Sick Doctors

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					               Sick Doctors




“There’s a crack in everything… that’s how the light gets in.”
                                                    Leonard Cohen
                    Aims
• To consider the
  unique position which
  doctors with mental
  health problems face

• To learn how to
  manage these
  problems responsibly,
  both in ourselves &
  others
                 Objectives
• To look at the evidence for why this is such an
  important topic
• To review how we may recognise ill health in
  ourselves and others
• To listen to & learn from doctors with first hand
  experience of ill health
• To consider ways in which we might deal with a
  colleague in difficulty
• To look at what formal support is available for
  ourselves and others
                    Plan
• Short presentation
• Small group work with
  guest doctors
• Tea break
• Switch over in small
  groups
• Rejoin for plenary,
  feedback and close
Background
•           of not being ill”
     “Culture
•    2003 BMJ Editorial:
           28% of doctors and other health
           professionals showing above
           threshold levels of stress,
           compared with around 18% in the
           general working population
                                           BMJ 2003;326:670-1



•    Higher rates of mental health
     problems in doctors, compared to
     general population

•    Reluctance to seek help

•    Fear of losing respect, referrals,
     career, income
BMJ 1997;314(7092):2 and Journal of Epidemiology and Community
                                         Health, 2001;55:296-30
                   True or False?
• There is a higher rate of suicide in anaesthetics, community health,
  general practice and psychiatry than in general hospital medicine

• Treatment outcomes for alcoholic doctors are poor

• There is a higher risk of suicide in female doctors compared to male
  doctors

• There is a culture of increasingly unsafe drinking among medical
  students

• Healthcare professionals with drug or alcohol problems under the
  care of professional services will mainly have self referred
                          True or False?
•   Higher rate of suicide in anaesthetics, community health, general practice and
    psychiatry than general hospital medicine
     – True (Journal of Epidemiology and Community Health, 2001;55:296-30)
•   Treatment outcomes for alcoholic doctors are poor
     – False (StudentBMJ 2006;14:265-308)
•   Higher risk of suicide in female doctors compared to male doctors
     – True (Journal of Epidemiology and Community Health, 2001;55:296-30)

•   Culture of increasingly unsafe drinking among medical students
     – True (StudentBMJ 2006;14:265-308)

•   Healthcare professionals with drug or alcohol problems under the care of professional
    services will mainly have self referred
     – False
          • The most common reason for referral was poor work performance or
             absenteeism (41%). Self referrals were infrequent (9%). (StudentBMJ 2006;14:265-308
          GMC: Duties of a Doctor

• Be honest and open
  and act with integrity

   – Act without delay if
     you have good reason
     to believe that YOU
     OR a colleague may
     be putting patients at
     risk
   –   http://www.gmc-
       uk.org/guidance/good_medical_practice/dutie
       s_of_a_doctor.asp
           Features of Burnout?
• Obvious:
   – Low mood, difficulty
     sleeping, poor appetite,
     anxiety, palpitations
• More subtle:
   – Irritability and cynicism
   – Dreading going in
   – Perceived clinical
     ineffectiveness
   – Lack of confidence
   – Putting off difficult things
   – Sense of depersonalisation
     in relationships with
     colleagues
         Features of Burnout?
• And other things such
  as:
  – Difficulty concentrating
  – More accident prone
  – Strain on relationships
    and home life
  – Increased use of
    alcohol or drugs
  – Absenteeism
Who looks after the sick doctor?




  The Sick Doctor by Jehan Georges Vibert
Physician Heal Thyself?
THE TIMES ONLINE

“GPs put their careers at risk by
  self-prescribing”
David Rose

•   Nearly half of family doctors are ignoring
    the rules
•   GMC gave warning that a doctor could be
    struck off its register for breaking the rules
•   Pulse survey
     –    Poll of nearly 1,000 medics
     –   43 % of doctors write prescriptions for
         their own use
           •   57% antibiotics
           •   36% painkillers
           •   8% cholesterol-lowering drugs
           •   5% sleeping pills
           •   5% for antidepressants
           •   2 % medicines for erection problems


                                 The Times, March 16, 2007
Learning from past experience…
Who’s this?
                    High Profile Case
•   Daksha Emson (34yrs)
•   SpR Psychiatry
•   Bipolar Affective Disorder
•   Died 2000

• Stabbed herself & 3 month old daughter, Freya, then doused them
  both in an inflammable substance and set it alight during psychotic
  episode

