'If you're crying this much you shouldn't be a consultant': the lived experience of UK doctors in training with mental illness.

There is some disagreement in the literature whether doctors in training suffer more from mental illness than an age-matched population. However, mental illness among doctors in training is a cause for concern because of the dual problems of reticence about accessing help and the clinical risk of doctors practising while mentally ill. The belief that is widely held among doctors in training is that to disclose a mental illness would be seen as weakness and may damage their career. A biographical narrative interview technique was used that enables the informant to tell the story of a painful episode in their lives in their own way and in their own words. Interviews were transcribed, and a thematic framework developed by consensus and then used to analyse all of the narrative interview data. Four major themes were detected: (1) Doing the job while ill, (2) Sick leave (initiating, being on, returning from), (3) Interaction with the employer; and (4) Sources of support. Practising while mentally ill caused significant challenges. Interviewees did the minimum, hated having to make decisions, and failed to study for postgraduate exams. All interviewees took sick leave at some stage. However, most were reluctant to do so. Being on sick leave meant being absent from the career that identified them and running the risk of being perceived as weak. Returning to work from sick leave was often difficult. Back to work interviews and occupational health support did not always happen. This study demonstrates the suffering encountered by doctors in training with mental illness. The job becomes much more difficult to do safely when mentally unwell. A great deal of presenteeism exists, which inhibits doctors in training from getting the medical care they need. It is imperative that confidential medical care is made available to doctors in training, which is sufficiently distanced from their place of work.