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Doctors’ health matters

April 2007

Vulnerable doctors
Doctors do not behave like other patients when accessing healthcare. Although patients want healthy doctors – they do not ‘permit’ their doctors to be ill. Enormous pressure is placed on doctors to not ‘give in’ to ill health and some view those doctors who do take time off sick as a ‘problem’. When a doctor takes time off for ill health, colleagues are often required to pick up additional workload and reflect on their own work practices. This may result in colleagues becoming either more defensive, ending up blaming the doctor for ‘abandoning ship’, or more sympathetic, identifying with the plight of their colleague. The latter potentially poses more difficulties, as colleagues may also have to begin to acknowledge their own problems.

Doctors themselves may collude with this view. They tend to be perfectionist, overly conscientious, approval-seeking, need to be in control, chronic self-doubting and disliking of praise. While many of these qualities may be good for patient care, they are not necessarily beneficial for doctors’ own health. Doctors may well have an inner need for validation, a needing to be needed, which may also disguise feelings of poor self worth and insecurity. A doctor’s identity may be so entwined in his or her professional role that when this is challenged, for example by a complaint, they may feel that their whole identity is threatened. The very traits that make ‘good’ doctors, such as empathy and involvement in patient care, may in fact militate against good mental health.

There is a culture, post-Shipman, that means colleagues may be looking to pass on a problem rather than try to contain it locally. A culture change needs to be encouraged within both society and the medical profession that ‘permits’ doctors to be patients while also recognising their particular health needs. This need not compromise patient safety. In fact, a more open environment may encourage doctors to come forward earlier for help which may actually improve patient safety. Promoting a sensible balance of all these different factors is vital to maintaining a healthy personal and professional life for the doctor [go to note 64].