0:00

Hello

0:09

and welcome back to Doctor Informed. You're listening

0:12

to season two, episode nine. This

0:14

is a podcast brought to you by the BMJ and sponsored

0:17

by Medical Protection. Doctor Informed

0:19

is primarily for those doctors working in hospitals,

0:22

taking you beyond medical knowledge and talking

0:24

about all those things that you need to be a good doctor,

0:27

but which don't involve medicine. I'm

0:30

Clara Munro,

0:30

a general surgical registrar in the northeast

0:32

of England and host of this podcast, Doctor

0:35

Informed. Now, I promised

0:37

that in this half of the season, I had some exciting

0:39

and gritty topics coming up. And the

0:41

first in that lineup is today's episode exploring

0:44

addiction in doctors and healthcare professionals.

0:47

We'll discuss types of addiction, how to

0:49

recognize problem behaviors in yourself, and

0:52

also how to recognize and support colleagues

0:54

who are affected by these issues. During

0:57

my research into this topic, one thing

0:59

struck me. None of us are immune to struggling

1:01

with addiction, and this is certainly not about

1:03

weakness. Today, I hope we can destigmatize

1:06

this really important issue in order to tackle

1:08

it head on and be better at supporting

1:10

our colleagues and ourselves.

1:15

Joining me today, I have a whole team of experts

1:18

and I can't wait to pick their brains about this. First

1:20

of all, Ruth Mayall, would you like to introduce

1:23

yourself and tell our listeners a little bit about

1:25

what you do?

1:26

Ruth Mayall, I'm a

1:28

retired consultant anesthetist.

1:31

I'm a trustee with the Sick Doctors Trust,

1:34

which helps addicted doctors and dentists.

1:36

I'm chairman of the Northwest Branch

1:39

of the British Doctors and Dentists Group, which

1:41

is a

1:42

peer support group for addiction. And

1:45

Liz Croton, it's also a pleasure to have

1:47

you with us today. Would you like to introduce yourself

1:49

to our listeners and tell us a little bit about what

1:51

you do and your involvement in this topic area?

1:54

Hi, hi. Yes. So my name's Liz Croton.

1:56

I'm a GP by background.

1:58

I've known Ruth since for many

2:00

years. And

2:03

I also trust the Sick Doctors Trust, which

2:05

I'm sure we'll talk about later. It's a charity,

2:08

fantastic charity.

2:09

And I work for Practitioner Health as

2:12

a clinician as well and have done

2:14

for the last three years, as well

2:16

as some frontline GP work as well,

2:18

just to kind of keep me busy as it were.

2:22

Thank you so much, Liz. And Zaid

2:25

Al-Najar, could you tell us about yourself? Hi,

2:28

everyone. I'm Zaid Al-Najar.

2:31

I'm also a GP and

2:33

I live in London. I'm one of the medical directors

2:36

at NHS Practitioner Health, which

2:38

is a free and confidential service for

2:41

healthcare professionals with mental

2:43

health and addiction issues.

2:46

Thank you so much, Zaid. I

2:48

really want to come back to you talking about the organisations

2:51

you're all involved with and how they

2:53

help doctors and healthcare professionals. Because

2:55

obviously this work is really important. But

2:58

I wanted to start from the very beginning

3:00

to really understand this topic.

3:03

Addiction obviously felt like a huge important

3:06

topic to cover. And when I spoke

3:08

to my colleagues, I did a quick straw

3:10

poll about this, there were lots of really important

3:13

questions. And many people

3:15

I spoke to reflected on the stigma

3:17

that still remains around this area.

3:19

One person I talked to described

3:22

becoming addicted, and I should reference that

3:24

this was a little bit of a tongue in cheek

3:27

comment, to a game on their mobile called

3:29

Candy Crush Saga when they were

3:32

a foundation doctor, which

3:34

got them through a really difficult time,

3:36

a really difficult job. And

3:39

we sort of chuckled about this, but obviously reflecting

3:42

on this, it kind of got me thinking, when

3:45

do these coping behaviours as

3:48

doctors or indeed any

3:49

healthcare professional become

3:52

addictions? Because we all develop

3:54

coping strategies, but are

3:56

there qualities of a thing or a substance

3:58

that are required? to pre-exist for

4:01

it to become an addiction. Zaid,

4:03

I'd like to start with you. Can you provide

4:06

a few definitions or diagnostic

4:08

criteria that helps us understand what

4:10

addiction is or more importantly,

4:12

what it isn't?

4:14

So I think that

4:16

we all have coping

4:19

mechanisms which help us

4:22

cope with everyday life stresses,

4:26

difficulties, challenges that we all encounter.

4:29

But I think

4:31

in terms of addiction

4:32

and unhealthy coping mechanisms,

4:36

it's when those mechanisms lead

4:38

to difficulties and

4:43

probably ill health, potential for ill health

4:46

with us. So for example, I think

4:49

almost anything probably could become addictive, but

4:52

there are some things which

4:54

inevitably are

4:57

more addictive by nature, nicotine,

5:00

alcohol, drugs, and

5:02

so on, gambling, internet,

5:06

porn, all sorts of things. And

5:08

then there are other things

5:10

that people use as more healthy coping

5:13

mechanisms, for example, I don't

5:15

think going for long walks, exercise,

5:18

socializing. And

5:21

I think it just depends on what

5:24

the outcome of those mechanisms

5:26

are. So I think people

5:28

can, for example, exercise is a very, very common

5:31

one, particularly with our patient

5:33

cohort. Lots of people like to exercise,

5:35

it helps in de-stress, increases

5:38

their levels of energy and

5:41

serotonin, evidence shows, but

5:44

some people become addicted to it as

5:46

well, so I've certainly seen that. So I think

5:48

it just depends on what it

5:50

is

5:52

that

5:54

you are using to cope. And

5:57

the effect that that might have on

5:59

you in the longer term.

5:59

and whether you

6:02

were able to stop with that difficulty.

6:03

And I think that's key.

6:07

Ruth, I'm interested from a personal

6:09

experience point of view, as

6:13

somebody who is recovering from

6:15

addiction, were there preconceived

6:18

ideas you had about what

6:20

addiction was and has that changed

6:22

through your journey?

6:25

Yes, to both of those. My

6:30

preconceived ideas were that it

6:32

always happens to somebody else. Everybody

6:36

around me does it, so it's all right. But

6:41

the things that characterised moving

6:44

from social use to addiction,

6:47

I think are the classic things

6:49

that they're mentioning in the definitions,

6:53

like craving,

6:56

the onset of craving, and this

6:59

totally baffling sort of compulsion to

7:02

carry on doing it, even though you

7:04

know what the negative consequences are like.

