Doctors With Mental Illness – Time For A Change

Mental Illness, particularly in the workplace, remains a stigma. It is time for attitudes toward mental illness to change, and we cannot ignore the doctors who suffer.

A push for mental health

 

https://www.gov.uk/government/news/prime-minister-pledges-a-revolution-in-mental-health-treatment

Earlier this year, former prime minister David Cameron pledged a mental health revolution of almost a billion pounds. Whilst this proposed outlay is welcome, it must be matched by a proactive change to the stigma attached to mental health in media, the workplace, and at home.

Mental health and doctors

 

Professor Debbie Cohen of Cardiff surveyed almost 2000 doctors this year and found that 60% had experienced mental illness in the UK (82% in England alone). In the general population, the rate is 28%. Doctors experience the same range of problems as everyone else, but the cocktail of work, exams, academia, family and relationships lowers the threshold for illness. Many have perfectionist traits which lead to doubt and self-criticism when things go wrong, leading to a self-perpetuating cycle.

Worryingly, more young doctors are being diagnosed with mental health problems. There may not be a pre-existing illness: After 25-year old junior doctor Rose Polge tragically committed suicide in February 2016, her family described a young lady with an infectious enthusiasm for life and no previous mental health problems, but long hours and work-related anxiety contributed to her decision to end her life.

Extreme stress early on

 

Doctors are as susceptible to mental problems as the general population. However, particularly early on in their careers, they face a unique combination of challenges. These include the need to develop countless skills within a short period (for which university education can never fully prepare) and service burdens in a chronically under-resourced environment, only more challenging for those with family or caring roles. Early junior doctors shifts are usually incompatible with outside interests, and losing day-to-day balance can unearth mental health struggles.

Doctors face a societal and professional weight compelling them to ignore difficulties. A cultural idiosyncracy of willing martyrdom exists, in which doctors feel it their role to attend work regardless of fitness. This is less prevalent in other countries, for example Australia and New Zealand, where attitudes towards sickness are more rational.

The stigma

 

Fewer professions stigmatise mental health disorders more prominently than medicine. In the Cardiff study, 41% of doctors with mental illness said that they would not disclose it. Doctors are not supposed to get ill, and seeking help is weakness which imperils trust in the practitioner’s ability to do his/her job. This featured in the heartbreaking suicide of GP Wendy Potts in November 2015 after a patient read her blog on living with Bipolar Disorder and complained to the surgery.

Some doctors find changing roles from helper to patient unnatural, others find treatment from a colleague embarrassing. Often the prevailing fear is of a career-threatening “black mark” on a permanent record: Doctors must labour through appraisals and assessments, and competition for jobs and training posts can be ferocious.

A culture of fear

 

A 2008 Department of Health report said:

“Doctors may fear that acknowledging the need for help will damage their career prospects or lead to scrutiny of their fitness to practise”

This happened in the case of Dr Dakhsha Emson, who killed herself and her baby during a relapse of bipolar disorder in 2000. A stirring tribute from her husband reflected a talented doctor and a successful medical career. However, worry of colleagues and patients finding out when she was applying for consultant posts led to a lack of treatment. The report highlighted a:

“Widespread stigma against mental illness in the NHS”

This stigma can arise as early as medical school, fostered by a triad of competitiveness, fear and uncertainty. Students sometimes receive conflicting information about mental health, and may fear disclosing illness. Pastoral care can be arbitrary, often with little demarcation between disciplinary roles and support roles. Some universities have introduced “fitness to practice” hearings to monitor student behaviour, fostering a culture of castigation.

For some doctors, this culture is epitomised by the General Medical Council (GMC), whose role is to protect the health and safety of the public. All doctors with mental health issues are required to notify regarding their problems, which are investigated under the same procedures as misconduct and poor performance. Subsequent fitness to practise processes are required to be declared on application forms for jobs. These can sometimes be beneficial, for example recommending support. However, often they are described as harrowing experiences, and the duress of investigation affects doctors personally and professionally.

The toll can sometimes be too much, between 2005 and 2013 there were 28 reported cases of suicides following investigation. One of those was GP Belinda Brewe, describing the process:

“threatening and isolating”, eroding “self-confidence and self-belief”.

What’s needed

 
  • The NHS needs continued active campaigns to encourage openness, tackle stigma and promote healthy working practice.
  • Medical schools should be proactive in support and awareness: counselling services, pastoral care positions and peer support.
  • The insight that doctors with mental health problems have when treating their patients should be valued.

A doctor who has a mental health disorder might put his patient at risk, but a doctor hiding or in denial because of a culture of fear will put his patient at risk.

