Editor's Choice

Doctors’ health matters

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2527 (Published 13 November 2008) Cite this as: BMJ 2008;337:a2527
  1. Fiona Godlee, editor, BMJ
  1. fgodlee{at}bmj.com

    When Kjell Magne Bondevik became severely depressed he discussed the problem with his colleagues, told everyone the diagnosis, announced that he was taking time off for treatment, and after a month made a full return to work. This story might not seem remarkable except for the fact that he was then the prime minister of Norway. In this week’s BMJ, David Owen, a former doctor and leader of one of the UK’s political parties, says that Bondevik’s frankness earned him the respect of Norwegians and helped fight the stigma of mental illness (doi:10.1136/bmj.a2486). Owen calls for similar openness about ill health from today’s national leaders, for their own sakes and because their electorates have a right to know.

    Although doctors are not under the same obligations of public accountability, they are responsible for lives and for the good standing of their profession. As a group doctors have more than their fair share of stress related health issues, with higher than average rates of suicide and drug and alcohol misuse reported in some countries. Michael Peters is the medical director of the BMA’s Doctors for Doctors unit, which provides confidential peer support for doctors. Interviewed in this week’s Career Focus (http://careers.bmj.com/careers/advice/view-article.html?id=3125) and in a BMJ podcast (http://podcasts.bmj.com/bmj), he says that “doctors are very reluctant to seek help for problems” and exist in “a culture of denial” with regard to their own health.

    Thankfully, as Joan Brewster writes in an editorial (doi:10.1136/bmj.a2161), society’s response to doctors in difficulty has moved from the disciplinary to the therapeutic. But evidence is limited as to which approaches work best. Three studies in this week’s journal attempt to fill this gap, and all provide grounds for optimism: where such doctors are identified and undergo treatment, outcomes seem to be good.

    Karin Isaksson Rø and colleagues followed up nearly 185 doctors referred to a counselling centre in Norway (doi:10.1136/bmj.a2004). Most were experiencing emotional exhaustion or “burnout”, a problem also discussed by Kathy Oxtoby in Career Focus (http://careers.bmj.com/careers/advice/view-article.html?id=3124). A year after receiving a short counselling course, the doctors reported lower levels of burnout, along with a small reduction in working hours. The authors make no unjustified claims for the programme in view of the study design, but they point out that the character traits that make some doctors vulnerable to depression are those that bring a capacity for empathy. “Support related to these personality dimensions would thus help doctors towards sound mental health in combination with good performance and empathic ability,” they say.

    The two other studies followed up doctors enrolled in physician support programmes in the USA (doi:10.1136/bmj.a2038) and Canada (doi:10.1136/bmj.a2098). All had drug and alcohol problems. Most completed the programmes and had favourable outcomes.

    Such approaches both reduce the suffering of ill doctors and protect the public. Next week in London an international conference will explore evidence, attitudes, and approaches to doctors’ health. Mike Peters hopes it will put doctors’ health issues “squarely on the map.”

    Notes

    Cite this as: BMJ 2008;337:a2527

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