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The views expressed in this piece are the opinion of the author and do not reflect the views of any institution.

Problem 1: Bunch of blimmin’ high-achieving, over-intelligent perfectionists (some of my favourite people are doctors)

Kevin, are you okay? How you going with all this?—Yes I’m fine, a little busy; I’m worried about Bob though.

Bob, I just want to check in with how you are doing.—Yes I’m fine, it’s what I trained for, but I’m worried about Kevin.

Problem 2: Unspoken doctor rules of what is and isn’t allowed to be said, as unscientifically collected through 15 years of informal doctor observation (ethical approval not obtained/not peer reviewed)

Okay to discuss: General references to burnout, workload, hours, pressure and being busy.

Okay to discuss: Teamwork, what we learn from this, communication, improving team function, team and inter-team relationships, concern for others and systems.

Okay to discuss: General vague references to “support” preferably of ‘other’ not ‘self’.

Less discussed: Daily burden of the consequences of decisions, habituation to risk and stress, self-protection strategies in response to emotional distress and trauma—depersonalisation and dissociation.

Less discussed: Carrying the day home, riding an emotional roller coaster of success and sadness and stoic responses in the face of unbearable pressure.

Not discussed: Reality of burnout, depression, anxiety, suicidal thoughts, relationship breakdown and alcohol or drug use.

Problem 3: The truth of mental health for doctors vs the ‘I’m fine’ narrative

• Ten percent of doctors have suicidal thoughts in previous year vs general adult population ~4%.1

• Fifty percent will experience burnout in career.3

• Alcohol misuse five times higher than general population.4,5

• Low rates of doctors get their own regular healthcare with a GP—it is compulsory in the UK.6

• Depression rates may be higher than general population, but only 16% of doctors with depression seek any treatment.7

Problem 4: Silence…why?

• Embarrassment

• Fear of impacts on registration—rights to confidential treatment?

• Inter-doctor stigma—a doctor who has sought help is inferior? Weak? Tainted? Inept?

• Pessimistic view of the value of mental health services—Talking therapy is a bit stupid, the therapist won’t be as smart as I am, otherwise they would have become a real doctor.

• Fear of psychotropic meds.

Problem 5: More barriers and excuses

• I can manage by myself.

• No time.

• Fear of being reported.

• Burnout more “acceptable” than depression.

• Doctors treat doctors differently—engage in medical talk, discuss papers (this defence mechanism is called intellectualisation)—this limits the doctor-patient norms and keeps the relationship doctor-to-doctor, which may interfere with effective treatment.

What to do?

Drop the defences dude. Doctors need to take a break from self-diagnosis (and self-medicating) and just be the patient for a little bit.8

Mindfulness, self-care, time off, exercise and healthy work environment—some of these are seen as too touchy feely, and there is a general tone of cynicism expressed. To combat this you need a bit of humour and peers who are wellbeing enthusiasts due to their own experiences.

Doctors need to start to talk about vulnerability and responses to trauma to reduce the stigma and model good behaviour. It is not okay to just talk about what can be learnt from stressful situations.

Changes are needed at group, social and institutional levels to transcend the barriers. Schwartz rounds are trending.8

Get a GP, for $%^*’# sake, you could get your cholesterol checked as a cover story. Maybe find your own therapist—if you don’t like them then get another one, get recommendations for someone good or try an online option if you are persistently allergic. If you have a therapist-in-waiting you can get in more easily when you are ready. The first time is the always the most difficult.

You’re worth it.

(I saw that eye roll.)

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Kathryn Russell, Clinical Psychologist, Psychological Medicine, Counties Manukau Health, Auckland.

Acknowledgements

Correspondence

Dr Kathryn Russell, Clinical Psychologist, Psychological Medicine, Counties Manukau Health, 100 Hospital Road, Auckland 1640.

Correspondence Email

kathryn.russell@cmdhb.org.nz

Competing Interests

Nil.

