Depressed doctors

Dr Chris Dowrick, Professor of General Practice, University of Liverpool, UK.

Contrary to popular mythology, doctors are not infallible omnicompetent superheroes. We have feet of clay. We get depressed too. In fact we are more likely to become depressed than most other professional groups. We experience the stresses and strains in our personal lives - illness, death and bereavement, failing relationships, (though not usually poverty or unemployment!) - which are known to engender periods of depression.

Medical practice constantly brings us face-to-face with pain and suffering, much of it insoluble. It is through experience, rather than any professional training or support, that we learn to come to terms with the limitations of what we can achieve. But it is often a traumatic process.

The past few years have seen a considerable increase in the range of duties and tasks we are expected to undertake - increasing emphases on health promotion and chronic disease management, pressure consequent on earlier discharges from inpatients beds - and an expansion in patients' expectations and demands on our time. Many doctors now wonder if they can cope with the demands made on them, are concerned at the pressures being placed on their families, and have considered giving up their chosen profession.

As doctors were are prepared to talk about 'burn out', and acknowledge that we ourselves may occasionally suffer from it - well, almost - or at least have a friend who has. But the boundaries between 'burn out' and depression are blurred, and may not even exist.

Ruth Chambers has suggested seven ways to stay on top of stress:

stop being a perfectionist
don't judge your mistakes too harshly
resist the desire to control everything
learn to decline extra committments
look after your own health and fitness
allow time for yourself and your family
don't be too proud to ask for help

For most of the time, these will be enough to maintain our mental health in reasonable working order.

But if you have talked to depressed patients about the way they feel and thought - 'Yes, that's exactly how I feel' - or filled in a mental health screening questionnaire and found yourself scoring very high on it - don't take the usual approach of dismissing your findings out of hand. You are probably depressed. You need some help for yourself.

You have several choices. You may wish to consult your own doctor (do you have one?), or a colleague in your own practice, or a friendly psychiatrist you happen to play golf with on Wednesday afternoons. In the UK you could contact the National Counselling Service for Sick Doctors (details are given below). It is not wise to try and treat yourself unaided, but it is immensely valuable to discuss how you feel with someone close to you. Remember, you have as much right to help and care as do any of your patients. It is part of the psychology of caring professionals that they often deny their own illnesses, but this is a dangerous strategy for the doctor, the doctor's family and the doctor's patients.

National Counselling Service for Sick Doctors,
1, Park Square West,
London.
Tel: 0171-935-5982

Follow-up letter:

Sir,

Doctors healing themselves (or each other) is a thorny subject. Most Medical Schools seem to have little opportunity for counseling or psychiatric assistance, and the notion of needing help is often only one step away from jeopardizing one's license (at least in the United States).

In Florida, the Physicians' Recovery Network (PRN) has been an invaluable group of physicians and other health professionals who assist physicians in trouble. Unfortunately, the emphasis is often on alcohol- and other drug- abuse, and there is little emphasis on depressions and anxiety disorders. Most psychiatric colleagues work with one or more physician patients, but there has been little organized activity in identifying and treating depressive disorders in physicians. Applications for hospital staff membership still carry questions about treatment for mental illness or drug dependence that most physicians would rather lie about. The stigma of mental illness (including depressions and anxiety disorders) is just as prevalent in the medical professions as it is in the general population. The Physicians Recovery Network is located in Fernandina Beach, Florida. The phone number is 1-800-888-8766.

Do you know of any other schemes for GPs and other doctors in other countries? Please solutions@priory.com and mark your mail 'resources for depressed doctors'.

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