Socks 2 B U
A critical review of Crazy Socks 4 Docs and how we tackle mental health among doctors
Trigger warning: Discussion of suicide, mental illness and the wellbeing industrial complex
“So, nurses, pharmacists and physios all get one day a year to celebrate their profession, and we get one day a year telling us to stop killing ourselves?”
This is how one follower put it, when I put out feelers trying to get an idea of the vibe out there in relation to another year of Crazy Socks 4 Docs.
I remember being a medical student when Crazy Socks 4 Docs came into being: a single day in a year, designed to raise awareness of the disproportionately high rates of physician mental illness and suicide. I recall the messaging being pretty clear back then, hell, I even put on a pair of mismatched socks and made an Instagram post. What else could I do? And year on year, the day continued and became associated with morning teas and occasional speaking events (neither of which I, nor many others I know, have ever been able to attend, due to the demands of, well… you know… work).
The intention behind the initiative is undisputedly good. Founded by a cardiologist in Melbourne who had struggled with stigma and discrimination based on their own experiences of mental ill-health, the ‘awareness movement’ wants to ‘support tangible positive outcomes for doctors’ wellbeing’.
By now, I’m assuming some prior knowledge of this yearly campaign – and apologies to my international readers/followers who probably don’t even know what a sock is and call it a foot-glove or something (I’m looking at you, Canadians). Essentially, one day a year, doctors will be called upon to wear mismatched, preferably colourful or highly patterned socks in order to create an instagrammable nugget of social media activism and a ‘water-cooler’ moment: a way of breaking the ice in discussing our profession’s declining mental health.
Except…
I wonder if it really does this.
No doubt, the dress-up component provides a ripe opportunity for gaining social currency in the market of performative pseudo-activism, but does it really provide a platform for change? Or are we all buying into a Happy Socks-sponsored medical Halloween and we are all of us being tricked, rather than treated? Try asking your colleague that at the water-cooler.
When I reached out to my followers earlier this year asking them for their thoughts, the majority were equivocal or wholly negative. “I’m so conflicted,” one follower told me, “I’m supposed to organise it at my hospital and I do it with a deep sense of ennui and self-loathing.”
Another: “The CMO told me off for having boring socks on (tears). Thanks boss, you cured my depression!”
“Co-opted by corporate entities that use it as window dressing that fails to do anything but ‘raise awareness’.”
At one major hospital, the promotional material actually forgot to put ‘4 Docs’ on it, so it just read ‘Crazy Sock Day’. The morning ceremony was spent reporting the percentage of completed discharge summaries and other KPIs.
Acknowledging the likely biased nature of my impromptu poll, and the fact that most of my followers are probably the cold-hearted, cynical audience my shitposting attracts, this at least confirms my intuition that there was growing awareness of the limitations of… er… raising awareness.
A mental exercise for you playing along at home: what tangible initiative has your hospital or institution put in place that has positively improved your mental health, or that you could imagine improving the mental health of a colleague?
If you’re having difficulty finding an answer, you’re not the only one. I have personally been offered several yoga sessions that would require me to be at work either an hour early or an hour overtime. No thanks!
How many times have you heard the word ‘resilience’ mentioned in the mental health discourse? Other than being a covert way of our employers telling us to simply ‘stop being depressed’, it places the enormity of the industrial, societal and cultural pressures that feed in to tipping a vulnerable person over the edge, back onto the individual.
Moreover, have we been able to measure any actual reduction in rates of suicide among our colleagues since hospitals became clued up? An analysis of the Australian data on health professional suicide in the last two decades has identified a worrying trend of increased rates of suicide among female doctors (from 3.1 to a staggering 15.0 per 100,000 person years), while rates among their male colleagues have remained static. As Petrie et al. explains, “One possibility is that the systemic and professional changes that have occurred in medicine over the last two decades have disproportionately impacted women. Traditional medical models of training and work were designed for men with limited family or caring responsibilities outside of work and have been slow to adjust to the changing demographics of the workforce. Increased workload, work–life conflict and time pressure, combined with less job security, reduced autonomy and increasing administrative burden, have been described as occurring in almost all developed healthcare systems.” (1)
But the data analysed only goes as far as 2017, leaving the mystery of what has actually happened to the stats since we started being offered all these yoga sessions?
