Physician, Heal Thyself

Surgo Editor 2014-15 Tom Baddeley with a fantastic insight into the world of medical education and mental health…

Doctors are good at healing other people, it’s looking after themselves that they often find difficult.  They are expected to be stoic and professional in extremely stressful and even disturbing situations and this invariably leads to a bottling-up of emotions.  It’s no wonder that doctors have the highest suicide rate of any profession with female doctors at 3.7-4.5 increased risk and males with 1.5-3.8 fold increased risk.  There are a number of risk factors for this: access to a wide range of prescription drugs and knowledge on how to use them, high expectations from patients and the public, heavy workload and unpredictable working hours and even possessing the personality trait of being self-critical; essential for reflective practice and being a good doctor, but with high potential to cause harm.  The results are similar for nurses as well; a tragic irony that if you commit yourself to caring for the lives of others, you become more likely to take your own life.

Mental health among the medical profession is a topical and contentious issue at present, with the ongoing saga about the junior doctors’ contracts bringing to the surface years of suppressed sentiments.  With doctors facing increasing pressure in their work and increasing scrutiny from the GMC (The number of complaints to the GMC doubled between 2007 and 2012, despite no evidence of failing standards) and the media, they are afraid to seek help for fear of jeopardising their career. This has created a stigma which impacts medical students and fosters damaging views about mental health.

For my 3rd year SSC essay titled ‘Discuss Stigma and Mental Health’ I decided to investigate the rates of mental health among medical students here in Glasgow.  The aim of this study was to assess medical students’ views on mental health, the stigma surrounding it and whether they would seek help. The questionnaire also quantitatively found the prevalence of mental health conditions among the medical student population.  I posted the multiple-choice Google form on the Facebook pages of every year group of Glasgow Medical School in March 2014, re-posting the form a month later.  The results were analysed after the second time.

There were 341 responses from approximately 1300 students giving a response rate of 26%.  63% or respondents were female and 37% male and 95% were in the 18-25 age range.

  • I found that 43% of respondents have suffered or currently suffer from a mental health condition.
  • Only 36% correctly identified the chance of suffering from a mental health problem in the course of year as 1 in 4.
  • 46% regarded having a mental health disorder as a weakness.
  • Only 5% of would tell the university and 1% would tell their employer if they were suffering.
  • Finally, ‘fear of judgement’ was the leading reason why people would not seek help.

The comments section of the questionnaire allowed people to voice their views:

“Mental health support amongst Glasgow Medical School students is poor. We should have easier access to services, particularly a lunchtime group for medics run by a counsellor who understands our course.”

“In my opinion the medical school has a ticking time bomb on their hands and I can just hope that no one is forced into a corner and does something that cannot be undone.”

“Medical students are offered woefully little support or opportunity to ask for it during medical school and particularly during placements when we are confronted with upsetting and emotionally charged situations on a daily basis.”

“I have come across most prejudice towards mental health from health professionals themselves. Regularly patients with mental health disorders are discussed in a negative light and once a patient is diagnosed with having a mental health disorder it seems health care professionals use that as an explanation for symptoms.”

The results show a higher prevalence of mental health problems than the general population.  Coincidently a report by the GMC in July 2013 found that 44% of medical students had concerns about their mental health showing that my results may have statistical relevance.  However these results could be due to people who have suffered mental health problems being more connected with this kind of survey than others, and so more likely to take part.  The study was done in March 2014 so ideas might have changed since then, especially after a recent high-profile incident within the medical school.  Additionally, those who claimed they have suffered could be giving a self-diagnosis rather than a medical one.  Furthermore the questionnaire was launched via social media and so might not have reached people who do not have access to this.  I think the next step would be to re-audit the views on mental health in the medical school again, as it has been 2 years since it was first released, then perhaps release the questionnaire to the rest of the university and see if these problems are as pervasive in other courses.  Hopefully the results can give the faculty ideas on how to improve welfare in the university especially when students are on clinical placement.  For example, Edinburgh University employs a psychiatrist who sees struggling students informally one day a week and can coordinate welfare service and help them decide what the best next step is, whether to take a year out or to stay in education with extra support. Luckily in Glasgow almost all medical students who take a year out return to their studies.

In conclusion, medical students are not exempt from mental health problems.  Misconceptions about mental health among those in the medical profession, including medical students, still remain.  There needs to be a change of attitude and better welfare systems to support those in need such as early intervention and raising awareness.  I feel that with good faculty support and assistance from the university financial services can really help to make students feel they are not sacrificing their career and make life just that bit easier.  By reducing this stigma the quality of life of doctors and medical students will increase, and ultimately the care of patients will too.

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