OPINION: 'It's OK for a doctor not to be OK'

Socks for docs
Socks for docs

It all started with a doctor by the name of Toogood. In fact, Australian cardiologist Doctor Geoff Toogood, who in 2017 started the CrazySocks4Docs (CS4D) Day to highlight the mental well-being of his profession after he himself was on the brink of breakdown.

It has grown into an international campaign, in South Africa with the slogan "Caring4OurCarers", and under the umbrella of the Ithemba Foundation, a non-profit that raises public awareness of depression and related diseases as clinical diseases and therefore treatable. It's an illness, not a weakness, and the earlier the symptoms can be treated, the earlier one can learn to manage them, as with diabetes or asthma.

No stats for SA

According to research, one can safely state that the most unsafe profession – ironically – in terms of mental health is that of the health professions. In the USA one doctor dies of suicide every day. It is the highest suicide rate of any profession, with the number of doctor suicides in the USA more than twice that of the general population. Although there are no such specific statistics for South Africa, one can surmise that the same crisis among the medical profession exists in our country.

In fact, when I sent an article to local doctors that appeared in the UK stating that for doctors with mental illness "help me" can be the hardest words, the response was unanimous: In South Africa the situation is much worse. And: Here we do not even have a special division inside our Medical Association to support the medical profession, as in the UK.

One doctor who literally started to walk the talk through wearing mismatched socks (although the first time by accident), was Australian Geoff Toogood. He has lived with both depression and anxiety and faced stigma and discrimination on many levels, but was determined to create awareness to break the deadly cycle that so many of his colleagues faced around the world. He wanted "to make it OK for a doctor not to be OK", because medical professionals also face the full range of mental health issues. Indeed, doctors "are leaving the profession in droves or struggling under inhuman expectations and enormous emotional, legal and paperwork burdens".

According to one study, one in five doctors has depression and one in four has thought about suicide. And one in 50 has tried. In 2016 a study found that 50% of female doctors who completed a questionnaire met the criteria for a mental disorder, but were reluctant to seek help because of the fear of stigma.

'Don't wait until it's too late'

When Ithemba informally promoted Dr Toogood's CS4D locally last year – on the first Friday in June – it got such support that the Foundation decided to make it an official project for 2019. All evidence showed that those whom we depend on to care for us are suffering in silence. Indeed, this was tragically emphasised shortly after last year's CS4D when the dean of the Faculty of Health Sciences at the University of Cape Town, Professor Bongani Mayosi, died of suicide at the end of July.

Ironically, the South African Medical Association's Insider magazine dedicated that July edition to doctors and mental health. In his article, "Depression: Don't wait until it's too late!" psychiatrist Christoffel Grobler, associate professor at Walter Sisulu University, wrote about his own mental ill-health. He stressed that "If we in the medical profession can't talk about our own mental illness, how can we expect our patients to not be ashamed of theirs, considering all the stigma surrounding the subject?"

Globally, statistics drew a dismal picture of the medical profession's mental health state. A UK survey found that 68% of the study's respondents had depression, a Canadian study that 80% of doctors were suffering from burnout, and in New Zealand mental health problems are nearly three times as prevalent in general practitioners and surgeons than in the general population.

It was a case of "ditto" for such studies from across the globe, showing increased anxiety, depression and suicidality – also among medical students. One study found that around a third of South African medical students have suicidal thoughts and that over 6% of medical students attempt suicide.

Breaking the stigma

With our medical students already in the red zone, "Caring4OurCarers" therefore also wants our future doctors to get mentally fit – not only during their studies, but also for what awaits them afterwards during their internships. Mental ill-health is debilitating our medical students, as they cannot say "Help me", fearing they will be discriminated against.

To break that stigma and that silence, 10 000 pairs of fun and funky socks will be distributed this week to medical students in Health Faculties across South Africa, sponsored by sock manufacturer Falke, to wear coming Friday. For medical practitioners, pharmaceutical company Cipla has sponsored 2 500 pairs of socks.

Besides the medical profession being a highly stressful job, the culture of the health industry also needs to be changed. And we as patients need to show our support to those who care for us by "Caring4OurCarers". To show you care, check out your most mismatched pair of socks in time for coming Friday's CS4D Day. Let's put on our odd socks. Let's walk the talk. Let's break the silence. So come on, doctor, or sister, therapist, or nurse: encourage your patients and their families to care for you as their GP, or specialist, or nursing sister, or our student doctors. Join the conversation and help break the stigma. Because it's OK for doctors not to be OK.

- Lizette Rabe is professor and Academic Principal for graduate students at Stellenbosch University and founder of the Ithemba Foundation (www.ithembafoundation.org.za). Ithemba means hope in isiXhosa. The Hope Hike and Hope Bike are held annually in October, Mental Health Awareness Month.

Post your sock-selfie and win!

Anyone can get involved on Friday 7 June by posting a photo of yourself wearing mismatched, brightly-coloured socks and post your sock-selfie on social media with the hashtag #CrazySocks4Docs and #ithembafoundation. Medical students can even win R1 000 with their "sock-selfies" – just post your "sock-selfie" and encourage family and friends to "like" yours. On each of the participating campuses the "sock-selfie" with the most "likes" will win its owner R1 000.


CIPLA 24-hour mental health helpline on 0800 456 789 or WhatsApp 076 882 2775.

Lifeline 24-hour helpline: 0861 322 322








Van Niekerk, L. 2019. Suicidal ideation and attempt among South African medical students. SA Medical Journal 102, 1–5

Image credit: Supplied

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