7:06

For instance, I dropped the casserole dish

7:08

I was about to put on the table and I had

7:10

people to do that. And

7:13

all sorts of things. Turning up

7:15

late for job interviews because I hung

7:17

over or something.

7:19

And broken

7:21

promises, loss of family life and

7:24

things. And

7:26

then, I mean, as people

7:29

who have prescribed opiates for normal people

7:34

in verticals for pain reliefs, say they

7:36

will exhibit tolerance and not

7:39

getting the same effect from

7:41

a given dose. So

7:43

that's not specific to addiction, but that

7:46

does happen as well. And I

7:48

think... Yeah,

7:52

I mean, unlike a lot of people, I didn't... I

7:55

have a family history of any addictions.

7:59

That's

8:02

the big number one thing is a genetic

8:04

predisposition.

8:08

Personality traits and things have

8:10

always tended to be a last half

8:12

empty sort of person, you know, not a

8:14

bit negative.

8:18

Access played a bit of a part in some

8:20

of the drugs I used as being in

8:22

a niche to test. And

8:24

then

8:25

often there's some sort of event that precipitates

8:27

the whole thing starting to spiral out of control.

8:30

I'm not sure what that was. But

8:33

I was in what's called denial for a long time

8:35

and I really couldn't see the harm that I was doing.

8:41

So, yeah, and I think a lot of doctors are

8:43

in denial and justify it, you know, by

8:45

COVID for instance, although that

8:48

was entirely justifiable. I

8:53

don't know. I don't know what sparked off my

8:55

just taking it to extremes. There was always

8:57

just that bit further, you know,

8:59

if I was

9:00

taking uppers and party drugs,

9:03

there was always that bit higher that you could get,

9:05

you know, which

9:07

a lot of people are just happy with one ecstasy

9:10

tablet say, you know, but I

9:12

always had to have more. I'm

9:15

really interested to pick up on something you've said

9:17

there about sort of family history,

9:19

pre-existing personality traits, because,

9:22

you know, I've heard people colloquially talk about

9:25

addictive personalities and

9:27

I'm interested, Liz

9:30

and Zade as well, for your opinions on this, is

9:32

there such thing as

9:34

somebody that is likely to get addicted

9:37

that has an addictive personality or is

9:39

that, you know, one of these myths that gets built

9:41

up?

9:42

Oh, I've certainly

9:44

heard that term. I don't like

9:46

it myself personally. I don't like the language

9:49

around it because it kind of attaches

9:51

addiction

9:52

to identity, sort of saying, well, that's

9:54

just kind of how I am. And

9:57

that's something that kind of keeps people stuck.

10:00

if they believe that. I

10:03

think every addiction has a purpose

10:06

and I think we have to look at you

10:08

know what that purpose might be. It's very easy

10:10

just to see the behaviour or the substance and

10:13

go yeah well but there's something

10:15

driving it you know there's an unmet

10:17

need there's something going on there. So

10:21

typically it's emotional pain not always.

10:23

As

10:24

doctors we like to put things into boxes

10:26

because it makes it simple and think that everybody

10:29

kind of has the same thing but

10:31

it's not it's individual

10:33

to the person. But I

10:36

tend to see it as something that people do rather

10:39

than who

10:39

they are and I think it's really important that

10:42

certainly when I'm talking to people with practitioner health

10:44

and certainly on the Sick Doctors

10:46

Trust helpline we very

10:48

much I try to frame it as something that someone

10:50

is doing rather than this is kind

10:52

of who you are. Because I

10:54

think that helps people kind of extract

10:57

from it really because the really important thing to

10:59

say is that you know people can get better from this and

11:03

that's there's a lot of hope actually

11:05

it's really important that people know that. Yeah

11:08

that's a fantastic reflection thank you for that

11:10

Liz. The other thing that Ruth

11:13

had said that I kind of picked up on there was that that

11:15

belief that it happens to someone else and

11:18

you know you talk about professional identity as

11:21

a doctor you know I think it'd be very easy to

11:23

think well you know that's what patients do

11:25

and I'm a doctor so I don't do that. And

11:27

Zayd is that something that people talk about

11:29

a lot when they you

11:32

know come to organizations such as yours is

11:34

that you know is that a starting block

11:36

you almost have to unpack that belief

11:38

that it is something that happens to someone

11:40

else. I think

11:42

one of the most difficult steps for

11:45

for people to to navigate really

11:47

is the acceptance that it's an

11:49

issue for them and

11:51

I think that's because it requires

11:53

you to demonstrate a level of vulnerability

11:56

and acceptance that

11:58

actually you are you are. are a human

12:00

being and that

12:03

you are a patient. So a lot of the work

12:05

that we do is

12:08

about allowing the people who

12:10

come to us, our patient cohort doctors and

12:12

healthcare professionals, to just be patients

12:15

because they spend their entire lives

12:19

dealing with patients and being that professional

12:21

directing care, making

12:23

clinical decisions, but they don't. And even

12:26

when they present to

12:27

local services like their GP

12:29

or people who had experiences with this, I'm

12:31

sure, with clinicians that you've

12:34

needed to be treated by, but you're

12:36

a doctor, what do you think? So

12:39

it is

12:43

really difficult for doctors and healthcare

12:45

professionals to just allow

12:47

themselves to be treated as

12:49

a patient. And that's part, a lot of the work

12:51

that we do is just giving them the

12:54

assurance that they can do that in the service, the

12:56

space to do that, allow the trust

12:58

to build up because trust is also a major

13:01

issue. There's a lot of fear around what

13:03

might happen to them in terms of their profession,

13:06

their personal lives, the

13:08

regulatory involvement, potentially, there's

13:10

a lot of fear around it. So it

13:12

is a big issue for them.

13:17

I want to come

13:19

back to your points about

13:24

how you think it's going to affect you professionally. But

13:26

starting from the beginning, if you are somebody who

13:28

maybe is struggling with certain addictive

13:36

or addicted behaviours, what's

13:39

the first step, and Ruth or Les happy for you to

13:43

both jump in here, what do you think the

13:45

first step in recognising those behaviours

13:47

in yourself is? Oh

13:52

gosh.

