The Vital Signs

A guide for doctors seeking help and advice

Wanted – medical staff

High academic achievers only with strong perfectionist and self-critical traits preferred.
Successful candidates will have had: 5+ years training in party-fuelled student culture followed by sleep deprivation and long hours in their twenties; regular exposure to death, loss and human misfortune; never-ending exams and lifelong study; constant onerous responsibility for other people’s health and wellbeing; strict, hierarchical, conservative training with a hint of bullying and intimidation.
Easy access to pharmaceuitcals.

Doctors are different

Doctors deal with difficult situations every day. After a bad day they can’t always say to themselves “that was a terrible day, but at least nobody died”. Even if no one dies there is a chance that they dealt with loss of some kind; of health, expectations or future.

Almost uniquely in the caring professions there is very little support on offer. Doctors are expected to carry on and there is even a sense that needing support is a sign of weakness.

As a result, many develop a psychological strategy to cope by shutting off the parts of themselves that would otherwise find some aspects of the work unbearable. This ‘survival personality’ allows them to function well in the work setting, but at a cost to other parts of their life. This process is seen in other settings too – the military in combat, and staff in long-term institutions, for example.

Other psychological strategies can also be seen. ‘Medical narcissism’ is a term coined to describe the attitude adopted by some doctors, especially when things go wrong (Banja 2004). Being a doctor comes with privileges and status but possibly at a cost.

Doctors often identify strongly with their role, and complaints are often sensed as personal attacks.

82% of doctors know of other doctors experiencing mental health issues such as depression and anxiety

Doctors are the same

Doctors may have to deal with difficult situations and take great responsibility – often with little support – but they are not omnipotent. They are fundamentally the same as anyone else and have the same needs.

They will have their own personality quirks, fears, phobias, likes, dislikes, and ways of coping with stress and conflict. Their personas may be armoured to cope with their job, but they will be feeling the full range of human emotions too. And if these are unbearable, or just difficult, they can be suppressed. In this case doctors may not be consciously aware of these emotions, but they may still be there.

Doctors at times feel anxious, frightened, depressed, deluded, suspicious, bad tempered, irritable, bored, martyred, unappreciated, bullied, tired, taken for granted and every other emotion. Just like everyone else.

Strange, then, that seeking help often feels stigmatizing. The ‘caring profession’?

In fact, doctors are just as likely to suffer from physical, mental and emotional issues as their non-medical peers. Seeking help should be just as natural.

73% of doctors surveyed know of other doctors experiencing marital and family problems

Prevention – mental hygiene

You should sit in meditation for 20 minutes every day – unless you’re too busy; then you should sit for an hour.

Zen adage

 

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. Those activities will be individual and personal but can include exercise, music, socialising, spending time with family, hobbies and other activities.

Management guru Stephen R. Covey uses the metaphor of trying to cut a tree down with a saw that gets progressively blunter. “Sharpening the saw means preserving and enhancing the greatest asset you have – you”. So often we continue sawing because we haven’t time to stop and sharpen the saw.

The key then is to know that you are functioning less well or feeling overstressed, and do something to improve the situation. This means monitoring yourself and being able to stop ‘frantically sawing away with a blunt saw’.

Developing a good degree of self-awareness will help you be a better doctor, and will have benefits in relationships outside work.

This awareness could ensure that help is sought early and before any harm is done clinically, professionally or socially.

90% of doctors believe their working hours put personal relationships under pressure

Common trigger points to look out for

  • Emotional toll resulting from the high level of interaction with patients and staff (doctors develop survival personalities to deal with huge losses)
  • Unsociable and long hours resulting in sleep deprivation
  • Lack of support at work
  • Under-staffed
  • Expectations of the NHS and patients
  • Financial concerns such as a large amount of debt to train and then set up in practice
  • Posts change and move providing an unstable situation for families
  • Burnout

80% of doctors believe increased scrutiny is a key factor contributing to the significant pressure on doctors today

Recognising the signs and symptoms

As discussed, when under pressure we often lose our sense of perspective and cannot always rely on subjective feelings. The following list has been compiled to help identify trainees in difficulty (Paice 2006). With a little imagination and stretching it could be applied to established doctors too. Doctors may need additional support at any stage of their careers.

