Doctors as patients – some readings

So the first day of the International Conference on Physician Health is over. I have felt for a long time that it’s often so hard for doctors who are struggling to get help. Which is why I was so pleased – pretty moved actually! – to see people coming together, from all over the world, because they care about it. I’m so inspired by the stories I’ve heard so far & I felt very lucky to be there.

Feeling all keen & warm & inspired I thought I’d put together a few bits of reading in the area that I’ve enjoyed, or learned something from. Then I’ve put some links at the end to some sources of support for doctors going through difficulties. For all I know this is all old news to everyone & if that’s the case I’m sorry 🙂 I guess the message that I’ve got from the conference is that there are so many people going through bad times too – & there’s support out there. I’d love all those struggling to know that they are not alone. That doctors do get mental health problems – especially burnout, depression, & addiction, but other illnesses too. That despite how we are taught to think about ourselves in medical school & as junior doctors, it’s ok to have vulnerabilities & be ill like everyone else. That the doctor who is ill can feel so isolated, but that there is help available. There really is – do please seek it out if you need it.

So first up, of course, is Jonny Tomlinson. I’ve learned so very much from his blog – probably more than any other – & I think it should pretty much be on every medschool curriculum. He wrote a piece here – ‘The Wounded Healers‘ – that bought to life viscerally & beautifully the struggles that can come with the profession. & includes my favourite quote from the piece: ‘We teach doctors about clinical depression but very little about human misery and we teach them how to treat cancer but next to nothing about how to deal with the fear of death.’

Next up is a piece by David Zigmond, a psychotherapist. He wrote this – ‘Physician Heal Thyself: The Paradox of the Wounded Healer‘ – a lovely & really well written examination of some of the reasons why doctors make bad patients, the personality types that can develop into something unhealthy (caring to self-neglectful, careful to obsessional, for example), & it also talks about how medical training could be improved.

Number three is a great piece that was in the BMJ in November last year, by Clare Gerada & Alex Wessely – ‘When doctors need treatment: an anthropological approach to why doctors make bad patients‘. Dr Gerada was talking about this work today. An excellent examination of some of the reasons why doctors don’t seek help – talking about structural barriers like shift patterns, but mostly about how the training of doctors, & the ‘institutionalisation’ we go through, can in itself develop psychological barriers to seeking help; the development of the ‘medical self’. As the piece says, ‘The nature of doctors’ training results in a deep rooted sense of being special and the institutionalisation of their professional identity … These characteristics, however, also distort doctors’ ability to seek help and adopt the role of patient. For example, when accompanying a relative or friend to hospital doctors often find it hard to relinquish their professional role and be the concerned lay “other.” Abandoning their medical self is challenging, even in the short term.’

Another piece by Clare Gerada is about those presenting to the Practitioner Health Program & particularly showing how young women are presenting to the service for help.

I love the writings by Liam Farrell. He’s someone I only know from twitter but really respect. His piece on drug addiction was massively, massively powerful, & his story of recovery – discussed here, is hugely inspiring. Someone I’d love to meet in person with one day.

@sectioned_ has told me about a lovely site with some personal stories from doctors going through illness.

Here is a TED talk on physician suicide by Pamela Wible.

Next is ‘Doctors as patients: a systematic review of doctors’ health access and the barriers they experience‘ – a piece from 2008 by Margaret Kay. It talks about the lack of research in the area, & also some of the difficulties – in the system & in the medical culture – that doctors can have accessing care.

So – what do we do? Well, I don’t know. But here’s a few suggestions. Make services accessible, confidential, & approachable. Get people talking early – like in medschool – about recognition of signs that you, or colleagues, are struggling; particularly about addiction. Make Balint groups or other peer support systems a routine part of medschool & foundation training. Have medical humanities as part of training too. End the blame & bullying culture that is going on in some areas of the NHS. Get good support for those going back into work after being off – like easy access to part time work, regular therapy & supervision, & flexible hours. And above all – let’s make it ok to talk about.

I’ll end with a quote from the last piece. ‘Culture change is needed. It is only when it becomes acceptable (culturally normal) for a doctor to seek healthcare for physical and mental health problems that health access will improve.’ Just so true. I hope a culture can be developed that we have as much compassion & respect for ourselves as we do for patients.

Some resources

The Practitioner Health Program – if in London, ill doctors can get confidential advice, support & NHS funded treatment – from therapy to rehab placements

The British Doctors & Dentists Group – a peer group set up by doctors with problems with addiction to provide support – they meet regularly & have meetings around the country

The Sick Doctors Trust – support for doctors who have addiction problems, & they have a phone line

The Doctors Support Network – support for those going through any sort of mental health problem, & help through GMC proceedings too.

The BMA counselling service

MedNet – for those in the London deanery – careers advice & therapy from staff at SLaM & the Tavistock

Northern Deanery Support Services – looks like a good service here

Support for those training in the Severn Deanery

Support for those training in the Peninsula Deanery

Support for those training in the West Midlands Deanery

Support for those training in Yorkshire

The Health for Health Professionals number can provide counselling services for doctors in Wales, & it has links to services for other professions too, like dentists & pharmacists.

Some colleges often have their own support systems too – like psychiatrists, anaesthetists, & surgeons.

I’d love to hear of any other links people would find useful! Let me know x