I have had the privilege of specifically treating doctor colleagues in my psychiatric practice in Canada for the past 12 years. I have gained insights and a deeper understanding of how we set ourselves up to feel stress, and why we cannot stop. We have many common personality traits, such as being perfectionistic, obsessive, approval seekers and overly responsible and conscientious, and feeling the need to please others.

Doctors often have self-doubts, and feel they are impostors, ready to be found out at any time. This compels them to work harder, to balance an unfounded sense of incompetence.

The culture of medicine plays a role in promoting these traits, and setting high expectations of doctors. This makes it difficult for doctors to acknowledge when they need help — this is seen as a sign of weakness or failure.

The stigma of mental illness exists everywhere in the world. Yet, nowhere is it greater than in medicine.

One of my doctor-patients tells the story of how he had a serious heart attack and was admitted to his hospital, and his colleagues came to visit him regularly and sent flowers and gifts. Another colleague in the same department was also hospitalised at the same time, on the psychiatric ward in the same hospital. He received no flowers, gifts or visitors from the department. My patient stated that he himself had the more “noble” disease.

Since doctors are intelligent, we use intellectual defences to prevent us from conscious awareness of our difficulties. We can deny, minimise and rationalise the situation, and even just work harder to avoid thinking about our problems. This is important since it is why doctors delay seeking help. Sadly, most doctors still wait until a crisis to reach out.

In addition, it is hard to reach out for help when we feel insecure and ashamed, and fear being judged or exposed. We worry about confidentiality. We do not know where to go for help.

Many Australian states have developed highly successful programs that offer help to doctors in need. The Doctors Health Advisory Service in NSW works to address and maintain the health of its doctors. There are similar health advisory programs in Queensland and SA, as well as the Victorian Doctors Health Program.

Efforts to reduce the stigma of mental illness in medicine need to be increased and focused, to promote physician health, and the programs above are incorporating prevention as well as assistance in their mandates. Prevention of illness can be achieved by encouraging and advocating for active lifestyles, better work-life balance, healthier workplaces, and fostering a positive sense of community in medicine.

Doctors need education programs to realise that stress is normal, how to recognise when stress turns to distress, and how to get help. Doctors can learn it is acceptable and recommended that they take care of themselves, have hobbies, slow down and pace themselves, take holidays, and balance work and home life — and all without guilt.

There are some key messages to impart:

–Doctors are human too.

– Any healthy person in an unhealthy work environment can become unhealthy.

–Our personality traits are what help us succeed as doctors. Yet, they are the same traits that make us vulnerable to stress.

–Doctors put themselves at the end of their list of priorities — self-care must be a top priority.

–Taking care of ourself is not a luxury, it is an investment.

– We see ourselves as care-givers, not care-receivers.

–Work is the last arena to be impacted. Just because you are managing at work does not mean that you are well.

–It is not a failure to get help. The real failure is in not getting help when we need it.

–There are programs available to provide the help.

–Doctors need to work together to create and foster a healthy culture in medicine.

Stigma has been shown to diminish by open thought and discussion. The role of media in portraying mental illness is known to impact stigma — a positive, sensitive, accurate portrayal is necessary. Having this article on this topic is one such step, and an important initial one. In addition, doctors are encouraged to follow up on this, write articles, share stories, speak up, and highlight their personal successes.

Dr Gautam is a psychiatrist in private practice in Ottawa, and an assistant professor in the department of psychiatry, University of Ottawa, Canada. She is a specialist in physician health and wellbeing, with physicians making up her entire patient population.