Focus: London

Another task for harrassed doctors

Stress, a BMA colleague remarked this week, is no longer news. Everyone, he said--policemen, teachers, farmers--suffered from it and increasingly were establishing services to help cope with it. Doctors are no exception, and the BMA will itself launch its stress helpline for doctors in a couple of weeks' time. In the meantime a report from the Nuffield Provincial Hospitals Trust on taking care of doctors' health reminds us why it's necessary.

The Nuffield trust is one of those useful, privately funded bodies that produce well researched reports and do good quietly behind the scenes, often in areas which don't attract much other funding or attention. This time it brought together a working group to tackle the twin problems that underlie the issue of reducing avoidable stress and improving services for doctors who fall ill: doctors' attitudes towards their own ill health (they often fail to acknowledge it) and the inadequacies of existing mechanisms to help ill doctors.

The report draws on a substantial body of evidence over the years that shows high levels of stress and mental illness among doctors; this evidence, it concludes, reflects the longstanding failure of the NHS to respond to the needs of its workforce. In other words, it blames the way clinical services are organised: the long hours, high expectations, lack of support, and, recently, the increased demands of the reformed NHS. As last week's editorial by Chambers and Maxwell advocated, "fix the job, not the doctors" (23 March, p 722).

The report also discusses the shortcomings of existing mechanisms for helping doctors with problems. Occupational health services within the NHS are poorly developed and may not be seen as discreet enough. The "three wise men" procedure is a very British mechanism which relies absolutely on discretion, and wisdom. If the three wise men, and particularly their chairman, are wise enough then it can be an effective mechanism for temporarily removing a sick doctor from practice and getting him or her treated. However, as the Nuffield report points out, the secrecy that characterises the procedure can undermine its effectiveness because people don't know how it works. Moreover, the system applies only to hospital doctors and is less effective now that district and regional directors of public health no longer have the power to provide locum cover at the request of the wise men.

A similar ignorance shrouds the National Counselling Service for Sick Doctors, set up in 1985 to provide a confidential counselling service and persuade doctors who need help to seek treatment. There is less ignorance about the GMC's health procedures, which are reported to work well and sensitively but suffer from their association with the council's disciplinary role.

The working party clearly thinks that there are probably enough sources of help for doctors. What is needed is better knowledge of them and more willingness to use them, together with a monitoring and coordinating mechanism. This, it suggests, should take the form of a committee operating at subregional level and initially chaired by the regional postgraduate dean. The committee would be responsible for reviewing what services were available and working to improve them and access to them, but it would also be responsible for reviewing working conditions and recommending improvements. In addition, a single named individual in each locality should act as the first point of contact for any doctor seeking confidential advice about either their own or a colleague's problems.. The committees should, the report argues, be funded directly by the NHS Executive.

That is a fair call on NHS funds: that this report should be written almost 50 years after the start of the NHS is an indictment of the service and its employment practices. But the report also represents an implicit criticism of doctors themselves: conditions in the NHS may have recently become more stressful (as doctors feel they have less control over them), but for many of those 50 years the organisation of clinical work was squarely in the hands of the medical profession itself.--JANE SMITH, BMJ

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?