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Doctors — the ‘invisible patients’

The doctors of the future at University College Cork (UCC) Medical Society have set a huge challenge in aiming to tackle one of the most sensitive issues affecting medical professionals.

Despite some improvements in the overall approach to mental health issues in Irish society generally, a huge stigma remains regarding the mental health of doctors.

Members of the Society have for the first time this year taken on a welfare role and placed a huge emphasis on the mental health of doctors and medical students.

Widespread interest in the topic was evident as over 100 medical students and doctors gathered at Brookfield Health Sciences Complex, UCC, recently to hear speakers address the issue of ‘A doctor’s toughest diagnosis: Their own mental health’.

Speakers included Dr Blánaid Hayes, Consultant Occupational Physician at Beaumont Hospital, Dublin; Dr Zeshan Qureshi, an academic and clinical paediatrician with a special interest in global health and medical education at King’s College Hospital, London, and the Institute of Global Health, University College London; and Prof Ted Dinan, Professor of Psychiatry and Principal Investigator in the Alimentary Pharmabiotic Centre at UCC.

Burnout

Dr Hayes was first to the podium with her talk titled, ‘Wellbeing of Irish hospital doctors’.

She is a Fellow of the Royal College of Physicians of Ireland and a Fellow and current Dean of the Faculty of Occupational Medicine.

Dr Hayes presented noteworthy evidence from the RCPI National Study of Wellbeing of Hospital Doctors in Ireland.

According to Dr Hayes, individual, workplace and societal factors all impact on the mental health of doctors.

Doctors are just as vulnerable as any other profession when it comes to their mental health, she told delegates.

The results of the study of over 1,700 doctors revealed that 35 per cent of hospital doctors experienced psychological distress, with the figure higher among trainees than consultants.

One-in-six were classified as having moderate levels of depression and there was also a high level of occupational distress.

The study looked at burnout among doctors and found that 50 per cent had experienced emotional exhaustion, while just under one-in-three experienced depersonalisation.

Only 19 per cent exercised to a level that was considered health-enhancing, while 10 per cent of respondents admitted to smoking.

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Dr Blanaid Hayes, Dean-elect, Faculty of Occupational Medicine

Dr Hayes offered the audience four practical steps to help avoid mental health problems, the first being to accept your vulnerability.

Doctors should also be alert for triggers, ask for help from family and friends and access care appropriately, she said.

The RCPI has supports available to doctors, including wellbeing workshops, education courses and information and advice, she added.

Stigma

Dr Qureshi was next to the floor with his talk, ‘Overcoming stigma and censorship’.

He delivered a very personal, open and honest account of his own battle with depression in the past and addressed the stigma surrounding doctors’ mental health.

“I left things too late and was very vulnerable,” Dr Qureshi related, as he detailed how a difficult and intense work environment in neonatal paediatrics in London, coupled with the death of his father, led to a breakdown at work.

Dr Qureshi received the specialist care he required and has since spoken about his experiences publicly a number of times, including taking part in a documentary for the BBC.

He urged attendees not to blame themselves and described mental health issues as a “problem within a system, rather than you as an individual”.

Prof Dinan looked at depression and explored the many causes and consequences of the illness among doctors.

Up to 10 per cent of doctors will suffer a depressive illness at some time during their career, Prof Dinan noted, adding that the impact could be quite enormous on individuals.

Prof Dinan primarily treats depression and he sees a lot of depressed doctors from all over the country at his practice, he said.

Self-prescribing

Doctors differ from other members of the population in their experience of mental health problems, in that they will continue to work when others will have stopped, he contended.

Secondly, he warned that the “dangerous activity” of self-prescribing is very common among doctors.

In a criticism of medical college curricula generally, Prof Dinan maintained that between 10 and 20 per cent of what students study is “bullshit” and could be condensed to alleviate the immense pressure on medical students.

So what are the most common reasons for depression in doctors? According to Prof Dinan, a strong family history of the illness, exposure to negative life events and retirement and/or the inability of doctors to retire are the main causes.

He revealed that many of his patients have nothing in their lives other than medicine and reminded audience members that “there’s more to life than medicine”.

Depression and mental health problems can also arise following a complaint to the Medical Council, even when a doctor has been exonerated of any wrongdoing, Prof Dinan remarked. 

Despite noting its important role, Prof Dinan criticised the Medical Council and advised that there are ways it could function in a much “less aggressive” manner.

In order to prevent mental health problems, Prof Dinan contended that it is vital to maintain outside interests.  Doctors should also exercise regularly, avoid drinking too much and maintain regular sleep patterns.

In his presentation titled ‘Physician, heal thyself’, Prof Jim Lucey explored the notion of wellness and outlined five aspects that define mental wellness.

Well people connect with each other, keep learning and they take notice of their surroundings. They are also active and “giving”, allowing themselves a break and giving to themselves, Prof Lucey remarked.

Resilience

He said resilient people have a well of resources they can dip into, including education and friendships. Doctors, however, are not good at maintaining friendships, he stated.

Having many interests, being socially competent and having positive values are also features of resilient people, he said. Additionally, a lack of sleep is a huge factor in mental wellbeing.

Consultant Gastroenterologist Dr Anthony O’Connor, who has suffered from depression, chronicled his journey through medical training and beyond and raised the notion of what he called the “imposter feeling” among doctors.

He expressed concern that doctors are wrongly being put on a pedestal as being the “elite” from as early as the pre-selection stage.

This, he believes, is incorrectly setting doctors up to fail and also represents a conflict, as doctors are placed on a pedestal at the same time as being asked to be humble.

He reminded the audience that being a doctor is “just a job” and also drew attention to the system in which doctors work, highlighting that institutions are not regulated as highly as individuals are, a situation that he believes is setting doctors up for failure.

Dr O’Connor warned that describing being a doctor as a “vocation” could be viewed as negative, as it can be used in an exploitative manner. 

He advised that part of the skill of surviving as a doctor is knowing when to say ‘enough is enough’.

“You need balance in your life,” he counselled.

Speaking from personal experience, he admitted to feeling like he placed a target on his back in the past when speaking out about unsupportive and stressful working environments.

He said patients deserved healthy, well-balanced doctors and stressed to audience members that “you are not an imposter… you are welcome and loved”.

Dr Margaret O’Rourke, author and Director of the SAFEMED Programme, a positive psychology coaching programme focused on clinician health that she developed for medical students, doctors and healthcare professionals, was the final speaker on the night.

She has published and presented on a wide range of topics including stress, mental health treatments, risk management, anger management, addictions, trauma, violence reduction and public safety.

She emphasised to students and doctors that it is possible to be a sick doctor with mental health problems and still be in the profession.

On another positive note, she stated that doctors respond very well and quickly to treatment when they do seek help.

Echoing Dr O’Connor’s remarks, she said patients deserve good doctors and cautioned that an ill doctor does not deliver good care to patients.

She voiced concerns about the unmet need in healthcare and remarked how doctors are often rightly described as the “invisible patient”.

In relation to the term ‘stress’, she outlined how it can be functional and dysfunctional and asserted that stress is preventable.

One’s “thinking styles” and “toxic cognition” can be sources of stress, she explained, adding that there is an unmet training need to look at behaviours and thoughts among doctors to prevent mental health problems.

“Ninety per cent of doctors I see have reactive depression,” she revealed, meaning that only 10 per cent have what she called “genetic depression”.

“We need to change the toxic cognitions and emotional toil of medicine,” she told the meeting.

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