What's up doc?

DOCTORS make the worst patients, or so the saying goes. Whether they’re too embarrassed to admit they need support, worried about stigma, or just plain in denial, seeking help does not seem to come easy.

But as work pressures and stress levels continue to rise, it has never been more important for doctors who are struggling to cope to ask for the assistance they need.

One new initiative hoping to raise awareness of this issue is the What’s Up Doc? campaign from the Royal Medical Benevolent Fund (RMBF), a registered charity set up to help doctors, medical students and their dependents. They offer financial aid and debt advice, and also provide a befriending service.

Staying silent

A recent survey carried out by the RMBF as part of What’s Up Doc? highlighted the overwhelming concern over the state of mental health and wellbeing amongst doctors, largely as a result of working under increasing pressure and scrutiny. It found a massive 82 per cent of doctors knew of other doctors experiencing mental health issues such as depression and anxiety. Despite this, they were unlikely to reach out for fear of discrimination or stigma from colleagues (84 per cent), or were inhibited by their ‘high achieving’ personality traits (66 per cent).

The survey of hospital doctors, consultants, GPs and charity supporters also revealed 78 per cent of doctors believed medics are so busy looking after others that they neglect to look after themselves, while over 90 per cent believe their working hours put personal relationships under pressure.

Of the key factors contributing to pressure on doctors, 80 per cent blamed patient caseloads and a similar number cited increased scrutiny (such as CQC inspections or the pressure of revalidation), while 76 per cent highlighted working hours.

Junior doctors in particular are increasingly in need of help. The RMBF’s annual review showed that in 2014-15, 68 per cent of new applicants were under 40 – up from 54 per cent the previous year. In 2011-12 the biggest single group of people applying to the Fund for assistance were junior doctors aged 25 to 35. Elsewhere, the annual NHS staff survey in 2015 showed that 31 per cent of juniors experienced work-related stress in the last 12 months. That’s compared with less than 20 per cent in 2010. Less than half (43.5 per cent) of trainees felt their job was good for their health, down from 55 per cent in 2011.

Getting help

In a bid to reverse this trend, the RMBF has undertaken a number of initiatives, including hosting a roundtable debate – sponsored by MDDUS – to explore effective means of support. They have also published a free downloadable guide, The Vital Signs, written by Dr Richard Stevens, a coach with the Thames Valley Professional Support Unit. The guide acknowledges there is “very little support on offer” in the caring professions, adding that doctors “are expected to carry on, and there is even a sense that needing support is a sign of weakness”. Many cope, it says, by developing a so-called “survival personality”, where they shut off parts of themselves that would otherwise find some aspects of the work unbearable. Other strategies include “medical narcissism”, a term used by ethics professor John Banja to describe the attitude adopted by some doctors, especially when things go wrong.

Key advice points from the guide include the following:

Self-awareness

The booklet encourages doctors first to be aware of the signs of stress and to do something to improve the situation. Admittedly this is not always easy. It states: “It is ironic that when we need to do the things that will help deal with a difficult time, it is the most difficult time to do those things.” The guide likens ignoring feelings of stress and burnout to cutting down a tree with an increasingly blunt saw. “Often we continue sawing because we haven’t time to stop and sharpen the saw.” Developing a good degree of self-awareness is crucial so that help can be sought before any harm is done “clinically, professionally or socially.”

Trigger points

Common factors to keep in mind include:

• Emotional toll of the large number of interactions with staff or colleagues

• Long hours/sleep deprivation

• Financial worries

• Lack of support at work

• Understaffing

• Burnout (emotional exhaustion; doubts about personal/professional effectiveness)

• Instability in working arrangements.

Key signs

The guide outlines a number of key early warning signs to help identify trainees in difficulty.

These include:

• Doctors who are often late/absent or not answering beeps

• A low work rate – slow at carrying out procedures; arriving early and leaving late yet struggling to achieve a reasonable workload • Bursts of temper/over-reaction • Colleagues find ways to avoid seeking the doctor’s opinion or help

• Defensive, unable to accept constructive criticism

• Behaviour changes, such as excess drinking or withdrawal.

Seeking help

Just because you’re a doctor, doesn’t mean you are expected to accurately self-diagnose. It is crucial to let yourself just be a patient – seek help early and don’t focus on concerns about being judged or stigmatised. If you are keen to avoid the usual healthcare structures, there are a number of options, such as the RMBF, the Sick Doctors Trust and the NHS Practitioner Health Programme in London. More detailed information can be found in The Vital Signs.

Joanne Curran is an associate editor of FYi

Links:

• The Vital Signs

• What’s Up Doc? campaign page