Support

  • http://www.php.nhs.uk NHS Practitioner Health Programme, free and confidential health service allowing doctors to self-refer.

Source: http://www.huffingtonpost.co.uk/nima-ghadiri/doctors-with-mental-healt_b_12760924.html

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Jeremy Hunt’s Seven-Day Homeopathic NHS: Just The Tincture?

Jeremy Hunt and the government appear to be on course for the world’s first routine 7-day health service. Unfortunately, this pioneering endeavour is hindered by a marked gap in resources. Currently (as according to NHS Providers) 80% of acute hospitals in England are in financial deficit, compared to 5% three years ago. Missed waiting time targets have risen from 10% to 90% during the same period. In recent years, healthcare expenditure per capita for the United Kingdom has been stagnant in comparison with other developed countries:

 

On the path to establishing this revolutionary provision, a number of steps have been taken to ensure that the foundations are as flimsy as possible. Jeremy Hunt has pushed a junior doctor contract which undervalues them and discriminates against women. He has also removed bursaries for student nurses and allied health professionals. This has nurtured an atmosphere in which applications to work abroad have skyrocketed and the portension of mass exodus hinted at in recent years may well come to fruition. Following recent events, a significant (13.5%) reduction in medical school applications over the last twelve months is unlikely to help matters.

So the question arises, how does Mr Hunt seek to introduce this 7-day NHS with negligible funding and staffing levels? And, perhaps, the answer has been there all along…

 

Back in 2007, before landing the job of health secretary, Jeremy Hunt asked the Chief Medical Officer to review three homeopathic studies. He also signed an Early Day Motion supporting the provision of homeopathic medicines (including simple saline solutions diluted to negligible concentrations) which “welcomes the positive contribution made to the health of the nation by the NHS homeopathic hospitals”, and “calls on the government to support these valuable national assets”. In 2014, he again called for herbal remedies to be made available on the NHS.

 

When one of his constituents wrote a letter to Mr Hunt disagreeing with the evidence basis for such treatments, the Secretary of State for Health responded:

“I understand that it is your view that homeopathy is not effective, and therefore that people should not be encouraged to use it as a treatment. However, I am afraid that I have to disagree with you on this issue. I realise my answer will be a disappointing one for you”

Our Minister for Magic Health’s judgement on this matter may have been influenced by another Conservative MP, David Tredinnick. Indeed, Jeremy Hunt’s request for the homeopathic studies to be reviewed was made at the behest of Mr Tredinnick, who has previously advised parliament that blood does not clot under a full moon, advocated the use of homeopathy as a treatment for HIV, tuberculosis and malaria and asked that homeopathic borax be used to control foot-and-mouth disease.

Are Mr Hunt and Mr Tredinnick on to something? The combination of drugs for treating TB vary between £5000 and £50-70000 depending on whether the variant is “normal” or “drug-resistant”. Dilution to homeopathic doses can make these expensive drugs much less costly.

Even better, nature’s finest Witch Hazel, which has been used for TB (albeit in the 19th century), comes in at a tidy £2.99 per bottle from your local chemist and can last for months if the degree of dilution is precise. It can even be grown on hospital grounds, generating further savings.

 

The workforce could also be rationalised in a homeopathic 7-day NHS. The impact of Jeremy Hunt’s contract for junior doctors (indeed, the need for doctors in the first place) can be negated by alternative healthcare practitioners, some of whom might not even require an income. A new hospital druid role potentially offsets the vast increase in applications to Australia and New Zealand and reduction in medical school applications.

Mr Tredinnick is also a firm believer in astrology as a “useful diagnostic tool” which, alongside complementary medicine, could take “pressure off NHS doctors”. As a Capricorn, the zodiac does indeed advise that his opinion should be reliable and trustworthy for Jeremy Hunt’s Scorpio. Mr Tredinnick states “I do foresee that one day astrology will have a role to play in healthcare.” Conceivably, that day may come sooner, and we will have alternative medicine permeating into our accident and emergency departments. This delightful sketch from comedy duo Mitchell and Webb might not be too far from the truth:

When the practical and economic feasibility of a routine 7-day NHS has been roundly debunked by senior doctors, service providers and analyists, it is only natural to ask how this is going to happen. Maybe, we ought to be thinking a little more naturally ourselves, and prepare for our complementary secretary of state for health to give us a very complementary 7-day routine NHS.

This article was first posted on the Huffington Post and can be found here: http://www.huffingtonpost.co.uk/nima-ghadiri/jeremy-hunts-7day-homeopa_b_12298592.html

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