Since my last blog (“Mental health issues among medical students“), I have been thinking about how mental health issues affect doctors. If such issues arise among medical students who have not yet stepped into the working world, what about doctors who have dedicated decades of their life to the medical profession? Through looking into this issue, I gained a small but crucial insight into the often closed door of mental health among doctors.
I came across a survey conducted by the Medical Protection Society (MPS) this year. The survey revealed that of the 631 MPS members who responded, 85% were experiencing mental health issues. Stress, anxiety, low self esteem, and depression were commonly reported. Thirteen per cent of doctors admitted to having suicidal thoughts (which is similar to the percentage of medical students in the Student BMJ survey—14%). The survey illustrates that mental health is a serious issue among medical professionals. Furthermore, it supports the literature that doctors have exceptionally high rates of mental health problems.
A number of occupational risk factors were identified from the survey. The length of working hours, a large workload, as well as criticism (including involvement in a negligence claim), and high levels of regulation were reported. More than 70% of respondents felt that long working hours and an increased workload were contributory causes to their ill health. Again, this correlates with the existing literature. Other occupational risk factors identified from the literature are high and possibly unrealistic expectations placed on doctors by patients, and the emotional nature of the job (for example, the frequent exposure to suffering and death). Doctors are also likely to have individual risk factors (perfectionists, obsessive compulsive traits) that may make them more susceptible to becoming mentally unwell.
It was also interesting but disheartening to read that 41% of respondents did not reveal their mental health issues, either because of the stigma attached (24%) or because they felt they did not require help (58%). This is not an uncommon finding among doctors. Some MPS members stated that their mental health affected their ability to empathise with patients (36%) and also their ability to concentrate (60%).
These figures further reinforce the fact that mental health is often not discussed in the medical profession and when it is there is a fear of the stigma attached to it. This means that doctors may not seek help and can pose a risk to themselves as well as to their patients, which I find very troubling. Unlike physical illness, which is obvious to see, mental health issues can often be hidden by the individual who may be in denial or in some cases even unaware that they are suffering with an illness.
I recently read an internal review of the General Medical Council’s (GMC’s) fitness to practice procedures during 2014. It detailed several problems with the GMC’s investigation process and made several recommendations for improvement. During 2005-13, there were 28 reported cases of suicide by doctors who were undergoing fitness to practice procedures. A large proportion of these doctors had a recognised mental disorder. Personal circumstances, such as bereavement and financial issues, were also contributory factors to the doctors’ suicides.
Several important worries were raised about the investigation process. Firstly, the incredibly long inquiry process (some cases took longer than others depending on the situation), which can cause more upset to the doctor in question. Doctors reported feeling “guilty until proven innocent” and a lack of acknowledgement of their illness by the GMC.
Other issues were the inflexible nature of the process, zero to very high levels of correspondence (with lots of legal terminology), and failure to involve the doctor’s medical supervisor who may have referred the doctor in the first instance. The recommendations included: ensuring the correspondence was understandable, without legal jargon, and by phone in addition to letters; greater inclusion of medical supervisors where appropriate; and employment of a senior medical officer to oversee the cases.
Poor mental health can have devastating effects. It is a tragedy that doctors are afraid to seek help for fear of negatively affecting their career prospects or possibly being seen as weak by colleagues. With adequate support, doctors can manage these illnesses and continue to provide excellent care for their patients.
There are a number of complex issues that impede doctors seeking help, one of which is stigma, and until this is erased or at least lessened mental health problems will continue to be hidden. We all have a duty to each other, as well as to our patients, to ensure that medical professionals with mental health problems are supported as much as possible so that they live happy, healthy lives. There are support services out there and it is imperative that these are made known, (see below):
• Guidance from the GMC for medical schools to support students with mental health conditions.
• The Practitioner Health Programme (NHS). This is a confidential service for doctors and dentists with mental and physical health conditions.
• MedNet is a confidential service for doctors and dentists with mental health conditions, based only in London and for professionals in training programmes managed by the Local Education and Training boards (LETBs).
• The Sick Doctors Trust is another confidential service aimed at those with addiction to drugs and/or alcohol.
• The BMA counselling and Doctor Advisor Service offer a free telephone consultation service to doctors.
• Interesting case studies from doctors who have left the medical profession and the mental health problems they surmounted.
Patrice Baptiste completed the foundation programme this August and is currently taking a year out of training.
Competing interests: None declared.