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Doctors’ health matters

April 2007

The health of doctors - evidence
Stress
A recent BMA report [go to note 52] suggests that many senior doctors suffer high stress levels as a result of their work and that this impairs their health and compromises their ability to provide high quality care to patients. The main sources of work-related stress for consultants and GPs are excessive workloads, organisational changes, poor management and insufficient resources, dealing with patient suffering and mistakes, complaints and litigation [go to notes 53, 54 and 55]. Pressures of work also impact on the health of junior doctors. Evidence from the BMA’s 1995 cohort study of medical graduates suggests that work impacts on the wellbeing and personal health of more than half of the cohort of doctors in training [go to note 56]. Many cohort doctors suggest that the introduction of the European Working Time Directive (EWTD) has impacted negatively on the well-being of junior doctors. Many find the full-shift rotas that many are required to work stressful and feel unprepared for the role of consultant given the perceived reduction in training [go to note 57]. Research undertaken for the BMA’s Doctors for Doctors Unit found that the workload of doctors impacted significantly on their personal health and wellbeing - the majority of respondents to this study report that their work affects their health and two-thirds report some degree of work-related stress (figure 1).

Figure 1 - Perceived impact of work and stress on personal health and wellbeing of doctors (%)

















While poor morale and motivation are often reasons given by doctors for leaving medicine, a recent study of early retirement in the NHS showed that the most common reasons that doctors take early retirement were psychiatric reasons such as depression, anxiety and alcoholism [go to note 58]. This has also been the experience of several respondents to the BMA Doctors for Doctors study:

‘Stress at work has recently led to my resignation from the trust.’

‘I have been retired for three years. By the end, worries about staff competencies in theatres, equipment and rehabilitation were keeping me awake at night and provoking nightmares on occasions. I and my colleagues regarded this as the normal stress of the job. In retirement and talking to friends outside the trade, we were obviously more stressed than some – I was not aware of any sympathetic back up at my hospital.’

Substance misuse and mental illness
The culture of medicine accords low priority to the health of doctors, and particularly mental health, despite evidence of untreated mood disorders and an increased burden of suicide [go to note 59]. To some extent, doctors may perpetuate the problem of mental distress. Doctors are reluctant to seek help and are less likely to take time off than other professions. They are more likely to self-medicate and continue to work despite ill health. The following respondent comments from the BMA Doctors for Doctors study reinforce this perception:

‘To this day work doesn’t know how depressed I was – there is a stigma – a consultant I worked with in the past went off with stress – but there was a stigma when she came back – and I was trying to climb the career ladder – so wouldn’t have risked it.’

‘I think it is still not widely accepted that doctors may use alcohol or drugs to cope with work. It is this area of ill health which needs to be tackled. Too often doctors will carry on without help till matters get out of hand.’

‘I have a sick colleague who has shown significant symptoms of stress/mental illness. The PCT has been very reluctant to review her sick leave, or do anything about it until it has become so obvious that they have been forced into action, but much too late in the day.’

Substance misuse is not confined to any one sector of the medical profession and has been found in general practice, hospital medicine and in the private sector. Evidence suggests that doctors who misuse alcohol are often, at the same time, involved in the misuse of other drugs, most commonly benzodiazepines and may switch between one type of substance and another over time [go to note 60]. A fifth of doctors in the BMA cohort study of medical graduates report that alcohol or drugs are used either by themselves or a colleague to help cope with work and ill health [go to note 61].

According to a recent survey undertaken by Pulse magazine, two in five doctors self-prescribe for personal use, including antibiotics, painkillers and other medication [go to note 62]. More than a third of respondents to the BMA Doctors for Doctors study admit that they self-prescribe to help cope with work and ill health and almost half of respondents report that they are aware of colleagues who self-prescribe to help cope with work and ill health (figure 2). Furthermore, one in 10 respondents report the use of alcohol or drugs to help them cope with work and ill health, and a quarter of respondents are aware of colleagues using such substances to cope (figure 3).

Figure 2 - Whether respondent self-prescribes to help cope with work and ill health or is aware of colleagues who do so (%)
















Figure 3 - Whether respondent uses alcohol or drugs to help cope with work and ill health or is aware of colleagues doing so (%)
















Seeking advice and support
The literature suggests that doctors are less likely than other professions to take time off work due to ill health. Research undertaken for the BMA Doctors for Doctors Unit confirms this, whereby less than half of respondent doctors (43%) had taken any days off work in the last year due to ill health. Furthermore, while the majority of respondents (98%) reported that they were registered with a GP, less than three-quarters of those doctors would go and see them when they are ill. The alternative is often self-medication or consultation with colleagues about their illness.

In most cases these respondents have suffered minor, self-limiting illness and hence feel that they are sufficiently experienced to treat themselves. Others suggest that it is difficult or inconvenient to obtain an appointment to see their GP. Confidentiality is also an issue for some respondents who find doctor-doctor consultations awkward. The following comments illustrate these issues:

‘I usually treat myself before I see my GP. I usually treat my children first. This is because there is no cover for me if I have to take time off to visit my own GP.’

‘The GP has a statutory role with regard to certain illnesses and fitness to practise. This may make some doctors reluctant to consult the GP if they think their illness/problem may put them off work. Also the GP is very busy.’

A culture of ‘not being ill’ is seen as inherent within the medical profession. There is a perceived lack of tolerance towards ill health among doctors and many suggest that doctors are ‘not allowed to be ill’, because it is seen as a form of weakness or liability. Heavy workloads, staff shortages and lack of flexibility within the healthcare system mean that for many doctors, it is virtually impossible to take time off for ill health. Regardless, there is a perception that doctors are not expected ‘to get ill’ and if they do, they are expected to treat themselves and continue working. It is suggested that this culture of ‘maintaining a stiff upper lip’ ultimately impacts on patient care. Others suggest that doctors lack objectivity about their own health and are reluctant to consult other health professionals due to concerns around confidentiality. Many are unaware how they would access support for ill health. The following verbatim quotes illustrate some of these concerns:

‘Continued stigmatisation of ill health among doctors causes the weaker and less confident members to hide their illness until more severe damage is done and denial is impossible.’

‘Especially if you are a consultant, one has to be stiff upper lipped to maintain boundaries. If you do talk to someone, expressing your feelings is misconstrued as you being mentally ill.’

‘I have a colleague who is obviously unwell due to stress and depression, but nothing effective has been done to address his problems. Then he is used as a scapegoat for anything that goes wrong. ’

‘Ill health is regarded as a burden to colleagues and carries stigma.’

‘There is pressure (sometimes openly verbalised) not to take time off when ill. Doctors with health problems are seen as potential problems.’

‘I don’t think the avenues are clear enough. There is enormous pressure on doctors not to ‘’give in’’ to ill health.’

Developing reliable and effective strategies for when health concerns are raised about a doctor is often more difficult for the medical profession. It is important that predictors of risk and ‘red flags’ for impairment are recognised and responses to early signs of distress are acted upon. Results from the BMA Doctors for Doctors study found that many doctors (56%) perceive a lack of support for doctors who are ill or have health problems. This perception is also reported by two-thirds of doctors in the BMA cohort study of medical graduates [go to note 63] and suggests that the profession must establish better ways of responding when a doctor’s functioning is compromised.