Book review: Beneath the White Coat. Doctors, their minds and mental health.
23 November 2021
Edited by Clare Gerada
Published by Routledge
Clare begins her preface by stating, "I had to write this book", explaining that she needed to try to understand the current apparent crisis of mental illness among the medical profession. The information in the book is based on her experience of running the Practitioner Health Service since 2008 which (before Covid) was called upon by about 3000 doctors per year. It is evident why she had to write the book: it contains plainly put and wide-ranging insights into the origins of problems doctors develop that she has witnessed, how they are manifested and some guidance on how to manage when things go wrong.
For this reviewer at the stage of early retirement, pertinently the book dives straight in looking at how the medical self is nurtured and develops with a sense of belonging to the profession (which Clare calls The Collective Self). The reality for many at retirement is how or indeed if to lose this identity, and if not, how to maintain it meaningfully. Reading it was tough because it held to my face clearly the reality of the subliminal way in which this occurs early on and remains with you throughout. Although there are no included suggestions for strategies for this for the group of doctors to which I belong, it felt useful to have it described to clarify my own feelings and develop a response for myself.
The chapters following this describe the consequences of how the identity and its parameters has effects, for example in resilience, burnout, and doctors as patients, relating situations we have all seen and felt. For some of course coping fails and outcomes such as leaving the profession through to suicide via mental health and substance abuse are considered factually and authoritatively. Even differences in the risk of mental illness in different specialities are covered together with a helpful coverage of our regulatory system.
For those readers for whom the detail highlights issues or who are helping colleagues, the afterword begins, "you may notice a common theme in this book, which is make sure you get help... although this is a tremendously difficult time, others are, and have been in the same situation" so you, as they can, can come out the other end and get back to normality. Who knows what additional issues or highlights Covid will be shown to have – certainly the story will continue? An excellent, important book.
Dr David Poll Chair, Vale of Trent Faculty, Royal College of General Practitioners.
Dr Clare Gerada becomes President of the RCGP for three years from 20th November 2021. I am sure that having the editor of this book in that position at this time gives an enormous feeling of reassurance.