Viewpoint: Looking after our own

MDDUS chief medical officer Dr John Holden observes that doctors have unique characteristics that make them vulnerable to the stresses that arise in dealing with the profound needs of others, and the profession must strive more to “look after our own”

WHEN I was first a clinical medical student, alongside the central "Bear Pit" of the main teaching hospital was a six-bedded ward that attended to the medical needs of staff. The cutbacks of the 1980s had recently caused the ward to close, but I perceived that its location in the heart of the hospital was a reflection of the importance that had once been ascribed to the “staff ward”. Later, when I first became a partner in general practice in the 1990s, the local senior gynaecology consultant provided a monthly NHS clinic on a Saturday morning expressly for health professionals and their families. When he retired, this service too came to an end.

At the time I thought of these services simply as a perk of belonging to the extended health service family. Looking back I recognise them as a recognition of the vulnerability of doctors and other health professionals. Whilst such resources have largely disappeared, others have evolved to meet the care needs of modern health professionals.

Uniquely vulnerable

Doctors and other healthcare professionals have unique characteristics that make them vulnerable to the stresses that arise in dealing with the profound needs of others. These vulnerabilities may be evident even before reaching medical school, as exemplified by the spoof advertisement written by Dr Richard Stevens and his colleagues in the Royal Medical Benevolent Fund (RMBF) Vital Signs leaflet for medical students:

Top of the class at school? Hard-working? Compassionate? Driven? Perfectionist? Earned A*s at A level and at least one Gold D of E award?

We are particularly looking for resilient individuals who enjoy black humour and have the ability to put bad experiences in firmly closed boxes. In general you will be expected to work out your own survival strategies and continue heedless to all internal warnings.

MDDUS was pleased to sponsor this leaflet as part of the work we have undertaken with RMBF in recent years – a time that has seen an impressive evolution of resources in support of vulnerable health professionals by RMBF and other organisations that MDDUS has supported.

Expanding support services

A decade ago, in February 2011, I attended a crisis meeting on behalf of MDDUS to consider how the work of the Department of Health’s Practitioner Health Programme might be financed and continued as it came to the end of its two-year pilot scheme. I am pleased to note that under the leadership of Professor Dame Clare Gerada, this programme has evolved into NHS Practitioner Health, a service that recognises that doctors and dentists have specific need for a specialist mental health service.

Similar services have evolved in Wales and Scotland. No direct equivalent service yet exists in Northern Ireland, although the Practitioner Health website flags other services available to doctors and dentists in Northern Ireland, such as that provided by the BMA. In an attempt to fill this gap, MDDUS has in recent months engaged in supportive dialogue focussed on creating an equivalent service for Northern Ireland.

Stress of investigations

One of the most stressful events that health professionals might encounter in their professional career is an investigation by their regulator. The General Medical Council has increasingly noted and acted upon both the health impact of an investigation and the underlying health problems that might generate an investigation into an individual’s fitness to practise, providing links to support services including a bespoke service provided for the GMC by the BMA.

MDDUS welcomes the initiatives undertaken by the GMC to reduce the impact and stress of investigations into a doctor’s conduct, performance or health, following the independent review conducted by Professor Louis Appleby.

More recently the GMC commissioned Professor Michael West and Dame Denise Coia to undertake a review to address the causes of poor wellbeing that doctors and medical students face. Amongst the conclusions was a confirmation of the fundamental importance of professional wellbeing, as “doctors with high levels of burnout had between 45 per cent and 63 per cent higher odds of making a major medical error in the following three months, compared with those who had low levels”. Further, there was a positive correlation between staff health and wellbeing, and patient satisfaction.

Similarly, the General Dental Council has started to explore the importance of mental health and wellbeing in the workplace as a step towards laying the foundations for safe patient care.

New MDDUS support service for members

The essence of these studies is that health professionals cannot look after patients adequately unless their own emotional and mental welfare is tended.

Accordingly, MDDUS has written to the Secretary of State in strong opposition to the proposal within the Department of Health and Social Care’s recent consultation Regulating healthcare professionals, protecting the public that health be removed as a separate ground of action in regulatory investigations and instead be categorised under the ground of 'lack of competence’.

MDDUS recognises the importance of healthcare professionals considering what steps to take in caring for their own mental wellbeing – and to that end we have introduced a 24/7 free, confidential support service YourHalo: Emotional Wellbeing, a holistic and evidence-based approach for our members to manage their emotional wellbeing.

More detail is available on the MDDUS website and I encourage you to view the details of the service, which has been developed in conjunction with our independent partner, healthcare rm.

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