Why Are Britain’s Doctors So Depressed?

This article originally appeared on VICE UK.

When the person before you goes into the GP, a few minutes later you see them come out, green slip of prescription paper clutched in their sweaty hands. Then, about two minutes later, the doctor will buzz you in. But what happens in those few minutes between patients?

I guess we all imagine that the doctor takes a robotic sip of still water, genially taps some notes into their old computer box, and then prepares for the next patient by shifting a tissue box around. But maybe, when the door slips closed on them, they just sit and stare out the window for 120 seconds, trying to think of reasons not to throw themselves out of it.

And then you turn up with your thrush or tonsillitis and they're forced to stave off the misery they're feeling for just a few moments more.

A recent survey conducted by Pulse—a news publication for doctors—claimed that half of GPs are at risk of "burnout." The symptoms of burnout mirror those of depression and anxiety but are framed in terms of "emotional exhaustion, depersonalization, and a loss of any sense of accomplishment," says Nigel Praities, a journalist from Pulse.

As with any mental health issue, there is an associated likelihood of alcohol and substance abuse, and also of the problem getting so bad that it results in suicide. And in a horrible instance of irony, it turns out that doctors are much better at killing themselves than the rest of us. They know how to get the job done, meaning their "suicide completion rate" exceeds the average for the population.

Doctors are supposed to help make you feel better—make your problems disappear so you can get back to your life. But a recent Medical Protection Society survey showed that 60 percent of GPs believed their mental health was having an impact on their ability to concentrate, and 36 percent felt it was making it harder to empathize with their patients. The Chair of the BMA consultants, Dr. Paul Flynn has said that studies have shown that sleep deprivation can have similar effects to drinking, and that yet, paradoxically, "You would never allow a consultant under the influence of alcohol to treat patients, but continue to turn a blind eye to doctors who are sleep deprived."

All of this stress, anxiety, and depression is a massive problem for the UK. It can result in misdiagnoses of patients, doctors having to take time off to turn into functioning people again, doctors leaving the NHS to go private and even doctors leaving the country to go practice in metaphorically sunnier climes. As Nigel told me: "It is a crisis. I can't stress it enough."

Could Tory-led changes to the NHS be to blame for this crisis? Hospital Consultant and Specialists Association (HCSA) will put forward a motion at September's annual Trades Union Congress that "stress amongst talented lifesaving doctors is continuing to impact on our NHS […] Consultant workload has been continuously increasing and the pressure to care for an ever increasing patient caseload is causing some consultants' mental health to be impacted." If you need evidence, then just look at the recent outcry from overworked and underpaid NHS staff in response to David Cameron's proposal for a "seven-day NHS."

The problem isn't just with GPs either. One psychiatrist, Cosmo Hallstrom, who has recently moved from the NHS to private healthcare, thinks that "the NHS has done well at systematically undermining the morale of doctors… It is a sick organization." New NHS structures mean that "the doctor loses clinical control and is subservient to non-medical managers who may well have a different agenda. The service is fragmented, and so the doctor no longer sees the patient though their journey and recovery as they used to."

And the NHS shit-storm is apparently coming from all sides. The unnecessarily frequent standards checks that are plaguing (even the most consistently well-performing) surgeries create an oppressive blame culture within practices. Dr. Prabhu Umesh, who is the Medical Director of an Acute Trust in Wigan and a committee member for BIDA, told me about the mindset of doctors at his practice who are constantly worried about being reported to the General Medical Council for malpractice. He said that "doctors are frightened and scared." He continues: "All these doctors need is help, support. and guidance. Not humiliation."

Despite the fact that most GMC investigations are ultimately dismissed, such a tortuous process can't fail to leave dents. For those with a mortgage and mouths to feed, the ill effects can be more acute—as an MPS members' survey seemed to confirm.

Dr. Gerada runs a service to care for mentally ill doctors in London and has gone so far as to call the NHS "an industrial hazard." One tweet he posted read, "Preparing for a day as a GP feels like preparing to go to battle. Sad, that the profession I love has become so undermined."

So what's the solution? Umesh told me that, at his practice, "We are very lucky because every consultant knows they can contact me for help. I stood up in front of my team and I said the first week, 'No blaming, naming, shaming, or disciplining.' But there is accountability for all of us—we have to be honest and we have to learn." But without lots of Umeshes around to foster healthy team spirit with his "happy doctors, happy patients" mantra, it is urgent that structures are put in place to deal with the results of the problem on a systematic, national scale.

Doctors' official communities are overwhelmingly in favor of national occupational health services that provide counseling and help for doctors who need it—like the Practitioner's Health Programme run by Dr. Gerada. Yet despite their success, the government is increasingly cutting funding to such services.

Gerada's PHP had to close its doors a while back because it was overwhelmed by demand. One service in Cornwall lost its government backing for treating doctors that weren't being formally investigated already, which seems the very definition of a sticking plaster approach to the problem. While national occupational mental health coverage keeps being promised, the current reality is a postcode lottery.

Doctors have likened their enduring, unreciprocated devotion to the NHS to an abusive relationship. They keep getting promises of change, and they keep on turning up even when these promises turn into abuse. Until someone at the top allocates part of the NHS budget to an occupational mental health service for doctors, you'll likely have to sit back and watch your GP push rocks up hills, before waltzing into their office hoping they're happy and sane enough to help you.