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.
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