[00:00:00] Mat: Welcome to Doctors at Work. My name is Mat Daniel and this podcast is about doctors’ careers. Today I’m having a conversation with Zaid Al Najjar. Zaid is the Medical Director of the NHS Practitioner Health and he’s a GP also. He tells me what the NHS Practitioner Health Service is, we discuss the challenges faced by doctors when accessing mental health support, and he shares his top tips both for seeking help and for being a good colleague at work.
I hope it’s useful.
Welcome Zaid, tell me a little bit about yourself.
[00:00:46] Zaid: Hi Mat Thanks so much for having me. So my name is Zaid Al Najjar. I’m a GP by background and I’m based in London and I’m also Medical Director of NHS Practitioner Health.
[00:01:00] Mat: Tell me a bit more about NHS Practitioner Health.
[00:01:04] Zaid: Okay so NHS Practitioner Health, for those of you who haven’t heard of it, we are a free and confidential NHS service which was set up originally in 2008 specifically for doctors and dentists because it was identified at day had significant barriers to accessing mental health treatment and care.
So since 2008, when it was set up as a small pilot project, it’s since expanded, and now it’s a national service operating across England and also Scotland. So we treat doctors, dentists, and other healthcare professionals where there is a barrier to them accessing confidential mental health care.
[00:01:46] Mat: What kind of barriers do people face?
[00:01:49] Zaid: Very commonly people don’t often think about these barriers to for healthcare professionals, but medicine and healthcare is a small world and people often know each other professionally or personally, they might have studied or trained together or they might work with each other or know someone who knows them.
So confidentiality and fear of fear of other people knowing what your issues is a real barrier. So for example, you might. Play tennis with your GP, or you might have gone to medical school with your GP, and you might not want to go to your GP to say that you’re feeling particularly anxious, or that you’ve suffered some sort of trauma.
There’s a lot of stigma attached to mental health conditions still and stigmatization of those conditions is another barrier to, to healthcare. Practitioners access, accessing mental health care and also the logistic aspects of it. So people are often moving around, particularly in training grades, moving hospitals, organizations, working shifts.
So actually accessing healthcare can be difficult logistically. So there are a number of a number of Main barriers
[00:02:49] Mat: what are your thoughts about how we as a profession can be better at challenging the stigma around mental health?
[00:02:58] Zaid: So I think talking about it, a conversation is important.
And I think the advent of social media has really helped that. And a lot of people have, come forward and told their story in the media and in social media. So I think. Give it, giving it a place in everyday conversation is important and that the medical profession I suppose in particular, accept that mental health conditions are part and parcel of the human condition.
So everyone at points in their lives will struggle. With adversity and some people become ill with it or are predisposed to become mentally ill with it, then there’s no shame in that. So I think it should be, it shouldn’t be seen necessarily as a weakness, but it’s part and parcel of being human.
So I think talking about it, the medical profession changing its culture a bit and acceptance that these things are part and parcel of real life, that they, and that, they should be given the space to be addressed when they occur.
[00:04:01] Mat: Because I think statistically speaking as a profession, we’re probably more likely to have an awful lot of those kind of problems than the general public.
[00:04:11] Zaid: Yeah off the top of my head, I can’t give you a statistic per se, but we do know that I can talk specifically about doctors are at more risk of suffering from mental health disorders, such as depression, anxiety, than the general public, so a dentist, and they are also at a higher risk of completing suicide, particularly female doctors, two, three times that the risk of the general public.
So we know that they, that there is there is a higher risk of suffering from those issues and the layman.
[00:04:45] Mat: And your service then it is super useful to deal with those kind of issues. Have you got any idea how many people does your service help typically, do you know?
[00:04:59] Zaid: So we’ve just entered our 15th year of operation. So last week we celebrated our 15th birthday. And we have seen over 27, 000. Wow. Patients in that time.
And so it’s grown exponentially in the last three years. And since the pandemic. This this year we’ve seen between six and 7, 000 patients. And when we started in 2008, I think it was about, I think it was about 50. So it’s grown massively.
[00:05:29] Mat: And what kind of problems do people bring?
[00:05:33] Zaid: So the number one contender always is anxiety. So I think as a profession I think a degree of anxiety is helpful because it makes you you’re almost on the alert all the time for looking out for things that go wrong or errors or harm that may come someone’s way. So I think it’s almost a.
a quality to be predisposed to being anxious. But anxiety is the number one mental health condition that we see a lot of. And also burnout features quite a lot low mood and depression. Increasingly over the last few years, we’ve seen more people coming to obtain treatment for trauma.
