In a series of articles, Dr Richard Duggins (pictured), Consultant Psychiatrist in Psychotherapy in House Concern, and Dr Rhona Knight, Clinical Lead for the Royal College of General Practitioners Health for Health Professionals Programme, explore the key challenge of helping health professionals stay healthy.
Differences and rewards in treating doctors
In my full-time work as Consultant Psychiatrist in Psychotherapy in House Concern, a specialist psychotherapy service for doctors and other health professionals in the North East of England, I commonly encounter five key differences in the way in which doctors’ health impacts on the doctor as patient and on healthcare delivery compared to other patients:
- Doctors are a hard to reach group
- Doctors are a high risk group
- Personality
- The economic benefits
- Outcomes of health care interventions
Doctors: a hard to reach group
Doctors with physical health, mental health and addiction problems are “a hard to reach group.” Doctors are very good at caring for others, but often feel deeply ashamed if they need help themselves. Other powerful deterrents to seeking appropriate help are fear of stigma, and worries about potential breaches of confidentiality through organisational grapevines. This difference is illustrated starkly by recent survey of 2,500 doctors in Birmingham, which demonstrated only 13% would seek help if they suffered a psychological ill health or addictions problem.1
Doctors: a high risk group
Doctors are a high-risk group. To put it bluntly, doctors are at higher risk of the four Ds: depression, drinking, drugs and death. The relative risk of suicide is raised for all doctors, and for female doctors the relative risk is 2.7 – 5.7 that of the general population.2 The higher risks are a result of multiple causes, and are likely to be partly related to delays in seeking and engaging with appropriate treatment.
Personality
The next difference is linked to personality traits that are more common in doctors. Students who show diligence, commitment, co-operativeness, agreeableness, open-ness and extraversion, are encouraged to be doctors, and when they are doctors they do well. However, under stress these positive personality factors can become an Achilles’ heel, when for example conscientious traits under stress become perfectionism, commitment becomes compulsiveness, or extraversion becomes narcissism.3
Economic benefits
The fourth difference is the powerful economic benefits of addressing ill health in doctors. The London Specialised Commissioning Group (SCG) has estimated that sickness in doctors and dentists costs over £23.2 million every year to the NHS in London. This comprises three figures, sickness absence of least £16.8 million every year, backfill for GPs’ sick leave of £900,000 per annum, and doctors suspended from duties as a result of health concerns at a cost of £5.5 million per year. If scaled up from 32,000 doctors and dentists in London to 152,700 doctors and dentists in the NHS in England, the estimated national cost of ill-health in doctors and dentists is 110.7 million per annum. In addition to these direct costs of sickness absence, there are also the costs of the significant risks of Presenteeism (attending work but underperforming due to ill health), which is estimated at 1.5 times the cost of sickness absence.4 The costs of training doctors are also significant, and the report of the Inquiry into the tragic death by suicide of the psychiatrist Daksha Emson and her baby daughter Freya accurately concluded: “doctors cost over £500,000 to train yet no special account is taken of the need to safeguard this asset. It compares very unfavourably with the care given to comparably costly pieces of equipment.”5
Outcomes of health care interventions
The final difference is the fact that doctors with psychological illness or addiction problems achieve outstanding outcomes, when engaged with appropriate treatment. Doctors show great resilience and determination to progress through their education and career, and when doctors with health difficulties are helped to harness these strengths through appropriate treatment, they do exceptionally well. In the House Concern service, 85% of doctors referred to the service remain in work or return to work during treatment, and these work related outcomes are echoed in other specialist services such as the London Practitioner Health Programme and MedNet.6,7 Clinical outcomes, related to mental health symptoms also show remarkable and rapid recovery. For addictions, the Practitioner Health Programme in London achieves an 82% recovery rate for doctors treated for alcohol addiction (compares to 10% for those treated for alcohol addiction in the general population), and an 88% recovery rate for doctors treated for drug use (compares to a 10-20% abstinence rate in the general population).
Conclusion
When these five key differences are viewed together, it is clear there are incredible rewards in terms of doctors’ health and economic benefit, by doctors engaging with appropriate treatment for their health difficulties. It is also evident that in order to reap these benefits, treatment needs to take account of key differences, including heightened shame, fears around confidentiality and stigma, and doctors’ personalities.
References
- Hassan, TM et al. (2009) A postal survey of doctors' attitudes to becoming mentally ill. Clinical Medicine, Journal of the Royal College of Physicians, 9: 327-332(6)
- Lindeman S et al. (1996) A systematic review on gender-specific suicide mortality in medical doctors. British Journal of Psychiatry. 168: 274-9
- Department of Health (2010) Invisible Patients, Report of the Working Group for the Health for Health Professionals.
- Department of Health (2009) NHS Health and Well-being, Final Report
- North East London SHA (2003) Independent Inquiry into the Care and Treatment of Daksha Emson MBBS, MRCPysch, MSc and her Daughter Freya
- NHS London Specialist Commissioning Group. (2010) NHS Practitioner Health Programme. Report on Two Year Prototype.
- Meerton, M, Bland, J, Gross, SR and Garelick, AI. (2011) Doctors’ experience of a bespoke physician consultation service: cross-sectional investigation. The Psychiatrist, 35, 206-12
Further articles to follow:
- Richard Duggins will introduce simple techniques doctors and other health professionals can use to manage stress and reduce their vulnerability to psychological ill health and addiction. He will also detail the local, regional and national services that are available to doctors and other health professionals with health concerns. Click here to go this article.
- Dr Rhona Knight will describe a pioneering training for GPs wishing to develop their competencies in caring for doctors and other health professionals.