There is an old and cynical joke about my trade. It is that we bury our mistakes. It is not that accurate: when things go wrong the person continues to suffer, and we have a duty to continue to care and help. We also are accountable. We need to be accountable.
But there are fatalities associated with this accountability.
Professor Terence Stephenson, Chair of the General Medical Council, said: ‘Over the course of my career I have twice been complained about to the GMC so I know first-hand how difficult the process can be. We are determined to do everything we can to reduce the pressure and anxiety for all doctors in our procedures, particularly where there are health concerns. It will always be a stressful experience but we want to offer whatever support we can to help them through the process. We have already made considerable progress in this area over the last 12 months but we know we cannot stop there.
‘Professor Appleby’s impartial advice will be extremely valuable in helping us pinpoint the parts of our procedures that could be more sensitive and compassionate to the needs of these doctors.
Professor Louis Appleby said: ‘Suicides by doctors facing investigation by the GMC are tragic evidence of the distress that may be experienced in these circumstances.
‘I will be helping the GMC examine how it deals with doctors who may be vulnerable or at risk, to ensure it does everything possible to support them, while fulfilling its over-riding duty to protect patients and the public.”
Professor Appleby will share his proposals at a special workshop with those who have an interest in this area in the spring of next year.
Professor Appleby is Professor of Psychiatry at the University of Manchester where he leads a group of more than 30 researchers at the Centre for Mental Health and Safety. He was England’s National Clinical Director for Mental Health between 2000 and 2010. During this time he published a report which highlighted the need for healthcare systems to improve their support for doctors with mental health issues. He also developed the National Suicide Prevention Strategy for England which focuses on support for families and prevention of suicide among at-risk groups, including the medical profession.
The GMC held a roundtable event in the summer of 2015 to discuss the recommendation made by the independent review to establish a national support service for doctors. A report of the event has been shared with the four health departments of the UK and NHS England. Following this event, NHS England announced that it would establish from April 2016 a new nationally-specified occupational health service for GPs suffering from burnout and stress, in partnership with the Royal College of GPs and the BMA’s General Practitioners Committee. The GMC has agreed to be part of a programme board set up to take forward the development of this service.
If you work long enough there will be complaints. As the chair of the UK General Medical Council notes, they are very stressful. Medics have a very high rate of depression: it is a cost of our job.
A doctor’s best debriefing tool after a hard day therefore turns out to be wilful forgetfulness. If you can minimise or better still, normalise catastrophe, you can keep going. Except, as a recent Australian survey of more than 14,000 doctors and medical students shows, this attitude comes at a great cost. One in 10 doctors entertained suicidal thoughts in the past year, compared to one in 45 in the community. More than a quarter of doctors are highly likely to suffer from mental illness. Oncologists like me, who routinely deal with death, face an especially high risk, as do young women and international doctors. This laudable study has caused a collective gasp in the community but for most doctors, it has simply put sobering numbers to a problem we are all too familiar with. Far too many of us have lost a dear friend and able colleague to drugs, alcohol, crippling mental illness or suicide. Many more feel like helpless bystanders as we watch good doctors slowly self-destruct.
One of the reasons I blog is that it helps me manage the job. It is also a reason I go to the gym: take photos, and take time out. There are parts of my job I cannot talk about to my beloved or children. And these stresses are one of the reasons double-medical marriages implode: we may be able to talk to each other about what is happening, but we then found ourselves being colleagues, not lovers, and definitely not spouses.
The colleges and medical councils and universities are aware of this. We are trying to support our own. However, the lay public expect perfection. It does not exist. And that drive leads to a culture of complaint, a hermeneutic of fear, and a number of doctors taking their lives.
My experience is that people expect service providers of all sorts to meet standards they would never get near themselves if roles were reversed. Its easy to complain but my experience is that most are the result of not getting what they want rather than a problem per se. Medical issues do have consequences that may be hard to address (can’t undo death) so a bit tougher I guess.