13:56

I don't know. It's... I

14:01

think I've already said how I when

14:03

I was really pinned down how

14:05

I was made to see what I'd been

14:08

doing

14:10

about I

14:11

don't think my work suffered

14:14

for it I mean we are

14:16

we do manage to be very high

14:18

functioning alcoholics and addicts somehow

14:22

but I think

14:25

if I turn it around and be objective

14:28

for a moment rather than subjective I

14:31

think the main thing is a change

14:33

in behavior you know behavior is the

14:35

number one sign so a

14:37

change in behavior in someone from their normal

14:40

pattern should be paid

14:42

heed to it's not always addiction sometimes

14:44

something else is going on but

14:47

you know someone becomes late or disorganized

14:50

with increasingly elaborate excuses

14:53

which I was doing and

14:56

in

14:59

anesthesia for instance someone

15:01

who an alcoholic will

15:04

stay away from work because then they drink

15:06

at home so they will have a lot of days

15:08

off sick whereas someone

15:10

who gets their drug supply from work

15:13

will offer for extra

15:15

shifts bank holidays you know

15:17

not go an annual leave and all these sorts

15:19

of things so they can continue

15:21

to get the supply of drugs

15:25

I think there's

15:27

a saying in AA that you get

15:29

to be sick and tired of being sick and

15:31

tired when you're about to hit your rock

15:33

bottom and

15:35

a lot of people

15:37

become depressed

15:39

and they present with depression

15:42

I think and that I was like

15:44

that and sneaking

15:49

drinks sneaking extra

15:51

lines of coat when no one was looking you

15:54

know sort of using

15:56

extra in private

16:00

And I guess to this day, a

16:03

friend stopped asking me out or

16:05

to join the fadilla parties and stuff. And

16:09

things, the drugs weren't working any longer.

16:12

You know, I needed far more

16:14

to still not even get a decent high. So

16:17

you end up using when you feel bad

16:20

to

16:20

feel better, but you also end up

16:22

using when you feel good because you want to

16:25

feel even better than that. So

16:28

you're sort of tailor making your behaviour just

16:31

to, you know, but at the end, you

16:33

don't get high off it anymore. You

16:36

just, you need something

16:37

to function. And I think that's one of

16:40

the signs, you know, when you just have to take

16:42

it to stave off withdrawals and things.

16:48

Yeah, nothing. Nothing

16:50

really makes you happy. But

16:55

you can't live with it and you

16:57

end up feeling quite low on things. But

17:00

you can't live without it either. You need

17:02

something to feel normal. Normal

17:06

in verticals. Yeah.

17:09

Does that echo your experience, Liz, and

17:11

that you often see people

17:13

seeking help when there's almost

17:16

like a sort of a turning point or

17:18

an intervention from someone else? Or, you

17:21

know, is it often people just getting to their

17:23

rock bottom before they seek help? Oh,

17:26

I think it varies. I mean, there was always this saying,

17:27

if people, you know, go into 12

17:30

step groups, there's loads of slogans and denial

17:32

stands for do not even know I am lying. I think

17:35

that's the slogan. It's

17:38

often something that other people notice first,

17:42

in my experience, from talking to doctors. And

17:44

they often don't know what the problem is, but they know something's

17:46

not right.

17:48

And what we've said spot on,

17:50

I suppose, the turning

17:52

up late, the taking ages to finish

17:55

sentences, drinking

17:58

a lot of people are using opiates that tend to drink.

17:59

a lot because their mouths are dry, so

18:02

drinking water, not necessarily

18:04

alcohol. But

18:07

it varies. I mean the thing is, the

18:10

kind of cognitive things that happen with addiction

18:12

is that people will often try and get caught.

18:15

They'll often get so down

18:17

the line where, I mean I remember adopting,

18:20

they needed help and they kind of ended

18:22

up being sort of, they got to the point where

18:24

they couldn't turn the computer on at work and

18:28

their colleagues sort of noticed something

18:30

was going on and they'd noticed

18:32

something for a while but they didn't know what it was. And

18:35

this particular individual couldn't

18:37

ask for help, they kind of had to show, they sort of

18:39

were leaving these sort of patterns around

18:42

and actually this particular individual did

18:44

very well because they had colleagues who were really

18:46

supportive and just said look you know get

18:49

it sorted type of thing. But

18:50

yeah I mean often people

18:52

will know something's not right. Sometimes,

18:56

I mean sometimes sadly, and this is this is what

18:58

we don't like to see happen but it happens, is

19:00

that people will be

19:04

pulled up on a drink driving charge, they

19:06

will be caught with drugs by the

19:08

police and that's usually

19:10

the GMC are automatically informed then.

19:12

So ideally we would want

19:15

people to seek help before that

19:17

happens because then, I'm not sure,

19:19

say we'll talk about the memorandum later with

19:21

the GMC that PH have but

19:24

you know and everyone's rock bottom

19:27

is different. I mean some people think that you think

19:29

of rock bottom

19:32

having no career, no

19:35

money,

19:35

that kind of thing but it's different,

19:38

it's different for different people. I mean sometimes

19:41

it's something that can be quite, other

19:45

people might not think is a rock bottom and

19:48

it is, I mean I thought what Ruth said

19:51

about

19:51

not wanting to live with it but not wanting

19:53

to live without it is absolutely key. There's this

19:55

sort of stuckness that people get where

19:58

they're stuck and they think I don't know where they're going. go

20:00

and then that can

20:02

be when

20:04

people seek help. So it's quite individual but there are

20:06

patterns. When

20:09

I was researching this topic

20:12

I was looking for some statistics which were quite

20:14

difficult to find and I suspect it's

20:16

a very under-reported area

20:19

across all healthcare professionals. But

20:22

Zaid I was interested, do

20:24

you in your experience find

20:27

that doctors

20:29

particularly acknowledge this or present,

20:32

to use a medical term, later than

20:35

the general public? Or do

20:37

they pick it up a lot sooner and

20:39

do something about it?

20:41

Again I think it varies

20:43

greatly. There's no sort of one-size-fits-all

20:47

answer to that because we

20:50

have had cases like this is talked about

20:52

where it's only come to light following

20:54

a drink driving offence. And

20:57

then there are others who were

20:59

present fairly early actually saying actually I recognise

21:03

that this might be an issue

21:05

or might be becoming an issue and I want to seek help

21:08

about it proactively. And that's

21:10

always a preference. You know

21:11

we would much rather that than

21:14

it be

21:16

rock bottom or some sort of crisis. But

21:19

sometimes the nature of the illness is actually sometimes

21:21

a crisis is needed for people to

21:24

actually seek help and that can be therapeutic

21:28

in itself and it can be life-changing.

