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Facing facts on physician health

In Roland Huntford’s biography Shackleton (1985, p.639) he describes how, in 1916, two members of Sir Ernest’s Imperial Trans-Antarctic expedition trudged 13 miles through a blizzard. Utterly exhausted, they stumbled into Cape Evans, where medical officer Dr John Lachlan Cope greeted them with: “Hello Ricky … I’m not good, I’ve got appendicitis – I’m shitting nanny-goats turds.” Ricky’s diary states: “The other fellows … told me that [Cope] was not quite normal.”

Antarctic conditions had eroded Cope’s mental and physical reserves, but at least here, in temperate climes, we don’t need to worry about physicians’ health. Or do we? Catherine Reilly’s piece in the Medical Independent (6 October 2016) is a sobering reminder – “the myth of the superhuman [is] still alive and well” − that doctors’ health is at risk. It was disconcerting to read that Medical Council President Professor Freddie Wood’s call for greater pastoral support for medics had sparked criticism from colleagues: “oh, we don’t need it”. With evidence accumulating to show that “oh, you do need it”, the notion of the superhuman physician, combined with the glib assumption that doctors are superhuman, confirms that autumn is indeed the season of myths and hollow truthfulness.

The introduction alone to the Delphi study by Hayes et al (BMJ Open doi:10.1136/bmjopen-2015-009564), cited by Reilly, is bleak reading, and that’s before you get to the meat of the paper, featuring quotes such as “There is pressure not to appear sick even if you have a problem as ultimately it will narrow your career options,” prompting one reader to wonder why those exerting such pressure cannot be named and … well, I suppose that anyone pressurising a sick colleague into feigning health is beyond shame.

Presumably those professional colleagues of Prof Wood who deny the need for greater pastoral support for doctors are prepared to rebut some of the evidence adduced to the contrary. For example, earlier this year Byrne et al, writing in the Irish Journal of Medical Science (2016, 185: 603−609) asked: “Is there a risk profile for the vulnerable junior doctor?” They found that 48.5 per cent of 270 junior doctors in Ireland were suffering psychological distress. This is disquieting in the context of studies cited by the authors showing that doctors are particularly vulnerable to a variety of mental health problems including stress, anxiety, depression, substance abuse issues, suicidality, and burnout. And with evidence demonstrating that around 28 per cent of doctors report high levels of psychological distress, Byrne et al’s figure of 48.5 per cent is a suitable rejoinder to ‘oh we don’t need’ [pastoral support for medics].”

In a study from Belfast, McAleese et al undertook An assessment of psychological need in emergency medical staff in the Northern Health and Social Care Trust Area, reporting in the Ulster Medical Journal (2016, 85: 92−98) that 65 per cent of 107 participants “thought that work-related stressors had negatively affected their mental health”. In addition, the highest incidences of secondary trauma symptomatology were found within some nursing grades and junior doctors.

Speaking of trauma, a UK study undertaken by Naghavi et al, Post-traumatic stress disorder in trainee doctors with previous needlestick injuries, and reported in Occupational Medicine (2013, 63: 260−265), found that 12 per cent of doctors with experience of needlestick injury had post-traumatic stress reactions.

But Reilly’s piece (Myth of the Superhumans) also draws deserved attention to a neglected aspect of the debate about physicians’ health. While she notes some encouraging signs that medic-associated mental health problems are being taken seriously, Dr Maria Stack makes the important point that whereas the Medical Council is cautious, indeed wary, about encouraging doctors with psychological problems back to work, “if you’ve got a medical diagnosis, they don’t want to know … you could be on death’s door with congestive cardiac failure or anything else and they think you are perfect”.

With Dr Stack suffering the excruciating pain associated with trigeminal neuralgia type 2 – indeed, her condition has been called the “suicide disease” – one possible inference from her compelling comments is that doctors suffering from medical conditions, as opposed to mental ones, are at risk of being alienated by members of their own profession, especially, as Dr Stack states, if “they don’t want to know”. Dr Stack also told me that her trigeminal neuralgia type 2 was not accepted as a physical illness: “Instead I was labelled with psychological issues. There is discrimination against doctors with a psychological diagnosis as the Medical Council are very slow to return those doctors back to work. Colleagues also feel you are a lesser doctor if you are affected by a psychological illness.”

The idea of evidence-based medicine is popular; indeed, so popular that few medics would dare disavow it – at least not out loud. But the evidence shows that evidence isn’t always held in high esteem. For example, despite evidence first adduced by Semmelweis over a century ago that handwashing can eliminate many infections, healthcare workers often wilfully ignore the accumulated weight of confirmatory studies and infect patients in the process.

Similarly, Prof Wood’s colleagues who say of pastoral care for medics that “oh we don’t need it” wilfully ignore the evidence that the mental and physical health of their colleagues needs to be addressed with a sense of urgency.

As a prospective patient I need to have a healthy doctor.

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