Healing doctors through groups: creating time to reflect together.

Abstract

Since 2008 the NHS Practitioner Health Programme (PHP) has offered a confidential service to doctors with mental health problems (www.php.nhs.uk). To date, over 2000 doctor-patients have been seen: three-quarters suffering from depression, anxiety, and a form of post-traumatic stress disorder; and one-quarter with problems with alcohol and/or drug dependence. As well as individual therapy, the service has treated doctors using doctor-only groups, helping to engage this hard-to-reach population in a psychotherapeutic process and to take on the patient role. International evidence suggests that doctors are at a higher risk than the general population for depression and up to three times the rate of death through suicide, yet are reluctant to seek help.1 There are many reasons for this.2 Explained briefly, working and living in the same area poses practical problems in obtaining confidential help. Frequent changes of address due to training rotations make it hard to register with a doctor or, once in treatment, have continuity of care. Psychological defences, such as depersonalisation and denial of feelings, are necessary to work in close proximity to death, despair, and disease3 but if left unchecked can lead to burnout or depression.4 Personality traits, such as perfectionism, obsessiveness, and denigration of vulnerability, common in good doctors, if exaggerated can cause problems.5 A compulsive triad of doubt, guilt, and an exaggerated sense of responsibility is a common finding among doctors.6 When doctors do approach services, staff and patients can treat them differently, adding to the isolation already felt by a doctor experiencing mental illness. There are other reasons linked to how doctors are trained that prevent them from seeking timely help, and through the creation of a ‘medical self’.7 During training, students learn, play, work, live, and love together; they learn a unique scientific vocabulary and ‘new’ …