21:30

So sometimes it

21:33

can be a lot of good to come out of that.

21:35

But in answer to your question it does

21:37

vary. We have people present

21:40

from very early on before

21:42

things become a real embedded

21:44

problem to write at the other

21:46

end of the scale where lives

21:48

and careers are at risk.

21:53

One of the few statistics I did find that I was

21:55

really surprised about was I suppose I

21:57

thought that potentially rates

21:59

of addiction would be higher in healthcare professionals

22:02

as a whole. And I was quite surprised to

22:04

find that they mirrored, well, on

22:06

the paucity of evidence we do have, they mirrored

22:09

that of the general population. But

22:11

actually the recovery in those

22:13

working in healthcare

22:15

was much higher or very reassuring

22:18

in that I think they're

22:20

looking at ongoing monitoring of people with addiction

22:22

problems. There were low rates of relapse with only,

22:24

with 71% remaining in recovery at five

22:27

years, which seems

22:29

like a good statistic

22:33

in the context of a

22:35

wider problem, I suppose.

22:38

Is there immediate steps

22:40

that you have to take when somebody

22:43

comes to you with this sort of problem?

22:46

And I'm thinking of things like safeguarding

22:49

issues or talking to the GMC, I know

22:51

we've touched on that already. Or

22:54

is the primary responsibility for

22:56

an organisation like yourself to help the individual?

23:00

Okay. So this is an

23:02

area which causes a great deal of anxiety actually

23:05

to, understandably, to doctors

23:07

and it's one of the reasons that the organisation

23:10

Practitioner Health was created is

23:12

to, because we know that

23:15

doctors are very good at hiding their illness,

23:18

whether that be mental illness, addiction or other,

23:22

they will continue going to work and

23:25

it's often the last thing to go,

23:27

actually work. They can be,

23:29

as Ruth has said, very high functioning

23:32

addicts and continue to treat patients.

23:35

No one would know but for some crisis,

23:39

which will happen. So we

23:41

take confidentiality very seriously and

23:44

to that effect we set up memorandums

23:46

of understanding with all the healthcare regulators

23:48

and the first two were the GMC

23:51

and the GDC, the General Medical Council

23:52

and the General Dental Council.

23:55

Now what those memorandums allow us

23:57

to do is to treat our patients with a mental

23:59

illness.

23:59

in set agreed parameters so

24:02

that we don't automatically need to refer anyone

24:04

with a mental illness or addiction to the

24:06

regulator for fear that there might be a patient safety

24:08

issue. So what the GMC, for example,

24:11

have historically said is that if you

24:13

have a health concern and

24:17

you are seeking treatment and advice

24:19

and following that advice, it

24:21

is not something that they would

24:24

be overly concerned about. The main issue

24:26

is that if you are in need of help,

24:29

you seek help and you're following the

24:31

advice given to you, including the advice

24:33

around patient safety issues and removing yourself

24:36

from work if needed and

24:38

so on, there would be usually no need

24:40

for the regulator to become directly

24:42

involved. There are very rare

24:44

circumstances in which the regulator

24:49

would need to be involved, but there are very

24:51

few in number and

24:53

as I said, we take those cases very, very seriously.

24:55

They're discussed at quite a high level at the

24:58

organisation and by and

25:00

large, they're a handful over

25:03

the 15 years now that we

25:05

have been operating. So my

25:07

main message to the listeners out there is that

25:10

our memorandums of understanding are freely available

25:12

on the website to look at. We

25:15

take confidentiality very seriously. The

25:18

reason that the service exists is

25:20

because of the confidentiality issues and the barriers

25:23

to accessing healthcare and that

25:25

I think if we reported

25:27

everyone to the regulator for having

25:30

a healthcare issue or an addiction issue, we

25:32

probably wouldn't be still in existence.

25:35

Thank you. That's a really useful point of clarification.

25:38

Yeah, Ruth, I'm interested in your reflections on

25:40

that. Yeah. Well,

25:42

actually, I just want to say a bit more about presentation,

25:45

if I can. Lizzie

25:48

and Zayd touched

25:51

on, I'll mention the words, fear. I

25:54

think

25:56

it's lovely when someone

25:58

presents and says, I've got a problem

26:01

but the majority unfortunately don't

26:04

and I think the reason for that

26:06

is a mixture of shame and

26:08

fear. The fear

26:11

is losing your job

26:14

you know and if your job's at risk

26:17

often by the time you hit the rock

26:19

bottom or you're summoned to the clinical

26:21

director's office

26:24

at work you know the glue

26:26

that's holding you together still when everything

26:28

else has fallen apart the glue that holds you

26:31

together is being a doctor

26:33

and if that's threatened

26:36

you know I think that's one reason

26:38

why when someone's gone home after an intervention

26:41

you should be very careful there's a big suicide

26:43

risk

26:44

then and it's

26:46

a big fear of the unknown really like

26:49

what the hell's going to happen to me now you

26:51

know but the shame as

26:53

well a lot of people do

26:56

express shame you know I'm a doctor

26:58

I should know better than this you

27:01

know people don't expect doctors

27:03

to end up like this you know

27:05

and until you

27:08

meet people in peer support groups when

27:10

you once you're in recovery you

27:13

know there's a lot of shame that

27:15

you're the only doctor that's

27:17

ever ended up like this you know and

27:20

it's addiction

27:22

really at the end is a condition of

27:24

isolation and especially if you think you're

27:26

the only doctor with it and you're full of shame

27:28

you know you're not going to be predisposed

27:31

to talking to people and getting

27:34

help I think it's

27:35

important you know that that it's

27:38

a condition of isolation and one of

27:40

the treatments is people

27:43

you know in support groups aa

27:46

narcotics anonymous and everything else

27:48

so sorry no thank you so

27:50

much I mean I think that that is encapsulates

27:53

a lot of of you know what

27:55

I'd come across when I talked about addiction

27:58

both with patients and

27:59

and with other doctors is that fear and shame.

28:03

Liz, what are your thoughts on that? Well I certainly

28:05

got very fired up when I was listening to Ruth speak.

