Book review for BMJ

published in BMJ Career Focus 30 September 2006

‘Doctors as Patients’ edited by Petre Jones. 2005. Radcliffe Publishing, Oxford, UK. Paperback, £24.95, ISBN 1-85775-887-0, 200 pages. ***

Petre Jones edits contributions from twenty four doctors, active in a range of fields from general practice to psychiatry, with a forward from the immediate past president of the Royal College of Psychiatrists, Mike Shooter. Ten autobiographical case histories are followed by sections on topics such as discrimination, General Medical Council procedures, flexible working and sources of support.

Written by doctors for doctors, about their own experiences of mental illness, the aim of the book is to raise awareness, encourage action and support, and reduce stigma. It is a sobering read for anyone entering or working in medicine.

Several contributors blame their illness on “macho” medical culture, requiring doctors to hide or minimise difficulties, combined with widespread compulsion to work hard. Half mentioned a family history of depression or mental illness. Most reported a reluctance to seek help until in dire straits because they felt ashamed of failing and feared harsh judgement by colleagues and the GMC, whose reactions are portrayed as mainly punitive. Given this context their bravery in coming out is laudable.

The book’s aim of presenting what it’s like being a doctor who succumbs to mental illness is well met, and its main achievements are likely to include providing support and encouraging greater readiness to seek help, particularly through the Doctors’ Support Network which it represents.

Many questions are unexplored. Everyone tried drug treatment as the first and principal remedy. Most continued with the treatment, sometimes for years, even those who felt no better or happier. There is no discussion about this. Jones asks why only some doctors succumb to mental illness, and whether high rates of mental illness arise from the nature of the work or people drawn to it. It is said being a doctor is more stressful than being a non-medical professional. I am not convinced.

I am doubtful whether it will succeed in raising awareness and encourage action. Probably only the converted would read the book and readers are left to pick the bones from the narrative text.  It needs a summary of explicit suggestions for action.

Whether it will reduce stigma is also hard to assess. The book presents a picture of emotional and psychological distress and disrupted, thwarted lives that is hard to equate to being ‘no more taboo than a broken leg’. Qualitative differences are made very clear.

Nonetheless some contributors continued working full time throughout their illness and most resumed work afterwards, often in a changed way more conducive to well being. Several said their experience had taught them to be more sensitive to depression in patients. By continuing to talk openly about such experiences and what can be learned from them, doctors can chip away at stigma in the medical profession and lead a debate about the pressures of professional life in general.