The caricature of the egotistical, authoritarian and overbearing consultant surgeon (most strikingly embodied, perhaps, in Richard Gordon's larger-than-life fictional Sir Lancelot Spratt) has dominated the public perception of hospital consultants for several generations. But, entertaining as such caricatures may be, they are not representative of the medical profession as a whole and serve to obscure the fact that there are high levels of altruism, as opposed to egotism, to be found in a majority of doctors. Indeed, altruism has been speculatively proposed as one of the factors in a doctor's life which gives the medical profession a higher-than-average suicide rate among the general population.
It will have come as no surprise, therefore, to hear from the annual conference of the Irish Medical Organisation (IMO) in Killarney over the weekend that women doctors are more than four times more likely than women in other professions to commit suicide. It was almost to be expected that this should be the case, but that is not to say that it should be a matter of no concern. Quite the contrary, given that a majority of students entering medical schools in Ireland now are women and that they are more likely than their male counterparts to gain honours in their examinations. Yet, as was further pointed out in Killarney, women are very significantly under-represented among the top ranks of hospital consultants.
A great deal more research, and more precise research, is needed further to elucidate the phenomenon of suicide among doctors - both male and female - with a view to identifying the causative factors and preventing the tragedies. But it would seem, even on the anecdotal and impressionistic evidence available, that there is need for some restructuring of the profession as it now stands simply to afford female doctors greater opportunities for promotion and fulfilment. This will not be likely to affect the suicide rates, of course, but should better and more fairly reflect the gender balance within medicine. And it might be that, with more women at the top of the profession, the current unfair structures could be more easily changed.
There is clearly an urgent need for change in the training structures, particularly at post-graduate level. There is a need to alter the proportions of consultants and non-consultant hospital doctors in both teaching and non-teaching hospitals. And, as the IMO conference was also reminded, there is long-overdue need to reduce (probably by way of legislation at this belated stage) the hours of work demanded of non-consultant doctors in the hospital services. This issue, which can be as damaging to patients as to the younger doctors who may be called upon to treat them in a state of mental and physical exhaustion, must be confronted and dealt with. It has been under active discussion for decades without any practical steps being taken to end it and the situation remains disgraceful.
It is up to the medical profession collectively to set about remedying the problems outlined in Killarney. Internal power-plays must be set aside and personal territorial imperatives must be overcome. Youth must be respected and better protected by the senior establishment. And if the doctors cannot or will not effect a cure for their professional problems, the State may have to intervene.