[Shame! Self-stigmatisation as an obstacle to sick doctors returning to work: a qualitative study doi 10.1136/bmjopen-2012-001776]
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 research published in the online journal BMJ Open.
The authors call for cultural change, starting in medical school, to allow doctors to recognise their own vulnerabilities and cope better with both their own and their colleagues' ill health.
The authors carried out semi-structured interviews with 19 doctors, all of whom had been on sick leave 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 they perceived themselves.
Illness had taken many of the interviewees by surprise and had shattered their professional identity.
One doctor said that without this, 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 that 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," and perceived as "weak," and that others considered they were no longer fit to be a doctor because they had become ill.
They frequently described feelings of emptiness, guilt, shame and failure, and blamed themselves for what had happened.
When they experienced difficulties, once back at work, their confidence plummeted, which further worsened their self esteem and made work even harder to cope with, they said.
The authors point out that doctors' rates of mental ill health, drug and alcohol misuse and suicide are at least as high as those of the general population, but the prevailing culture in medicine is that they are "invincible."
This must change, say the authors. "Aspects of personal and colleague health, especially mental health, should be part of the curriculum for all medical students," they write.
And they conclude that:"Doctors must learn to provide themselves and their colleagues with the same level of excellent care that they provide for their patients."
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