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 or one of the organisations listed at the end of this
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 Directive, etc.
- 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
- relationship difficulties with
colleagues at work and partner/family at home
- career development factors,
including job security
- 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 have?
- Monitor your sleeping pattern.
Ensure that you are getting 8 hours of good rest every night.
2. Healthy living
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
- It is important to have a balanced
diet and ensure that you do not miss meals during the day because
- 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 you enjoy?
- Are work stressors having an
impact on your home life?
- How do you cope with stress?
- Are you able to find time within
the day to relax?
- Have you found yourself drinking
too much alcohol because you are feeling stressed?
- Do you need to keep an alcohol
- Do you need to seek help for
4. Discuss with friends and
It is important to have a network
of support outside work, and, if possible, interests outside of
5. Informal discussion with
- Through local peer groups or
mentoring relationships. Your colleagues have probably faced
- 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 situation.
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 stress.
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 clinical director?
- 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
- 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 problems
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 consultant advice
- Make sure you are registered with
- If you are unwell, seek the advice
of your GP
- 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
- 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
10. Do not ignore the early warning
signs of stress
- Speak to colleagues, friends and
- Analyse the cause of the
- 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
Free confidential service for doctors in the London area who have
mental or physical health concerns or problems with
Tel: 020 3049 4505
Free telephone advice and support to members of the Royal College
Tel: 0207 2450 412
Service and Doctors for Doctors service
A confidential service where doctors in difficulty can discuss
problems and be offered support. Doctors may choose to speak to a
counsellor or a doctor-advisor.
Tel: 08459 200 169
A website developed by the Royal Medical Benevolent Fund with a lot
of useful information about stress, as well as mental and physical
health advice for doctors.
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, 233–237.
Cox, J., King, J., Hutchinson, A.,
et al (eds) (2006) Understanding Doctors’
Performance. Radcliffe Publishing.
© Royal College of Psychiatrists 2011
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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
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