Why so unhappy?
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7341.0/g (Published 06 April 2002) Cite this as: BMJ 2002;324:0-h
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Dear Sir,
For centuries the society and its doctors have maintained very cordial, noble, and devout ties with each other. But pestilence of petrifying moral values of our social structures seems to gnaw at the very root of this solemn and divine relationship. The common man has commenced to cast doubts upon doctors’ impeccability via newspapers, enquiry-columns, journals and dissertations. The contemporary patient is no longer prepared to regard doctors as panacea possessing ‘God’; instead he wonders in askance, questions his verity and castigates him on failures. We assume, it is a sign of social awakening and welcome it with pleasure.
In a similar vein present day physician also has no more inclination to live the destitute, impecunious life of a self-abnegating, sylvan monk. He is no longer bamboozled by the sententious medical ethics. The sallying storm of fast modernising social values has lifted him off the modicum ground and lodged him at the pinnacle of materialistic ambitions. Since, this is just another vicissitude of the turning time wheel, we must accept it gracefully.
Factually speaking, unless both, the common man and the doctor relinquish their peremptory stand in the dichotomy and yield to each other’s altered perspectives, a vicious cycle of bitterness may ensue and be unsavoury to both. Thus it becomes essential to understand each other properly. The administration, society and doctors should engage in a trialogue to sort out common misconceptions and understand each other’s expectations and responsibilities. Only then the doctors and society could once again be in better harmony and peace.
Umesh Dashora
Newcastle upon Tyne
Competing interests: No competing interests
Why do air-force pilots fail as commercial pilots? The slightest rough handling of a commercial airliner is sufficient to cause heart attacks in the passengers. The issue here is not the pilot's ability, but the confidence in the PASSENGER's MIND about the safety of the flight.
Our problem is similar. The issue here is not the doctor's intention (commercial exploitation of patients vs. justly needed diagnostics or therapy). But the issue is WHETHER THE PATIENT IS CONFIDENT ABOUT THE DOCTOR'S INTENTIONS?
The problem of placing absolute trust in the doctor is as old as the hills. The solution to this is also equally old.
Absolute trust demands a guarantee that there will be no conflict of interest on the part of the trusted party. The doctor has to provide an ironclad guarantee, that he is NOT motivated by any other concern EXCEPT the well being of the patient. The only way he can do this is by renouncing his material possessions. Which is why in our ancient social system, those who had already renounced their Material Possessions were ONLY allowed to enter the noble professions of teaching, law and medicine.
In today's material-possessions-crazy world, doctors want zooming bank balances, latest cars, social dignity, very good commercial lives, and on top of that they want the patients to trust them!
You can't eat your cake and have it too...!
How will the patient trust he is paying for a diagnostic-test which he really needs and not for the doctor's gasoline-guzzling car?
The world-wide interest in alternative medicines amply establishes the fact that the average man-on-the-street has lost confidence in the 'medical establishment' which appears nowadays to be more concerned with establishment rather than medicine.
The hard fact of the matter is that YOU CANNOT BE IN A NOBLE PROFESSION AND STILL PURSUE MATERIAL INTERESTS. A CONFLICT OF INTEREST IS BOUND TO OCCUR WHICH WILL SMUDGE THE SHEEN OF YOUR NOBILITY.
Pharmaceutical companies with aggressive commercial targets are the most to blame in this whole scenario.
In fact, if at all you locate happy doctors, you will find that they became happy only after they stopped worrying about their material lives. Which is probably why Ayurvedic doctors live longer and happier lives than their commercially successful allopathic counterparts.
Atul Kherde
Competing interests: No competing interests
EDITOR – There is a difference between unhappy and unwell. David Brandon, a mental health professional with first-hand experience of mental illness, wrote “we are happiest when unconcerned and not knowing whether we are happy or not” 1. Nigel Edwards 2, Chris Ham 3 and colleagues have elegantly illustrated the widespread unhappiness associated with the collective loss of confidence amongst, rising demands upon and growing conflict between clinicians. Where organisations like the National Health Service prove unsupportive of dedicated staff experiencing work- related stress, some will cross the invisible frontier into illness and potentially into life-limiting disability.
