Doctors at greater risk of depression

Sometimes very distressed doctors in the NHS do make the news – as with Daksha Emerson, a young psychiatrist who killed herself and her baby whilst suffering from post natal psychosis, and also more recently, junior doctor Rose Polge, whose body was found in the sea off Devon in April.

In my experience, the vast majority of doctors with mental health issues suffer in silence, only coming for help when they are in desperate straits, if they come at all. I have had patients at my sick doctors’ service who are literally catatonic with fear and stress, brought on by the stress of the increasingly toxic workplace which is the modern-day NHS.

We already know that medicine is a stressful profession. Of course, it is when you are given responsibility for people’s lives every day. The suicide rate for female doctors, matched in age to the female general population, is two and a half times higher. That is not because stressed unhappy people go into medicine. Far from it. In fact, anyone who succeeds in entering the medical profession has to show a high degree of competence and self-discipline from a very young age. So, it looks likely that the career itself imposes the extra mental health burden.

But in recent years, the stresses felt by doctors at a younger and younger age have been increasing exponentially, and it’s not because the ‘life and death’ aspect of medicine has changed. In 2008, 22 per cent of doctors presenting to our service were under the age of 35. Last year, in 2015, that number had shot up to 54 per cent of the total.

There are many reasons for this, but one of the key causes is unbelievable fatigue. Doctors are now working shifts, which reduce their hours on paper, but actually catapult them into a cycle of insomnia and overwork. When I was young, we worked some unbelievably long shifts, from Friday morning to Monday afternoon sometimes, but we did actually get real time off without phones bleeping or constant interruptions. Also, we were allowed real blocks of time to sleep. Today, a London-based doctor may work a shift on Friday from 8am to 8pm but actually not finish to 12 midnight because there is no one to cover. Bed in a suburb far away from the hospital by 2 am and then tossing and turning because of the adrenaline surge when you work so long and so close to emergencies. Next shift starts at 7am, giving you a measly three to four hours shuteye and working until 5pm if you are lucky. Then a complete night shift starting at 10pm or later.

Doctors are also bullied and harangued by managers. This is not about them and us, but I see so many doctors who are suffering through the endemic unkindness, bullying, fear and blame. At the moment, I am seeing several senior consultants who I believe are suffering from ‘betrayal syndrome.’ After years of giving their all, setting up departments and steering world-class services and making our NHS great, these senior consultants are being belittled and harried by management, essentially so they leave and let younger, cheaper and more malleable doctors, or increasingly non-doctors fill their mighty shoes. It’s a huge waste of talent and experience and the same bullying managers names come up again and again as do the organisations in which they work. I wish it wasn’t a confidential service and I could publically expose these people and Trusts but I imagine even if I could (which I never will in public) I too will be treated as many of the whistleblowers already do.

For all doctors, I am seeing a huge rise in what looks like Post Traumatic Stress Disorder – anxiety and depression, flashbacks, nightmares coupled with intense fear. I hate using the term burnout because it makes it sound so trivial, but this is also what it is.

And doctors from overseas are the worst affected of all. These are people who do not often have a family support structure to cushion them from the worst excesses of bullying managers, and the terrible environment in which they have to work. Some of them may have come from war-torn countries and have given everything to come to this Country and now find themselves alone and struggling to adapt to working in the NHS. My sick doctor service has seen over 100 doctors who have qualified overseas in the last 18 months and I am sure the numbers will continue to rise. I am very worried about what will happen to these individuals who are such an important part of our NHS.

Paradoxically, the junior doctors’ strike is not likely to cause a major increase in the number of young medics coming to our service for help. What is going on now will probably give strength to the juniors from the strong sense of cohesion and common purpose they now feel as a group. Isolation and helplessness are strong predictors of depression, not togetherness and a sense of ‘us and them’ which is now so strong in that determined band.