28:07

I mean I think shame is gosh

28:10

shame is such a painful emotion and

28:12

it is about disconnection. I mean you're absolutely

28:15

right and often shame

28:17

that people can't stop or they feel they can't

28:19

stop and

28:21

sometimes people come into it you know the

28:23

reasons that we dispose people to addiction

28:27

you know there may be there may be difficult

28:29

emotions in the background and shame is is

28:31

often you know it's not uncommon for people to

28:33

come into. I think medicine

28:36

can be quite a shaming place actually. You

28:39

know and there's been a few there's been quite a lot of discussions

28:42

about this recently so shame

28:45

is nearly always floating around and shame

28:48

is one of these emotions which

28:51

makes kind of people want to retreat and

28:54

it can get attached to people's identity

28:56

and so they can feel like they're a bad person they're

28:58

a terrible person so

29:00

and that's the thing people think

29:04

that they are the only person and a

29:06

big plug for the BDDG as well which Ruth

29:08

has been involved with for ages and

29:13

you know what I can say about

29:16

doctors is there's many many doctors in

29:18

recovery now who are

29:21

you wouldn't know actually unless you went

29:23

to one of these meetings but you'd be surprised

29:25

and

29:27

they're living you know that they they are no longer

29:29

using they're engaging

29:31

in life they're you know enjoying their

29:33

careers and so you

29:38

know it's so important to kind of plug

29:40

into these meetings and actually meet people and you

29:43

also get some CPD sometimes as well because

29:45

you meet all sorts of senior colleagues who

29:47

kind of you know can teach you a bit about

29:50

all sorts of stuff which I think is really needed so

29:54

I think leading on from the peer support side of

29:56

things I really want to talk about how

30:00

doctors, how they can

30:02

support colleagues who

30:05

they're worried about. But first, before

30:09

we dive a little bit deeper into that, a quick

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31:28

Okay, back to the show. After

31:31

doing a quick straw poll of some

31:35

of my colleagues, like I said,

31:38

worryingly, there were

31:41

people throughout many stages of our careers

31:43

that we can remember worrying or struggling

31:46

with addiction. Lots

31:48

of us didn't really know what to do at the

31:51

time or how bad the behaviour

31:53

had to get before you broached

31:55

the topic with somebody. And I'm really interested

31:58

in

31:59

what your thoughts are on how,

32:02

when, where you can

32:04

talk to people if you're worried that they're

32:06

struggling with addiction?

32:08

Well I think, talk

32:13

to them I think. I mean use

32:16

what we're saying as kind of psychoeducation.

32:18

I think that's the buzzword isn't it? As to how,

32:20

I mean Zaid's so eloquently described the memorandum

32:25

which is freely available and people need

32:27

to know that they, you

32:29

know, that they're going to be supported. It's kind

32:32

of a firm sort of support because we have to

32:34

protect patients as well but

32:36

talk to them. I mean, you know, get them a coffee

32:38

and have a chat with them.

32:42

I mean

32:44

I would definitely say start with open questions.

32:48

Don't make assumptions because Ruth's

32:50

absolutely right. Doctors are really good at kind

32:52

of, hiding's not the word but

32:54

they're really adaptive, they're really good at sort of, you

32:57

know, kind of, I think leaving

32:59

kind of trails of breadcrumbs sometimes it's

33:02

something's not right. So open questions, I've noticed

33:04

this, you know, we're here

33:07

to support and all that and have an idea

33:09

of what you'll do next. It's a bit like giving a diagnosis

33:11

to a patient.

33:12

You'd never give a diagnosis to a patient without knowing

33:14

what you'd do next. So to kind

33:17

of know where the support is. I mean in

33:21

England and Scotland doctors can refer

33:24

directly to practitioner health and

33:28

I believe Wales has a system also for

33:30

healthcare professionals but I don't know as much about

33:33

that. I

33:34

think if you're concerned

33:37

that, you

33:39

know, there are patient safety issues then it is

33:41

wise to, you know,

33:43

take steps to address that which might involve encouraging

33:46

people to, I mean it's easier if they refer

33:49

to practitioner health because we can see them and give

33:51

them a, you know, and have that

33:53

kind of discussion with them and provide

33:57

medical certificate or something with over there.

33:59

we can put vague diagnoses on that, which

34:02

I think is fair to say. So

34:04

it's easier if people do that. But

34:09

what they need to know is that

34:11

they need to feel that people care.

34:14

I had a really interesting story the other

34:17

day where somebody had an addiction

34:19

problem and the boss came around to their house and

34:23

they came around and they said what's going on and

34:25

the individual told them and they said well we need

34:27

you back as a doctor, you're a good doctor,

34:29

but you need to sort

34:32

this out and we'll support you. And

34:36

that was really important actually,

34:38

they needed to hear that. That's

34:40

so powerful. Yeah, yeah, yeah, because

34:42

you think that

34:45

people are going to go right, get out, don't talk in

34:47

my doors again type of thing. But people,

34:49

that was kind of a model really.

34:54

And this boss, this individual who

34:56

was the boss of a friend of mine, you know,

34:58

made no mistake. They had to, you know, they wouldn't have

35:00

allowed them to go back to work and see

35:02

patients, but they were still, you

35:04

know, we're with you on this, we'll help you out.

35:07

I had another colleague who was taken out for a curry

35:09

I think by colleagues,

35:11

you know, and

35:12

just said we, you know, we care, you know. So

35:14

it was just really, you know, it was nice. Yeah,

35:18

approaching it with empathy rather than an accusation.

35:21

I've been on both sides

35:23

of the table with this one. But

35:27

I think when I've been speaking to

35:29

someone who's hitting

35:32

the deck, I use

35:34

these little phrases you can use like

35:37

look, you know, this is a bit of a difficult conversation,

35:39

but it's been brought to my

35:41

notice that, you know, I think

35:44

the most, one of the most important things is

35:46

not to be judgmental. You

35:49

know, you get an awful lot more out

35:51

of someone if you

35:53

don't appear judgmental, you know. And

35:56

as Liz said, include them in the conversation.

35:59

by

36:01

just saying, do you know

36:03

why I've called to see you? Or

36:07

is there anything you'd like to say? And

36:10

then at the end, I think it's

36:12

quite important to say, what

36:14

do you understand?

36:16

You know, we've decided or

36:19

we've said during this conversation, because

36:21

if someone's really,

36:22

you know, if their brain's in bits, plus

36:26

the adrenaline of being in front of

36:28

the medical director

36:29

or something, there's quite a lot that

36:31

you don't remember at these interventions. So

36:33

I think it's important to make sure that they

36:35

have heard the important bits. And

36:39

go to the intervention with a

36:42

list of helpful numbers.

