Do norms create an expectation of stress and aversion to reporting distress?

by Cassie Lowery (Project Intern 2016)

Medical identities of doctors and medical students tend to be quite strong.  And while such strong identification with this identity has been shown to correlate with well being, there may be other, more negative, consequences.  Identification with a group leads to the acceptance of the norms, values, and goals of the group.  Though many norms within the medical community are beneficial, such as a firm sense of ethics, some are more detrimental. (McNeil, Kerr, & Mavor, 2014).

An article in the New Statesman highlighted the prevalence rates of mental illness amongst NHS doctors.  These results were published by Dr Debbie Cohen, a senior medical research fellow at Cardiff University, who conducted a survey of roughly 2,000 British doctors (Cohen, Winstanley, & Greene, 2016).  The findings concluded that 60% of the respondents had experienced some form of mental illness.

While such statistics are startling at first glance, when viewed alongside the daily demands of their work, it is rather more surprising that such high percentages of physicians do not suffer from anxiety or depression.  Indeed, for many doctors, taking on immense mental and emotional burdens is simply part of their job description.  Doctors Nadia Masood and Janis Burns both spoke of the inherent difficulties they face as doctors for an article published by Mirror, ‘Why are Junior Doctors Striking?.’  

Dr Masood said, “as a doctor for 11 years I have always worked evenings, weekends, and night shifts in addition to routine Monday-Friday duties.  Our job by its very nature is gruelling emotionally, physically, and mentally.”

Likewise, Dr Burns noted that “no one becomes a doctor expecting an easy time of it and, although we probably hate to admit it, most of us thrive on the loveable chaos that is the NHS.”

When stress is viewed as normative, those who have difficulties taking on the ‘chaos’ and stress of their career can take this as a personal failing to fulfil their medical duties.

When stress is viewed as normative, those who have difficulties taking on the ‘chaos’ and stress of their career can take this as a personal failing to fulfil their medical duties. This feeling of failure can intensify if they perceive their struggle to adapt to the stress of the workplace as outside the norm for the medical community.

Many institutions, such as the NHS, have tried to offer resources for troubled physicians.  However, Dr Cohen’s survey data indicated that despite 46.5% of trainees reported suffering from mental illness, only 39% of those suffering disclosed this information to their workplace, and roughly the same numbers were reported for GPs.

In an article by the British Medical Association, an Oxford specialty trainee 6 in anaesthesia and intensive care, Segun Olusanya, discussed why many programs aimed at helping ailing doctors may not be the panacea they require.  Olusanya notes that these resources require a self-referral, and he believes many will fail to comply “for fear of being labelled a ‘difficult’ trainee”.  

This quote highlights a norm of behaviour for ‘good’ trainees’ as someone who does not deviate from the group by applying for these resources.  For doctors and medical students struggling to keep pace with the demands of their work, self referral may represent a further deviation from their medical identity, which many could be unwilling to pursue.

In an op-ed titled ‘Why do Doctors Commit Suicide’ published in The New York Times, Pranay Sinha, a doctor, who in 2014 was in his first year of residency in the department of internal medicine at Yale-New Haven Hospital, wrote about the difficulty of working within a perceived culture of infallibility.

“There is a strange machismo that pervades medicine. Doctors, especially fledgling doctors like me, feel pressure to project intellectual, emotional, and physical prowess beyond what we truly possess,” Sinha wrote.  “We masquerade as strong and untroubled professionals even in our darkest and most self-doubting moments.  How, then, are we supposed to identify colleagues in trouble — or admit that we may need help ourselves?”


Cohen, D., Winstanley, S.J., & Greene, G. (2016).  Understanding doctors’ attitudes towards self-disclosure of mental ill health.  Occupational Medicine, 66, (5), 383-389.