Thousands of doctors are continuing to treat patients while hiding their own problems with drink, drugs and depression because of a "culture of invincibility" among health professionals.
Each year hundreds of medics are treated for addiction and mental health issues, according to official statistics. But researchers investigating the issue say that this masks a much bigger problem, with thousands of doctors concealing their symptoms.
The extent of ill-health among doctors – often put down to burn-out caused by the high-pressure demands of their job – was highlighted in a General Medical Council report detailing 1,384 doctors who had been assessed for underlying health concerns over the past five years. Of these, 98 per cent were diagnosed with alcohol, substance misuse or mental health issues.
Some 544 doctors were found to have drink-related problems and 598 were diagnosed with mental conditions such as neuroses.
At the same time, the Practitioner Health Programme (PHP), a national service that sick doctors can contact to seek help, found that of 554 referrals, 85 per cent were related to mental health problems and 28 per cent to substance addiction.
Dr Max Henderson, from King's College London's Institute of Psychiatry, believes that these numbers represent the tip of the iceberg because doctors are often deterred from admitting that they are sick and need time off by feelings of shame.
A recent study led by Dr Henderson showed that medics who do fall ill fear being perceived as "weak" or "a failure" by colleagues. "There is a feeling among doctors, that illness shouldn't happen to them – that they should somehow be invincible," said Dr Henderson.
"Doctors are particularly vulnerable to 'presenteeism' and we know they are reluctant to use mainstream healthcare services and will sit on their symptoms and not share them with anyone. So they may treat themselves or they try to get their friends to treat them through what are known as 'corridor consultations'.
"The idea that there might be several thousand who have psychiatric problems and are unable seek help due to fear and issues of confidentiality is entirely feasible."
Dr Steve Moorhead, a consultant psychiatrist at Northumberland, Tyne and Wear NHS Trust, said: "When we treat doctors, we see the difficulty that they have coming to terms with their need for help. Maybe this is part of the health service culture of looking after other people first."
There has been little evidence to suggest that patients have been harmed by doctors who remain at work despite being unwell. But Dr Henderson admitted that such physicians are likely to provide a "less good service" to their patients.
One of the most recent surveys on the health of NHS staff, which involved questioning 2,500 doctors in Birmingham, showed the extent to which doctors are willing to hide mental problems or substance abuse issues. Only 13 per cent of respondents said they would seek help for mental health disorders or addiction, while 87 per cent said they would self-medicate or seek informal medical advice.
Occasionally, however, this unwillingness to seek help tips over into tragedy, as in the case of Daksha Emson an Indian-born psychiatrist who hid her fight against manic depression as she built her career. In 2000, during a psychotic episode, the 34-year-old mother stabbed herself and her three-month-old daughter to death. An inquiry later found that Dr Emson had feared her illness would not remain confidential and that the resulting stigma would have "haunted" her work and her life.
Despite improved specialist support services for doctors since then, Dr Henderson says that taboos among doctors about their own mental health continue.
He argues that doctors remain wary about making official reports about their illness for fear of having to deal with the GMC, which could "take their career away".
The Royal College of General Practitioners and Dr Henderson called this weekend for more funding for confidential support services for doctors, warning that looming cuts and the reform of the NHS would lead to an increase in the number of medics suffering poor mental health.
Dr Clare Gerada, chairwoman of the royal college and PHP's medical director, said: "We are seeing more sick doctors, more GPs in particular, more shame, more presenteeism, as doctors are worried about their futures. "
A Department of Health spokesman said yesterday that a new system of regular appraisals to support doctors is due to start next year.
'I didn't want to admit something was wrong. I just told myself to get over it'
Dr Peter Verow describes himself as a 'type A personality'. A former champion squash player who represented Britain and a respected consultant, he is by any standards a high-achiever.
But five years ago, at 55, he was hit was a debilitating illness — not cancer or heart problems — but depression. He went from exercising every day and enjoying a top-level career to barely being able to get out of bed.
"The depression came on out of the blue," he recalled. "It's like having a permanent black cloud hanging over your head."
At his lowest point, the occupational health specialist, now 59, admits that he even had thoughts of suicide. "But I knew that because of my wife and children I would never actually do that."
Despite such internal struggles, Dr Verow kept his meltdown secret. "I was probably ill for six months to a year before I finally accepted I had to go off work. Colleagues and friends didn't realise how bad I was.
"I didn't want to admit that there was something wrong with me. I frequently told myself to 'get over it, and pull yourself out of it'. But you can't pull yourself out it."
Dr Verow eventually sought help from a psychiatrist and took six months off work to recover. "My time away helped me to recognise that I had to change my work role in some way and so I went part-time," he said.