The times I was off sick in 35 years in the Health Services are all clear in my mind. A day off after wisdom teeth extraction, 3 weeks after viral meningitis, 6 weeks after a blow out fracture, 6 weeks after a hip replacement, and 3 months after a cancer or two.. This is a lot compared to most GPs. The times I did not go off sick, with a fractured jaw, a fractured malar and numerous viral illnesses are vaguer memories… Will the culture change as disengagement becomes the rule?
Sickness is a daily part of my working life. Some of my patients are very sick – so much so that I wonder how they make it to the surgery when what they really need is an emergency ambulance and a hospital bed. Others attend with a sore throat and I wait in vain to see if there is a second “hidden” problem. I write sick notes for patients and extenuating circumstances letters for the many students who are registered with us. I cannot recall the last time I wrote a sick note for a doctor.
In fact, I do not often see doctors as patients even though there are many doctors registered with our practice. Although doctors will often recognise when they have a physical or mental illness, they will present late as they find it hard to be patients and relinquish their medical role.
The last time I saw a patient who was a doctor was some years ago: she had been suffering from chest discomfort for a few days which she had put down to indigestion from erratic eating habits and too much coffee. The usual remedies having not helped, she had presented to the surgery. Her symptoms were atypical, her ECG very abnormal and she was admitted acutely with a heart attack. She made a recovery, but with a significantly impaired heart function due to her late presentation.
Mental health problems form a big part of my work, particularly in the 20-40 age range patients. I have always believed in the doctor-patient relationship and being the patient’s advocate, and have felt privileged that patients will disclose their life stories to someone who is, after all, a complete stranger.
Patients will tell you tragic, or outlandish, stories from their lives, but what has happened to them can happen to us all. Being a doctor does not make me invincible. Indeed, doctors have high rates of mental health problems including anxiety, depression and addictions of all sorts. At some point in their career 10-20% of doctors suffer from depression.
Yet we are not very good at talking about this taboo subject with our colleagues, with GPs, or even with our friends. The stigma associated with mental health problems in our society is even worse in the medical profession.
Like many fellow doctors, I have faced stress at various points in my career, particularly as a very junior doctor on the wards when I felt isolated and out of my depth. When I returned to work as a GP trainee some years ago, after the birth of my twins, I was anxious for months.
It is only now that I recognise that this was anxiety – at the time I called it lack of sleep. I felt unable to discuss it with anyone except my husband – a fellow doctor. I know now that my anxiety stemmed from the need for organisation, order and predictability, things that were absent from our lives as junior doctors with a young family.
I have taken two days of sick leave since graduation in 2002 – both were on occasions when my children were sick. My husband last took sick leave of one week as a junior doctor 20 years ago, following a broken ankle.
I know GPs who have never taken a day off sick throughout their working lives. This is not always something to be proud of, but the reality is that guilt also plays a significant part here. Urgent work, whether it is in hospital or at a GP surgery, cannot be postponed and we all know that someone else will have to cover our workload – in addition to their own – in our absence.
Although many NHS organisations are supportive of their sick staff through their occupational health departments – for instance in Bristol the local medical committee offers online support for GPs and practice managers – there are many more that are not.