After The Death Of Dr Rose Polge – Who Has A Duty Of Care To Doctors?
by Dr Raj Persaud and Dr Peter Bruggen
The UK media are reporting that a body found at the seaside in Dorset has been formally identified as that of missing junior doctor Rose Polge. The press had stated that when she first went missing she may have written a note which mentioned Health Secretary Jeremy Hunt.
Jeremy Hunt, the UK Minister for Health is currently locked in a battle with the British Medical Association – the ‘doctors’ union’ – over proposed changes to the doctors’ contract with the National Health Service. Amongst many reasons the medical profession are resisting these proposals is doctors argue these changes will make their lives even more stressful just as working conditions for physicians in the UK become ever more impossible.
The family Of Dr Rose Polge have requested their privacy at this very difficult time.
Speculation as to what happened would be inappropriate. But it is inevitable that this kind of tragedy draws attention to the stress junior doctors are under, and their campaign over working conditions.
A study published in the ‘Journal of Epidemiology and Community Health’, entitled ‘Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979–1995’, found that the suicide rate in female doctors was higher than in the general population, whereas the rate in male doctors was less than that of the general population.
This investigation, by a team led by Professor Keith Hawton, from the University of Oxford found the difference between the mortality ratios of the female and male doctors was statistically significant. There were also significant differences between specialties, with anaesthetists, community health doctors, general practitioners and psychiatrists having significantly increased rates compared with doctors in general hospital medicine.
Keith Hawton, Aslog Malmberg and Sue Simkin from the Centre for Suicide Research, Department of Psychiatry, University of Oxford, published a study in 2004 which remains one of the largest psychological investigations into suicide in doctors.
The authors describe their research as a ‘psychological autopsy study’, of 38 working doctors who died by suicide in England and Wales between January 1991 and December 1993. Most of the deaths appeared to have been planned and two thirds of doctors had left a suicide note, while a third were known to have spoken of suicide before their deaths, most within the week beforehand.
Twenty-five of the doctors had significant problems related to work, 14 had relationship predicaments and 10 had financial difficulties.
Given the current working atmosphere in the NHS, it is particularly interesting that the study found most doctors had significant problems at work. Seven were facing complaints, which in five cases appeared to have been a key factor leading to suicide. Most of these doctors were also facing other difficulties at work or home. Other common professional problems included feeling overloaded by the volume of work, long hours and struggling with the responsibility of the job.
The study entitled, ‘Suicide in doctors: a psychological autopsy study’, was published in the ‘Journal of Psychosomatic Research’. It investigated 28 men and 10 women. 44% were under 35. 47% were married, 29% single and 10% divorced or separated. Of 25 who worked for the NHS, 15 were consultants or principals in general practice and 10 were junior staff. Twelve worked in general practice.
The pattern of diagnoses was similar to other studies, but with lower rates of psychotic illness and personality disorder, as would be expected, the authors of the study contend, in such a professional group.
The authors argue that physicians in general tend to minimise their own health problems, often fail to seek suitable help, do not take time off work and distrust occupational health services. The doctors in this sample, the authors explain, reflected this pattern. They were less likely to have consulted their GPs shortly before death than people in other population-based studies of suicide. A surprisingly high proportion, the authors say, had received treatment for depression compared with subjects in other studies. However, their probable ability to conceal the profundity of their hopelessness and suicidal drive from others might explain why so few had been admitted to hospital or seen by their GPs before death.
The authors of the study conclude that the impact of complaints, overwork and burden of administration on some of the doctors studied is of great concern. Given the study was done in 2004, David Casey and Kartina Choong from the University of Central Lancashire, in their more recent investigation of doctor’s suicides, quote a report issued by the Royal College of Physicians in 2012. This demonstrated that there were one-third fewer acute trust beds than 25 years ago yet a 37% increase in hospital admissions over the last 10 years.
David Casey and Kartina Choong’s study cites evidence that 75% of medical consultants reported being under more pressure than 3 years ago and 25% of medical registrars reported their workload as unmanageable.
Niall Dickson, Chief Executive and Registrar of the General Medical Council (The UK authority with responsibility for regulating doctors) recently gave advice in the light of junior doctors’ industrial action which has been widely reported in the press as counselling doctors against strike action given risks to patients.
The GMC statement boasts several headings including: ‘Advice for doctors contemplating industrial action’, ‘Advice for doctors in leadership roles’, ‘Advice for senior doctors and those not in training’, and ‘Advice for employers’.
Niall Dickson’s proclamation did not appear to have a heading on advice for doctors under enormous stress from the NHS and who are now at a loss to know how to cope.
Such a heading might have been expected from the GMC following the publication of an investigation entitled, ‘Suicide whilst under GMC’s fitness to practise investigation: Were those deaths preventable?’ – a review article published in the ‘Journal of Forensic and Legal Medicine’, in January 2016.
In their paper, David Casey and Kartina Choong point out that 28 doctors committed suicide between 2005 and 2013 whilst under GMC fitness-to-practise (FTP) investigations. These shocking figures were revealed following a Freedom of Information (FOI) request made independently to the General Medical Council in 2012 by psychiatrist, Dr Helen Bright.
David Casey and Kartina Choong emphasise that of all 28 doctors who committed suicide, at no point did the coroner’s system consider that their prevailing circumstances might be contributing to the future deaths of doctors. This is despite the coroner, in one case, asking the GMC to comment on a suicide note, which clearly implicated the GMC in the doctor’s death.
Yet coroners have a duty, the authors of this study explain, where appropriate, to report on a death with a view to preventing future deaths. Reviewing the chief coroner’s recommendations on when to issue such a report, it can clearly be seen from this investigation, that there were future risks of death.
David Casey and Kartina Choong point out should there have been a cluster of mental health deaths a coroner would have issued a report.
These authors also point out that should there have been a series of preventable hospital inpatient deaths a coroner would have issued a report. The concern must be that 28 doctors committed suicide, beyond all reasonable doubt, whilst under GMC investigation, yet there is no evidence that the coroner issued a report.
David Casey and Kartina Choong argue that although the responsibility of regulators towards those they regulate remains unclear, the case of Watson v. British Boxing Board of Control (BBBC) Ltd55 demonstrates that a regulatory body does owe an affirmative duty to exercise care towards those it licensed as professional boxers.
Therefore, the authors conclude, the relationship between a regulator and those it licensed falls within an established category of liability for which a duty of care arises.
The GMC and the NHS appear ever more concerned about doctor’s duty of care towards patients, as UK doctors’ protests against their hours and working conditions continue to escalate, culminating in ever more extensive industrial action.
But what about the NHS’s and GMC’s duty of care towards doctors?
Raj Persaud and Peter Bruggen are joint podcast editors for the Royal College of Psychiatrists and also now have a free app on iTunes and Google Play store entitled ‘Raj Persaud in conversation’, which includes a lot of free information on the latest research findings in mental health, plus interviews with top experts from around the world.
Download it for free from these links:
Dr Raj Persaud’s new novel ‘Can’t Get You Out Of My Head’ on the narcissism of stalking and obsessive love is released in support of UK National Stalking Awareness Week April 18th, all proceeds from sales donated to the Suzy Lamplugh Trust the UK’s anti-stalking personal safety charity.