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At the heart of general practice since 1960

I failed to spot I was cracking up

Dr Simon Atkins describes how he was in denial about his breakdown

Dr Simon Atkins describes how he was in denial about his breakdown

In 2001 my life was turned upside down when, out of the blue, a previously undiagnosed cancer crept up on my father and in four short weeks the life was sucked out of him.

As I sat by his hospital bed and watched him dying I felt completely helpless. Here I was, a doctor, and I could do nothing at all. I felt I was letting him down.

The suddenness of it all left me reeling. Back at work the experience began to eat into my confidence. If I could let my own father down and miss his diagnosis how many more diagnoses was I missing in my patients? How often was I letting them down too?

Crisis of confidence

Anxiety began to invade every second of my working life. I would question every diagnosis. I worried that I had not referred people I had said I would.

I checked and double checked that they had been for the blood tests or x-rays that I had ordered (even to the extent of phoning them to check they had followed my instructions). The job is busy enough without generating this extra work and I became tired and run down with the stress of it all. And feeling below par just exacerbated the anxiety to crisis levels.

As a result I would wake every morning with a feeling of sickness in the pit of my stomach.

My heart would race and my bowels would eject their contents with all the rapidly and force that the fight or flight response can muster. It felt like every drop of my blood had been replaced by neat adrenaline.

My partners began to notice my symptoms when I would run case after case past them. But I ignored their pleas to slow down and get some rest. I am a doctor, not a patient and we don't get ill! We are not made of the same flesh and blood as mere civilians.

But my symptoms became so extreme that I literally began to crack up. And one day on call when the mounting pressures of a normal busy day in general practice added to my extra self-generated work I just wanted to get under my desk, curl up in a ball and sob.

Under strict instruction from family and colleagues I finally made an appointment to see my own GP.

She was fantastic and after spending more than my allotted ten minutes discussing my symptoms and allowing me to be a patient, she sent me away with a sick note, a prescription for citalopram and the details of the Avon GP support scheme.

But despite my med3, I still turned up for work the next day, afraid of the stigma associated with being on the club; of being known as ‘that doctor who had the nervous breakdown'.

But my partners, who were extremely supportive, insisted I took as much time as I needed and I headed home for the next four months.


Turning the corner


During that time I benefited enormously from the cognitive behavioural therapy I accessed via the support scheme, from the ability to take time out and reflect on the effect of my father's death and despite their early side effects, from the SSRIs. The drugs do work after all!

The experience taught me a lot about myself as a person but also about myself as a doctor. We are not immune from illness, mental or otherwise, and we can be hunters who become the hunted.

Our greatest weakness as a profession is that we find it so hard to admit that. At worse we ignore it; at best we self medicate with either prescription medicines or at the off licence.

But it is vital we pick up the signs of stress in ourselves and colleagues and face up to them before we do have the breakdown we kid ourselves can't possibly come our way.

My own symptoms were those of anxiety but others include:

lack of concentration, poor timekeeping and productivity, irritability and aggression with practice staff or patients, withdrawal, change in personality, increased cynicism about the job or patients and increased tendency to make mistakes.

The stress can affect the doctors relationships at home with their family and increasing tensions there may become obvious, they may be late for work or spend ever increasing amounts of time at the pub.

Spotting the signs

A colleague who takes longer to finish surgery, doesn't come out of their room to chat over coffee and always seems distracted is heading for trouble and these changes which soon become obvious to everyone they work with, should not be ignored.

As individuals we also need to be more self aware and dispense with the notion that as doctors we are somehow invincible to the ravages of human disease. We are the same species as our patients and life events can affect our mental health in the same way as it can theirs.

I chose to ignore the significance of my symptoms for that reason alone not because I wasn't aware of them.

Because they were extremely intrusive and disabling. And if a patient had come to me feeling the same way I would have offered treatment immediately.


If I had that time again, I would seek help much earlier and try and adopt strategies both at work and home to diffuse the stress which crippled me.

Alerting colleagues at an early stage can allow your workload to be altered to relieve pressure. Surgeries could, for example, be arranged to have breaks in the middle or longer appointment times. Partners could help by temporarily sharing your paperwork, on call responsibilities or management roles.

There's evidence that exercise can help mental health and that was something that my psychologist advised I should do. I took it to extremes and entered and trained for the London Marathon. But any exercise will have the same effect and I certainly felt it helped me with my anxiety, even if it was a bit tough on the quads.

Where to get help

Seeing a GP is also a good way to access other help and support and provides the possibility of medication (that doesn't come in a corked bottle) and a sick note. Removing myself from the stressful situation by taking time off was a lifesaver, even if I did agree to it reluctantly.

And counselling and psychotherapy can also be beneficial.

They are not a lot of mumbo jumbo given for and by woolly minded weaklings. They provide an opportunity to confront issues and change unhelpful mental attitudes which are fertile soil in which stress can grow.

Studies repeatedly show that stress is endemic in general practice but it does not have to be crippling.

We owe it to ourselves and our patients to get over our belief that somehow our white coats protect us from illness and to confront symptoms in ourselves and our colleagues as soon as they manifest themselves. It's now six years since the time I was ill with stress and I don't ever want to go back there.

Dr Simon Atkins is a GP in Fishponds, Bristol

Dr Simon Atkins: was initially in denial about his breakdown Dr Simon Atkins

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