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Medicine should provide doctors with interesting, worthwhile, rich and varied careers. Despite recent changes it still offers good remuneration and reasonable job security and conveys high social status. So why are the rates of psychiatric illness, suicide, disillusionment with work, marital disharmony and divorce so high amongst doctors in comparison with many other professional groups? There have been no well-controlled comparative studies to date examining whether certain specialties within medicine in general are more prone to burn-out or psychiatric disorder. However, there have been suggestions that the particular stresses of cancer medicine place oncologists at particular risk (Delvaux et al., 1988; Whippen and Canellos, 1991). The report by Ramirez et al. in this journal reveals that 28% of their survey of 393 British oncologists had a psychiatric disorder. The study group also showed signs of burn-out (Freudenberger, 1974), with approximately one-third reporting high levels of emotional exhaustion and a sense of low personal accomplishment. Clinical oncologists appear to be most vulnerable to these problems. Doctors impaired in this way cannot provide good quality care, and these unrelieved stresses adversely affect their personal lives and those of their families (McCue, 1982). There is an obvious need to consider what can be done to maximise both the personal and professional fulfilment of doctors in cancer medicine.

Can we improve the professional and personal fulfilment of doctors in cancer medicine?