1. Gerada C. Doctors, suicide and mental illness. BJPsych bulletin. 2018;42(4):165-8. Epub 2018/05/02.

2. Medscape. Medscape national physician burnout, depression & suicide report. 2019.

3. Chambers CN, Frampton CM, Barclay M, McKee M. Burnout prevalence in New Zealand’s public hospital senior medical workforce: a cross-sectional mixed methods study. BMJ open. 2016; 6(11):e013947. Epub 2016/11/25.

4. Outhoff K. Depression in doctors: A bitter pill to swallow. South African Family Practice. 2019; 61(sup1):S11–S4.

5. Fry RA, Fry LE, Castanelli DJ. A retrospective survey of substance abuse in anaesthetists in Australia and New Zealand from 2004 to 2013. Anaesthesia and intensive care. 2015; 43(1):111–7. Epub 2015/01/13.

6. Kay M, Mitchell G, Clavarino A, Doust J. Doctors as patients: a systematic review of doctors’ health access and the barriers they experience. The British journal of general practice: the journal of the Royal College of General Practitioners. 2008; 58(552):501–8.

7. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. Jama. 2016; 316(21):2214–36. Epub 2016/12/07.

8. Kinman G, Teoh K. What could make a difference to the mental health of UK doctors? A review of the research evidence. 2018.

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

The views expressed in this piece are the opinion of the author and do not reflect the views of any institution.

Problem 1: Bunch of blimmin’ high-achieving, over-intelligent perfectionists (some of my favourite people are doctors)

Kevin, are you okay? How you going with all this?—Yes I’m fine, a little busy; I’m worried about Bob though.

Bob, I just want to check in with how you are doing.—Yes I’m fine, it’s what I trained for, but I’m worried about Kevin.

Problem 2: Unspoken doctor rules of what is and isn’t allowed to be said, as unscientifically collected through 15 years of informal doctor observation (ethical approval not obtained/not peer reviewed)

Okay to discuss: General references to burnout, workload, hours, pressure and being busy.

Okay to discuss: Teamwork, what we learn from this, communication, improving team function, team and inter-team relationships, concern for others and systems.

Okay to discuss: General vague references to “support” preferably of ‘other’ not ‘self’.

Less discussed: Daily burden of the consequences of decisions, habituation to risk and stress, self-protection strategies in response to emotional distress and trauma—depersonalisation and dissociation.

Less discussed: Carrying the day home, riding an emotional roller coaster of success and sadness and stoic responses in the face of unbearable pressure.

Not discussed: Reality of burnout, depression, anxiety, suicidal thoughts, relationship breakdown and alcohol or drug use.

Problem 3: The truth of mental health for doctors vs the ‘I’m fine’ narrative

• Ten percent of doctors have suicidal thoughts in previous year vs general adult population ~4%.1

• Fifty percent will experience burnout in career.3

• Alcohol misuse five times higher than general population.4,5

• Low rates of doctors get their own regular healthcare with a GP—it is compulsory in the UK.6

• Depression rates may be higher than general population, but only 16% of doctors with depression seek any treatment.7

Problem 4: Silence…why?

• Embarrassment

• Fear of impacts on registration—rights to confidential treatment?

• Inter-doctor stigma—a doctor who has sought help is inferior? Weak? Tainted? Inept?

• Pessimistic view of the value of mental health services—Talking therapy is a bit stupid, the therapist won’t be as smart as I am, otherwise they would have become a real doctor.

• Fear of psychotropic meds.

Problem 5: More barriers and excuses

• I can manage by myself.

• No time.

• Fear of being reported.

• Burnout more “acceptable” than depression.

• Doctors treat doctors differently—engage in medical talk, discuss papers (this defence mechanism is called intellectualisation)—this limits the doctor-patient norms and keeps the relationship doctor-to-doctor, which may interfere with effective treatment.

What to do?

