Being a doctor is all about control. Certainly, the expectations placed on doctors by themselves, their superiors, and the general public are enormous. Behind closed doors and with the knowledge you are going to be on call every night for one year (as is what happened to a surgical trainee I know well), between working sometimes sixteen-hour days, relatively paltry remuneration and extremely costly exams, is it any surprise that people then lose control? Be that with infidelities, abuse of drugs and alcohol, significant mental distress and, the worst case, suicide. I felt physically ill when the same surgical trainee told me on more than one occasion during this time period he had gone close to the roof of the hospital, with calm and clear intention to throw himself off.

The impact of superiors showing their juniors kindness and care cannot be overstated. I know this from first-hand experience. I was very fortunate to have some consultants who I trained under be extremely kind and supportive, and this, between having a close-knit group of friends I could be very honest with, made the difference between me finishing my training and going under, for want of a better term. It may come as a surprise to senior consultants or hospital administration how vividly their juniors recall a kind word, a signed overtime sheet, or just a sense that they have someone they can speak to who actually has the power to meaningfully assist them when they are feeling lost or isolated.

There is a kind of omerta that exists around the walls of a teaching hospital. Every now and again someone will break the silence and there will be shock and awe at the sudden window the general public is given into the mystical world of medical training, but the people who speak out know the cost at which their truth comes. The system promises change but the statistics surrounding junior doctor suicide and mental health remain dire. The flurry of responses to whistle blowers, if you want to call them that, dies down, and the cycle continues to perpetuate. This book I hope will contribute to breaking that cycle, and push towards meaningful and practical change. We are making steps, albeit small ones, to attempt to stamp out a culture of bullying, intimidation and unsafe working hours. Some hospital departments have had their training accreditations stripped from them until they improve the conditions their trainees work under, and I largely applaud this, despite the impact it undeniably has on doctors trying to finish their specialisation.