The “Superdoctor” / “Hero” Trap

Most doctors go into the field because they want to help people. The irony is that whilst our role involves caring for others, we are in general pretty horrendous at caring for ourselves. Unlike the advice we give our patients on a daily basis, when we ourselves are sick or stressed or exhausted, we fail to grant ourselves the right to rest and recuperation.

Presenteeism and Guilt 

According to a survey of UK doctors done by the Medical Protection Society (MPS) in 2019, a whopping 72% of doctors said they will always come into work, even when they are too unwell, fatigued or stressed to be productive – a behaviour known as presenteeism. Meanwhile, 46% felt guilty taking time off work. These results aren’t that surprising when you consider how underfunded and under resourced the NHS is. We know that when we don’t turn up to work we make the chronic understaffing rampant across many NHS departments even worse.

When we turn up to work too unwell to perform at our best, we often think we are doing our department, our colleagues and our patients a favour. “Half a doctor is better than no doctor,” we tell ourselves. But is this really the case?

Presenteeism is associated with burnout, mental health problems, longer term sickness as well as increased medicolegal risk, as doctors who are too unwell, tired or stressed to work are naturally more inclined to make mistakes. In the MPS survey, more than 1 in 4 doctors suspected that emotional exhaustion had contributed to an irreversible clinical error and 67% said this was due to a lack of concentration. 

Stigma

But the issue here isn’t just one of logistics or perceived duty. In medical culture, there is still a stigma attached to doctors raising their own health concerns or taking time off sick (even more so when this is for mental health reasons). Worryingly, 12% of respondents to the MPS study reported that their colleagues made them feel guilty for taking sick leave.

Mental Health Stigma 

It’s especially hard for us as doctors to give ourselves the right to sick leave when we we are struggling with our mental health. As with all invisible medical conditions, it’s hard for us to validate the experience as even qualifying as “sickness” – and it doesn’t help that others in the medical profession, due to mental health stigma, may not validate our needs either. As a profession, we need to do better with normalising taking sick leave as well as “mental health days” when we need them.

If you struggle to believe that any mental health struggles you’re experiencing are deserving of sick leave, imagine this scenario: You’ve been in a car crash and broken your leg. You are slowly recovering but currently rely on your crutches. Your on call duties require you to carry a bleep and to run to emergencies when a crash call goes off. Would anyone think that at this stage in your recovery, you are capable of performing those duties? Probably not. Why then, if your brain is suffering the huge insult of a mental health condition, which may impair your concentration and your ability to function efficiently, should you be expected to perform that same duty? It’s just a different body part and a different insult – one not directly visible to the naked eye. 

The Binary of Patient vs. Doctor 

Partly to blame for stigma might be our medical training which has, for centuries, indoctrinated medical students and doctors into thinking of ourselves in terms of binaries – you can be either a doctor or a patient, but never both. In some ways this is a natural psychological safeguard that we develop against the emotional distress of dealing with sick and dying patients on a daily basis. We have to compartmentalise the natural emotional distress of working with people who are suffering. As a result it can be hard for us to imagine ourselves in their position or to accept sickness when it presents in ourselves or our colleagues. 

“Superdoctors”

Unfortunately, we are often encouraged by our medical training and by society to think of ourselves as superhumans or “Superdoctors” who don’t have the same needs as other people. Doctors who think of themselves in this way often have strong beliefs about the virtuosity of self-sacrifice, coupled with an acceptance of poor or challenging working conditions (“this is what we signed up for”) and therefore set unachievable or superhuman expectations for themselves which can contribute to burnout. Members of the public often regard this stoicism with a degree of admiration.

“Heroes” 

You can see this concept in action even today. It happens every time we are lauded as “NHS heroes”. It might sound ungrateful to complain about this. The public thinks of us as heroes for our service, and it may be flattering to think of ourselves in this way. Of course we appreciate being valued. However, we have to be aware of the repercussions of using this type of language. “Heroes” are strong and excel in challenging conditions. “Heroes” sacrifice themselves for the benefit of others and for the greater good. “Heroes” do not need help and certainly do not ask for it. Doctors already struggle with being vulnerable with each other due to inherent stigma in the medical profession. There is a fine line between boosting morale and indoctrinating doctors into believing they exist beyond the need for help – either for their physical or mental health – & therefore discouraging them from asking for it.

“You’re not a Superdoctor and you’re not a Hero, you’re a Human” 

Dr Natasha Holmes
THEWELLDOCTOR.ORG

Working Within the Limits of your Competence 

Understanding that you are not a Superdoctor or a Hero, but a regular human being with needs is an important part of “recognising and working within the limits of your competence”, one of the core tenets of Good Medical Practice as stipulated by the General Medical Council in the UK. It’s not just about limitations in terms of knowledge or ability but limitations in CAPABILITY. You need to understand that when you are too tired, or sick or struggling with your mental health you are not doing yourself or anyone else any favours by turning up to work – you need to take the time to look after yourself and get better. “Half a doctor” is not better. It is actively worse – especially if you end making a mistake or go so far into burnout that you get signed off of work longer term, like I did in 2017.  

The Hippocratic Oath 

Remember the Hippocratic Oath you swore when you completed your medical degree? The 2017 amendment to it added the phrase “I will attend to my own health, wellbeing and abilities in order to offer care of the highest standard.” 

It might be flattering to be branded as “Heroes” or to think of ourselves as “Superdoctors” but beware – this type of thinking perpetuates the idea that we don’t have the same needs as other people. It is an insidious stripping away of our right as human beings to care when we are unwell – physically or mentally. This thinking is not helpful, and it’s dangerous. Normalise the practice of taking sick days when you need them. Normalise taking mental health days when you need them. You swore an oath to do so. Lead by example and support others in doing the same so we can erase stigma. Don’t fall into the Superdoctor/ Hero trap. You’re not a “Superdoctor” and you’re not a “Hero”, you’re a human being.