How can a doctor become ill when they treat illness? Some people are neglectful in understanding that doctors are human and suffer from the same issues as them. This is one
reason that doctors feel like there is a stigma around being ill so are reluctant to ask for help. There are high rates of depression in the healthcare population, which is widely undiagnosed. 1 in 15 adults in the UK have attempted suicide and 1 in 5 have considered it, for doctors this is between 2 and 5 times greater.

Causes of depression
The Medical Protection Society found that 52% of UK doctors are dissatisfied with their work-life balance, 46% feel guilty about taking time off, and almost 40% believe their employer does not support them to do their job well.

  • Intrinsic Difficulties of the Occupation
    Burnout is a major component leading to mental illness in doctors. They work long hours under demanding conditions, so their mental and physical health can be compromised. A systematic study taken over 20 years shows that in the UK, 31 – 54% of doctors feel overworked and drained. The effect of burnout is more significant in junior doctors as they feel insecure about their performance and can struggle in the competitive nature of the field.
  • Lack of Support
    Doctors also feel a lack of support due to diminishing resources in the NHS. The NHS is immensely understaffed and there is a huge lack of funding for the work they need to perform. The lack of support from consultants can make these junior doctors feel insecure and casts doubt on their decisions. In the UK in 2017, W.H.O stated there were only 2.8 physicians per 1000 people. This often leads to long waiting periods for patients which result in numerous complaints.
  • Financial Stressors
    Junior doctors also have 5-6 years of tuition debt to pay off; exacerbating stress. Indemnity once qualifying as a doctor results in a significant amount of their salary going towards insurance against being sued. The cost of the insurance depends on the speciality and some doctors do not have the financial means to cover this.

Effects of the disorders
According to the NHS, mild symptoms of depression make you feel low in spirit and unhappy, while severe symptoms can make you feel suicidal. Depression can stimulate physical illness such as intestinal issues which can prevent them from going to work. A severe case can lead to depersonalisation, which causes strained family relationships and development of a hostile attitude towards patients. Therefore, they can become ineffective in their job increasing the risk of making medical errors. These doctors learn to hate a job they once loved. A lack of passion leads to their occupation feeling like a chore. As well as this, The General Medical Council (GMC) will investigate doctors for ‘poor performance’, if their ‘mental health issue is affecting their ability to practice medicine’. The substantial pressure that the GMC puts on doctors who are being investigated correlates to additional pressure the doctor then places on themselves. Doctors are afraid to confide in the GMC about their mental state due to fear of being removed from the medical register.

Interview with Dr. Clare Gerada
We interviewed Dr Gerada, the founder of the NHS Practitioner Health, who began her journey to establishing the NHS PH after reading about the suicide of the psychatrist Daksha Emson. This inspired her to create a system for doctors in order to support their mental health in the early stages and thereby prevent it from progressing into a more unmanageable state. The service can help with mental health issues such as stress, depression or substance abuse. Doctors specialised in mental health support these doctors. The service is available in various locations across England.
What are the most common mental illnesses your patients face?
80% suffer from depression or anxiety while the other 20% suffer from substance addiction
or PTSD, others experience psychosis.
Is burnout the most common cause of these illnesses?
Yes, burnout is an occupational hazard that can lead to depression. It is prevalent in every
job.
Are any specialities affected more than others?
50% are GPs however there are more GPs compared to other specialties so the numbers
are proportional.
How do you think coronavirus will affect the mental health of your patients?
Although the pandemic, Covid-19, has increased the workload of the NHS, the
acknowledgement they receive from the public and sympathy has led to a greater sense of
morale and reinforces purpose. The reinstatement of 20,000 retired doctors has
strengthened the support system. As a result, it will most likely have a positive improvement
on their wellbeing.
What are you most proud of?
80% of the patients at PHP, who were previously unable to work, recover and are healthy
enough to return.
What advice would you give to students to prepare for the pressures of medical
school?
Medical students are accepted on the basis of their exceptional academics and capabilities
of becoming a skilled doctor. They are used to working diligently, which also causes them to
aim for perfectionism in their work and meet standards they have set for themselves. These
standards can often be extremely high. Therefore lowering them would prevent self-
deprecation.

Success stories of PHP
Person A suffered from severe anxiety attacks, due to her position she was able to self-
prescribe medication for 10 years and suffered in silence. This led to her living with her
parents. She was later diagnosed with severe recurrent agitated depression. Within 18
months, she was more mentally stable and could adequately support her second child.

Person B was struggling with his surgical exam and without the comfort of alcohol, he quickly became agitated and relentless. After releasing his dependency on alcohol to carry out his day to day life he realized that he was desperate for help. His relationships were deteriorating and he was losing his passion as a doctor.  2 years after seeking help he developed a stronger relationship with his new wife, children and himself. PHP allowed him to rediscover his love for medicine.

How are different specialities affected?
General Practitioners – 50% of the Practitioner Healthcare patients are GPs, of which 67% are female. GPs tend to be isolated in their room all day, therefore they have limited contact with other colleagues so have no time to de-stress. They are limited to 10 minute appointments which can be a time- pressured situation as they must include investigation of the issue, reading hospital notes, giving a diagnosis and medication, referrals and administrative work. GPs are required to fill out a heavy amount of admin on new, complicated software which is not compatible with hospitals therefore transmitting patient information is slow and retrieving information is also delayed. There are currently only 28,000 GPs in England with 160 million appointments scheduled in one year. This number may be due to some patients seeking advice from their doctor for issues that are not as significant as they thought.  According to the GP Workforce Census on 30 September 2014 the number of GPs per 1,000 patients per practice in England is 0.58, which is significantly lower than other medical specialties which heightens stress.
Psychiatrists – PHP reported that a majority of their patients who were psychiatrists suffered more from mental health than addiction. They are inflicted emotionally by their empathy for their patients which can take a huge toll on their mental state of mind. They also feel as if they cannot confide to psychiatrists as there is a high chance of them being their colleague.

Conclusion
In conclusion, doctors are known to be resilient individuals which evolves from the
combination of pressure, responsibility and high expectations. Other allied healthcare
professions are also susceptible to depression. Recent meta-analyses of global studies
estimate clinical depression in 27% of medical students, 29% in registrars and up to 60% in
practising doctors. This demonstrates that even some doctors are vulnerable to depression
despite preconceived notions of them being strong-willed and tenacious.

Written By Shreya Arun, Prache Agrawal and Charlotte MacMahon

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