My Experience as a GPST While Suffering with Mental Health Issues

Coping with training and illness

To start with, I had a friendly and informal chat with the occupational health doctor who was very supportive and non-judgemental. My first post was accident and emergency (A&E) and I was entering into the unknown. Having a history of mental health problems was the least of my problems it seemed. I swatted up on the relevant handbooks and relied on all my past experiences of training. I vividly remember all the horror stories written by previous trainees that I had read in journals. In reality, it was not so bad.

As a first year trainee (ST1), I had to cover nights. I needed to take my medication at a time when the side effects were minimal, and it was essential that I never missed a dose; just as an insulin-dependent diabetic is reliant on medication. This game-plan saw me through nights in general medicine and obstetrics and gynaecology too.

I have lived with my diagnosis of mental illness through my medical school finals, the birth of my son and my jobs thus far. I have real compassion for those who have the very debilitating set of symptoms that I have experienced which, at their peak, are crippling. Seeing such patients strikes a chord with me. I can empathize with how they feel and what they are going through, so in some ways, my illness makes me a more understanding and compassionate doctor.

What should I tell others?

Being a very private person and too well aware of the social negativity and stigma attached to mental health problems, I shied away from telling my peers and colleagues about my illness. It was like a covert military operation. I was never sure of the full ramifications of telling my peers. It almost seemed a subject that I just could not broach. When was I to tell them? In the little time in the mess? At the Christmas do? The ball? When?

My close non-medical friends and family were aware of my illness but no-one at work knew. Maybe it was a matter of pride. Or perhaps, I just did not want people to see me differently to them. Is it true that as many as 40% of trainees are struck by such diseases?

Relapses

I have had two relapses: the first at the birth of my child and the second when I was established in my GP training. Both relapses occurred when my medication was discontinued on medical advice. I am now writing this article while recovering from my most recent episode. Doctors are used to functioning at a high mental and social capacity and these are stripped from you when a relapse occurs. An episode is almost like being in the wake of a tornado.

Near the end of last year, I was advised that I had recovered from my illness and my medications were stopped. At the time, we were suffering the worst winter for as long as I could remember. Soon after coming off medication, I developed suspected swine flu and an infective exacerbation of asthma. I attended the A&E department where I had recently worked as part of the training scheme and was seen immediately by my ex-boss who asked me about any previous medical history. Like many doctors, I said I was ‘fit and healthy’ almost as a reflex. I was then prescribed a course of steroids. The steroids triggered a relapse of my mental health problem and a long period of time off work. My ultimate fear was admission to a hospital and thankfully that did not happen.

I now know that it was foolish not to declare my full history. I have also learned the hard way that my health is more important than what people think of me and my so-called ‘integrity’.

Mental health problems put a huge burden on the people closest to you. Those people are most likely to notice the marked change in your behaviour and your day-to-day functioning when mental illness strikes. They also tread the difficult and often thorny path to recovery with you. Without my family, I do not think that I could have seen the light at the end of my tunnel.

An unnecessary mountain to climb?

During my most recent relapse, I discovered that as well as dealing with my illness, I also had a mountain of complex and lengthy administrative tasks to complete. I had to notify my then-employer, my deanery, my GP course tutors, the GP performance unit, the accommodation officers, my medical indemnity provider, the local occupational health department and my upcoming employers about every aspect of my illness. If it were not for my direct family, friends and support from my GP tutors, I certainly could not have coped with all that administration.

I understand that being a doctor carries a great responsibility to others and, of course, yourself. However, after my most recent relapse, I was very upset by the attitude of the medical profession towards mental illness when I was referred by my psychiatrist (on the advice of the clinical director) to the General Medical Council (GMC), even though there had been no history of compromise of patient care. Any doctor shudders at the thought of review by the GMC, but I was especially disappointed to be referred when I had done nothing wrong. I was just ill.

In my view, referral to the GMC not only caused me additional and unnecessary anxiety but it also created yet more administrative tasks, correspondence and stress. In many cases, that extra burden could hamper recovery. Should a less daunting body be established to deal with doctors like me whose illness may question their ability to practice? Thankfully, due to the perseverance of my community psychiatric nurse, GP and psychiatrist I was proved fit to practice and I am now back at work.

My wishes for the future

In future, I hope mental health problems will be viewed as any other chronic disease. Often, patients respond well to medication after a definitive diagnosis and have productive lives. Rather than being sidelined in generalist settings, I feel that it is important for those with mental health issues to be given more time and understanding. This would ensure a more sensitive approach to patient care, better treatment for these patients and faster recovery.

I would like an independent body other than the GMC to oversee fitness to practice for doctors with any chronic disease. I would also like to see more help for sick doctors. This could practically take the form of a liaison officer to ensure that all relevant parties are kept informed about what is happening on behalf of the sick doctor. That would have made a huge difference to me.