Doctors’ mental health

is Clinical Professor of Psychiatry and Medical Director at St. Patrick's University Hospital, Dublin, Ireland. He is a keynote speaker at this week's #ICPH2014

People sometimes ask me whether doctors are any different from other people when it comes to their mental health. Do they suffer more or less? Do they have different disorders and distress? The truthful answer (as with so many human questions) is a bit like, “Yes and No”.

Of course doctors can have physical and mental health issues, but this fact is often hidden from public view. Mental suffering in particular is a clandestine experience, and disclosure is especially hazardous for doctors, since it adds professional jeopardy to their burden of shame and guilt.

Awareness of doctors as human beings with real personal problems and stresses is not widespread in the community but this may be changing. Surveys amongst the public consistently place the medical profession at the top of the ladder of trustworthiness. This public trust and the reality of our health problems are not necessarily linked (at least not linearly) but maintenance of our iconic position of respect in the community comes at some personal cost. The changing public image of doctors in the media provides a useful monitor of these tensions. In my youth TV doctors were reliable avuncular figures who automatically commanded great respect. They were invariably males such as Marcus Welby MD or Dr Finlay with his Casebook. AJ Cronin’s family physician was a particular favourite of my childhood. The kindly hero in capacious tweed dispensed wisdom that was resourceful, intelligent and unerring. The modern TV image of doctors in shows like “Scrubs” or “House” depicts more erring and often much troubled fellows with deeper and more alarming needs. Perhaps there is progress in this.

Actual change has also come via the medical regulatory authorities. These have shifted their emphasis away from support of the doctor towards much more explicit attention to the duty to protect the public from the doctor.

All of this leaves the sick doctor and particularly one with mental health issues in a potentially lonely space. The biblical dictum “Physician Heal Thyself” comes to mind, and yet there is hope for the doctor once his or her personal responsibility is taken seriously. Many of us still do not have a doctor for our own health needs. Each of us to could have a personal health plan and this could start with the simple measures that make such a great difference to our own patients, such as having and attending our own GP.

A greater practical understanding of the effects of work and life balance would also be helpful, but this is also not sufficiently widespread amongst the profession. One of my medical patients groans about these themes, routinely dismissing them as clichés without substance. “Why must it be that I have all the work” he would say “while my colleagues have all the balance”. The truth is that reorganisation of our work stream and professional context is not a luxury for a doctor hoping to sustain a lifetime in practice, it is a necessity. And we have a collective responsibility in this regard. Well managed practices and clinical services should have an interest in maintaining the health of their staff! Thankfully the profession is doing more to promote health awareness in the profession. This is starting at medical school level and is building at professional levels through colleges and societies. There is still much work to be done is this regard.

Surely the Holy Grail involves acceptance of the need not just for physical health but also for mental health awareness amongst the profession. These are after all our commonest health issues and yet their existence remains taboo and their prevention and treatment is given insufficient priority. Mental distress and disorder is common and preventable and treatable in the community and it is in the profession. The deleterious effects of stress are understood now in many other professional settings. Our profession is no longer single sex and our broad human needs can be best understood by ourselves. Modern mental health interventions with appropriate diagnosis and intervention should be supported by doctors and where necessary be available to doctors. Neglect is not an option. The expectation of recovery should be a right for every one and this includes those in the profession. Perhaps this way we can move away from the medical fantasy toward towards a new reality. There is a mindful healthy alternative for the profession and it is one that does not involve reruns of the old TV programs! The doctor of the 21st century can do much more to be a healer, but only by starting by with himself or herself.

This blog is part of a series that @CMAJBlogs is publishing related to the #ICPH2014 to be hosted by the September 15-17 in London, UK