Working as a doctor can be stressful. Despite
a lifetime of work spent offering advice to patients about healthy
living, including diet, exercise and lifestyle modifications,
doctors are not always good at seeking appropriate help for
themselves. Stress can occur at any point in a persons’ career,
from training grades through to consultant posts. Trainees face
particular challenges with membership exams, shift patterns and
night-time working, although many potential causes of stress exist
for doctors at all levels.
There are many different causes and sources of
stress at work, including:
- Factors related to the job such as workload,
time pressures, shift patterns related to the European Working time
- Role-related stress, including the notion of
the level of responsibility and the concept of having
responsibility without any control
- Conflict between home and work life
- Relationship difficulties with colleagues at
work and partner/family at home
- Career development factors, including job
- Factors related to the organisation you work
in and the teams in which you work; these factors might include
problems with communication in teams and feeling that you are not
able to participate in decisions. (Adapted from Arnold et
Depression and burnout
The prevalence of depression in UK doctors is
between 10 and 20% (Ghodse, 2000). Among doctors, rates of burnout
of 25 to 76% have been reported in the literature. Burnout is
defined as a syndrome of emotional exhaustion, involving the
development of negative self-concepts, negative job attitudes and a
loss of concern and feeling for patients (Pines & Maslach,
1978). Stress and burnout lead to maladaptive coping strategies,
such as substance misuse.
About 1 in 15 doctors have a history of drug
or alcohol dependency (British Medical Association, 1998). One
study found that family practitioners have the highest prevalence
of substance misuse (McGovern et al, 2000) and
another study found that psychiatrists have rates of substance
misuse of 14.3% (Hughes et al, 1992).
How to look after yourself
1. Monitoring your own health and
- Consider how you are coping with work – are
you getting angry or feeling overwhelmed by the amount of work you
- Monitor your sleeping pattern. Ensure that
you are getting 8 hours of good rest every night.
Although we are very good at talking to
patients about the importance of diet and exercise, we are not
always good at following our own advice.
- It is important to ensure that you have time
to exercise for at least 30 minutes five times a week
- It is important to have a balanced diet and
ensure that you do not miss meals during the day because of
- Consider reducing your caffeine intake to one
cup of coffee or equivalent per day
3. Monitor your own coping strategies
to stress, including alcohol or substance use
- Do you have time within the week to do things
- Are work stressors having an impact on your
- How do you cope with stress?
- Are you able to find time within the day to
- Have you found yourself drinking too much
alcohol because you are feeling stressed?
- Do you need to keep an alcohol diary?
- Do you need to seek help for addictions?
4. Discuss with friends and
It is important to have a network of support
outside work, and, if possible, interests outside of work.
5. Informal discussion with
- Through local peer groups or mentoring
relationships. Your colleagues have probably faced similar
difficulties or problems, and can help you to think about
strategies for making a change.
- Discuss with individuals you trained with/are
training with, to get another person’s perspective on the
6. Formal discussion with
This might be through discussions with the
clinical director or via mechanisms such as the job planning and
appraisal processes to help tackle work-related issues leading to
7. Make changes to your work/life
- Is the balance working for you, your family
and your colleagues and patients?
- Do you need to review your job plan with your
- Could you consider re-organising your work,
or reducing the number of hours you work?
- Do you have time for exercise and
- Would a supervisor or mentor be an
appropriate source of support and advice?
- Does your trust or organisation have
mechanisms to identify mentors for you?
- Would case supervision with a psychotherapist
or other senior colleague be helpful on a regular basis?
- If you have a supervisor, have you discussed
any difficulties with that person?
- For trainees, most deaneries have a training
support unit (TSU). You can refer yourself to a TSU and they can
see you to discuss any difficulties. They are able to support you
in a variety of ways, including career guidance, counselling and
tailored training to meet your needs.
9. Seek help for health
A UK study (Forsythe et al,
1999) found that although 96% of doctors are registered with a
general practitioner (GP), little use was made of their services
and a quarter of consultants would bypass their GP to obtain
- Make sure you are registered with a GP
- If you are unwell, seek the advice of your
- Avoid prescribing medication for yourself or
your family members
- If for any reason you feel that you cannot go
and see your GP, you may need to consider changing your GP
- If secondary care is needed, talk to your GP
about a referral to a local or an out-of-area service. Contact one
of the organisations listed below for support or advice.
10. Do not ignore the early warning
signs of stress
- Speak to colleagues, friends and family
- Analyse the cause of the stress
- Initiate discussion with your clinical
director and local colleagues to see whether changes could be made
to your work
- Seek appropriate medical help when
Further advice and support
For further advice and support, please see the
PSS Resource Booklet.
Arnold, J., Cooper, C. & Robertson, I.
(1995) Work Psychology: Understanding Human Behaviour in
the Workplace (2nd edn). Pitman.
British Medical Association
(1998) The Misuse of Alcohol and Other Drugs by Doctors.
Report of a Working Group. BMA.
Forsythe, M., Calnan, M. & Wall, B. (1999)
Doctors as patients: postal survey examining consultants’ and
general practitioners’ adherence to
guidelines. BMJ, 319, 605–608.
Ghodse, H. (2000) Doctors and their health –
who heals the healers? In Doctors and their
Health(eds H. Ghodse, S. Mann & P. Johnson), pp.
10–14. Reed Healthcare.
Hughes, P. H., Brandenburg, N., Baldwin Jr, D.
W. C., et al (1992) Prevalence of substance use
among US physicians. JAMA, 267, 2333–2339.
McGovern, M., Angre, D. & Leon, S. (2000)
Characteristics of physicians presenting for assessment at a
behavioural health centre. Journal of Addictive
Disorders, 19, 59–73.
Pines, A. & Maslach, C. (1978)
Characteristics of staff burnout in mental health
settings. Hospital and Community Psychiatry, 29,
Cox, J., King, J., Hutchinson, A., et
al (eds) (2006) Understanding Doctors’
Performance. Radcliffe Publishing.
This information guide is intended for a
psychiatrist who needs advice about looking after themselves. This
information should be used as a guide only and is not a substitute
for professional advice. If you need further advice and support,
please contact the Psychiatrists’ Support Service.
If you require advice and support about a particular issue then please contact the
Psychiatrists' Support Service at the Royal College of Psychiatrists on 0207 245
0412 or email
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