Wednesday, 23 July 2008


I hope you will excuse a little more self-assessment (or self-indulgent navel-gazing, depending on your point of view) before I get back to those exciting tales of derring-do in the consulting room. But this is rather important to me.

For some time I have been depressed at work, although lately it has only been at work. I enjoy my time off very much indeed, my family are wonderful and I have good friends. But work has stretched out like a tedious gruelling ordeal every week. I now think that the basic problem has been my lack of confidence in myself. I was fairly confident in my early days as most young men are. But as I got older I was no longer young enough to know everything, as Oscar Wilde remarked. I think that my confidence was also slowly sapped by the ever-increasing demands of the criteria to remain a trainer, and then by the onset of appraisal and revalidation. And I have misread the signs. All doctors make slips and errors from time to time, but each one I made was evidence that I wasn't good enough for the job. And there are bound to be occasional grumbles by patients, but each one fortified my belief that I was doing badly. We don't get a lot of overt praise and I assumed that the praise or thanks I did receive was just politeness or, alternatively, badly informed. They thought I was a good doctor but really I was just successful at pretending to be one. I was embarrassed to receive the occasional present. My 360 degree assessments were positive except for the fact that practice staff found me grumpy and difficult to approach, which was a side effect of my lack of confidence. Sometimes there were signs that were difficult to misinterpret. Martha, whom I admire greatly, has always thought well of me and seems to see me as a clear thinker who can cut through obfuscation in diagnosis or management with my sharp wit. Yet even there I felt that she was somehow mistaken.

Looking back I am far better than at my nadir about three to four years ago when my depression spilled over into my personal life and things almost ground to a halt. I was never suicidal but at one point I remember thinking that I didn't really mind whether I lived or died. I can understand why doctors sometimes kill themselves and I am extremely grateful that I never got that bad. Fortunately I am good at calling for help, and I have received an awful lot of help and support from Martha and another very good friend who fortuitously has a lot of experience of helping doctors in difficulty. I am indeed a fortunate man.

Since then things have slowly picked up, but it is only recently that I have started noticing all the positive feedback and begun to believe it. Over the past few days I have spotted several occasions on which anxious patients were reassured, as much by my personality as by my explanations. I usually have young children eating out of my hand. And this evening I was talking with my daughter over dinner when she informed me that I have a secret admirer. She currently has a summer job as a sales assistant in a shop in town and today she found out that her supervisor's mother is one of my patients. I know the mother quite well, she is in her eighties and I try to look after her properly because she is the widow of a local GP who died many years ago. The feedback I got today, daughter to daughter, was “he's so dreamy, he's such a good doctor and gives you plenty of time”.

So there you have it. Fortunate and dreamy, that's me. :-)

I really am feeling quite a lot better, and I might even continue working as a GP for a few more years. With a bit of luck this blog might become more upbeat as well.


Anonymous said...

I am very glad you're on an "up" curve. Depression is a horrible illness. In many ways I was lucky to have been so young when mine struck for the first (and I hope only) time - I was an emotionally articulate young woman without too much life baggage. As soon as I realised that suicide was no longer something "other people" thought about, and became something which seemed like a fair and rational way out of what was a very dark world indeed, it was like a switch had been flicked and I got the flash of insight that made me realise I was ill. I asked for help, I got it, and I was pulled out of the darkness.

There are a couple of books which really helped me and which I now recomend to others. One is Tim Cantopher's "Depression - the curse of the strong" (he is a psychiatrist in the Priory group). The other is "Doctors as Patients" edited by Petre Jones - a collection of essays by doctors who have experiences difference types of mostly mental illnesses.

I wish you best wishes in keeping the black dog at bay.

Dragonfly said...

Glad to hear. It is so good to hear the positive stories as well!
Good luck with keeping that black dog out of your yard.

Elaine said...

Depression is indeed a black dog. I wish you well in your recovery. If it hadn't been for the sharp eye (initially) and continuing support of my GP, I might not be here today. Empathy is what makes you a better doctor, but it is also what puts a strain on you.

madsadgirl said...