Drop the defences dude. Doctors need to take a break from self-diagnosis (and self-medicating) and just be the patient for a little bit.8

Mindfulness, self-care, time off, exercise and healthy work environment—some of these are seen as too touchy feely, and there is a general tone of cynicism expressed. To combat this you need a bit of humour and peers who are wellbeing enthusiasts due to their own experiences.

Doctors need to start to talk about vulnerability and responses to trauma to reduce the stigma and model good behaviour. It is not okay to just talk about what can be learnt from stressful situations.

Changes are needed at group, social and institutional levels to transcend the barriers. Schwartz rounds are trending.8

Get a GP, for $%^*’# sake, you could get your cholesterol checked as a cover story. Maybe find your own therapist—if you don’t like them then get another one, get recommendations for someone good or try an online option if you are persistently allergic. If you have a therapist-in-waiting you can get in more easily when you are ready. The first time is the always the most difficult.

You’re worth it.

(I saw that eye roll.)

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Kathryn Russell, Clinical Psychologist, Psychological Medicine, Counties Manukau Health, Auckland.

Acknowledgements

Correspondence

Dr Kathryn Russell, Clinical Psychologist, Psychological Medicine, Counties Manukau Health, 100 Hospital Road, Auckland 1640.

Correspondence Email

kathryn.russell@cmdhb.org.nz

Competing Interests

Nil.

1. Gerada C. Doctors, suicide and mental illness. BJPsych bulletin. 2018;42(4):165-8. Epub 2018/05/02.

2. Medscape. Medscape national physician burnout, depression & suicide report. 2019.

3. Chambers CN, Frampton CM, Barclay M, McKee M. Burnout prevalence in New Zealand’s public hospital senior medical workforce: a cross-sectional mixed methods study. BMJ open. 2016; 6(11):e013947. Epub 2016/11/25.

4. Outhoff K. Depression in doctors: A bitter pill to swallow. South African Family Practice. 2019; 61(sup1):S11–S4.

5. Fry RA, Fry LE, Castanelli DJ. A retrospective survey of substance abuse in anaesthetists in Australia and New Zealand from 2004 to 2013. Anaesthesia and intensive care. 2015; 43(1):111–7. Epub 2015/01/13.

6. Kay M, Mitchell G, Clavarino A, Doust J. Doctors as patients: a systematic review of doctors’ health access and the barriers they experience. The British journal of general practice: the journal of the Royal College of General Practitioners. 2008; 58(552):501–8.

7. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. Jama. 2016; 316(21):2214–36. Epub 2016/12/07.

8. Kinman G, Teoh K. What could make a difference to the mental health of UK doctors? A review of the research evidence. 2018.

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

The views expressed in this piece are the opinion of the author and do not reflect the views of any institution.

Problem 1: Bunch of blimmin’ high-achieving, over-intelligent perfectionists (some of my favourite people are doctors)

Kevin, are you okay? How you going with all this?—Yes I’m fine, a little busy; I’m worried about Bob though.

Bob, I just want to check in with how you are doing.—Yes I’m fine, it’s what I trained for, but I’m worried about Kevin.

Problem 2: Unspoken doctor rules of what is and isn’t allowed to be said, as unscientifically collected through 15 years of informal doctor observation (ethical approval not obtained/not peer reviewed)

Okay to discuss: General references to burnout, workload, hours, pressure and being busy.

Okay to discuss: Teamwork, what we learn from this, communication, improving team function, team and inter-team relationships, concern for others and systems.

Okay to discuss: General vague references to “support” preferably of ‘other’ not ‘self’.

Less discussed: Daily burden of the consequences of decisions, habituation to risk and stress, self-protection strategies in response to emotional distress and trauma—depersonalisation and dissociation.

Less discussed: Carrying the day home, riding an emotional roller coaster of success and sadness and stoic responses in the face of unbearable pressure.

Not discussed: Reality of burnout, depression, anxiety, suicidal thoughts, relationship breakdown and alcohol or drug use.

