** For the purposes of anonymity and confidentiality this interview has been fictionalised – no one real-life doctor corresponds to one character in the following piece. Rather, it is an amalgamation of views and statements from a number of healthcare professionals along with my own perceptions and ideas**
Commonly, if not always, we see a doctor in their professional capacity, unfazed by words such as ‘cancer’ and substances such as blood, able to do the impossible - cut into human flesh, on a hunt for a tumour or clogged artery or haemorrhage . Perhaps viewing a doctor in this way allows us to have more trust in them and therefore, hope that we will be okay: by applying these superhuman qualities, the void between patient and doctor grows bigger - "they are a doctor, they can fix this!", we tell ourselves. With this in mind, and as someone who admittedly also chooses to view them in this light when I am in need of their expertise, I was curious about what it is like for a doctor when they are the patient, when they are in my shoes. What if the reason for visiting a hospital is for themselves or a loved one? What is it like sitting in a consultation room as a patient? And do the feelings change depending on what they need help for?
While the pandemic has been a time when doctors have helped patients more than ever before, it has also been a time when doctors have needed help more than ever before. You need not search very long to find the stats to support this: a study by the BMJ showed that two fifths of doctors have worsened mental health due to the pandemic, a study by the Royal College of Physicians concluded that 1 in 4 doctors have sought mental health support over the pandemic, and cases of burnout and suicide have reached record highs during the past 18 months that the American College of Surgeons have dedicated September's Suicide Awareness and Prevention month to physicians, physician suicide being another ever-loudening silent epidemic.
Upon asking Tamsin and Nafisa what it is like to seek mental health support as a doctor, they gave answers I was hoping they wouldn't, but sadly was expecting, with Tamsin saying: “it’s definitely hard because for me, as a healthcare professional, there’s a sense of ‘I should know better. I’ve had mental health consultations with my GP for anxiety and that is hard because you feel that sense of “I’m a doctor I shouldn’t have this problem, I'm meant to be the one fixing". With similar sentiments, Nafisa, who suffered from OCD as a medical student, told me that upon visiting her GP she "was so embarrassed - how could I, the person that was meant to save people, be struggling? I wasn’t allowed to, that’s what I thought”. Here, there seems to be a direct reflection of what patients expect of healthcare professionals, back onto healthcare professionals themselves: you can't fail, you can't struggle, you are invincible.
While these sentiments are deeply sad and concerning, due to their prevalence amongst healthcare professionals, bittersweetly, this meant that their GPs understood how they felt: “My GP totally related to me in the sense of knowing better. She still made me feel like I was her patient but didn’t make me feel guilty and adapted to the fact I was a doctor but the patient in this context", said Nafisa. Likewise, Tamsin said that she felt relieved after speaking to her GP due to the validation and empathy he gave her. On the process of seeking help, both explained that the hardest part is “acknowledging there is a problem, that you need help and then contacting somebody to explore what options there are.”
Upon asking Jacob, as a mental health practitioner, about healthcare professionals’ willingness to seek mental health support, he explained that often it is internalized: "They are aware there’s something wrong but do not believe it’s an illness or that they need help for it, I see it very often". Developing further, Ben, also a mental health practitioner, informed me that this is largely why the NHS have specific platforms for healthcare professionals to seek mental health support: “There are quite a lot of routes for getting help as a doctor, and especially during COVID they expanded the funding so that it covered all healthcare professionals, and you could get 8 sessions of private therapy. There is a lot of access if you know where to look and how to find it”. Expanding further, Jacob cited another reason for reluctance to seek help being fear of it going on their record or the General Medical Council finding out. Speaking from experience, Ben said: “When I was in medical school, my dad passed away unexpectedly and I was really struggling. There was this rumour circulating that if you were mentally struggling during medical school, they would kick you out and deem you as unfit to continue. This was only a myth and completely unfounded but the medical profession does definitely have this reputation for being hardcore and ruthless”. Almost in an instant, I was reminded of a post in a University Facebook group from a girl asking whether she would get kicked out of the medical school if she was struggling with her mental wellbeing. While the replies and comments were sympathetic and reassured her that she wouldn't, clearly this fear still exists.
What is made painfully clear here and a point I want to highlight is that the stigma surrounding mental health affects everyone. Whether you are under informed, adequately informed or fully aware and knowledgeable – the stigma associated with seeking help for mental health excludes no one, doctors included, and makes itself known in different ways.
Along with mental suffering, healthcare professionals also suffer physically. Again, we only need to look to the pandemic for the proof: as of May 2021, 115,000 healthcare workers have died due to COVID, a harrowing figure that Chief of the International Council of Nurses, Howard Catton, compared to a commercial airliner crashing with no survivors everyday for the 17 months.
While not necessary focusing on COVID-19, rather seeking help for physical ailments and injuries more broadly, Nafisa said that "it’s definitely weird being on the other side of the curtain. I kind of just sit there and tell myself ‘be normal’, ‘be cool’, ‘don’t be weird’, ‘don’t try and be a doctor here’”. Agreeing, Tamsin said that in those moments she tries as hard as she can to “jump out of [her] doctor shoes”. In this sense, Nafisa and Tamsin both signalled a desire to almost change their identity despite being in the same and very familiar environment: when not in need of help, they are disseminating medical knowledge, assessing symptoms, dishing out diagnoses, putting together treatment plans and gauging a prognosis, but when in need, they are the obedient patient, sitting quietly, trying to quiet the medical professional they are and mute the many years of medical knowledge and experience they posses.
What struck me here was the commonality of embarrassment and self-consciousness and the active effort taken to avoid occupying the backseat driver position in the consultation room. The idea that they feel out of place, despite the fact that, out of our population, they, as healthcare professionals, possess the most knowledge about the clinical setting, is intriguing. I was also perplexed by the sentiment of needing to control themselves in the consultation room. With lay patients, there is also a frequent need to control oneself, but specifically trying not to get overanxious, or be presumptuous or hysterical. The task here is to remain calm and rational whilst obediently listening to the doctor. Paradoxically, when healthcare professionals are the patients, there is a sense of having to govern the medically aware and emotionally detached element of themselves and instead focus on becoming more emotionally engaged.
Similar to Jacob's thoughts about healthcare professionals seeking help for mental health, Tamsin told me that “doctors are classically terrible for not presenting – they either present really late or generally don’t want to. I have had colleagues who have developed various symptoms and I have gone ‘oh maybe you should get that checked’ again and again, and weeks go by and they do nothing. Eventually they do of course, but late. I say this, but I’m no better myself”. On why this might be the case, Nafisa said: “Maybe because we are confident in our own knowledge or perhaps we have that feeling of invincibility.”
The feeling of invincibility seemed to be common both in relation to physical and mental health. It appears that while the non-medical population impose qualities of invincibility on healthcare professionals, healthcare professionals also, to a certain extent, impose them on themselves too in relation to their own health. Perhaps this has happened subconsciously as a by-product of the widespread 'healthcare hero' narrative, or, perhaps it is consciously self imposed such that they can deal with other peoples trauma and tragedy or perhaps the two work together. Through my interviews and discussions with healthcare workers, I have come to realise that the label 'hero' is often not well received and a label they do not identify with. The shared feelings of invincibility and subsequent lack of entitlement my interviewees felt in seeking help, further confirms how damaging the superhero narrative is and why we must move towards a human lexicon that allows and encourages healthcare professionals to seek help when they need - without feelings of guilt or failure.