Myth of “golden age” of medicine worsens mental health of young doctors, says leader of doctors’ mental health service
Authors: Abi Rimmer
Publication date: 18 May 2017
Older doctors who present the past as a “golden age” of medicine are contributing to the deteriorating mental health of younger doctors, one of the doctors providing a national doctors’ mental health service has said.
Clare Gerada, a partner at the group of GP practices that run the NHS GP Health Service and the Practitioner Health Programme, said that a mythologised age of medicine places a burden on younger doctors. She made her comments when she gave the William Pickles lecture at the Royal College of General Practitioners spring general meeting in London on 12 May.
“I believe that the rise in mental illness among doctors has been made worse by the older generation, my generation, clinging to a distorted past, a golden age that never was,” she said. “This mythologised past places an enormous burden of unrealistic expectations on the current generation of GPs.”
She added, “My generation reminisces about continuity of care, partnerships, and the freedom to do what we felt was right for patients, unconstrained by the demands of a marketised healthcare system. It’s true, it was like that. But what we don’t mention is the paternalism. Or the patronage: you got on largely by who you knew, not what you knew. We don’t mention the bullying, or the long hours, or how as junior doctors we were left unsupported, expected to do most of the work on our own.”
Gerada said that there was a sense that the increase in doctors’ mental health problems are because the current generation are not “resilient enough” and are “somehow lacking the required stiff upper lip.”
“What I do know is that doctors, past and present, are among the most resilient people in society.” she said. “Given the right support, doctors survive and thrive in the face of adversity. Resilience is about bending with pressure and bouncing back. But each of us has our breaking point, beyond which we can go no further. And it was always thus.”
Many young GPs, Gerada said, make a “valiant but futile attempt” to live up to impossible standards set by their older peers. “Facing up to our professions’ past helps us to see that those who came before us were no better or worse than we are today,” she said.
During her speech Gerada also discussed what the future GP would look like—beginning with five years of training. “Not with the three years training that we have now, or even four years, but I hope five years because extended training will bring more opportunities and increased confidence to tomorrow’s doctors,” she said.
Despite general practice becoming faster, more litigious, and more regulated it was also safer, more equal, and more varied, she said. “It may surprise you when I say that, despite the difficulties we currently face, I believe that there has never been a more exciting time to be a GP,” Gerada said.
In the future doctors and patients will have more equal relationships, one where patients are more involved but also more responsible for their own health, she said. “Social media will play a part in the way that doctors and patients communicate, creating a less formal, more democratised relationship.”
Gerada also predicted that genomics would take off, heralding an era of truly personalised medicine. “The new kind of doctor will have learnt how to decipher and translate this information for patients, something we GPs with our ability to manage risk, deal with uncertainty, and care for our patients holistically are skilled at,” she said.
- Rimmer A. Doctors will need an understanding of genomics, says HEE. 2017. [Link] .
Abi Rimmer BMJ Careers