• Freya died of smoke inhalation, Emson survived a further 3/52 in a
  burns unit

                                                            BMJ 2003;327:1008
                       Inquiry
• Inquiry by the London Strategic Health Authority found:

   – “Systematically failed by the NHS”

   – Received a “significantly poorer standard of care than
     that which her own patients might have expected”

   – She concealed her illness…because she was afraid
     of breaches in confidentiality; the stigma that would
     have resulted "haunted her work, life and treatment.”
                                                 BMJ 2003;327:1008
                       The Report
• In response a group was formed under auspices of the DH, chaired
  by National Director for Mental Health

   – Features unique to doctors:
      • High rates of disorder

       • May conceal or deny problems, carry on working when ill, ask for
         help late


       • Access to prescription drugs & bypass formal channels for help


       • Working environment may contribute to illness & delay recovery
                                      Society of Occupational Medicine. Newsletter 112, Chapter 6, April 08
     Group’s Recommendations
• Doctors who are ill should be treated first and foremost as patients,
  not colleagues

• Rules on confidentiality should be strictly observed

• Additional safeguards to ensure privacy of care

• Doctors should be registered with a local GP

• Doctors treating other doctors should have appropriate expertise
  and seniority.


                       Society of Occupational Medicine. Newsletter 112, Chapter 6, April 08
      Recommendations Cont…
• Out-of-area care should be arranged unless local care required

• Doctors should receive the same care and risk management as
  other patients.

• Occupational health services should help doctors access
  appropriate mental health expertise.

• Doctors should fully understand the importance of maintaining their
  own health, to understand the stressors inherent in a medical career
  and how to manage them

                             Society of Occupational Medicine. Newsletter 112, Chapter 6, April 08
          Our Guests Today
• The Doctors Support Network
  – Doctor with mental health concerns
    • stress, burnout, anxiety, depression, manic
      depression, psychoses & eating disorders.
  – Contact with and support from other doctors
    can help recovery
  – Support groups
  – Helpline
  – Campaigning & awareness
         Small Group Work
• Using flipchart brainstorm what questions
  you would like to ask the doctor joining
  your group
• Listen to your doctors story
• Chance for questions
• Switch over after short tea break as time
  allows
• Rejoin large group at end for 10-15mins
Plenary Session
         Sources of Support
• Talking to colleagues/seniors in hospital
  environment if concerns

• Approach trainer, supervisor, TPD

• Speak to own GP
                Support
• BMA (Counselling line & Doctors for
  Doctors)
• Doctors Support Network
• Sick Doctors Trust
• British Doctors and Dentists Group
• Medical Council on Alcohol
• The Royal Medical Foundation
• … and of course GMC
                   Finally
• Pick up leaflet of
  resources on way out

• References available

• Any questions?

• Feedback forms
                             References
•   Singh, D. “NHS criticised over suicide of mentally ill doctor” BMJ 2003;327:1008
•   Society of Occupational Medicine, Newsletter 112 (April 2008) Chapter 6.
•   Meikle, J. Fear of stigma that led to tragic deaths. The Guardian, Saturday 25
    October 2003 08.48 BST
•   Armstrong, E. Career Focus: Rehabilitating troubled doctors BMJ 1997;314:7095
•   Brandon, S & Oxley, J. Career Focus: Getting help for sick doctors. BMJ
    1997;314(7092):2
•   General Medical Council: Duties of a Doctor. Accessed online: http://www.gmc-
    uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp
•   Hawton, K., Clements, A., Sakarovitch, C., Simkin, S., Deeks, J.J. (2001) Suicide in
    doctors: a study of risk according to gender, seniority and specialty in medical
    practitioners in England and Wales, 1979-1995. Journal of Epidemiology and
    Community Health, 2001;55:296-30
•   Harwood, I. & Stansfeld, S. Doctors and alcohol misuse. StudentBMJ 2006;14:265-
    308
•   Firth-Cozens J. Doctors, their well-being, and their stress. BMJ 2003;326:670-1
                          References
•   BMA Scotland: The health of doctors – evidence. 08 May 2007 Accessed online:
    http://www.bma.org.uk/sc/doctors_health/doctorshealth.jsp?page=3
•   McCrory, P. WARM UP The long dark night of the sports medicine soul British
    Journal of Sports Medicine 2007;41:343-345

				
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