36:45

Because it's

36:48

another suicide gap, a suicide

36:51

trap. If you just send someone home

36:53

after blowing their life up and

36:57

they live on their own, you know? So

37:00

I think that's nice about the curry list, you

37:02

know? But

37:05

if I was asked to

37:07

do an intervention, and you know, I would always

37:09

phone them either later on that evening or

37:12

first thing the next morning. And it just

37:14

shows that somebody

37:16

cares enough to make sure

37:18

that they're all right,

37:18

you know, that they really aren't just been

37:21

kicked out sort of thing. So

37:25

yeah, and it's, you

37:28

know, people hold doctors in

37:30

high esteem, but we do lie and cheat

37:32

and steal to keep our habit going. And

37:35

again, there's a lot of shame around

37:37

that too. So

37:41

we're not our better

37:43

selves when we're at

37:45

an intervention. Yeah, so

37:48

sick doctors first, or

37:50

British doctors and dentists group. I've

37:53

got a thing that you can put on the website

37:56

or whatever,

37:58

of helpful contact numbers. Yeah.

37:59

Yeah, we'll definitely, we'll

38:02

add all of the, all of

38:04

the organizations and resources that we've

38:06

discussed in the show notes because

38:09

I think they're really, really important. So

38:13

changing tack ever so slightly, let's

38:15

say that this hypothetical colleague that you've

38:17

got, you're worried about

38:20

a patient safety issue because of their

38:22

behavior, and

38:24

you approach them and you do all the amazing

38:26

things that Liz and Ruth

38:29

you've both suggested about being empathetic,

38:33

being caring, not judging them,

38:36

and they're just not ready to engage with

38:38

the process.

38:40

Are you then sort of a bit stuck and you

38:42

have to step back? Or if

38:44

there is that patient safety issue, particularly

38:46

as in some of our, as

38:48

you say, very few cases, but

38:51

there may well be,

38:52

is there another tack that you can

38:55

take without making

38:57

it seem more shameful or making

38:59

things worse?

39:02

And Zade, I suppose I'm looking at you for this

39:04

question just because of your sort

39:06

of medical legal experience.

39:07

I think that's a

39:09

really difficult, that's a really difficult

39:12

situation to be put in, to

39:14

be found in. So, and this

39:18

goes not just for, this

39:20

isn't just about addiction, this is about any sort

39:23

of illness, whether it be mental or

39:25

physical or other.

39:29

So the General Medical Council

39:31

says that you need to ensure

39:34

that your health is such that you're able to

39:36

treat patients safely or worse

39:38

that effect. So you should put others at

39:40

risk, you should take appropriate steps.

39:43

And if you do have a medical

39:46

condition, then you should seek advice

39:48

and follow that advice,

39:50

and particularly in respect to patient safety.

39:54

I think

39:56

it's, the difficulty

39:58

is when, as you say, the...

39:59

person is not ready to accept that they

40:02

may have an issue or there might

40:04

be a real, their insight

40:07

is lacking. Thankfully,

40:10

I think that those situations

40:13

are few and far between and I think as

40:15

an individual and as a registered medical doctor,

40:19

you would need to seek your own advice and

40:21

you can do that via your medical defence

40:23

organisation about what you might do in that scenario.

40:26

But before getting to that stage, I would really

40:28

hope that the conversation could be

40:30

had with that individual

40:33

about

40:35

perhaps taking some time

40:37

off to seek help

40:39

and providing the sources of help to them, the

40:43

empathetic approach that we talked about

40:45

shortly beforehand because they will be scared

40:48

in the vast majority of circumstances about what

40:50

it might mean for them and

40:52

their future. And

40:55

sometimes it is just

40:58

a journey, sometimes it just takes some time for

41:00

them to come round to accepting that.

41:04

But I think if you are fearful that there

41:06

is a patient safety issue and patients are

41:08

at risk, then of course you must not rest on

41:10

your laurels, you must take advice about what

41:13

you are obliged to do in those circumstances.

41:16

And I think it's that conflict

41:18

between looking after your colleague who you

41:20

know and love and looking after patients,

41:22

isn't it? Liz, what were you going to say?

41:26

I must say, because

41:28

that

41:30

is really clear actually because this is something

41:32

that we do get on the helpline quite a bit

41:35

with colleagues phoning up and saying

41:37

what should I do. And that is

41:42

the advice we give. I was just going

41:44

to say, it is really to heart

41:46

back to Ruth's point about talking

41:49

to colleagues when you have a concern. It

41:51

can be useful sometimes to send an

41:54

email or putting the, because sometimes

41:56

they don't remember what was said. But

41:58

what discussion

42:00

with a colleague not long ago

42:03

is really avoid shaming language.

42:05

So much of our,

42:08

because shame and suicide are linked, you

42:11

know, and that's often kind of the, suicide

42:14

is complex, but shame can

42:16

be, and also change if people

42:18

can't actually kind of move past something

42:20

that's happened or kind of process what's happened.

42:23

That might be when someone might consider

42:25

that. So any sort of

42:27

language correspondence needs to be kind

42:30

of treating the person like a human. So

42:32

we had this discussion, I hope you're

42:34

feeling,

42:35

rather than, I'm just trying

42:40

to think of it, I've given that example and I can't think

42:42

of an example now, I'm disappointed by this behaviour.

42:46

We as a department are

42:49

incredibly unhappy about this, that sort of language.

42:53

Try and avoid that, it happens an awful lot

42:55

within the NHS and it's quite

42:58

infantilising actually. So

43:00

it needs to be positive. We agreed that,

43:02

you know, these are the sources

43:04

of support, we will

43:05

be thinking of you, we will be checking in with you,

43:07

you

43:09

know, and we value

43:11

you as a human being because it is about,

43:14

you know, it's about belonging, it's about you

43:16

do not want to cut this person out of the team. And

43:19

doctors are sometimes a bit funny with other doctors

43:21

who are real, it makes us feel uncomfortable. We don't

43:25

like it and we often don't like talking about it.

43:28

And we can put our shame onto other people as

43:30

well. And it is, it's about,

43:33

you know, we need to change this,

43:35

you know, we can't, we can't, but actually

43:37

we're going to help you

43:39

with that. And then, you

43:41

know, obviously when you're better than,

43:43

then come back. Yeah,

43:47

I think you're so spot on with that.

43:49

You know, we are so scared of it in ourselves

43:51

that the other ring of other people almost

43:54

sort of passes, passes it away

43:56

from us. Ruth, are there particular

43:59

words?

43:59

that people should avoid that are

44:02

really sort of triggering shameful words

44:04

that maybe we wouldn't even realize that we were using

44:07

that that really sort of project shame onto people

44:09

with addiction.

