Making doctors better

The editorial 'Making doctors better' (1) raises some very important points; doctors are subject to many pressures as outlined in the article, the results are evidenced by the increased morbidity and widespread recognition across the profession.

Systemic solutions are very important; if the working environment, procedures & processes are causing illness, it is crucially important to change & adjust them as it is the only reasonable solution which will actually reduce the onset of illness. It is also important to provide effective timely support systems in the workplace for doctors and other health professionals, so that they can have actions put in place to help them improve their health, attendance and productivity at work. These actions can be for the individual, the organisation or both.

However, the article completely ignores a significant concern which is the behaviour of doctors when they are ill. Doctors are subject to the same illnesses as the rest of the population and there are very effective treatment services availabile within the NHS. The difficulty is caused by the unfortunate way doctors develop & evolve certain beliefs when they become ill which impacts on their behaviour as cited in the editorial. In particular, doctors often ignore illness, seek different pathways of advice and treatment because the medical culture can encourage consciously or unconsciously that illness needs to be hidden. The availability of a 'special doctor only service' such as the Practitioner Health Programme, is counterproductive because it can actually reinforce the beliefs that illness is something to be inherently ashamed and embarrassed about, especially if the service undertakes an advocacy and 'protective' only role.

If the fundamental issues of changing doctors' beliefs, and the recognition of the importance collaboration and coordination with employer services and educational support services are not addressed, the other measures outlined in the editorial may make temporary improvement but doctors will continue to have dysfunctional health related behaviour that may impact on patient care and have the possibility of further relapses.

All doctors should understand that there is nothing wrong with being ill but it is unprofessional to be unwell and take no action to address it.

Dr Ian Aston
Dr Harj Kaul

(1) BMJ 2018:363:k4147

While there is no doubt resilience is needed among healthcare professionals I agree that this can only be a piece of the puzzle. It seems to put the onus on the doctor and if you are not “resilient” it is yet another piece of evidence you are failing, probably at a time you’re already at your lowest ebb.

The recent stats on female doctors having a x4 suicide rate compared to baseline is appalling and should focus minds. But whole system change is a long and slow process and we can only try and chip away slowly. Recent negligence manslaughter cases, etc, seem to have set things back, but I am hopeful we can slowly get back on track with better institutional compassion for healthcare workers rather than the current environment which is still a long way from being optimal.

A relative of mine is a therapist. He had mandatory one year of psychotherapy as part of his requirement to qualify and ongoing supervision by a senior colleague, primarily for his wellbeing.

Annual appraisal for GPs can have some features addressing practitioner wellbeing but feels primarily an exercise in checking up that we are safe and up to date. That’s fine, and sensible, but we can’t pretend it is supervision to support our wellbeing.

I agree that we need more protection to say “enough is enough” as the article puts it, but in general practice there is no contractual protection from incoming workload, and with a shrinking GP workforce and growing consultation rate it’s difficult to see how time can be set aside for self-care as part of the working week. I think practices can help create a supportive work place, but only if those in a position of leadership are themselves coping.

I do notice one paradox, however, which is that many GPs opt for locum work, etc, to protect themselves from stress (see recent Nigel Watson partnership review interim report) but actually a great source of my own support comes from patients I’ve developed a relationship with by being a list holding partner and having continuity of care.

I think the changes required are generational but will come as mindset shifts, individual by individual. “The system” however still feels institutionally hostile due to multiple incremental changes, legally, societally, culturally, etc, etc, etc.

Undeniably the life of doctors has become increasingly complex and complicated. Ways and means and methods to improve and modify the 'system (s) ' favourably are at work the world over. If 'death' tends to be surrounded by allegation of mistreatment and negligence too often , it denies the doctors of fairness ; doctors dutifully do the best under the circumstances and rarely claim credit , unlike some other professions. But there are few facts that doctors too need to consider. a) though doctoring is considered a 24 hour affair , too many of them may not realise that sound relations with parents , spouse and progeny constitute a stabilising force and a positive effect on general well being . b) being a doctor need not be an exclusive and unending exercise for promotions , enhanced qualifications, fellowships, honours and the like if one finds difficult coping up. Nurturing and asserting ego in every situation may not go well with mental well being. c) Becoming professional and rational may come easy but maturity , poise, balance, optimism takes years as time passes by ; the chosen may turn philosophical and even 'spiritual' at the sunset of life particularly when society considers that doctors never 'retire'. In short , personal life and attitudes do contribute to total well being of doctors as well . Dr Murar E Yeolekar. ( former Director , M E & R /Dean ) Mumbai.