Feryad Hussain is a clinical psychologist and has worked across the speciality of health psychology for over 20 years.
Doctor: That’s a terrible picture, who is it supposed to be?
Patient: It’s a photo of you, doctor.
Doctor: That’s me?!
Patient: Don’t you know what you look like?
Doctor: (Shrugs shoulders) Busy day … next!
While it is a well-known fact that the role of the doctor is both a personal and professional challenge, little progression has been made towards addressing the problem. With scarce research in the area, the issue is rarely given priority. It is only in recent years, with the impact of the COVID-19 pandemic, that the physical and emotional burden faced by doctors has been raised — and even then largely in relation to its impact on already strained resources and subsequent patient care as opposed to the doctors themselves.1
While available research on mental health problems and psychological wellbeing within the medical profession supports the idea for doctor-specific psychological support services, options are extremely limited and barriers within the profession itself mean that any subsequent uptake is poor.2–4
It is only in recent years … that the physical and emotional burden faced by doctors has been raised …
This article aims to raise awareness of the importance of addressing psychological wellbeing within the medical profession. In building on guidance by the British Medical Association, it suggests that for the promotion of successful psychological self-care the concept itself requires normalisation through greater multidisciplinary working with specialist psychology services and simple integration into professional development from training to qualified status.
Mental health problems and self-care strategies do not exist in isolation to each other (although psychological interventions for treatment may differ); however, they do have a shared aim — to restore positive wellbeing and good mental health.
Challenges impacting on doctors’ mental health
Mental health problems within the medical profession are a combination of both personal and professional stressors and/or predictive factors, with existing research reflecting the complexity of the role as a direct contributory factor.
The specific types of mental health problems affecting the medical profession include problems such as stress, anxiety, low self-esteem, depression, specific work-related problems, drug and alcohol addiction, as well as trauma and post-traumatic stress disorder, with a number of studies also highlighting the disproportionate suicide rates within the profession.5–7
Notable differences in experiences of mental health problems were found between pre- and post-qualification (though not exclusive to each). For example, Tyssen and Vaglum,8 found that mental health problems in medical students were moderated by factors such as family background, personality traits (neuroticism and self-criticism), coping by wishful thinking, and contextual factors including level of training, perceived medical-school stress, perceived overwork, emotional pressure, working in an intensive-care setting, and stress outside of work.
… doctor-specific psychological support services … are extremely limited …
Alternatively, Oxtoby9 found that for post-qualified professionals, moderating factors included issues such as hours worked, high patient through-put, work-related resources, ongoing changes in responsibility, wider organisational changes, and concerns around an increasing litigation.
The differences in experiences were further reflected in support and intervention where studies suggest that formal diagnoses were most likely given to junior doctors, with senior doctors and those qualified overseas not being able to access support resulting in high levels of self-prescribing in post-qualified staff.10,11
This current, albeit scant, picture regarding mental health problems within the medical profession, reflects the complexity of the situation not only in the challenges they face but also the disparity in response and intervention.
Barriers to accessing and acting on psychological care
There have been a number of studies recommending ‘medic-specific’ mental health services advising that the issues facing medics are specific to their profession, with the importance of immediacy of intervention being important to the individual as well as the subsequent impact on healthcare service delivery.3,12
However, despite a specific initiative having been set up in the form of the NHS Practitioner Health Programme triggering other local services, the utilisation of such services has been low. The low uptake has been explained by a number of factors including fear of judgment by peers, lack of confidentiality, impact of professional development, stigma of mental health (from both patients and peers), and minimalisation of the importance of mental as opposed to physical health.4,13–15
… the system itself does not allow for time and opportunity to access [psychological wellbeing and self-care] facilities.
Kinman and Teoh12 make the very valid point that in spite of the acknowledgement of addressing psychological wellbeing and self-care strategies within the medical system, it is the system itself that does not allow for time and opportunity to access these facilities. As such, medics are caught between conflicting personal and professional and/or patient and physician priorities — all feeding into an unwritten belief that part of being a doctor means excluding one’s personal problems from the professional setting.2
In light of the above, creating the related changes in social and professional culture may take considerable time. This — coupled with the lack of consistency and structure of existing support systems – may limit progression. That said, the process may be facilitated by introducing access points to allow triggers for change within the system and across the ‘life cycle’ of the doctor.
This can in large part be achieved by greater multidisciplinary working with specialist psychological services, commissioning not only in the previously advised psychological interventions but developing areas of psychological wellbeing from training to retirement. While there may be an issue with time and resources, these may be creatively used to gain maximum benefit for staff.