And then dealing with everyday life adversity, as I said before, so people may just be going through a particularly difficult time in their life. At work or difficult bereavement or multiple bereavements or caring for family or members who are very ill, and they just need some Support with their mental health because it can result in in an abnormal reaction to an adverse life event.
So we’re there to support those people too. We’ve got particular expertise in helping professionals with the interface with the medical regulator or the healthcare regulators. If we’re particularly concerned to help those who are subject to regulatory investigation or monitoring, particularly when it impacts on their health or features health issues.
That’s it in a nutshell in terms of what we treat.
[00:07:02] Mat: I’m interested, maybe I’ll pick anxiety first of all and yes, I can see that we’re all predisposed to that because it’s good, isn’t it, in some ways, if there’s always a bit of it that sort of says, are you sure this is the right thing?
Should you ask for a second opinion? Should you do a bit more reading? I can see that’s a really helpful characteristic for all of us. What would be your top tips for how people might manage anxiety so that it’s helpful rather than destructive?
[00:07:31] Zaid: So I think recognizing that you might just generally, people talk about being an anxious person.
And I suppose I don’t know necessarily that’s true. I think, but I think recognizing that when it is you become anxious, so no, just noticing in the first it’s what’s going on with, in you at the moment. What, how are you feeling? What’s happening? Are you feeling anxious? If you’re feeling anxious, why do you think that is?
And it’s generally keeping a bit of a score or a diary, not a diary. You can keep a diary, but a marker on how often that’s happening. So it’s normal. Anxiety, feeling anxious is again, normal, a normal part of the human condition. But if you’re anxious all the time, it becomes pathological. So it stopped, it stops you doing things that affects your daily function.
impacts your sleep or appetite or as I said, ability to function, then that’s when you probably need to seek advice from a professional. But I think just be becoming aware of what, when you’re anxious, thinking about what might be prompting it, what can you do to tackle that? And acceptance, accepting that anxiety often just comes and will pass.
[00:08:37] Mat: What about burnout? You mentioned that’s another big reason why people come. So what would be your advice for doctors, maybe both for preventing burnout and for dealing with it once it happens?
[00:08:48] Zaid: Burnout is complicated because it’s not actually there’s no clinical diagnosis of burnout and it’s not more of an occupational an occupational condition but burnout does, is something that people do talk about a lot.
There is, there are various surveys you can a BMA, for example, offer one to, okay. to judge whether or not you are or break your level of burnout, whether you are burnt out or not. But I think the main features of burnout are really One of the main things is a loss of empathy and a loss of interest in the patient withdrawal feeling, feeling tired not wanting to do things that you would usually do.
Maybe becoming more irritable generally. There are, there’s lots of overlap with depression and burnout. They’re not quite the same. But I think if you’re noticing in yourself or a colleague that there’s a change in behaviour. And that might, for example, result in a change in practice.
So you might find that people complain or there are comments about that person and I think It’s probably worth a conversation about it with them so you’re not just turning a blind eye to it. And in yourself, what can you do? Again check in with yourself regularly. How are you feeling?
Is it a good day? Is it a bad day? Are you having more bad days than good days? How are you feeling about work? Taking some time, I think, after you see patients to housekeep, as they say, they teach you in general practice housekeeping, looking after yourself after you’ve had particularly difficult consultations.
And if you are struggling, then you have to speak to someone again about it.
[00:10:20] Mat: You mentioned that sometimes a colleague will notice burnout in another person. Can you tell me a little bit more about how… How we can be better colleagues when it comes to helping each other deal with burnout.
[00:10:33] Zaid: So I think it’s very it’s very easy to ask someone how they are and accept the first I’m fine. Thanks. How are you? And I think that’s very, that’s part and parcel of British culture is how are you? I’m fine. Thank you. And you often hope that the person does say fine. Thank you. And that’s, that is what’s culturally accepted because if they say, actually, I’m not so good people don’t often know what to do with that.
So I think the question, how are you? And actually, if you’re not convinced Curiosity is helpful. Being curious about the other person, your colleague, how they are actually things don’t seem quite the case. And. persist, how are you really, or giving them an opening. So actually it’s been a quite, quite a difficult day or it’s been a difficult week because of such and such a reason.
I don’t know, funding has been cut or someone’s off sick or, and it might give them a bit of an opening into allowing them to talk about what might be troubling, troubling them. So I think just being. Looking after each other, really being just checking in with each other regularly. I don’t know if you’ve heard of Professor Neil Greenberg.
He’s a psychiatrist who did a lot of trauma research and work. And he found that in Afghanistan, soldiers who had a boss or a manager who was, who checked in with them regularly to find out how they were doing, did better mentally, far better mentally than those who didn’t have what was perceived as a supportive boss or manager.
