Sick Leave Brings Sense of Shame, Failure for Physicians

Jenni Laidman

October 18, 2012

Physicians on sick leave may be so worried that colleagues will see them as failures and so overcome by their own sense of shame, that they find it difficult to return to work, according to a study published online October 15 in BMJ Open.

Max Henderson, PhD, clinical lecturer, Institute of Psychiatry, Kings College, London, United Kingdom, and colleagues conducted in-depth interviews with 19 physicians whose medical conditions kept them away from work for 6 months or longer. Seven of the physicians had problems with their physical health, and all but one had problems with mental health or addiction. The physicians ranged in age from 27 to 67 years, with an average age of 46 years. Ten of the physicians were women.

The semistructured interviews revealed that many physicians were so unprepared for their own vulnerability and their temporary inability to practice medicine that their view of their place in the world was shattered.

One physician told an interviewer, "Once you try and put that doctor persona aside, I realised there wasn't much left of me." Another said, "I can't, emotionally I can't retire. I mean, I gotta be involved. I feel total emptiness."

"[Y]ou just simply got lost in a, in a huge sea without any navigator and you don't know what to do," said a third.

The researchers conclude that self-stigmatizing views play a significant role in the challenges these physicians face. "Many doctors internalise the perceived negative responses of colleagues and others to their illness," they write.

"It is possible that in absorbing them, doctors perpetuate and reinforce the negative views of others," the authors add.

In interviews lasting between 1 and 3 hours, some physicians reported difficulties in relationships with family and friends, and others reported supportive relationships. However, several said that a lack of caring from other physicians was part of the culture of medicine.

"I mean we're meant to be caring people [laughs] but we don't, don't seem to care about each other at all in my experience," one physician remarked.

Another said, "I don't think they would really care unless you drop dead and they were only bothered about the work being done, regardless of what happened to you. And I think the only time they would get concerned is if the work wasn't being done."

"You're seen as being weak," another said.

The authors say the problem could stem from a "general tendency to stigmatise" among physicians — research has shown physicians will stigmatize the mental health problems of others. However, the authors place a great deal of blame on physicians' need to be invincible.

"Self-stigmatising views, which possibly emerge from the belief that 'doctors are invincible', represent a major obstacle to doctors returning to work," the authors write. "From medical school onwards cultural change is necessary to allow doctors to recognise their vulnerabilities so they can more easily generate strategies to manage if they become unwell."

Physicians construed invincibility "in binary fashion — you are either invincible, or you are completely useless," the authors write.

Changing the medical culture will require physicians to return to work after sick leave. "As with all stigma, reducing social distance can help change minds," they write. More physicians returning to practice "will act as a counter-weight to the notion that 'doctors are invincible,' " they add.

The authors conclude: "But if we are to create an environment which facilitates the return to work of doctors with long-term difficulties, attention must be paid to how the 'invincible' culture in medicine is generated."

The authors have disclosed no relevant financial relationships.

BMJ Open. Published online October 15, 2012. Full text