An article published last year in the Medical Journal of Australia by Wijeratne et al. summarises the ‘action’ taken by our employers so far.
“To date, the approach to managing this problem has prioritised educative approaches promoting individual resilience, self‐care and self‐awareness over tangible systemic and cultural change that enhances wellbeing and supports health access. At the organisation level, individual colleges and employers have endorsed disparate and uncoordinated initiatives, ranging from altruistic grassroots interventions to reactive administrative responses. Uncoordinated initiatives with unknown outcomes have been the resulting legacy.” (2)
It would be foolish and unfair to expect a separate corporate body, including well-meaning charities such as Crazy Socks 4 Docs, to fix the problem for us. Neither will simply being ‘nice’ to one another, or ‘nice’ to ourselves. I can only really think of one strategy that has led to tangible good in the time I’ve been working in healthcare: the Enterprise Bargaining Agreement. The ability for a union or association that represents doctors being able to demand change in workplace relations, from fair hours to fair conditions, has placed meaningful power (and I don’t mean ‘resilience’) back in the hands of the workers themselves. And perhaps its scope needs to be widened to include the ever-increasing competitiveness of training program entry, the arbitrary yet mandatory requirements for career progression, and the exploitation of the burgeoning ‘unaccredited trainee’ workforce.
I am writing this at a time when there has been another notable case of a doctor taking their own life in Victoria, adding extra urgency to the discourse. At the individual level, it is an unspeakable tragedy. At a national level, it is a huge system failure.
We need to stop being seduced by attractive ‘awareness’ campaigns that organisations can hold up as hollow and cost-effective examples of unproven success and demand real change.
If you have been affected by issues raised in this article, please seek help and consider talking to someone via the following resources:
Lifeline Australia: 13 11 14
Suicide Call Back Service: 1300 659 467
Beyond Blue: 1300 224 636
References:
(1) Petrie K, Zeritis S, Phillips M, Chen N, Shand F, Spittal MJ, Harvey SB. Suicide among health professionals in Australia: A retrospective mortality study of trends over the last two decades. Aust N Z J Psychiatry. 2023 Jul;57(7):983-993. doi: 10.1177/00048674221144263. Epub 2023 Jan 19. PMID: 36655674.
(2) Wijeratne C, Kay MP, Arnold MH, Looi JC. Australia needs to implement a national health strategy for doctors. Med J Aust. 2022 Oct 3;217(7):338-341. doi: 10.5694/mja2.51714. Epub 2022 Sep 7. PMID: 36069157; PMCID: PMC9825878.
Couldn’t be better said. Also, full support from the MDT on this (in this case, nurses), as far as honestly, all of us feeling the performative BS nature of all of it - whether it’s socks for docs or ‘nurses day/week/month/blah blah’. I can’t think of a single ‘celebrate the nurses’ day where I’ve actually made it for the health-and-wellness-restoring, burnout-curing, free pizza or burgers (although I did walk by once, on my way to from one ward to another, having missed lunch, and noticed all the exec team there!?!? HA! Sounds right. The high-pressure to comply and celebrate ‘it’s YOUR day! Take care of YOU! Have YOU accessed your EAP support?? Have YOU done your ‘take a minute to breath and have a snack’ (as per the poster by the urinalysis machine, which is, you know, in the pan room…a great place to not breathe deeply…) — harped on during every handover/scrum during the aforementioned day/week…while the rest of it is spent talking about how people are ‘misusing the reporting systems’ and ‘if you haven’t taken your tea break at 9:15 when your TL says to, there will be consequences, we don’t want to treat you like children but…and also, bloods and ECGs are not being done in a timely manner…’
Yeah.
Crazy socks, like so many of these initiatives (minus EBs!) - noble thoughts behind. Useless without actual systemic changes. I think it says a lot that doctors and nurses I work with find more validation, catharsis, and support, via insta/sub stacks like this, than through the ‘have you picked up your Thank You pebble and fortune cookie?’ Initiatives…
<3 anyway. Keep up the amazing work. In the words of last night’s (regrettably somewhat delirious) patient: ‘I can’t believe there aren’t more staff. You should all get raises. Those fat cats sitting up there are all the same.’ Maybe he wasn’t that delirious…