2 nd Plenary Session: Doctors in Difficulty
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1 1 st 3 rd December 2010 EAPH Annual Conference, Barcelona Healthy Physicians for a Healthy Society 2 nd Plenary Session: Doctors in Difficulty Dr Antony Garelick Associate Dean MedNet London Deanery and Consultant Psychiatrist/Psychotherapist Tavistock Clinic & NELMHT 1-3 October 2010 Garelick/MedNet Slide No 1
2 Deaneries in England and Wales London KSS 1-3 October 2010 Garelick/MedNet Slide No 2
3 What is the MedNet service? Addresses work, personal or career related problems Clinical assessment and brief treatment service A network of resources Confidentiality (within explicit limits of patient safety) 1-3 October 2010 Garelick/MedNet Slide No 3
4 Nature of Service Self-referral Psychiatric and psychological assessments Up to 6 sessions Staffed by Senior Psychiatrists/Psychotherapists Narrative based, holistic exploration 1-3 October 2010 Garelick/MedNet Slide No 4
5 Morbidity in the Medical Profession Goldberg % doctors above threshold on GHQ compared to 18% workers outside health profession Caplan % stress, 29% anxiety, 27% depression 1-3 October 2010 Garelick/MedNet Slide No 5
6 Morbidity in the Medical Profession (2) Borrill (1997) - 27% psychological morbidity Ramirez (2000) - Evidence of stress among consultants. 27% psychiatric morbidity on GHQ (management and communication) Firth-Cozens (2000/3) - 28% doctors show workrelated stresses 1-3 October 2010 Garelick/MedNet Slide No 6
7 Case A Obsessional / depressive difficulties 1-3 October 2010 Garelick/MedNet Slide No 7
8 Dominant Personality Configuration Compulsive personalities with very demanding superegos Gabbard (1985) - doubt - guilt feeling - exaggerated sense of responsibility Krakowski (1982) - perfectionism - excessive devotion to work - doubt - unable to take leisure time Socially valuable traits but personally expensive 1-3 October 2010 Garelick/MedNet Slide No 8
9 Empirical study by personality characteristics Brewin (1992) Higher levels of self-criticism associated with high rates of depression and less satisfactory parenting 1-3 October 2010 Garelick/MedNet Slide No 9
10 Problems with team working Absence of an agreed aim Ambiguous roles and responsibilities Lack of agreement about what working together means Problematic power relationships Ideological differences Conflicting models of care Cynicism/loss of faith (detached/depersonalised working) 1-3 October 2010 Garelick/MedNet Slide No 10
11 Group v Individual (the dialectic) Relegation of individual needs and opinions in the service of the group Compromise Tolerate frustration Capacity to consider different points of view and approaches Ability to cope with complexity Ability to relinquish individual control for the collective approach 1-3 October 2010 Garelick/MedNet Slide No 11
12 Stressors High demand, low control Recurrent organisational change Recurrent organisational demands The culture of perfection 1-3 October 2010 Garelick/MedNet Slide No 12
13 Case B Bipolar Disorder 1-3 October 2010 Garelick/MedNet Slide No 13
14 Stigma Firth-Cozens Problems frequently longstanding, untreated, and appear proportionately higher than in other occupational groups External - adverse effects on career Internal - shame, fear of failure Conflicts with still prevalent role model of the invulnerable clinician able to cope with any professional stress 1-3 October 2010 Garelick/MedNet Slide No 14
15 Addressing the challenge of stigma 1-3 October 2010 Garelick/MedNet Slide No 15
16 Number of Patients who have completed the Follow Up Survey broken down by year 35 Total 98 Respondents Completed the Survey of 391 Contacted = 25% October 2010 Garelick/MedNet Slide No 16
17 Work Are you in Full time work? Total number currently working full time in medicine 66/98 Are you in Part time work? Total number currently working part time in medicine 23/98 If you are not working, is this by choice? Total Number not by Choice 7/98 Is this for health reasons? Total Number for Health Reasons 2/ October 2010 Garelick/MedNet Slide No 17
18 The importance of peer group support 1-3 October 2010 Garelick/MedNet Slide No 18
19 Maslow - esteem The need for self respect entails confidence, mastery, achievement, independence and freedom The need for respect from others entails recognition, acceptance, status and appreciation 1-3 October 2010 Garelick/MedNet Slide No 19
20 Doctor s Feedback Want greater understanding of what generated their problems Importance of being in charge of ones own destiny Want more than protocol driven approach Value knowledge as a means to autonomy and self worth E Halpert, International Journal of Psychoanalysis October 2010 Garelick/MedNet Slide No 20
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