Perspective: Help at last for troubled medics

15 February 2010

By Joanne Curran, associate editor, MDDUS

Physician, heal thyself. The saying is nearly as old as medicine itself, yet many doctors and dentists still seem to find looking after their patients’ health an easier task than looking after their own.

Research into the profession frequently throws up worrying statistics. The rate of fatigue, depression and anxiety amongst doctors and dentists is consistently amongst the highest of all professions, while suicide rates are estimated to be far higher than among the general population.

Problems with drug and alcohol abuse are also a major issue for healthcare practitioners. The pressure of achieving the best patient care while avoiding potentially life-threatening errors and juggling any number of issues from sleep deprivation to excessive workloads often takes its toll.

Success rate

But in the midst of all this bad news comes a glimmer of hope in the shape of the NHS Practitioner Health Programme. The brainchild of chief medical officer Sir Liam Donaldson, this initiative was launched as a pilot programme in London last year with the aim of helping doctors and dentists who are suffering from health problems. And the results have been encouraging.

In its first year, the free, confidential programme treated 184 people, with a 77 per cent success rate. Of those treated, 62 per cent had mental health problems while 36 per cent were addicted to drink or drugs. And of the 78 who weren’t working when they first came to the scheme, 46 per cent returned to work.

The project’s medical director, Dr Clare Gerada, admitted to being surprised by the extent of substance misuse. Of the 67 doctors and dentists who attended the service with addiction problems, 51 were drinking too much alcohol while 16 were abusing a range of drugs – including heroin, ketamine and cocaine.

Most of the people who sought help for mental health issues were diagnosed with depression, but the PHP also uncovered six cases of psychosis that hadn’t previously been treated. Practitioners who use the service have access to a team of GPs, nurses, psychiatrists and therapists who jointly assess and manage their care.

Eye-opener

Dr Gerada said: “This has been a real eye-opener. I thought at first we'd see a bit of stress and burn-out. But it soon became apparent how troubled some of these doctors and dentists were. They're not the easiest patients in the world - and behind them are patients who could potentially be harmed. They tend to present at a late stage, but very few dropped out of treatment, and most of them tend to do well."

Psychiatrists, anaesthetists and paediatricians were the specialties most commonly attending the service. PHP also seems to be doing well in keeping doctors and dentists healthy once they leave the programme. More than 80 per cent of those who were treated for addiction were shown to have stayed abstinent afterwards - compared with about 10 per cent of the general population.

Following the publication of its first-year progress report, the Department of Health-funded project has been hailed a big success and there are hopes that it will be rolled out to other cities across the country. Possible future sites include Newcastle and Avon.

This must surely be good news at last for some of the country’s troubled doctors and dentists who often struggle to access the same level of healthcare as their patients. Concerns over anonymity, embarrassment or perhaps plain stubbornness are often reasons why they avoid seeking help for themselves.

Helping patients

If this scheme is expanded then it should help more than just the practitioners. One of the functions of the PHP is to make sure patients aren’t put at risk by doctors and dentists who are unwell, making it another important safety net. Five of the programme’s patients removed themselves from their duties after being told they should do so – and on two occasions, the PHP contacted the regulators to express concern about its patients.

The programme’s success has been hailed by many senior healthcare figures. Sir Liam Donaldson said: “From the number of patients accessing the PHP during its first year of operation, it is clear that there is a need for this highly specialised service. Never before have we had such a service that helps doctors in great need and protects patients.”

RCGP president Dr Steve Field said the PHP “fills an enormous gap” in supporting ill doctors and dentists.

And Professor Alastair Scotland, who chaired a recent working group looking at the health of health professionals, said PHP service should be made available to practitioners across the country, adding: “Evidence shows that ill health in health professionals may remain hidden, with potential impact on quality of care provided for patients. We need three or four of these services across England, backed up by a panel of GPs and occupational physicians with extra training to treat health professionals.”

The PHP has already become the largest of its kind in the world and hopefully it will continue to expand across the country.

For more information about the service, please visit www.php.nhs.uk