Problem 3: The truth of mental health for doctors vs the ‘I’m fine’ narrative

• Ten percent of doctors have suicidal thoughts in previous year vs general adult population ~4%.1

• Fifty percent will experience burnout in career.3

• Alcohol misuse five times higher than general population.4,5

• Low rates of doctors get their own regular healthcare with a GP—it is compulsory in the UK.6

• Depression rates may be higher than general population, but only 16% of doctors with depression seek any treatment.7

Problem 4: Silence…why?

• Embarrassment

• Fear of impacts on registration—rights to confidential treatment?

• Inter-doctor stigma—a doctor who has sought help is inferior? Weak? Tainted? Inept?

• Pessimistic view of the value of mental health services—Talking therapy is a bit stupid, the therapist won’t be as smart as I am, otherwise they would have become a real doctor.

• Fear of psychotropic meds.

Problem 5: More barriers and excuses

• I can manage by myself.

• No time.

• Fear of being reported.

• Burnout more “acceptable” than depression.

• Doctors treat doctors differently—engage in medical talk, discuss papers (this defence mechanism is called intellectualisation)—this limits the doctor-patient norms and keeps the relationship doctor-to-doctor, which may interfere with effective treatment.

What to do?

Drop the defences dude. Doctors need to take a break from self-diagnosis (and self-medicating) and just be the patient for a little bit.8

Mindfulness, self-care, time off, exercise and healthy work environment—some of these are seen as too touchy feely, and there is a general tone of cynicism expressed. To combat this you need a bit of humour and peers who are wellbeing enthusiasts due to their own experiences.

Doctors need to start to talk about vulnerability and responses to trauma to reduce the stigma and model good behaviour. It is not okay to just talk about what can be learnt from stressful situations.

Changes are needed at group, social and institutional levels to transcend the barriers. Schwartz rounds are trending.8

Get a GP, for $%^*’# sake, you could get your cholesterol checked as a cover story. Maybe find your own therapist—if you don’t like them then get another one, get recommendations for someone good or try an online option if you are persistently allergic. If you have a therapist-in-waiting you can get in more easily when you are ready. The first time is the always the most difficult.

You’re worth it.

(I saw that eye roll.)

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Kathryn Russell, Clinical Psychologist, Psychological Medicine, Counties Manukau Health, Auckland.

Acknowledgements

Correspondence

Dr Kathryn Russell, Clinical Psychologist, Psychological Medicine, Counties Manukau Health, 100 Hospital Road, Auckland 1640.

Correspondence Email

kathryn.russell@cmdhb.org.nz

Competing Interests

Nil.

1. Gerada C. Doctors, suicide and mental illness. BJPsych bulletin. 2018;42(4):165-8. Epub 2018/05/02.

2. Medscape. Medscape national physician burnout, depression & suicide report. 2019.

3. Chambers CN, Frampton CM, Barclay M, McKee M. Burnout prevalence in New Zealand’s public hospital senior medical workforce: a cross-sectional mixed methods study. BMJ open. 2016; 6(11):e013947. Epub 2016/11/25.

4. Outhoff K. Depression in doctors: A bitter pill to swallow. South African Family Practice. 2019; 61(sup1):S11–S4.

5. Fry RA, Fry LE, Castanelli DJ. A retrospective survey of substance abuse in anaesthetists in Australia and New Zealand from 2004 to 2013. Anaesthesia and intensive care. 2015; 43(1):111–7. Epub 2015/01/13.

6. Kay M, Mitchell G, Clavarino A, Doust J. Doctors as patients: a systematic review of doctors’ health access and the barriers they experience. The British journal of general practice: the journal of the Royal College of General Practitioners. 2008; 58(552):501–8.

7. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. Jama. 2016; 316(21):2214–36. Epub 2016/12/07.

8. Kinman G, Teoh K. What could make a difference to the mental health of UK doctors? A review of the research evidence. 2018.

Contact diana@nzma.org.nz
for the PDF of this article

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