Recommendations to support doctors in psychological care
There are a number of points where psychologists may access support, which if implemented would directly manage and reduce the impact of barriers, as mentioned above, to accessing help or considering self-care. They aim to be offered across both pre- and post-qualification:
Medical training. Although medical training courses have started to consider the mental health of patients within acute and secondary settings (quite apart from the psychiatric specialism) — the issue of self-care for doctors themselves remains somewhat random and taboo. Training sessions highlighting psychological wellbeing and self-care would certainly counteract issues of peer judgement and fear of negative impact on professional progress, challenging the belief that medics’ personal needs are irrelevant in a professional setting. Alternatively, the importance of self-care may simply be modelled by including specific activities for medical students to complete as an active part of their training and reviewed as such.
Training sessions highlighting psychological wellbeing and self-care would certainly counteract issues of peer judgement …
Online resource library. While doctors may be encouraged to develop patient mental health and wellbeing resources, staff-specific resources are rarely considered. The availability of practical self-care strategies and mental health awareness resources for both trainees as well as qualified professionals, be they in the form of a formal induction pack or online access to a range of services and strategies, would address both the absence of personal resources as well as facilitating access to services in a discreet and accessible manner. These may be linked both to training courses as well as Trusts.
Training, placement, and employment inductions. The inclusion of encouraging one to take responsibility for one’s psychological wellbeing should begin at the introduction to each stage of training and employment. In addition to a session of mental health awareness, access details to doctor-specific or local mental health services as well as staff helplines and related referral procedure should be included with all induction programmes. Again, this supports normalisation of the concept of mental health issues and in turn reduces related stigma.
The remaining two recommendations can help to reduce wider issues related to role-specific stress not only by addressing personal concerns but also as a forum for raising and identifying practical concerns, allowing for wider system changes.
Reflective practice. Reflective practice sessions are normally offered by a qualified clinical or counselling psychologist and create an opportunity (monthly) for professionals to reflect and identify the impact of their individual qualities and experiences on their professional input. As an established form of reducing work-based distress, such groups also allow for identification and referral on to individual specialist services. As a preventative and ongoing measure of managing mental health as well as a form of self-care, reflective practices are a regular aspect of the job of health psychologists.
There is increasing awareness of the need for doctors to consider their own psychological wellbeing throughout their careers.
Psychological supervision. In conjunction with reflective practice groups, clinical or counselling psychologists often offer psychological supervision around any work-based psychological distress and complex psychological cases. This supervision, as above, is often part of the health psychologists’ role and to date has largely been offered to nursing staff alone; though medics are equally frontline, this support is absent for them.
The above-mentioned strategies would go some way to counteracting the barriers to accessing support and maintenance of good psychological wellbeing, further demonstrating clearly how the system itself may actualise its advice in a more structured manner. For the medical professional this will reiterate that personal wellbeing and self-care must be given equal consideration to patient care, going beyond words and into action.
There is increasing awareness of the need for doctors to consider their own psychological wellbeing throughout their careers. Professional bodies have gone so far as to set up doctor-specific mental health services; however, uptake remains low due to a number of personal and professional barriers and expectations. Greater integration of the importance of psychological wellbeing and self-care strategies within training, recruitment, and employment processes would go some way to supporting the medical profession, clearly demonstrating our value for them as individuals as well as professionals.
1. British Medical Association. Caring for the mental health of the medical workforce. 2019. https://www.bma.org.uk/media/1365/bma-caring-for-the-mental-health-survey-oct-2019.pdf (accessed 21 Mar 2022).
2. Unadkat S, Farquhar M. Doctors’ wellbeing: self-care during the covid-19 pandemic. BMJ 2020; 368: m1150.
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4. Brooks SK, Gerada C, Chalder T. The specific needs of doctors with mental health problems: qualitative analysis of doctor–patients’ experiences with the Practitioner Health Programme. J Ment Health 2017; 26(2): 161–166.
5. Hawton K, Clements A, Sakarovitch C, et al. Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979–1995. J Epidemiol Community Health 2001; 55(5): 296–300.
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11. Clarke J, O’Sullivan Y, Maguire N. A study of self-care among Irish doctors. Ir Med J 1998; 91(5): 175–176.
12. Kinman G, Teoh K. What could make a difference to the mental health of UK doctors? A review of the research evidence. 2018. https://www.som.org.uk/sites/som.org.uk/files/What_could_make_a_difference_to_the_mental_health_of_UK_doctors_LTF_SOM.pdf (accessed 21 Mar 2022).
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