The Mental Health Foundation’s 'Out at Work' study has shown how frequently people struggling with mental problems conceal their illness from their employers. Medicine is not the only caring profession with a submerged population iceberg that might benefit from better occupational health services: in our study of nearly 500 social workers with depression, four fifths attributed their illness to work causes like “overload and exhaustion” 4. In public health terms, in the distinct population of doctors, generic employment initiatives like 'Improving Working Lives' 5 might succeed as health protection for clinicians who are now unhappy but well. However, just considering the common conditions of clinical depression or alcohol dependence (which increase measurable health risks for suicide, accidents, sickness-absence and a premature exit from the workforce) there are probably thousands of clinicians with unrecognised but treatable conditions in the UK today. There is a duty of care towards our colleagues. This year the BMA has been most supportive of our research efforts to understand those doctors who seek help for their psychological distress. However, except for anecdotal subsamples from the GMC and various specialist counsellors, we know practically nothing about that much larger population of doctors who are struggling to cope with a mental disorder invisible to colleagues, employers, patients and sometimes the professionals themselves. There is an urgent need to conduct
* a mental health needs assessment across the profession
* a scoping health impact assessment for early detection and intervention techniques within practice,
in order to plan an acceptable, responsive and effective service for sick doctors. The Department of Health consultation in 1999 Supporting Doctors, Protecting Patients assumed the equation sick = irresponsible or dangerous. Let’s just start with the assumption that sick = sick.
Woody Caan
professor of public health
School of Health Care Practice, APU, Chelmsford CM1 1LL
Judith Stanton
senior registrar in public health medicine
International Centre for Health and Society, UCL, London WC1E 6BT.
1 Brandon D. Tao of Survival. Spirituality in Social Care and Counselling. Birmingham: Venture Press & BASW, 2000.
2 Edwards N, Kornacki MJ, Silversin J. Unhappy doctors: what are the causes and what can be done ? BMJ 2002; 324: 835-8 (6 April).
3 Ham C, Alberti KGMM. The medical profession, the public , and the government. BMJ 2002; 324: 838-42 (6 April).
4 Manthorpe J, Stanley N, Caan W. Is depression a workplace issue ? Professional Social Work 2002; February: 12-13.
5 Abbott S. Valuing doctors. NHS Magazine 2002; April: 22-23.
Competing interests: No competing interests
Mutual trust is an important attribute in doctor-patient relationships. This trust has been eroded by medical insurers warning doctors of malpractice explosions caused by litigious patients. Further one insurer attracted members by reminding doctors that they are blameless, and it would do everything to ensure that they are seen to be blameless. Brainwashed, doctors whose treatments have less than perfect outcomes become anxious, depressed and guilt-ridden. Many years ago, an Australian medicolegal expert revealed that in Australia, at least one doctor committed suicide every year following malpractice claim. Just one question, please: why would doctors kill themselves if they receive excellent defence from their insurers? With respect, in some cases, medical defence and protection is neither comforting nor ethical. Some deserving patients have been denied equitable damages because medical defence succeeds much more often than fails. My studies of reported medical negligence cases have shown that medical insurers have defended the indefensible with unbelievable ease through, amongst other strategies, putting up a defendant as an independent expert. Ethical doctors are not impressed. They would be a lot happier if insurers respect their opinions, and provide more effective counselling if and only if ( not when) they are sued.
Competing interests: No competing interests
A solution to this issue...
We all understand the problem. What is the solution? Actually, the solution proposed in the 'CAKE' letter above seems to be too theoretical in the present context. We are surely not having doctors renouncing their cars and property on their own.
However, a practical solution (albeit a longterm one) on the same lines, would be to neuteralise the differences arising out of material possessions in doctor's lives. This can be done by giving a fixed salary to all doctors regardless of their age, experience and expertise. Anyone whose intention is merely to make money would then choose other professions which would be more amenable to making tons of money. Medical profession should remain one of service without consideration (payment).
The differences in the level of skill, expertise and knowledge would immediately be apparent by the degrees of respect and admiration shown by students and patients towards the better (and not so good!) doctors. Recognition of excellence in performance would come in non-material forms.
This would require some very strong legislation. However, if we have come to a point where we are openly admitting our inability to deliver as per the expectations and even trying to rewrite the social contract...then let us also remember that path-breaking things are always seen to be impracticable and absurd in the first place. They become path-breaking later on after they become successful.
Thanks
Competing interests: No competing interests