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Doctors' well-being: back from the brink

Drink in hand

For doctors facing addiction and mental health issues, a GMC investigation can exacerbate stress to dangerous levels. Fortunately, there is a plethora of help available, if only doctors can overcome the stigma of seeking it

When a GP found himself fantasising about driving into a wall on the way to work, he knew something was seriously wrong. 

After a stressful time at his practice when a senior partner left, he turned to alcohol in an attempt to relieve his anxiety.

The London GP, who we will call Dr Jones, says: ‘It took me to extremely dark places. I couldn’t sleep and was drinking into the early hours of the morning. At 3am I’d still be awake, looking at the ceiling having panic attacks.’

His situation deteriorated over two years, until he was reported to his medical director for smelling of alcohol and was advised to self-refer to the confidential London-based mental health and addictions service for doctors, the NHS PHP (Practitioner Health Programme).

He says: ‘Until then I didn’t know there was help out there. With a lot of doctors there’s a feeling of shame and embarrassment. It was a sense of complete and utter failure. I thought I could try and handle it and get better by myself.’


Suffering in silence

This is a common experience, according to PHP medical director Clare Gerada (pictured below). She says: ‘Doctors suffer in silence. They may be registered with their friends or so shamed by their illness they don’t seek help.’ 

gerada

It is this stigma that makes the existence of confidential services such as the PHP and the BMA’s Doctors for Doctors, which offers counselling and peer support, so important. 

Doctors for Doctors service coordinator Tom Rapanakis says: ‘In the face of rapidly changing work environments and ever-increasing pressures on doctors, their health and well-being is a priority. 

‘Support services are required that take into account the stigma that can prevent doctors from accessing help.’

Being investigated by the GMC can exacerbate stress for doctors facing addiction and mental health issues. 


Character destroyed

Dr Jones was referred to the GMC for an interim orders panel, which looks at whether a doctor’s registration should be restricted while allegations about conduct are resolved. 

As a result, he was allowed to return to work for four sessions a week, subject to conditions such as being treated by a psychiatrist, having a GMC medical supervisor and showing evidence of attending the British Doctors and Dentists Group, a confidential peer support group for practitioners. 

He says: ‘It’s quite a daunting process. Your character is basically destroyed. 

‘My whole career prior to that was of no relevance at all. It didn’t take into consideration my 20-plus years as a professional. It’s very black and white.’

Doctors who have been away from work with a health problem find the GMC’s processes ‘anxiety-provoking’ and ‘distressing’, according to research from King's College London published in BMJ Open. 


Appropriate measures

Dr Gerada agrees: ‘We think that doctors who are mentally ill should be dealt with in a different pathway. 

depressed woman‘Clearly if a sick doctor does something despicable they really have to be dealt with appropriately, but for most, being dealt with in a sickness service rather than an adversarial service is much better.’

The PHP, which has seen nearly 1,500 patients since it opened in 2008, offers a wide range of care services including a group specifically for doctors who are suspended by the GMC.

Dr Gerada says: ‘For many suspended doctors their whole social and professional network is gone in one instant. They usually feel ostracised and shamed. It’s a very hard time for suicide risk.’ 


Procedure review

The GMC is due to publish a report into the deaths of 96 doctors who were under investigation in the past 10 years. 

Chief executive Niall Dickson says the GMC is reviewing the way it communicates with doctors in procedures and tries to avoid hearings in cases relating to a doctor’s health when possible. 

‘We must always act first to protect the public and that can involve taking immediate action when we believe patients may be at risk. But at the same time, we have a duty of care to the doctors who are referred to us,’ he says. 

The good news is that there is a high level of recovery in doctors who follow an evidence-based programme. 


Return to work

BMA forensic medicine committee co-chair Michael Wilks (pictured below) is a trustee of the Sick Doctors Trust, which offers an anonymous helpline for addicted doctors. 

Michael WilksHe says: ‘If the GMC encourages doctors who are reported on health grounds to follow these programmes, their chance of a prompt return to work and the removal of restrictions is high.’

Other services specifically for doctors include MedNet in London, which offers sessions with a psychiatrist and confidential helpline Health for Health Professionals in Wales.

Dr Jones has abstained from alcohol for two years and has now returned to full-time work.

He says: ‘Without [the] PHP I don’t think I’d be here today. My perspective on life has completely changed. Although I take my work as a GP and partner seriously, it isn’t what defines me anymore. 

‘We’re not trained to reflect on our own well-being, but it’s the most important thing and without it everything else falls apart.’

 Find out more about NHS PHP

 Find out more about the BMA Counselling and Doctor Advisor Service

 Read about one doctor's battle with depression

 Read the King's College London research


Dr Gerada talks about the importance of specialist health services for doctors



Help is available

  • For the Sick Doctors Trust helpline call 0370 444 5163
  • For Health for Health Professionals Wales call 0800 058 2738
  • For MedNet call (020) 8938 2411


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