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Sick doctors returning to work struggle with feelings of shame and failure

Posted on 12/11/2012
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Doctors who have been on long term sick leave find it hard to return to work because they are overwhelmed with feelings of shame and failure, and fear the disapproval of colleagues, finds new research led by King’s College London’s Institute of Psychiatry. 

The study was funded by the Royal Medical Benevolent Fund and the authors call for cultural change, starting in medical school, to allow doctors to recognise their own vulnerabilities and cope better with ill health, both their own and their colleagues'.

Dr Max Henderson, Senior Lecturer in Epidemiological & Occupational Psychiatry from King’s Institute of Psychiatry and lead author of the paper published in BMJ Open, says: 'The doctors we interviewed were brutally honest about how they managed their difficulties, and the problems they faced. There is a huge discrepancy in the way doctors address their own health problems, compared to those of their patients.

'There is maybe a feeling amongst doctors, that illness shouldn’t happen to them – that they should somehow be invincible. The stigma attached to illness, especially mental illness, is a huge obstacle in many returning to work. There need to be significant changes from medical school onwards to help doctors recognise their vulnerabilities so they can more easily cope when they become unwell.'

The authors carried out semi-structured interviews with 19 doctors, all of whom had been away from work for six months or more within the past year. Their ages ranged from 27 to 67, with the average age 46. All but one doctor had a mental health or addiction problem, which included depression, anxiety, bipolar disorder and alcohol dependence. Seven also had physical health problems. Fourteen of the doctors had come to the attention of the doctors’ professional regulator, the General Medical Council.

The main themes to emerge during the interviews, which lasted between 1 and 3 hours were professional identity; relationships with family, friends, and work colleagues; and the way in which the individual doctors perceived themselves.

Illness appeared to have had taken many of the interviewees by surprise and had shattered their professional identity. One doctor said that without that, he realised “there wasn’t much left of me.” Another described it as having “everything taken from you.”

Several doctors described good levels of support from friends and family, but many reported the opposite, and felt they had become “a nuisance,”  or “an outsider in my own family,” or that they  were no longer highly thought of.

Some said they deliberately hid their illness (and its treatment) from their families because they feared that coming clean would have a detrimental impact on their personal relationships.

Some doctors said that they did feel supported by work colleagues, but not especially by other doctors. One commented: “We’re meant to be caring people, but we don’t seem to care about each other at all, in my experience.”

Interviewees said that they felt “judged” perceived as “weak” and that others considered they were no longer fit to be a doctor because they had become ill.

The sick doctors frequently described feelings of emptiness, guilt, shame and failure, and blamed themselves. When they experienced difficulties after returning to work, their confidence plummeted, which further worsened their self esteem and made work even harder to cope with.

The authors point out that doctors have rates of mental ill health, drug and alcohol misuse and suicide that are at least as high as those of the general population, but the prevailing culture in medicine is that they are “invincible.”

The funding for the study was provided by the Royal Medical Benevolent Fund, with the support of the General Medical Council and the Practitioner Health Programme. 

Full paper: Henderson, M. et al. ‘Shame! Self-stigmatisation as an obstacle to sick doctors returning to work: a qualitative study’ BMJ Open (October 2012) doi 10.1136/bmjopen-2012-001776

For further information, please contact Seil Collins, Press Officer, Institute of Psychiatry, King’s College London. Tel: 0207 848 5377 or email: seil.collins@kcl.ac.uk

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