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Sick doctors’ return to work hampered by colleagues’ disapproval

Culture change needed to allow doctors to recognise their own and colleagues’ vulnerabilities

Caroline White

Tuesday, 16 October 2012

Doctors who have been on long term sick leave find it hard to return to work because they are engulfed by feelings of shame and failure, and often face the disapproval of colleagues, finds research published in the online journal BMJ Open.

The authors call for cultural change, starting in medical school, to allow doctors to recognise their own vulnerabilities and cope better with both their own, and their colleagues’, ill health.

The authors carried out semi-structured interviews with 19 doctors, all of whom had been off work for six months or more within the past year. Their average age was 46.

All but one doctor had a mental health or addiction problem, including depression, anxiety, bipolar disorder and alcohol dependence. Seven also had physical health problems. Fourteen of the doctors had already come to the attention of the General Medical Council.

The main themes to emerge during the interviews were professional identity; relationships with family, friends, and work colleagues; and the way in which they perceived themselves.

Illness had taken many of the interviewees by surprise and had shattered their professional identity. One doctor said that without this, he realised “there wasn’t much left of me.” Another described it as having “everything taken from you.”

Several doctors described good levels of support from friends and family, but many reported the opposite, and felt that they had become “a nuisance,” or “an outsider in my own family,” or that they were no longer highly thought of.

Some said they deliberately hid their illness (and its treatment) from their families, because they feared that coming clean would have a detrimental impact on their personal relationships.

Some doctors said that they did feel supported by work colleagues, but not especially by other doctors. “We’re meant to be caring people, but we don’t seem to care about each other at all, in my experience,” commented one.

They said they felt “judged,” and perceived as “weak,” and that others considered they were no longer fit to be a doctor because they had become ill.

And they frequently described feelings of emptiness, guilt, shame and failure, and blamed themselves for what had happened.

When they experienced difficulties getting back to work, their confidence plummeted, which further lowered their self-esteem and made it even harder to cope, they said.

Doctors’ rates of mental ill health, drug and alcohol misuse and suicide are at least as high as those of the general population, the authors point out, but the prevailing culture in medicine is that doctors are “invincible.”

This must change, they say, adding that: “Aspects of personal and colleague health, especially mental health, should be part of the curriculum for all medical students.

Doctors must learn to provide themselves and their colleagues with the same level of excellent care that they provide for their patients.”

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