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Doctors suffer from mental illness, just like other people.儲存 The problem is what should be done when it happens.DOCTORS can become mentally ill. Such a statement seems obvious. Yet some people are sometimes surprised when they hear it.Perhaps a patient seeking help wants to think (or simply assume) that doctors are always fit and capable. After all, a patient's life can literally be in the hands of his or her doctor.Doctors are responsible for the well-being of their patients. Indeed, the interest of the patient takes precedence over that of the doctor. Hence, the continuing fitness of a doctor to practise medicine competently and safely is paramount.The Singapore Medical Council (SMC) is the regulatory body that both issues and revokes medical licences. Its Ethical Code and Ethical Guidelines (ECEGs) obliges a doctor suffering from a condition that compromises his or her fitness to practise to inform the council, and seek the appropriate treatment.The notification triggers an independent assessment of the doctor's fitness to practise. Even though the SMC strives to be fair and take the doctor's interest into consideration, it is likely that affected doctors would think that the emphasis should be on protecting the public. Indeed, this is probably – and certainly should be – the case.This can give rise to unease and apprehension, especially among doctors with mental illness. The fear of the consequences on career, reputation and even livelihood might understandably drive them to hide their illness. It might even prevent them from seeking help.Fitness to practiseTHE mere presence of a mental illness should never be taken blithely as synonymous with impairment, incompetence or danger. Unfortunately, most people would think and react otherwise.In a survey of executive directors of the state medical boards (the equivalent of the SMC) in the United States, 37 per cent indicated that the diagnosis of mental illness by itself was sufficient reason for the board to sanction a doctor.The crux of the matter is the assessment of a doctor's fitness to practise. That can be a tough judgment call to make when different duties appear to conflict with one another.Consider the case of Dr Steven Miles, a doctor practising in Minneapolis. Writing in The Journal of the American Medical Association, he narrated his two-year battle with his local licensing board after he dutifully reported his bipolar disorder during a routine relicensing process.Citing its duty to protect the public, the board sought to review Dr Miles' personal medical records. But Dr Miles and his psychiatrist refused on grounds of preserving patient confidentiality. Dr Miles argued that the assessment of his ability to practise medicine competently and safely should not be based on the diagnosis and the details of the treatment, which he saw as "an oblique and needlessly intrusive way" to evaluate his professional competence.He referred to a declaration by the American Psychiatric Association that protecting the patients "does not require assuming that a psychiatric patient (in this case the doctor) is potentially so harmful to patients that he or she cannot practise medicine without presenting his or her otherwise private medical records... It is likely that abolishing confidentiality of a physician's personal health records would simply discourage troubled people, many with treatable disorders, from finding appropriate medical help and would hamper those trying to help them... Such an impaired individual is far more likely to endanger patients".To tell or not to tellAS A psychiatrist, I see the confidentiality of the doctor-patient relationship as almost sacrosanct: So much of what psychiatrists do in their effort to help depends on their patients trusting them with their innermost thoughts迷你倉 feelings and urges. But this duty to maintain confidentiality is not absolute. Sometimes it is breached in order to prevent harm to the patient or others.The dilemma is deciding when the line should be crossed, particularly in the case of an unwell doctor who might refuse treatment. This can happen as a result of certain cognitive impairments arising from certain mental illnesses. The doctor (who is now a patient himself) may also lack the capacity to understand the ramifications of the illness, including the possibility of causing inadvertent harm to his patients.The SMC's ECEGs tell doctors that it is their "special responsibility to alert the SMC" when they have reason to believe that there is "risk of potential harm posed by another doctor's conduct".To be honest, I think most doctors would baulk when they discover they have to do this.Boston surgeon and writer Atul Gawande commented in an essay in The New Yorker: "There is an official line about how the medical profession is supposed to deal with these physicians: Colleagues are expected to join forces promptly to remove them from practice and report them to the medical licensing authorities."It hardly ever happens that way. For no tight-knit community can function that way."Citing the work done on medical communities in the US, Britain, and Sweden when confronted with a problematic colleague, Dr Gawande noted that the "dominant reaction was uncertainty, denial, and dithering, (and) feckless intervention."There is no sinister "conspiracy of silence" but rather a reluctance to initiate a course of action that could possibly end the career of a previously competent and decent colleague. For many, not doing anything, or waiting and hoping that someone else will do it, is the easier option.But not doing anything can be calamitous, and not just to patients. Research suggests that doctors have higher rates of depression and suicide than the general population. I know of doctors who have killed themselves. The news would almost inevitably give rise to expressions of shock and bewilderment in the medical community. Sometimes there is also a tinge of guilt that perhaps – just perhaps – something could have been done."Ours is a dangerous profession," wrote Dr Danielle Ofri, a professor of medicine at New York University, after a fellow doctor inexplicably killed himself."There is the constant assault of physical and emotional challenges of taking care of patients, which is layered upon the already difficult task of conducting our own lives... The cliche says that doctors make the worst patients, that they are the last to seek treatment. We are always trying to help our patients to get beyond their denial, but it seems that we use it the most on ourselves."Doing the right thingTHERE is still a long way to go to overcome the stigma of mental illness that impedes help-seeking among doctors. Perhaps there should be a raft of measures such as educating medical students and doctors – not just on the inevitable stress of training and practice but also on the possibility of mental illness that can befall any one of us. Somehow that shame and apprehension of seeking help has to be addressed.But beyond the will to do all that, heart and guts are needed for doctors to overcome the fear of approaching unwell colleagues, and to do the difficult and right thing. Doctors need to look after themselves better and perhaps they should talk more openly about their afflictions. They should also accept and help colleagues who become mentally unwell, and not stigmatise them.At the end of the day, patients and the public would be better served when doctors seek treatment willingly, and without fear.stopinion@sph.com.sgThe writer is vice-chairman of the Medical Board (Research) with the Institute of Mental Health.self storage