44:13

I think out and out calling

44:15

someone an

44:16

addict or you know I think

44:18

you're an alcoholic I think that's

44:21

very avoidable and probably quite necessary

44:24

in the early stages.

44:25

In Alcoholics

44:28

Anonymous meetings people say that you're

44:30

the one that decides you're alcoholic

44:33

or not you know when you've heard everybody else's

44:36

stories and things but that's there

44:39

still is stigma someone said earlier

44:41

attached to the words.

44:46

Yeah I think

44:50

just going quickly back to the expansion

44:52

type scenario I think it's important

44:55

to have some proof of what

44:57

you're talking about and you

45:01

can always if someone really denies

45:03

it and you've got proof and more than one

45:06

person's expressed their concerns

45:08

for instance ask us the

45:10

person will look would you mind

45:12

then you know giving us a urine or

45:14

a hair sample

45:16

and if they refuse that's

45:18

another topic altogether but I would say please

45:21

don't report

45:27

these people to the police even if you

45:29

if they've stolen opiates

45:32

you know from work or propofol

45:34

from the operating theatre

45:36

and there's enough to deal with with

45:38

the guilt shame and threat of losing

45:40

your job you know and going to court

45:43

for the police who don't understand addiction

45:46

and it's just stressful on top

45:48

of it and the police anything any

45:50

doctor who appears in court I think someone

45:53

else said and is

45:54

automatically reported to the GMC

45:57

so that brings that forward and you can't then

45:59

benefit from the memorandum

46:02

that practitioner health has,

46:04

or human resources because

46:06

they treat you as a disciplinary

46:09

problem and

46:11

not a health problem. I

46:13

mean you've mentioned human resources,

46:15

is there any role for occupational

46:18

health in these situations?

46:22

You're nodding Zaid, is that something that

46:24

is helpful to clinicians? Absolutely,

46:25

I think there has been a historical fear

46:28

about seeking help with

46:31

addiction because of

46:33

fear of confidentiality again, so

46:35

being reported to various agencies,

46:39

so including your employer,

46:41

to the general medical council, and

46:46

I think that most

46:48

occupational health

46:50

clinicians will,

46:53

particularly those working in healthcare or with healthcare

46:55

professionals, this won't be

46:57

their first rodeo, so this is not going to be the first time

46:59

that they come across a regulated

47:02

healthcare professional with an

47:05

addiction. So I think again,

47:07

and I had

47:09

this

47:11

with one of my patients the other day, she was very worried

47:14

about speaking to occupational health

47:16

about her addiction

47:21

and I said to her, ask for

47:23

their confidentiality, for

47:26

the agreement for the information about confidentiality,

47:29

what is it, so you understand what it

47:31

is you're getting into before you have that consultation.

47:34

She did and she disclosed the addiction

47:36

and unsurprisingly

47:38

the

47:39

physician

47:41

was supportive and again,

47:43

this is not something which

47:47

was new to him, so

47:50

there is a role for occupational health services

47:54

and as I say, they will have dealt

47:57

with addiction in the

47:59

past. But

47:59

I think the main message

48:02

here, and I'm going back to the

48:05

scenario where you notice someone might

48:07

be struggling, is that

48:09

it's easy to turn a blind eye because

48:12

it's just easier to get on with your job, go

48:14

home and forget about it and hope it's someone else pick

48:16

it up. But I would

48:20

try and engage, I try and speak

48:22

to them

48:23

because they will be feeling alone and

48:26

there are lots of different offers

48:28

of support out there now. So occupational health is

48:31

one potential, there's us, Practitioner

48:33

Health, there's the Sick Doctors

48:36

Trust. So

48:39

it's

48:39

just important to seek help from

48:42

someone if you are struggling and I'd

48:45

encourage that very much.

48:46

I want to, you know,

48:49

talking about that colleague that might

48:52

be in trouble, going back to what you

48:54

said, Ruth, about you know, if

48:56

there's a few of you, let's say

48:58

you're all working in a team who have noticed behaviour,

49:02

is that, because I suppose

49:04

I was reticent about asking about

49:06

this because I was thinking it might feel quite

49:09

threatening if four or five people sort

49:11

of, you know, are coming at you saying, well

49:13

we've all noticed this. Is there

49:15

a way of framing that? I don't

49:17

know if you've got any thoughts on this Liz, you

49:19

know, is it better for one person to

49:21

go and speak to an individual one-on-one?

49:24

Is it better for a group of people? Would that

49:26

feel more or less threatening? I suppose it's

49:28

all quite situational dependent but

49:31

I don't know if you've got

49:32

any particular thoughts on that. Well

49:35

my gut feeling is it's probably easier one-on-one

49:38

but it needs to be someone who has appropriate

49:40

authority. I think, you know,

49:42

that the buck probably has to stop with them

49:44

and they can make decisions because, and

49:48

they need to know what to do next. And

49:51

I think we have to, I mean I think

49:53

what Ruth was saying, you know, you've got to kind

49:55

of take sort of,

49:57

you know, facts verifiable data

49:59

to things rather than...

49:59

an opinion. I was talking to someone

50:02

the other day about this and with regards to

50:04

feedback, you know, people sort of say things

50:07

that there's got to be, you know, you

50:09

have to bring facts into it and sort of just

50:12

kind of,

50:14

you know, and bring

50:16

it to them and say and see

50:19

it's a bit, I suppose it's probably a bit like breaking bad

50:21

news actually, you don't kind of go in and you know,

50:24

what did they teach us how to do at medical school,

50:26

that sort of, was it chunk

50:27

and check or firing

50:29

warning shots. Something like that. Gosh,

50:32

I can't remember it was so long ago. But

50:35

you kind of go in and sort

50:37

of say, well, actually, you know, this is what we've

50:39

noticed,

50:41

and actually give them the opportunity

50:43

to share. And

50:45

if they don't, then I think, yeah, you'd have to say, well,

50:47

we're concerned about because of this,

50:49

this and this and, you know, allow

50:51

them to and then and then

50:53

sort of talk about what would be next. But I

50:57

think a whole load of people and it needs to be

50:59

it needs to be a private place as well.

51:02

Not not the cafe or the cafeteria

51:05

or the ward or the the sister's office

51:07

or the, you know, it's got

51:09

to just

51:11

be because it's terrifying. It's

51:14

it's absolutely terrifying. And

51:17

people are

51:19

frightened that you are going to and people frightened

51:21

people are going to phone the GMC up. That's that's the fear.

