'The first 2 years of my career could have been the last': Why doctors' health must be more than a tick box exercise

Core medical trainee Dr Carys Fleming highlights the medical profession's 'tick box' approach to trainee wellbeing, and questions whether it can be doing more to recognise health issues in students whose focus is on helping others. 

I am now 3 years into my medical career, and feel compelled to speak out about my own experience of mental illness in the medical profession. 

I remember sitting in a lecture theatre sometime towards the end of my final year of medical school and listening to a moving talk from a doctor who had suffered from mental health issues and alcoholism while practising medicine. The take home message was: ‘seek help if you’re struggling’.

Although the message delivered in that lecture was sound, I believe there is more we can do. It is in the very nature of those suffering from poor mental health to hide it and deny it – as best we can – not only from others, but from ourselves. This is where the flaw in that message lies: it is difficult to seek help from colleagues, supervisors, or even your own GP when you’re having a hard enough time convincing yourself you have a problem.

I suffer from anorexia nervosa. I write this article from a healthy, relatively happy body, and I wouldn’t be surprised if nobody suspected anything untoward at work, because at the moment there’s not much to suspect. But during my foundation years? I’m afraid and ashamed (because stigma around eating disorders and mental illness is a seemingly unshakeable part of our society) to say that I spent the first 6 months of my career losing one-third of my previously healthy body weight, and the next 15 or so months maintaining that, if not losing more.

Apart from those first few months losing weight with frightening speed, and the last few gaining some of it back, I spent my entire foundation years with a BMI that would have most of us speed-dialling the hospital dietitian.

Apart from those first few months losing weight with frightening speed, and the last few gaining some of it back, I spent my entire foundation years with a BMI that would have most of us speed-dialling the hospital dietitian.

I rotated through six specialties and four hospitals over my two foundation years and not once did anyone so much as blink. My family and close friends were tearing their hair out; my GP, I’m sure, was biting her nails over the regular weigh-ins, and yet nobody at work batted an eyelid. Each end-of- placement educational supervisor report was concluded with a cheerful ‘tick’ in the ‘no health concerns’ box and a pat on the back for my hard work. Excellent feedback. No concerns raised.

I lacked insight, and look back on that time with horror. It’s all very well to say ‘seek help’, but seeking help requires you to acknowledge that there is a problem. And for me, and for so many others with mental illness, we are inclined to bury our heads in the sand about the problems wreaking destruction behind closed doors.

Except it wasn’t behind closed doors. I barely ate at work, day in, day out. I remember the day I ate half of half of a ham sandwich. I remember the day I had some sticks of pepper and a slice of bread. People laughed – ‘weird lunch’. No one asked. I remember attending my ALS course and not being able to give decent CPR because I couldn’t depress the chest deeply enough. My course supervisor joked, ‘you need an extra sack of potatoes on your back’. We laughed. We moved on. No one asked.

No one raised any concerns. This seems like a strange thing to say, but I am in the ‘privileged’ position of suffering from a mental illness that has physical manifestations. And if no one asked me, how many of us are out there suffering from other eating disorders: depression, anxiety, alcoholism, drug addiction, with no one asking them? I look back at photos from that time and I am horrified that, surrounded by healthcare professionals, nobody saw what was right in front of them. I didn’t see it myself back then; I wasn’t going to be able to point it out.

I kept going until I physically couldn’t keep going any more. I called in sick for three night shifts during my obstetrics and gynaecology rotation. I was too physically exhausted to get out of bed, let alone retract for hours, or apply fundal pressure at 8am after a busy shift on call. I lay in my bed and I cried.

I was too physically exhausted to get out of bed, let alone retract for hours, or apply fundal pressure at 8am after a busy shift on call. I lay in my bed and I cried.

I couldn’t go on. Finally, I had a glimpse of insight into my situation. The next day I went to work and told my educational supervisor that I was struggling. She reassured me that nobody had had any concerns about me at work. ‘Great,’ cheered [my] anorexia. No problem here. Continue. But my supervisor also suggested I take the next two on-call shifts off. For me. For my health.

I spent 2 days repeating my new mantra: ‘You are ill. You are off work because you are ill.’ I spoke to my GP about antidepressants to get me through the inevitable mood crash of re-feeding. And I never looked back, until now. I walked through fire and hell to reach this stage of recovery. I know I can never go back, no matter how tempted I am. But now I can look back and see how much there is to be learned from those two years.

We must ask. If any of my supervisors had sat with me in those meetings and asked ‘how is your health?’, rather than just ticking that box, maybe things would have been different. If anyone had looked past the doctor and seen the frail and exhausted person underneath; if anyone had questioned the tiny meals or the emaciated body, maybe things would have been different. 

Maybe it would have helped me see the problem much earlier, before I reached the point where I couldn’t effectively deliver CPR or the point of total exhaustion. Our junior doctors are vulnerable, in stressful, busy jobs. Our personalities lend themselves to mental health problems like eating disorders; perfectionists, high achievers, a desire to be in control. If these problems are going to emerge, the foundation years are as likely a time as any. We must be vigilant. We must ask. By all means, seek help if you are struggling. But above that, I beg that you look out for colleagues who are suffering silently. They are there. I was there.

Dr Carys Fleming works at East Surrey Hospital. This article appears in April's Commentary magazine.

  • If you feel you have a health or wellbeing issue and would like professional support, the British Medical Association (BMA) has compiled a Sources of Support resource that lists a range of organisations, services and websites which can offer help.