Doctors’ own mental health issuesBMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1238 (Published 16 March 2016) Cite this as: BMJ 2016;352:i1238
- Kathy Oxtoby, freelance journalist
Kathy Oxtoby investigates why so many doctors experience mental health problems
Life as a doctor can be stressful. The profession is not only physically but also mentally and emotionally demanding. This is especially true if doctors are working with limited resources, have little support, and are working in a constantly changing organisation.
“Work stress occurs when the demands and pressures of work outweigh our ability to cope as a health professional. As a doctor the job is often stressful because we have multiple important decisions to make with limited time and resources, and it can feel like juggling a number of plates,” says Jim Bolton, a London based consultant psychiatrist and member of the Royal College of Psychiatrists.
Surveys have highlighted just how stressful working in healthcare can be. A recent Medical Protection survey of over 600 members revealed that 85% have experienced mental health issues, with stress, anxiety, low self esteem, and depression being among the most common complaints.1 Doctors’ organisations have also expressed concern about the stresses members of the profession are under. Last year, a report from the Royal College of Physicians noted that 38% of NHS staff in England had experienced work related stress.2 The report also showed that less than two thirds of trusts (65%) have a staff health and wellbeing plan in place.
Last July, the Royal College of General Practitioners warned that fatigue among overworked general practitioners is becoming so prevalent that it could jeopardise patient safety. The college claimed that unrelenting and increasing workload pressures are pushing GPs to their limits.
Why are doctors feeling stressed?
Doctors experience mental health problems for many reasons. Bolton says factors that contribute to work stress include staff shortages, lack of administrative support, high patient demand, abuse and aggression from patients, inadequate facilities, and lack of management support. “And what comes out time and again is a lack of personal control over our work. The more we are dictated to, the less flexibility we have and the more stressful our job becomes,” says Bolton.
Rob Poole, professor of social psychiatry at Bangor University and chair of the Royal College of Psychiatrists, Wales, who treats clinicians with mental health issues, adds, “Not being able to take appropriate steps for patients is a major stress—and doctors talk about lying awake worrying about what’s happening to their patients because they want the best for them.”
Doctors use their own coping mechanisms, but Bolton believes these individual coping styles can have an impact on stress levels.
“If we see ourselves as ‘superhuman,’ for example, with the intention that we can cure everything and our care is always perfect that would be a recipe for stress. The most important thing I was taught by one of my trainers is perfectionism is a recipe for burnout,” advises Bolton.
Criticisms of profession add to stress
An increasingly litigious society coupled with the threat of national media vilification adds to the pressures doctors are under. While acknowledging the value of having a collaborative approach with patients and families, “the patient empowerment revolution has created some additional stress,” suggests Seb Gray, vice chair of the Royal College of Paediatrics and Child Health trainees committee.
“Most hospitals now have lawyers in the entrance foyer. It becomes a sad state of affairs when defensive medicine replaces evidence-based. Doctors are walking on egg shells and fantastic clinicians are changed forever by simple human error,” says Gray.
The government’s current hardline attitude to doctors may also contribute to a feeling of being under pressure.
Clare Gerada, medical director of the NHS Practitioner Health Programme, says, “People have gone into medicine with altruistic virtues, yet at the same time we have a government that appears to denigrate the professionalism that is hardwired into the DNA of doctors from an early age. This doesn’t sit well with individuals who just want to help others. It’s an abusive relationship.”
Doctors still feel stigma
While there is growing awareness about mental health issues in general, some doctors still view any mental health problem as a shameful secret.
“There is still a stigma about doctors’ mental health issues. If you’re depressed, if you’re off work, or if you’re referred to the GMC [General Medical Council], can you imagine what this means for your career? There is a career risk, a registration risk, a risk of exposure. As doctors, you’re not allowed to be unwell,” says Gerada.
Confidentiality issues can deter doctors from seeking help for mental health difficulties. Clinicians are often concerned about what their patients and their colleagues will think of them. BMJ Careers spoke to doctors with mental health problems, who wished to remain anonymous.
One consultant surgeon reached a point where he thought about committing suicide, and while he is now receiving support, he believes that mental health issues that doctors experience are recognised “far too late.” He adds, “When we’re depressed we don’t know who to go to, or we fear asking for help.”
A consultant with depression believes some doctors “simply don’t understand mental illness.”
“If I had a physical illness I could prove I had a problem. But if you have depression people question your competence to do your job,” he says.
Competing interests: None declared.