So it is those small things which I think are important.
[00:12:00] Mat: So being curious, caring for your colleagues, having an attitude of caring and curiosity and. creating opportunities for people to open up because it’s quite difficult, isn’t it, to open up?
[00:12:14] Zaid: It can be difficult and also, you know that it’s not easy to do that when you may not be feeling 100 percent yourself You know, you’ve had that you’ve had a long day yourself.
The last thing you want to do is probably hear about someone else’s difficulties, but I think sharing it sharing those experiences is really helpful in practice and Spaces to allow clinicians to come together to talk about their experiences and how it’s making them feel is really helpful. So you’ll often find that the organizations which function really well and the general practices which function really well are those that maintain a sense of community in the practice.
So they make sure that regular get togethers. are a part and parcel of the day, so they meet for coffee, they meet for lunch, despite how those are fixed those are fixed things, because sharing is important of experiences in a day, and humans are humans, you’re social, we’re social animals.
[00:13:10] Mat: And it’s always sad that often those things are the first things to go when we’re busy.
Yeah, but the reality is that they are, they’re essential for longevity because, we can be busy today and tomorrow, but in 10 years time, there won’t be anybody left because, all of us will be burnt out. Those social team activities, group activities, they’re an investment into longevity of ourselves and the NHS.
[00:13:33] Zaid: Yeah, exactly. It’s, you can, medicine or healthcare can be quite lonely. And particularly if you work as a for example, in general practice, you can often go a whole day or a dentist even without speaking to anyone. But a patient or perhaps reception or the dental nurse that you’re working with.
It’s important. Particularly in primary care. I think it’s in secondary care. There’s, it’s a bit easy. Can you got a team around you a lot of the time? And there are always lots of people that you might have a bit of banter with. But I think it’s important to keep that because it’s one of the reasons people go to work.
[00:14:10] Mat: So let’s say that, if you are a doctor who finds them themselves, with any of the issues that you’ve outlined what can they do about them?
[00:14:22] Zaid: Very much depends on where you are and what kind of work you are. So there are different offers for different groups of healthcare workers. There is always help out there. Number one, of course is your GP. You can always seek help from your GP. There’s also local talking therapies available all across the country.
You just need to you could do a quick Google search finding out about how to access talking therapy will give you. I’ll give you that. Then specifically, for example, doctors, BMA run a counselling service that they can access the RC, the RCN for a counselling service for those members the Royal College of Nursing for.
For trainees, it’s worth checking out what’s available by your deanery, because they will often be their professional support units, and they will have vast experience in dealing with trainees who are who have been dealing with difficult times. Whatever that reason and there are during COVID the NHS England commissioned over 40 mental health and being hubs across the country to allow staff to access free and confidential mental health care.
Sadly, the funding’s not available for many of those hubs, but some are still open. It’s worth checking whether that your, yours is open locally. And then of course NHS Practitioner Health. We are here for, as I said, doctors and dentists and those who may find, would find it difficult to access confidential mental health and addiction support elsewhere because of their role.
And how do people access you? Self referral. So it’s very easy online. You just go to our website, Google NHS practitioner health, and there’s a self referral form that you can complete. And it takes a bit of time. We ask a lot of questions because we want to know more about what’s going on. But yeah, it’s fairly easy.
And if you have any difficulty filling that format, then our patient services team would be happy to help.
[00:16:16] Mat: And then my final question is, what would be your top tips for doctors at work?
[00:16:21] Zaid: I think we talked a lot about checking in with each other. So one of again this is Professor Neil Greenberg talking about buddying up with people is really helpful.
And that’s something we’re trying to implement actually with practitioner health is new staff members. So buddying them up with other clinicians, because it’s. Really helpful for one to check people to check on each other just at the end of the day. How’s it gone? Issues that’s really that’s a nice thing And I think particularly maybe for trainees to do would be to buddy up with another trainee That you’re working with and just checking on each other and attend to your basic needs.
So Maslow’s triangle so eat eating sleeping and just looking after yourself often go out the window quickly, when, if you’re becoming stretched at work is often the last thing to go when with doctors, we found off the beat, they can be operating okay at work, but be just be a wreck at home. Just attending to your everyday.
Being if you have well being needs at home. Keeping active, keeping socially engaged and making sure you have a life outside of work. There is more to life than being at work and passing exams. So I think those are my top tips.
[00:17:38] Mat: Wonderful. Thank you very much,
[00:17:39] Zaid: Zaid. It’s a pleasure.