common victims of workplace assaults, across the whole nation and all professions, are nursing aides, orderlies, and attendants, accounting for 15.7% of all assaults by persons in any industry.
The Proportional Mortality Ratio (PMR) is a ratio of how likely a death in a given occupation is from suicide, as opposed to other causes, than a death of someone matched in age and gender in England and Wales as a whole. Howard Meltzer and colleagues, in a study entitled ‘Patterns of suicide by occupation in England and Wales: 2001–2005’, published in the British Journal of Psychiatry, found those working as health professionals had among the highest suicide PMRs for both men and women.
Meltzer and colleagues explain PMR is calculated by first finding the proportion of deaths in the general population from suicide. This is applied to the number of deaths in an occupation. An expected number of deaths from suicide can therefore be calculated. The ratio of the actual number to the expected number is multiplied by 100 to deliver the PMR.
Meltzer and colleagues clarify that a PMR of 100 indicates no difference in the ratio of suicide deaths to all deaths in the given occupation compared with the general population of England and Wales. PMR of 50 means chances of a death in a given occupation being due to suicide become half that of the general population. PMR of 200 indicates the occupation has double the proportion of all deaths certified as suicide, than expected from the proportion of the general population.
According to Meltzer and colleagues, in 2001–2005, health professionals had some of the highest suicide PMRs for both men and women: 164 among men and 232 among women. Suicide therefore becomes an important cause of death in these occupations compared with other causes.
Keith Hawton and Lida Vislisel, from the University of Oxford Department of Psychiatry, commented in their review paper entitled ‘Suicide in Nurses’ that nurses are one of the occupations at highest risk for suicide. Nursing suicides accounted for 5% of all suicides in women aged 16-59. Nurses were the occupation contributing the largest proportion of all female suicides in England and Wales during the period examined by the study. The suicide rate in nurses is the fifth highest of all occupational groups in the UK.
It is notable how much the caring professions feature high in the suicide ranking order. Vets, ambulance workers and doctors, according to some studies, suffer even higher suicide rates than nurses.
One theory for elevated suicide rates in professions like nurses and doctors is, besides high stress, these are people whose day job allows them greater knowledge of how to kill oneself. The same person suffering identical strain levels and suicidal intent, may not proceed to a final act if in a different vocation, given lack of competence in how to achieve the goal.
Another hypothesis is that the kind of person who becomes the most selfless pursuer of excellence in these ultra-responsible roles, can develop paranoid fears of letting people down, or of shame.
Hawton and Vislisel point out in their review, published in the academic journal ‘Suicide and Life-Threatening Behavior’ that a greater proportion of female nursing suicides (58%) in England and Wales between 1989 and 1992, were by overdoses, than was the case for all female occupational groups (47%).
These authors speculate that it’s possible the size or other aspects of the overdose, meant death was more likely, reflecting the greater pharmacological expertise of this group. There has been a previous study into eight nursing suicides in which they had all injected themselves with dangerous medical agents such as insulin and anaesthetic agents.
Professor Keith Hawton, Sue Simkin and colleagues from the Centre for Suicide Research at Oxford University published an investigation entitled ‘Suicide in female nurses in England and Wales’ where 106 nurses in England and Wales were compared with 84 living nurses to investigate what was it about the nurses who killed themselves, that made them different from nurses who don’t.
Hawton, Simkin and colleagues’ study, published in the academic journal ‘Psychological Medicine’, showed that the nurse suicides were significantly more likely not to have been living in their own home. They were more likely to have been living alone and to have moved house at least twice in the previous 5 years. All the living comparison nurses had at least one person they could confide in, but the nurse suicides were significantly less likely to benefit from this.
In terms of occupational stress, it is also intriguing, that in Hawton and colleagues’ research, the nurses who killed themselves appeared to differ from the living nurses in stress over excessive responsibility at work.
Hawton and colleagues also wondered from their research whether a possible factor in nurse suicides was whether those beginning to suffer from psychiatric problems which lead on to increasing their risk of suicide, were not receiving optimal health care.
In our experience doctors and nurses are neglected by health care systems and this problem is compounded because they frequently end up working and living in relative isolation (because they often live in hospital accommodation and do not have a normal family life).
Nurses, as well as doctors, are much more likely to kill themselves than most other occupations, and so the carers need caring, which is something that continues not to happen.
We wish those who work in the field, would offer more support for each other, and that the media would respect such caring professionals more, as they used to; and that could lead to more respect for patients too.
Raj Persaud is a Consultant Psychiatrist in Private Practice in Harley St London and Nicholas Morris is a Consultant Obstetrician and Gynaecologist in Private Practice in Central London.
Patterns of suicide by occupation in England and Wales: 2001–2005. Howard Meltzer, Clare Griffiths, Anita Brock, Cleo Rooney and Rachel Jenkins. The British Journal of Psychiatry (2008) 193, 73–76.
Suicide in Nurses. Keith Hawton and Lida Vislisel. Suicide and Life-Threatening Behavior, Vol. 29(1), Spring (1999), 86-95.
Suicide in Female Nurses in England and Wales.K. Hawton, S. Simkin, J. Rue, C. Haw, F. Barbour, A. Clements, C. Sakarovitch and J. Deeks. Psychological Medicine, Volume 32, Issue, 02 February (2002), pp 239 – 250.