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Supporting doctors with mental health problems

Compared with consultant physicians, we are more than three times as likely to commit suicide. GPs have the highest incidence of work-related mental ill health of any profession, with a rate more than 15 times the overall average.

Compared with consultant physicians, we are more than three times as likely to commit suicide. GPs have the highest incidence of work-related mental ill health of any profession, with a rate more than 15 times the overall average.

The practice of medicine is a privilege and can give us a great sense of achievement, but there is a darker side. Compared with the general population, doctors are significantly more likely to suffer from one or more of drug misuse, alcohol misuse and depression.1 GPs are particularly vulnerable; compared with consultant physicians, we are more than three times as likely to commit suicide.2

The recently published report by the Department of Health Mental health and ill health in doctors3 is therefore to be welcomed, even if there are no easy solutions.

Doctors have the highest incidence of work-related mental ill health of any profession, with a rate more than 15 times the overall average.4

According to Karasek's model, work stress results from a combination of high demand and lack of perceived control.5 Increasing patient expectations coupled with diminishing autonomy and control makes for a toxic combination.

A degree of obsessiveness is common among doctors and can help to make us both conscientious and committed. However, if excessive, it can lead to perfectionism and an intense need to feel in control.5 Empathic, patient-centred doctors experience more time pressures and consequently find their work more stressful.6 Some doctors depend on patient approval to compensate for low self-esteem and find it hard to resist unreasonable patient demands.5

The consequence of a demand-control imbalance for vulnerable doctors is likely to be burnout, with the attendant risks of depression and/or substance misuse. Depressed (but not burnt out) doctors are significantly more likely to make mistakes.7

Doctors are notoriously reluctant to admit that they have a problem. Sick doctors may fear being stigmatised as weak and inadequate and may also have concerns about confidentiality, GMC involvement and losing patients' respect.

Even if doctors do seek help, current services are often inadequate. Although most doctors are now registered with a GP, they may be reluctant to consult because of close professional or personal links. Most GPs have no access to occupational health services,8 and even if they are available, many occupational health staff have little training in mental health. Where doctors require specialist services, out-of-area care should be available, but many areas lack specific arrangements.

The most fundamental change required is a change in attitudes. The Department of Health report rightly recognises that medical schools have an important role to play in this. However, in my opinion the report itself has too negative an attitude towards vulnerable doctors. Mental ill health may result in poor performance and put patients at risk, but it is important to acknowledge that it is often the best doctors who succumb. Furthermore, doctors who have experienced mental illness may have a unique ability to empathise with, and help, mentally ill patients.

The report recommends that doctors treating other doctors should have appropriate expertise and seniority, local agreements should be in place to provide out-of-area specialist care and occupational health services should be improved and expanded.

All of this is laudable. However, I think more emphasis should have been placed on the important responsibility we all have towards our colleagues. In my experience, 360° appraisal can help partners to feel more valued and supported, and can increase awareness of behavioural changes that might indicate a colleague is in difficulty.

It is encouraging that a start has been made towards addressing the problem of mental ill health in doctors. Many of our best doctors are most at risk. We cannot afford to lose them.

Author

Dr Phillip Bland
BA BM BCh MRCGP DRCOG
GP, Dalton-in-Furness

Doctors have the highest incidence of work-related mental ill health of any profession

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