The peer counsellors noted that the framework of the scheme, such as confidentiality, readily available appointments and a meeting with someone who understands, but stands apart from the job situation, is important for doctors to make contact. This accords with international studies that have found that doctors more easily make contact with schemes that provide similar frameworks
(7, 13, 18). The peer counsellors nevertheless ask themselves whether perhaps even more doctors ought to make use of the scheme.
Some of the peer counsellors have noticed that it has now become somewhat more common for doctors to support each other. This may imply a decrease in the need for the collegial support scheme. A survey conducted ten years ago revealed that 40 % of the doctors were unaware of the scheme; this was especially true among younger doctors as well as those in the northern counties
(19). This may indicate that the scheme ought to be promoted more actively.
The function of the peer counsellors must be adapted to a broad range of complex and serious issues. Colleagues who face conflict-ridden or difficult working conditions often need a personal contact, which the peer counsellor can provide. However, in light of the reports of an increasing number of contacts related to (excessive) workloads and pressure in the workplace, it should be considered whether the function of peer counsellors may also help maintain system failures that otherwise would be useful to address through other channels, such as the management or the elected employee representatives.
The increasing number of young women doctors who attended the sessions may indicate that the function of the peer counsellors could change somewhat. We know that the proportion of women doctors is increasing, in Norway as well as internationally. It is thus important to be aware of possible needs for other types of help and support resulting from this change.
The peer counsellors identified three kinds of utility provided by the scheme: that it helps raise awareness, that it constitutes an important contingency scheme and that it eases the burden, thus lowering the threshold to treatment and inspiring confidence in the helper. The peer counsellors claimed that the scheme has contributed to a change in the doctors’ attitudes towards seeking help for themselves as well as helping their colleagues.
Could there be a contradiction between use of the collegial support scheme and upholding professional solidarity? Many doctors with some years of experience perceive a loss of personal autonomy and status, and may have their hands full taking care of themselves in the daily grind. This could provide less room for positive collegial relationships, and the peer counsellors must step in. This may perhaps represent an increasing challenge to the peer counsellors – on the one hand being able to provide support to colleagues who feel that the health services provide less room for individual autonomy, while on the other hand communicating that increasingly, professional autonomy must be of a collective nature, and that doctors must be there for each other
(20). When professional loyalties are under threat, it is especially crucial to take care of each other as colleagues, for example through a scheme for provision of collegial support.
Most of the peer counsellors emphasised that the scheme is important in terms of the contingency it provides. It could be an essential safety net in a job situation in which the risk of exclusion (for example by committing a mistake or falling ill) can be perceived as threatening to an extent that may even cause some to plan suicide, as described by one of the support colleagues. Data from Norway as well as the UK confirm that doctors who seek help tend to report suicidal thoughts more often than other doctors
(7, 13). The importance of the safety net may simply consist in the opportunity it provides to make contact with a support colleague, since this may be sufficient to help someone withstand a difficult situation.
Moreover, it is important that the contact with the scheme can be established through others, such as next of kin or a colleague, when the doctor feels powerless to do so. Norwegian doctors are still reluctant to take their own needs into account when it comes to treatment and sickness absence
The peer counsellors reported that in their feedback, the doctors who came for help noted that the contact eases the burden and lowers the threshold to seeking further advice and support. When helping to categorise and identify needs, the peer counsellors may point out and insist on the seriousness of the situation, while the doctor perhaps may initially play down or reject any needs for treatment. The contact in itself helps build confidence in the benefits of seeking help.
A higher frequency of treatment, especially psychotherapy, has also been documented after use of another low-threshold service for Norwegian doctors, the Villa Sana resource centre, as well as internationally after use of similar low-threshold options for doctors
(7, 12, 13, 21). Support schemes for doctors appear to result in more appropriate use of public health services.
Strengths and weaknesses
Strengths and weaknesses
The strength of qualitative studies, such as focus-group interviews, is their ability to provide experience-based knowledge, rather than a quantitative ranking of importance or the proportional distribution of opinions (16, Ch. 1). On the other hand, this may limit the generalisability of their results to a wider group. In this study, however, we have included doctors from all of Norway’s counties, thus making for transfer value to the group of Norwegian peer counsellors as a whole. The issues may also be transferable to similar support schemes in Denmark and Sweden.
The fact that both of the interviewers were doctors themselves, with special familiarity with support activities, may constitute a methodological weakness. On the one hand, this may have facilitated their understanding and recognition of the descriptions provided, but on the other hand it entails a risk of making assumptions about phenomena that thereby remain underexplored. The different types of prior understanding between the interviewers, whereby KR has a background in individually oriented clinical studies and OGA in long-standing research on the group of medical practitioners as a whole, may have helped provide nuance to the interpretation of various phenomena.
In this study we have investigated the assessments made by the peer counsellors and their reporting of what the help-seekers have told them. The framework, function and benefits of the scheme should also be described by the doctors who have used it before a total assessment of how it functions and ought to function can be made. Such a study is currently being planned.