Professor Dame Clare Gerada explores the reasons why doctors find it so hard to seek help when needed.
For the last decade, I have been caring for mentally ill doctors. Some have referred to me as a ‘doctors-doctor’. Over this time nearly 14,000 individuals have self-presented, with numbers increasing during the Covid pandemic what has puzzled me, is why, given their many protective factors, doctors have high rates of mental illness, but more so, why they find it so difficult to seek care when unwell (often only presenting late, in a crisis or after a drink-drive offence) (Brooks et al., 2011). The jobs doctors do; the high intensity of work, the closeness to suffering and the expectations for perfection, can sap resilience and increase rates of burn out, anxiety and depression. In addition, individuals are chosen for traits which outwardly make for good doctors (perfectionism, altruism, obsessional) but when pushed, can predispose to mental illness. However, whilst these factors might explain high rates, they do not explain the reluctance to seek help. To understand this, I am been drawn to the literature on identity (Elias & Scotson, 2008) (Cruess et al., 2014), especially professional identity (Jarvis-Selinger et al., 2012), a popular theme for study for decades and defined in different ways in different discourses. Most theories propose, in one way or another, that individuals proceed through life continuously organising their experiences into a meaningful whole that incorporates their personal, private, public and professional ‘selves’ (Goffman, 1990). Of course, doctors, like everyone else, have conflicting identities for different times and contexts; being at work or at home, with family or with patients, being a carer or being a patient. But for doctors, their professional self is particularly ingrained due to their vocation, long training and the elevated status of the ‘healer’ which has historic roots dating back to antiquity. These all contribute to the personal (the ‘I’) and the group identity (the ‘We’) becoming merged to create the medical self’ (Wessely & Gerada, 2013). A doctor is something you are, not something that you do. I can no more take the doctor out of myself than an artist can cast off their creativity; the two are inextricably linked. Part of this identity, moulded during medical school and beyond, dictates that it is patients who become unwell, and we, doctors wear magic white coats which protect us. Clearly, this cannot be true but does explain why as a group, doctors find it so hard to adopt the patient role.