51:23

You know, they think they've got a bat phone with the

51:25

GMC next to them. And

51:28

that's not necessary. So so that

51:30

they will be my thoughts.

51:32

Just digging a bit deeper on that idea

51:35

of it being somebody a bit

51:37

more senior. And, you

51:39

know, when I was chatting through

51:42

with some of my friends about this, actually, I

51:45

think the time when it

51:46

sort of was most relevant to us was actually,

51:48

you know, going back a lot of years now. But

51:51

when we were foundation doctors, and,

51:53

you know, you're obviously you're a couple of years

51:55

out of med school, you're the most junior people on

51:57

the team, you're quite

51:59

scared.

51:59

maybe a bit reticent to go to your head

52:02

of department, you maybe don't have that

52:04

closeness in relationship with because of

52:07

difference in age, difference in hierarchy. Is

52:12

it still appropriate to have

52:14

these conversations

52:16

at the same level, or

52:18

should you involve somebody more senior?

52:23

I think it has to be someone who's got, who

52:26

can make decisions, but

52:29

often the decisions are easier. I mean,

52:31

not the decisions, the conversations are easier from

52:33

a peer to peer. But my

52:36

fear would be that you might be in an echo chamber,

52:38

where people are sort of, because

52:42

this is a serious thing in the sense that

52:44

we have to think about patients,

52:46

we have to think about the doctor as

52:49

well. It's really important that we

52:51

protect the doctor and we protect the patients.

52:53

So my

52:55

worry would be that it might open

52:57

up a kind of a bit of a proverbial can of worms,

52:59

and then everyone would be like running around going, what

53:01

do we do? But

53:04

again, I suppose it depends on how approachable your senior

53:07

is, because we do hear of seniors that wouldn't

53:10

be supportive.

53:14

Yeah, to finding that person that's

53:16

senior, but that you can trust. Yes,

53:21

Ruth. Yeah, I agree with

53:24

Liz. I think someone

53:26

more senior, hopefully, might

53:29

know

53:29

a bit more about things

53:31

and life, or there's more chance

53:33

that they may know someone who's been through the same.

53:36

The more senior you are, the more people you've

53:39

met. So yeah, I

53:41

agree with that.

53:43

Well, this has been such

53:45

a rich discussion and we are sort

53:47

of winding up towards the end. But

53:51

I thought I'd end this. Obviously,

53:54

you've all got this sort of rich tapestry

53:56

of experience from lots of different angles.

53:59

I wanted to know what your one

54:02

piece of advice or two pieces of advice

54:04

if you had to fish it To

54:06

a doctor who is worried that

54:09

they might be Addicted and

54:12

what what would that piece of advice or support

54:14

be?

54:16

I'll say Two

54:19

things I think without being given much time

54:22

to think about it and Is

54:25

don't be afraid Doctors

54:28

who get well get work

54:30

That's a hot need phrase from recovery

54:33

circles But it's true

54:36

you get well

54:36

you get work. I know doctors who've been

54:38

homeless and are working now I

54:41

know doctors who've been in prison and

54:43

On a back at work as doctors. So

54:46

don't give up. Hope is my message and And

54:50

the other thing is You

54:55

Might not believe it now, but a

54:57

good day for you now and

55:01

A bad day for you when you're in recovery

55:04

is infinitely better than

55:06

a good day when you're addicted Hmm

55:09

really good advice. Thank you Ruth How

55:13

about you Liz I'm just you

55:16

had one of mine there And

55:22

the thing is I mean hope hope is really

55:24

important because we talk about stigma doctors

55:26

get well You know and health professionals

55:28

get well doctors are really Their

55:31

behavior is quite driven and if they

55:32

can get kind of they think and channel that I

55:34

mean I've met many doctors who are Now

55:37

working who've had all sorts of backstories and

55:40

if they can channel that kind of desire to

55:42

get well you know

55:45

Into into the sort of direction of kind

55:47

of you know I suppose moving

55:49

on from this and a lot of them approach

55:51

it as if it was a kind of mr. Cp part one

55:55

You know that there's that drivenness is that curiosity

55:58

there's that compassion there the tooth things actually,

56:00

they're really two things that are key for getting

56:03

better from this kind of thing is

56:05

curiosity and compassion towards oneself.

56:07

Curiosity is to what I suppose led one

56:09

there because

56:12

there usually is something underneath and

56:15

looking at that and also compassion because

56:17

we're all doing the best we can and

56:20

then we get more information,

56:22

more insight and then

56:24

we can change. So

56:27

please get in touch and speak to

56:29

someone, that's the most important thing.

56:31

If that was your ad lib after Ruth

56:33

stole your point, that was really excellent. You did

56:36

very well on the spot, that's excellent,

56:38

excellent points. A couple of other

56:40

things is nobody

56:44

said it's going to be easy getting

56:46

well again. It's probably one of the more

56:48

difficult things you've done in your life but God,

56:50

it's worth

56:51

it and Liz

56:53

has maybe heard someone say this

56:55

as well sometimes, if you put as

56:57

much effort into your recovery

56:59

as you did into obtaining

57:01

your drugs then you should

57:03

do okay. Yeah,

57:06

yeah, excellent point. And

57:08

just to finish with you Zaid, what would your advice

57:11

be? Gosh, so I think all

57:13

the goodies have been taken. Sorry,

57:15

I left you last. But

57:18

I would say the first thing is to

57:21

just remember that you are not going

57:24

to be the first person nor

57:26

the last person to suffer in this way, that there

57:28

are many others who have gone before and will go

57:31

before and that

57:35

if you're worried about it, if you're thinking

57:38

is there a, do I have a problem, you're not quite

57:41

sure, speak to someone about it, ask,

57:44

read about it. There's a lot

57:46

of information out there and there's a lot of people in organisations

57:48

who are willing and have devoted

57:51

their careers really to helping people

57:53

in these situations. So again, I know

57:55

it's repetitive from

57:58

some of the previous advice points but

58:00

Number one is you're not alone

58:02

in this. Number two, that if you

58:04

are worried, seek help from someone. Thank

58:07

you so much. And thank you

58:09

for all of the resources that you've mentioned. We'll

58:12

link in the show notes to Practitioner

58:15

Health and Sick Doctors Trust, and

58:17

all the other bits and pieces that we've mentioned.

58:25

Thank you all so much for joining for this episode.

58:27

And thank you for listening to Doctor In Sadly,

58:31

that's all we have time for today. We're

58:33

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58:35

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58:36

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58:39

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