When one has suffered from depression it makes it easier to understand the problem in others. I speak from experience.

I'm glad that you seem to have regained confidence in your ability to do your job; lack of confidence in one's ability to do the things that you enjoy can be one of the worst 'side-effects' of depression and something that I can talk about from experience.

I hope that things continue to improve.

Anonymous said...

Whether your blog entries are happy or sad, there is an underlying warmth and this is a trait in a GP that should not be underestimated. Obviously medical training is handy too, but you get the idea. You appear to be in the right vocation.

Anonymous said...

What a lovely, insightful post.

"They thought I was a good doctor but really I was just successful at pretending to be one."

A fine example of how your lack of self-confidence was eroding your belief in yourself.

"but it is only recently that I have started noticing all the positive feedback and begun to believe it."

Hurray! I'm sure if you can learn to believe in yourself, your future happiness will be secure.

Your daughter must be very proud of you!

Anonymous said...

I'm glad you were able to find good, competent help. I'm starting to think I never will...this was a really good post. Thank you for being so honest.

Anonymous said...

im in a different business, but

yes had self doubt and many insecurities

took a year off to do a post grad, broke the cycle of long hours and fire fighting the impossible, gave me a chance to look at the world from a different perspective, that was a few years ago

im much less tolerant of crap now, and fortunatley have survived taking the high risk approach quite often, although this gets harder as you get older

so dont just think its medics, i peaked in my skill/confidence in my 20s, nowadays i have a different balance of strengths

Ms Medic said...

Glad to hear things are on the up

Anonymous said...

Glad to hear that things are on the up. Depression really is a horrible illness.

From what I have read on this blog I would be happy to have you as a GP!

Anonymous said...

oh, good on ya, Doc! What middle-aged person would not like to be thought of as dreamy? Puts a little bounce in the step, doesn't it? (irrespective of the source of the admiration!)

Anonymous said...

Mate, I spent a lot of my time in medicine wondering when I was going to be "found out". Good supervisor reports and happy patients, but I, to, thought I was just good at pretending. I let every error get magnified in my head so there was no room for the good stuff. The doctors that I am close to are often like this too. I don't know the answers. But just wanted to let you know that you're not on your own.
Medicine often attracts a breed of people who are both sensitive and academic. Those two traits can make us quite introspective, and can actually make us quite cruel to ourselves as we examine every failing wit a highly critical magnifying glass. I've often read your blog, and I think you're one of the good guys.

All the best,

Dr. Thunder

Anonymous said...

I wouldn't be alive today were it not for my GP, but somehow I've never found the right time or way to tell him. I bet that you have many patients who would also tell you how much they appreciate you if only they felt able to do so.

Nurse To Doc said...

I have just found your blog and really loved this post. I am a medical student and have the same feelings of not being good enough for this job. I have just finished my GP placement and have hated every minute because every time a patient walked through the door, i dreaded being quizzed and not knowing what the answer was. I think that being a GP is terrifically difficult. You seem very human and I would want a GP like you!

PhD scientist said...

I think the "thinking you're not goof enough" is one of the hazards of the profession, but the extra whammy is that it often hits the best people hardest. I think this when I look at Mrs PhD Sci, who had to leave hospital acute medicine after a decade due to burn-out/depression/exhaustion.

Elaine's remark about "Empathy is what makes you a better doctor, but it is also what puts a strain on you." is part of it, as is "feeling you are never good enough but are just pretending". A third interacting element is "knowing what the optimal care the patient could and should receive is, and then having to fight the system to deliver it, sometimes coming up short".

I think this last, which also brings in things like understaffing / bureaucracy / target culture etc etc. is a big part of what burns people out, certainly in acute care. I say this based on years of listening to Mrs PhD and her colleagues / contemporaries.

PhD scientist said...

Oops, mistype, meant "good" in the first line, of course.

Dr Andrew Brown said...

I must apologise for not replying sooner. Your comments have been helpful, informative, supportive, touching, and just marvellous.

You are the finest group of readers a blogger could wish for.