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There is certainly some good evidence that doctors suffer an increased prevalence of mental health problems compared with the general population, 1- 3 the early postgraduate years being possibly the most stressful of all. 4- 6
However, there have also been recent papers that throw doubt on the conventional belief that the medical profession has any particularly unusual psychological difficulty. 7 Other studies of health workers reveal there are groups, such as nurses and managers, who show equally high stress levels. 8 The fact that it's not just doctors but also others who work in the health services who suffer from high levels of psychological problems would naturally point the finger of suspicion for all this stress in medicine, to the workplace.
Work pressure can be considered as consisting partly of the strain embodied in the intrinsic practice of medicine wherever it is executed, but there are also specific working conditions to consider-the particular context in which clinicians practise. Levels of strain might vary from hospital to hospital or clinic to clinic.
Yet given the high levels of stress that are repeatedly documented in such large numbers of doctors, there surely needs now be a new move away from the previous individualist focus on particular doctors and clinics who are feeling the strain. We now require a novel more global examination of where and how doctors' work is so pathogenic.
It may well be that traditional medical training does not adequately prepare doctors for the stress of their actual professional lives, and indeed could even directly contribute to the problem. For example it is sobering to note that a strong personality predictor of which medical student will suffer future psychological problems is the attribute of perfectionism. 9 This is a trait that is encouraged during medical school and may be necessary for survival while training, and yet this characteristic could be counterproductive when encountering the messy and chaotic real world of clinical practice.
But also perhaps the modern unease in medicine arises because times have changed. Historically, the public viewed physicians as powerful professionals it was safer to collaborate with in order to improve your health. Doctors previously enjoyed substantial autonomy, and had received significant prestige and reward for performing a respected, complex, socially useful...