Seven key early warning signs

  • The ‘disappearing act’: not answering bleeps; disappearing between clinic and ward; lateness; frequent sick leave.
  • Low work rate: slowness in doing procedures, clerking patients, dictating letters, making decisions; arriving early, leaving late and still not achieving a reasonable workload.
  • ‘Ward rage’: bursts of temper; shouting matches; reacting badly to real or imagined slights.
  • Rigidity: poor tolerance of ambiguity; inability to compromise; difficulty prioritising; inappropriate ‘whistle blowing’.
  • ‘Bypass syndrome’: junior colleagues or nurses find ways to avoid seeking the doctor’s opinion or help.
  • Career problems: difficulty with exams; uncertainty about career choice; disillusionment with medicine.
  • Insight failure: rejection of constructive criticism; defensiveness; counter-challenge.

Family, close friends and colleagues may provide feedback as well as support, though sometimes it is hard to hear it. They may notice changes in behaviour, such as drinking more or withdrawing, before you are aware of them.

66% of doctors are inhibited by their ‘high achieving’ personality traits

Burnout

Burnout can occur when our resources are overwhelmed by the emotional and physical demands made on us. The term was originally coined 40 years ago and has had growing acceptance and recognition as a genuine entity now supported by neuroscience. It is now included as a condition in ICD-10.

Although it is usually the result of a sustained period of exposure to stressors the time frame can be variable. Factors known to affect doctors include workload, control, reward, community, fairness, and values. A sense of autonomy in the job seems to be protective.

The hallmarks of burnout are:

  • emotional exhaustion – characterized by a feeling of emptiness and emotional blunting.
  • depersonalization – manifested by cynical attitude and negativity.
  • reduced personal accomplishment – doubts about personal and professional effectiveness.

Early recognition and remediation is key. As is being prepared to seek help – it is a legitimate condition.

78% of doctors believe that doctors are so busy looking after others that they neglect to look after themselves

Seeking help

When doctors see a doctor, they too often feel the need to consult with a diagnosis and formulation ready. There is a temptation to medicalise, catastrophise and self-medicate. It sometimes helps just to be the patient and not a doctor for once.

When I was a GP, a professor at a distant medical school consulted me about his back pain. “I could have mentioned it to a colleague at work,” he said, “but they would have had me in the scanner by lunchtime. I just wanted your perspective on whether I should worry and what I should do”.

We should feel no pressure to self-diagnose or feel judged, but be allowed to be patients with no additional expectations placed on us. Likewise, doctors treating their colleagues should allow and expect them to be patients.

People are sometimes concerned about confidentiality and the stigma of seeking help. These are damning indictments on the profession. If you want to consult outside the usual structures, many areas and employers have access to Physician Health Programmes or Professional Support Units.


How the RMBF can help

If you are a doctor, and you are facing financial hardship as a result of illness, injury, disability, bereavement or age, you may be eligible for financial support from the RMBF.

We also offer:

Other sources of help

The British Medical Association – Counselling and peer support services

Free and confidential 24/7 counselling and peer support services open to all doctors and medical students (regardless of BMA membership), plus their partners and dependents.

Sick Doctors Trust

Independent, confidential organisation offering support and help to doctors and medical students dependent on alcohol or drugs.

Doctors Support Network

Peer support by qualified doctors offering a confidential and anonymous service covering mental health, work problems, relationships and anything else.

NHS Practitioner Health Programme

A free confidential service for doctors and dentists with issues relating to a mental or physical health concern or addiction problem, in particular where these might affect their work.

Cruse Bereavement Care

If someone close to you has died, Cruse can offer information, advice, and emotional support to help with grief.

About this guide

Written by Richard Stevens FRCGP, Associate Director and Coach at the Thames Valley Professional Support Unit and Trustee of the Royal Medical Benevolent Fund.

Statistics included in this guide are taken from a survey of 1,351 health professionals, including hospital doctors, GPs, consultants and charity supporters. January 2016 via Survey Monkey.

Download this guide

The Vital Signs: a guide for doctors seeking help and advice (.pdf)

More guides in this series

The Vital Signs in Primary Care

The Vital Signs for Medical Students

Vital Signs in Anaesthesia

Returning to Medicine: a Vital Signs guide