B. Marien|F. Mckinna
The Elephant in the Room?
St Bartholomew's Hospital|University Hospitals Sussex NHS Foundation Trust
thirty years ago anthony allibone chairman health committee general medical council observed attitude medical profession health members always one disinterest temporarily discarded disaster overtakes one number disturbing view caring profession seems prevalent today little way research prevention treatment stressrelated illness doctors medical careers associated higher rates psychological distress psychiatric morbidity compared professions 1british household panel survey 19931994 colchester institute social economic research 2001google scholar general population 2singleton n better worse longitudinal study mental health adults living private households great britain office national statistics london2003google scholar doctors likely experience depression alcoholism 3firthcozens j interventions improve physicians wellbeing patient caresoc sci med 2001 52 215222crossref pubmed scopus 244 google scholar substance abuse increased risk suicide 4hawton k malmberg simkin suicide doctors 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associated increased risk mental health problems stigma shame mental illness remains barrier doctors seeking help 18brewin cr firthcozens j dependency selfcriticism predictors depression young doctorsj occup health psychol 1997 2 242246crossref pubmed scopus 48 google scholar likely want portray image wellbeing perfect health mask relaxed brilliance friends colleagues patients number major obstacles acknowledging elephant changing status quo feeling emotionally distressed feeling stressed upset upset called metaemotion wellrecognised predisposing maintaining factor mental illness apparent difficulty doctors heeding distress signals colleagues initiating conversation psychological issues form emotional phobia resulting fear avoidance pattern behaviour noted allibone compounds difficulty faced distressed doctor additional obstacle lack clear confidential care pathway doctors distress various barriers contribute avoidance difficult essential conversations conspire maintain medicines embarrassing blind spot group oncologists brighton agreed department proposal study researching preventative strategy using combination cognitive behavioural therapy cbt neuroscience relevant insights psychological medicine cbt comprehensively researched form shortterm therapeutic intervention approved national institute health clinical excellence nice primary intervention depression anxiety disorders 21nice guidance management anxiety depression nice cg23 2007google scholar pilot study designed assess acceptability feasibility groupbased cbt programme specifically explore participating groupbased cbt programme affects participants psychological wellbeing working lives sessions designed provide us range proven techniques promote psychological wellbeing specifically tailored suit needs knowledge base programme consisted eight 2 hours group sessions cbt 2 week intervals followup sessions 1 3 months individual encouraged identify personal goals create personal action plans implement problemsolving techniques adaptive coping strategies sessions conceived coordinated medically qualified cognitive behavioural therapist bm experience running cbt courses stress management programmes health professionals small pilot study confirmed feasibility delivering cbt programme group consultant oncologists group reported benefits including supportive working environment improved communication team work colleagues better equipped deal complaints management difficult patients relatives half group experienced common mental health problem study perhaps important outcome acceptance normalisation emotional distress among group gaining greater emotional literacy seemed help destigmatise stress anxiety low mood exculpate individual doctor consistent negative effects recorded clear limitations study work required evaluate effect group cbt programme doctors robustly participant numbers small provide statistically significant results significant life events befell participants course programme recorded making individual changes difficult attribute pilot study carried workplace setting group welleducated employees able find protected time working hours programme delivered one doctor also trained health psychology cbt success intervention may depend variety factors experience characteristics trainer participants results could influenced personal intellectual biases held researchers participants need research using randomised controlled trials help identify key ingredients promote positive outcomes doctors effect group psychoeducative cbt occupational settings remains underresearched yet good evidence improving mental health literacy help reduce stigma improve mental health since extended educational elements programme new trainees consultant colleagues brighton undertaking study within centre radiographers managers nurses may inconvenient truth ample evidence oncologists experience high levels psychological morbidity associated widespread serious sequelae elephant room many individual systemic factors perpetuate status quo reducing burden mental health problems medical profession would benefit doctors families patients national health service developing evidencebased approach could help reduce morbidity mortality doctors challenge raise awareness across profession normalise destigmatise facilitate access evidencebased treatment authors would like thank consultant oncologists sussex cancer centre participated cbt pilot david bloomfield anthony chalmers george deutsch andreas hiersche sankha suvra mitra geoff newman joanna simpson richard simcock andrew webb marie wilkins dr duncan gilbert help manuscript work funded sussex cancer fund treatment research dr marien medical director specialist clinical service national health service doctors 1994 2011 runs independent practice psychological medicine london sussex