Soundings Soundings

Postmenopausal doctors

BMJ 2002; 324 doi: http://dx.doi.org/10.1136/bmj.324.7346.1165/a (Published 11 May 2002) Cite this as: BMJ 2002;324:1165
  1. James Owen Drife, professor of obstetrics and gynaecology
  1. Leeds

    The medical menopause affects doctors of both sexes. It normally occurs in the mid 50s but its basis is controversial. Those who believe in a hormonal cause say it is the end result of decades of disturbed circadian rhythm combined with bursts of excessive adrenalin secretion. Others argue that it is psychological, triggered by reaching the horizontal phase of medicine's 30 year learning curve.

    In many cultures it is welcomed and the postmenopausal doctor (PMD) is valued for his or her wisdom. In Britain and the United States, however, attitudes are ambivalent. PMDs are appreciated by patients but not by healthcare systems. One of the features of the medical menopause is disinhibition, and the NHS has difficulty in relating to professionals who speak their minds.

    Self medication for the condition has been used for centuries but modern sufferers are particularly hard hit. In the early part of their careers they worked long hours to maintain the service while their seniors had a pleasant lifestyle. Now they work long hours to maintain the service while their juniors enjoy a pleasant lifestyle.

    In Britain, today's PMDs have worked throughout their careers in a severely underfunded service. When they pointed this out they were ignored. Indeed, the public was told that if only the doctors would work harder, the NHS would be fine. The recently announced cash boost will produce improvements shortly after these PMDs retire.

    Pharmacological treatments remain inadequately researched. Clinical opinion is divided between Highland and Islay malts on the one hand and claret and burgundy on the other. The most effective remedy, however, is surgical. Cutting oneself off from the NHS produces immediate and lasting relief of symptoms. Sleep and temper improve, the will to live returns, and the doctor alarms his or her friends by becoming cheerful again.

    The NHS, having previously encouraged such surgery, is now beginning to question the high rates. Britain needs more doctors and its major suppliers—developing countries—may not be able to cope. Stopping the haemorrhage of PMDs would help but cannot be achieved unless the system recognises and manages this treatable condition.