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Independents' Day

GP stress: seeking help when you can no longer cope

To launch a short series on GP stress, Dr Chris Williams offers facts and figures about the problem and lists some organisations that can provide support for struggling GPs. See below for a list of organisations and contacts if you need help.

To launch a short series on GP stress, Dr Chris Williams offers facts and figures about the problem and lists some organisations that can provide support for struggling GPs. See below for a list of organisations and contacts if you need help.

The prevalence of common mental disorders in doctors is higher than the general population.

A survey of GP's in 2001 found that 21% experienced work related stress to be "excessive and unmanageable". Fifty five per cent considered that work impinged on their quality of life to an unacceptable extent.

The magnitude of addiction amongst doctors is estimated at 1 in 15. GMC data in 2001 showed that of the 201 doctors being supervised under voluntary health procedures or referred to the health committee, 199 were for alcohol, drug or mental health problems.

Compared with the general population doctors have an increased suicide rate. Moreover general practice as a specialty has a significantly increased suicide rate compared with general medicine.

It's not only the GP who suffers; their families do too. One study revealed that wives of GPs were four times more likely to commit suicide than other women.

Causes of stress

So what makes some GP's enter that world of despair, hopelessness and depression? Studies in the 1980's found that insecurity about work, isolation, poor relationships with other doctors, disillusion with the role of GP's and changing demands were contributory factors.

Little has changed it seems, in spite changes in working hours and the new GP contract. In fact one caller to Doctors' SupportLine stated that the lack of 24hour responsibility and increased earnings added to the stress. He felt the public were now more demanding and regarded being a GP as an easy number.

These days the cause of stress seems to be less the provision of emergency care and more increasingly inappropriate patient demands and increasing patient expectation.

This, together with managerial interference and a target driven and consumerist approach to medicine, has led to a whittling away of old fashioned trust.

Added to this is the worry caused by patient complaints and a feeling that the media is hostile to general practitioners, leading to a culture of blame.

Most GP's will have at least one complaint made against them during their professional life. The stress of receiving a complaint is well known in spite of help from the defence organisations.

Only ourselves to blame?

Of course some of the stress at work is brought on by the affected GPs themselves.

One study found that many of the main stressors are caused or perpetuated by the GPs' own policies: starting surgeries late, overbooking patients, making insufficient allowances for extra emergency patients, and allowing inappropriate telephone interruptions.

Partner and practice arrangements are very important. Another survey suggested that "practices which had equitable and inclusive partner and practice relationships, managed workloads better than practices that were a collection of disparate individuals."

Seeking help

How much stress is caused by the job and how much by the personality of the doctor?

It has been suggested that medical students' motivation to study medicine are due to unconscious neurotic drives and that it is a way of improving their own well being by healing others.

Psychobabble this may be, but research has shown that doctors tend to be perfectionists and highly self-critical.

With this background doctors are often unwilling to discuss their problems or to seek help appropriately. Instead they use a colleague for informal advice. And they self- medicate.

They fear seeking support will be viewed as a sign of weakness, or that their careers will be damaged by colleagues being aware of their emotional problems and by the stigma of mental illness.

So what are the signs and symptoms of stress? There's no need to list them to GP's.

We know all about that, we've passed that exam. But as Dr Simon Atkins wrote about himself in the Observer in 2003 when he became ill: "when it came to recognising the symptoms (of mental illness) in myself, I missed them completely, even when they were staring me in the face.

The most likely reason for this is that as a doctor, I subconsciously chose to ignore them. It couldn't possibly be happening to me. Doctors don't get ill like everyone else. We're special. But of course, we aren't."

So where can the stressed GP find help, who can he contact for support?

There are both national and in some PCT areas local support services.

Our experience at Doctors' SupportLine is that doctors are often initially reluctant to contact any ‘local' service organised by their PCT, in spite of reassurances of confidentiality, because of fears of disclosure.

Many of the support services for doctors set up by formal doctor organisations such as the Royal Colleges, including the BMA are often, rightly or wrongly, perceived to be seen by our worried colleagues as being in some regulatory capacity. With the result there are concerns about contacting even them.

The future

Doctors with emotional problems need easy access to support that will provide a safe first step to resolving their problems.

They want confidentiality and initially anonymity with skilled treatment and follow up services they can trust. Unfortunately, at the moment, such support is very limited.

However in February this year the mental health tsar, Professor Louis Appleby, produced the report "Mental health and ill health in doctors". The report and its recommendations are the findings of a group that considered what steps might make it less likely that doctors would become unwell and easier for them to seek help early.

Troubled doctors continue to call Doctors' SupportLine and other support organisations every week. Let's hope that as a result of the Appleby report increased appropriate national and local service provision for our profession becomes a reality.

Organisations available to support GPs Organisations available to support GPs

Doctors' SupportLine

A telephone helpline providing peer support to doctors and medical students who want to talk through work and personal problems. All calls are answered by trained volunteer doctors. Completely anonymous and confidential. Works with Doctors' Support Network
Tel: 0870 765 0001

Doctors' Support Network

Self-help group for doctors with any form of mental health concern. Provides an email support forum, local support meetings and a newsletter.
Tel: 0870 321 0642

Doctors for Doctors

A service run by the BMA for doctors and medical students. It deals with a wide range of problems including doctors who are suspended or going through complaints procedures.
Tel: 020 7383 6739

BMA Counselling

The BMA provides telephone counselling by qualified counsellors for members
Tel: 08459 200 169

Sick Doctors Trust

This independent charity runs a 24 hour helpline providing support for doctors who believe they have a problem with alcohol and/or drugs. The helpline is manned entirely by doctors.
Tel: 0870 444 5163

British Doctors and Dentists Group

They provide a network of support groups providing help for doctors and dentists recovering from substance abuse
Tel: 0207 487 4445


Run by the Royal Medical Benevolent Fund, it provides financial help for sick doctors who are unable to work. It also signposts to other organisations that can help.
Tel: 020 8540 9194

GP stress

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