I grew up believing that doctors were on a higher level than the rest of us. Their knowledge was vast and mysterious, their advice kept us healthy and when I went to university I heard that medicine was one of the hardest courses to get on - and my respect for them only grew.
It was only when I came to Romania in 1990, as a volunteer working with disabled children, that I found out that doctors are just as prone to fault as the rest of us. What I noticed was that the most difficult volunteers who came over from Britain to help were doctors and medical students. They seemed to think in different ways to the rest of us and if we asked them to do something they would think up all sorts of reasons why it should be done differently.
When I started to work for a Scottish rehab clinic I was told that general practitioners in the UK know little about the treatment of addiction, and most apparently don't even know the names of their local rehab clinics. Even though addiction is said to cost the UK economy a whopping £22 billion pounds a year in health and social costs, the NHS has no coherent policy for treating addiction. But that's another story.
What really struck me recently is that medical staff are twice as likely to get addicted to drugs or alcohol than the general public. How can this be possible? I spoke to Dr Jim Craig, a consultant psychiatrist at our clinic in Scotland, in order to get an insight. Dr Craig estimates that about 15% of Scottish doctors, which is about 1,500 people, have an addiction or mental health problem.
Dr Craig told me that "doctors tend to be rather conventional and we don't like change. There is a terrible fear of failure among us and we don't like to own up to mistakes. We're not good with criticism or feedback. We're also not good at expressing our feelings and when it comes to addiction there tends to be a lot of double standards. There's an old joke that says 'an alcoholic is someone who drinks more than his doctor.'
"The positive side of the medical profession is that we are highly motivated, and I would say that almost 90% of those who become doctors want to work with patients, they want to help people. The downside of this is telling patients and their families bad news. That's a very difficult thing to do and not enough attention is paid to the fact that transmitting bad news, or dealing with a case that goes wrong, can have a negative effect on a doctor."
The NHS offers very little support for addiction and other mental health problems among doctors. The issue first came to the fore in 1975 when the Merrison Report proposed setting up specialist services for clinicians with mental health problems. But progress has been glacial. The 2004 Shipman Inquiry, named after Dr Shipman who was convicted for the murder of 15 people, came with over 100 recommendations for reforming the medics watchdog - the General Medical Council (GMC).
Dame Janet Smith, the High Court Judge in charge of the Shipman enquiry found that the GMC sided too easily with doctors and accused it of being too reactive - taking action only after medical scandals had surfaced. She also said the GMC's half hearted reforms would not be enough to protect patients from "dysfunctional or under-performing doctors."
Dr Jane Marshall, a psychiatrist, is one of the few doctors in London who is working for medics with mental health problems. At a presentation in June this year, Dr Marshall said that stress, anxiety and depression are common among medics and there is a tendency to conceal or deny problems. Many medics who are faced with mental health problems prescribe themselves drugs, thus avoiding the need to address the problem in a formal way. Their punishing work routine and long hours also contributes to the problem.
Dr Marshall has proposed some principles of clinical care for doctors and the first of these is that "doctors who are ill should be treated as patients, not colleagues." She also recommends that all doctors should register with their local GP.
One of the most important principles stated by Dr Marshall is that "out of area care should be arranged." As a representative of a rehab clinic that is located in the Scottish countryside (some say "it's in the middle of nowhere") I strongly relate to this last point. This is one of the keys to our success. Getting an addict out of his/her environment, and teaching them how to avoid relapse, is an essential step to breaking the habits of addiction.
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