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MY Twitter feed revealed yet another story of doctor suicide, and again a brave widow has shared her story of grief in The Guardian. It’s becoming all too frequent.
There were many themes but underlying was a prolonged investigation by the General Medical Council (GMC), the UK’s regulatory authority for doctors. In this case, Dr Richard Harding, an anaesthetist, was cleared after a 5-month investigation. The trauma and fallout remained, and he took his trauma to his grave, leaving a grieving family.
In the UK, 28 doctors took their own lives between 2005 and 2013 while under “fitness to practice” investigation by the GMC. It required a Freedom of Information request to the GMC by psychiatrist Dr Helen Bright for that statistic to be exposed. Neither the GMC nor the coroner appeared to have noticed an association. .
The following story from an anonymous colleague of mine conveys further stresses associated with “in-house” investigations.
“I had been off work after, a few years earlier, having had a mental health issue. I had returned to my normal working duties completely recovered but had felt under a veil of behind-the-scenes discussion about my health. I realised that information was being collected and work colleagues were being questioned about my behaviour. This resulted in a report on my fitness to practice and I was stood down pending investigation by a large group of which two-thirds did not do, or had ever done, my job. I was required to provide doctors’ reports. Nothing was found. In fact, my performance was superior to my chief complainant’s. No apology followed, and I am still picking up the pieces, mainly emotionally, but also financially.
“It was a traumatic experience handled very poorly. I turn up to work feeling like I have a target on my back and there is a constant perceived lack of trust by those around me. It was a humiliating experience. I was isolated by my colleagues and I felt like a modern-day leper.
“I now practice defensive medicine to protect myself. It is always on my record, so I need to report it when reapplying for work.
“I doubt I will ever recover, even though it was found that I had no case to answer. I required therapy to counter suicidal thoughts.
“I no longer enjoy medicine. I still have to work with those who judged and reported me.”
The GMC data show an incidence rate of 227/100 000 of suicide in doctors who are undergoing “fitness to practice” investigation compared with 11.6/100 000 in the UK general public.
In fact, all investigations from local to the governing bodies lead to altered mental health of doctors.
The feeling of isolation, lack of peer and leadership support, the prolonged nature of the review, the financial issues and the defensive medical practice are all reported in a study published in BMJ Open which looked at all investigations and surveyed a group of 7926 doctors.
The reported incidence of moderate to severe depression in those who were or had recently been investigated was 16.9% compared with 9.5% of those with no complaints against them. This incidence increased with the level of investigation, the highest rates seen after GMC referral.
In doctors with current or recent complaints against them, suicidal ideation and self-harm was 2.08 times higher than in their counterparts.
The researchers reported very high rates of defensive practice including avoiding high risk procedures and patients, with 20% of doctors under investigation feeling victimised over whistleblowing. Thirty-nine per cent felt bullied, 27% missed over a month of work.
Investigation therefore leads to anxiety, depression, defensive medical practice, and some even leave or reduce their practice as the trauma has become too great. Is this not what we want to avoid?
Investigation of a doctor should be considered as a risk factor for suicide, even more so if that individual has a past history of depression.
Do we have data in Australia about this? I am not aware that we do. Should the coroner indeed investigate whether a doctor who dies by suicide has been under any investigative process? My answer is yes, and that the data should be publicly available.
In the UK, doctors felt they were depersonalised by the investigation process and that it took a prolonged period of time. Off-the-record conversations I have been a part of reflect the same in this country.
Protection of patients is paramount in any health system. That is not in question, but protection of health professionals under investigation is also important. I feel that, tragically, this has been lost or ignored.
Suicide prevention programs identify risks to individuals and work to address them. It would appear very clear that investigation of a doctor is a clear suicide risk factor and should be treated as such. Was it the initiating factor or just the last straw for the individual? We need to know this.
If our own regulatory authority does not protect us or see this as their role, then as a collective medical society we must consider those under investigation as a suicide risk, and support, not isolate them. We must support them in their return to work. The coroner also must consider this issue in any doctor’s suicide and address changes if required.
An excellent review in greater detail has been written by Casey and Choong.
Dr Geoffrey Toogood is a cardiologist and a long-time advocate for mental health. He has swum the English Channel. He came up with the idea of crazysocks4docs day.
If this article has raised issues for you, help is available at:
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Is anyone aware of an organised body of people formally pursuing this matter with the GMC / AHPRA? I would like to take it formally to these organisation for a response, to instil change.
I am not bothered with exposing my name as I am in my semi retirement years. I have been ‘clean’ till I came to Oz and the systemic bullying culture go me. But life goes on. Here is my Bio: https://independentaustralia.net/profile-on/leong-ng,134 Bullies get away with it and get awarded medals etc. The system sucks and I am an opponent of mandatory reporting of all sorts. copied from the UK after Bristol and Shipman. A balance must be struck as it has now clearly shown to have failed. The GMC put is FTP protocols into ‘pilot mode’ in July 2016 but psychopaths still remain and continue with its mendacities. The law must be reformed to make the GMC and AHPRA liable to financial and other suits.
