Doctors' identity and barriers to seeking care when unwell.

Doctors have a deep-rooted sense of professional identity 'the medical self'. This allows them to do the jobs society expects from them, but also acts as a barrier when seeking care when unwell. This article discusses how the medical self is formed drawing on psychoanalytic, anthropological and psychiatric literature.

Confidentiality, anonymity and amnesty for midwives in distress seeking online support - Ethical?

BACKGROUND: Midwife health is intrinsically linked to the quality of safe patient care. To ensure safe patient care, there is a need to deliver emotional support to midwives. One option that midwives may turn to may be a confidential online intervention, instead of localised, face-to-face support. RESEARCH DESIGN: Following the Realist And MEta-narrative Evidence Syntheses: Evolving Standards publication standards, this realist synthesis approach explores the ethical considerations in permitting confidentiality, anonymity and amnesty in online interventions to support midwives in work-related psychological distress. An iterative search methodology was used to select nine papers for review. To assimilate information, papers were examined for ideas relating to ethical dimensions of online interventions to support midwives in work-related psychological distress. This review takes a narrative approach. FINDINGS: Online interventions can support the development of insight, help seeking and open discussion. Additionally, Internet support groups can become morally persuasive in nature. Anonymity and confidentiality are both effective and therapeutic features of online interventions when used in collaboration with effective online moderation. Yet, ethical dilemmas remain where users cannot be identified. DISCUSSION: Confidentiality and anonymity remain key components of successful online interventions. However, sanctioning the corollary component of amnesty may provoke moral discomfort for those seeking immediate accountability. For others, amnesty is seen as essential for open disclosure and help seeking. Ultimately, the needs of midwives must be balanced with the requirement to protect the public and the professional reputation of midwifery. CONCLUSION: In supporting midwives online, the principles of anonymity, confidentiality and amnesty may evoke some resistance on ethical grounds. However, without offering identity protection, it may not be possible to create effective online support services for midwives. The authors of this article argue that the principles of confidentiality, anonymity and amnesty should be upheld in the pursuit of the greatest benefit for the greatest number of people.

The specific needs of doctors with mental health problems: qualitative analysis of doctor-patients' experiences with the Practitioner Health Programme.

OBJECTIVES: The current paper aimed to explore doctor-patients' views about their treatment from the Practitioner Health Programme (PHP), a UK-based service treating health professionals with mental health/addiction problems. Aims were to gain insights into the issues most important to patients and consider whether a service specifically for doctors is important in helping to overcome barriers to accessing mental healthcare. METHODS: Nine doctor-patients attending PHP took part in semi-structured interviews between September 2010 and June 2011. Thematic analysis was used to explore recurring patterns in the data. 134 written comments from PHP patients were also included. RESULTS: Participants reported difficulties in finding appropriate treatment; problems were often severe by the time PHP was involved. Concerns about confidentiality, judgement and impact on career were obstacles to help-seeking and important issues during treatment. Analysis of written comments provided further support for these findings. CONCLUSION: Whilst some of the needs of mentally unwell doctors mirror the needs of patients in general - e.g. a supportive and non-judgemental attitude from clinicians - they do have specific needs related to confidentiality and stigma.

Doctors and dentists with mental ill health and addictions: outcomes of treatment from the Practitioner Health Programme.

BACKGROUND: The Practitioner Health Programme (PHP) was developed to provide expert assessment and support to practitioners (doctors and dentists) with mental and physical health problems affecting their ability to work. AIMS: This paper examines the treatment outcomes of the practitioner-patients utilising PHP. METHOD: We assessed outcomes on consecutive patients using the PHP. The Clinical Outcomes in Routine Evaluation Outcome Measure and the Work and Social Adjustment Scale were completed at initial assessment, 8- and 26-week follow-up. We also report the percentages of practitioner-patients off work at each interval, and examine global improvement and satisfaction scores for both follow-up intervals. RESULTS: Two hundred practitioner-patients entered PHP due to a mental health or substance abuse problem and subsequently completed questionnaires at baseline; 102 patients returned questionnaires after 8 weeks and 95 returned questionnaires after 26 weeks. Results suggested that patients reported less distress and less impairment of functioning at 8 and 26 weeks. Scores for satisfaction and global improvement were consistently high. CONCLUSIONS: The PHP is providing a valuable service to practitioner-patients, significantly helping to decrease levels of distress and improve work and social functioning.

Ditching the single-payer system in the national health service: how the English Department of Health is learning the wrong lessons from the United States.

Reforms to the British National Health Service introduce major changes to how health care will be delivered. The core elements include the creation of new purchaser organizations, Clinical Commissioning Groups, which unlike their predecessors will be able to recruit and reject general practices and their patients without geographical restriction. The Clinical Commissioning Groups are to transition from statutory bodies to freestanding organizations, with most of their functions privatized and an increasingly privatized system of provision, In this paper, we explore the likely consequences of these proposals, drawing in particular on the experience of managed care organizations in the United States, whose approach has influenced the English proposals extensively. We argue that the wrong lessons are being learned and the English reforms are likely to fundamentally undermine the principles on which the British National Health Service was founded.

