Professor Dame Clare Gerada explores the reasons why doctors find it so hard to seek help when needed.
For the last decade, I have been caring for mentally ill doctors. Some have referred to me as a ‘doctors-doctor’. Over this time nearly 14,000 individuals have self-presented, with numbers increasing during the Covid pandemic what has puzzled me, is why, given their many protective factors, doctors have high rates of mental illness, but more so, why they find it so difficult to seek care when unwell (often only presenting late, in a crisis or after a drink-drive offence) (Brooks et al., 2011).
The jobs doctors do; the high intensity of work, the closeness to suffering and the expectations for perfection, can sap resilience and increase rates of burn out, anxiety and depression. In addition, individuals are chosen for traits which outwardly make for good doctors (perfectionism, altruism, obsessional) but when pushed, can predispose to mental illness. However, whilst these factors might explain high rates, they do not explain the reluctance to seek help. To understand this, I am been drawn to the literature on identity (Elias & Scotson, 2008) (Cruess et al., 2014), especially professional identity (Jarvis-Selinger et al., 2012), a popular theme for study for decades and defined in different ways in different discourses.
Most theories propose, in one way or another, that individuals proceed through life continuously organising their experiences into a meaningful whole that incorporates their personal, private, public and professional ‘selves’ (Goffman, 1990). Of course, doctors, like everyone else, have conflicting identities for different times and contexts; being at work or at home, with family or with patients, being a carer or being a patient. But for doctors, their professional self is particularly ingrained due to their vocation, long training and the elevated status of the ‘healer’ which has historic roots dating back to antiquity.
These all contribute to the personal (the ‘I’) and the group identity (the ‘We’) becoming merged to create the medical self’ (Wessely & Gerada, 2013). A doctor is something you are, not something that you do. I can no more take the doctor out of myself than an artist can cast off their creativity; the two are inextricably linked. Part of this identity, moulded during medical school and beyond, dictates that it is patients who become unwell, and we, doctors wear magic white coats which protect us. Clearly, this cannot be true but does explain why as a group, doctors find it so hard to adopt the patient role.
Recording of the talk
Having first trained in psychiatry at the Maudsley Hospital, Professor Dame Clare Gerada followed her father’s footsteps and became a general practitioner, working in her practice in South London for thirty years. Over this time, alongside her clinical practice, she has held a number of national leadership positions including in 2010, Chair of the Royal College of General Practitioners, only the second women in its 55-year history to hold this position. She has led the way in reforming how drug users are managed in general practice and was awarded an MBE for her services to medicine and substance misuse in the 2000 Birthday honours. Since then she has led the way in developing services for doctors and dentists with mental health problems, establishing and leading NHS Practitioner Health since 2008. This has been, not only a world first, but massively impactful, particularly on young doctors and consequently on the patients they look after and the teams in which they work.
The service was awarded Outstanding by CQC rating in March 2019. Currently, Dame Clare not only still leads NHS Practitioner Health but has, in 2020 established a service for problem gamblers; Chairs the newly formed registered charity, Doctors in Distress, is now co-chair of the NHS Assembly and was made a Dame in the queen’s birthday honours, making her the first Maltese person to ever be knighted. She is a highly respected NHS professional, whose views are listened to by NHS professionals and patients alike.
Professor Dame Clare Gerada has also published ‘Beneath the White Coat Doctors, Their Minds and Mental Health‘, published by Routledge. Royalties from the book are being donated to Doctors in Distress.