Our colleague Richard wrote: “….I had felt under a veil of behind-the-scenes discussion about my health. I realised that information was being collected and work colleagues were being questioned about my behaviour. This resulted in a report on my fitness to practice and I was stood down….”
Appalling! Medical directors and senior consultants who enable, even fuel, this kind of culture need to be identified and performance-managed out. Some are quite narcissistic and are doing untold damage to their health service.
Bullying in the Medical Profession has come more into the light with the Senate Inquiry. One form is vexatious notifications under the guise of “mandatory reporting”, which I have been subjected to.
It shouldn’t be hard for medical staff committees to identify these subtly bullying doctors, and stop them getting into senior positions within a public health service. The way all staff in the service are treated needs to be monitored as a k.p.i. The culture of that workplace must be nurtured. It must be foremost in the minds of directors, administrators and managers, not an afterthought.
Thanks Geoff for all your energy and advocacy in this important area.
I would be grateful to learn from you (and perhaps your anonymous colleague) how workplaces, and particularly peers, can support our friends and colleagues who are struggling. Mental illness is a greatly sensitive issue, which still unfortunately holds so much stigma, and I think this is experienced by the sufferer as well as the colleague. The colleague may then be incredibly well-intentioned but just not confident regarding what is correct approach, including whether to bring it up in conversation or not.
Some tips from you would be really valuable (of course remembering that they may not be generally applicable).
Hi Kate
Thank you for your kind words and your bravery
I have faced many of these issues too and fortunate to have survived
I will as others continue to fight for change and awareness ….deeply touched by your comments thank you
Geoff
Thank you so much for drawing attention to this Geoff, and for the mention of my husband Richard. Just before he died, he was trying to put in place regular supervision for himself as someone working in a high-pressure speciality, and to give his medical director credit, the latter was very supportive of this. However, Rich took matters into his own hands before such support could be arranged. There were so many factors that led to his death, and of course the complaint was a major one, but so was its timing, just as we prepared to emigrate to NZ; the one other *huge* factor in his decline and death was the constant disruption of his sleep by his on-call rota. He became more vulnerable to this as he got older – he tolerated the effect of his work on his sleep much less well – and this was so particularly subsequent to his complaint. No easy answers to that one, of course. I am trying in a small way to draw more attention to this issue in the UK and it is really cheering to see that it is being talked about more in Australia and NZ (both countries Rich and I have worked in, and loved. Still love, in my case!)
Thank you Geoff for continuing to advocate the mental health issues of doctors at all stages of their careers. You are a legend.
Thankyou for these posts Geoff and your continuing promotion of kinder more compassionate care within our profession. Much appreciated- you are a cardiologist with true heart reaching out to others with warmth and firm action.
It is wonderful to see this conversation occurring. I wish more doctors would feel comfortable to seek psychological intervention, and that their employers as well as insurers support this pathway. As a psychologist in private practice on the Sunshine Coast, I have had the privilege to work with a few clients who are medical professionals and they have thrived following engaging in the therapeutic process. The more doctors I have seen, the more aware I have become of the need clinical support but often feel frustrated that there are barriers to accessing me/my colleagues. Unfortunately, the need to maintain an image of coping, as well as the lack of peer or institutional support, eclipses the need to acknowledge and attend to their mental health. A pathway via which doctors can seek psychological support in a private, confidential and nonjudgmental space is imperative.
Whilst I am a nurse and not a doctor, I can attest to the manifold ramifications of such intensive scrutinisation.
Although there are a lot of differences between the two stated professions, there are also a lot of similarities.
Namely, from what I have witnessed and worked through over the last 16 years, in both private and public hospital work, is the near total juxtaposition between how we treat and care for those in our care and the way in which we treat and care for one another, including ourselves.
It seems that to some degree, defensive practice takes many forms. In nursing at least, the slightest little deviation from the status quo, either perceived or real, results in formal escalation via the lodging of a “riskman”. Far from affecting any positive change, I feel that such actions only diminish the confidence and resolve of those on the receiving end.
Does this kind of hyper-reporting stem from our colleagues wanting to protect their own interests and to be seen to be doing the “right thing”, or maybe to deflect blame from themselves? Is it a case of ego or professional jealousy? Or perhaps just an outright act of maleficence, whereby those in the firing line have very few options in the way of recourse.
Well, I’m not sure. One thing I am sure of though, is that there would likely be few cases where the catalyst for such reporting was driven by the honest desire to change things for the better or avert a real risk.
If only we could all be kinder to one another, more united and more pragmatic.
Thank you for writing this article.
The risk to doctors is real. I no longer enjoy medicine, having spent years working with a bully – who subsequently was sacked. I raised the issue – and it took almost 2 years to resolve. I had to work with them during the process. The hospital was unhelpful. They had no idea how to manage the situation.Even now – although the person has been sacked – it is not the same.I have severe anxiety and deprression. I wish I had resigned back in 2014.