Doctors vulnerable to psychological distress and addictions: treatment from the Practitioner Health Programme.

BACKGROUND: The Practitioner Health Programme (PHP) is a service set up to provide expert assessment and support to health professionals with mental and physical health problems affecting their ability to work. AIMS: The aim of this article is to examine the demographic and clinical characteristics of doctor-patients utilising PHP. METHOD: We report on scores for the CORE-OM, the Work and Social Adjustment Scale and the FAST for the first 200 patients seen by PHP. RESULTS: Prevalent conditions included depression and alcohol dependence. Patients with co-morbid disorders showed severe distress and impairment of functioning. Ages ranged between 24 and 67, with 33.5% of the cohort aged between 30 and 39. Patients aged below 50 showed greater impairment of social functioning. CONCLUSIONS: The needs of doctors are profound, with young doctors particularly vulnerable. Measures should be put in place to ensure that doctors at an early stage of their careers are aware of help available to them. The results highlight the importance of a service such as PHP.

Review of literature on the mental health of doctors: are specialist services needed?

BACKGROUND: Mental ill health is common among doctors. Fast, efficient diagnosis and treatment are needed as mentally ill doctors pose a safety risk to the public, yet they are often reluctant to seek help. AIMS: To review literature regarding risk factors and potential barriers to help-seeking unique to doctors; to consider the success of interventions by specialist services for doctors. METHOD: Key phrases regarding the 'mental health of doctors' were entered into internet searches and journal databases to identify relevant research. When key authors were identified, author-specific searches were carried out. FINDINGS: There are contradictory reports about the prevalence of mental ill health in doctors but it is generally agreed that doctors face a large number of risk factors, both occupational and individual; and help-seeking is difficult due to complexities surrounding a doctor becoming a patient. Specialist services developed specifically for interventions for doctors with mental health problems tend to show promising results but further research is needed. CONCLUSIONS: The unique and complex situation of a doctor becoming a patient benefits from specialist services; such services should focus on early intervention and raising awareness.

Reflections on leadership during the Covid pandemic.

Doctors lead, in and out of the clinical environment, from ward to board; their roles will range from dealing with risk and uncertainty, communicating with different audiences and managing crises. At the heart of leadership is the ability to make decisions; which operation to perform or treatment to give or, as during this pandemic, what policy to implement or vaccines to order. If leadership is about making decisions, successful leadership is the ability to make the right decisions. This, after all, is what distinguishes a good leader from a poor one. During this pandemic we have been able to compare different leaders, drawn from across the health, political and other sectors. This article identifies how leaders behaved during this pandemic and importantly what can be learnt from their actions.

Doctors, suicide and mental illness.

This article focuses on doctors and suicide. It provides real examples to illustrate why doctors die by their own hand. These reasons are replicated in the general population, but also include a host of additional risk factors related to being a doctor. In each case, information about the doctor is in the public domain or, as in one case, consent from the next of kin has been obtained for a detail not in the public domain. The author is a doctors' doctor, heading up a confidential health service for doctors with mental illness or addiction, the National Health Service Practitioner Health Programme. Mortality data from the programme (January 2008-January 2017) will also be included. For the sake of confidentiality, data is collated and details regarding age and gender have been approximated.Declaration of interestNone.

What difference does training make? A randomized trial with waiting-list control of general practitioners seeking advanced training in drug misuse.

AIM: To measure changes in knowledge, attitudes and clinical practice of general practitioners (GPs) enrolled to receive training in the management of drug misusers. DESIGN: Two-group randomized trial with training (T) and waiting-list (WL) control comparison conditions. SETTING AND PARTICIPANTS: A total of 112 GPs working in primary care practices in England. INTERVENTIONS: A 6-month, part-time, mixed-methods training course provided by the Royal College of General Practitioners. GPs randomized to the WL control received no special training or guidance during the study period. OUTCOME MEASURES AND ANALYSIS: Knowledge, therapeutic attitudes (commitment, role security, situational constraints and prescribing confidence) and clinical practice behaviour change (numbers of drug misusers seen, treated). Intention-to-treat/train (ITT) analysis, supplemented by treatment/training received (TR) analysis. FINDINGS: Training applicants had positive attitudes towards and were already involved in the care of drug misusers. Improvements in attitudes and behaviour were greatest among the T group, although only 'role security' and 'situational constraint' reached statistical significance (ITT). A subgroup in the WL group circumvented their allocation and received training, prompting supplementary analysis by TR. Overall, GPs who received training showed markedly greater improvements in knowledge, attitudinal and prescribing confidence measures and remained more actively involved in treating drug misusers than GPs who remained in the WL control group (TR analysis). CONCLUSIONS: GPs seeking special training for the care of drug misusers are both positively disposed to this patient population and clinically active. Benefits unambiguously attributable to the course were modest. While a TR effect was observed, strict adherence to ITT analysis failed to identify significant benefits observed with the training provided. Randomisation and waiting-list controls design are insufficient as a research method for training evaluation studies if ITT analysis is used exclusively.