OPEN ACCESS | Letter to the Editor | Published Online: 15^th  November 2025                                                                                   

RESPONSE TO THE LETTER TO THE EDITOR IN RESPONSE TO "THE WEIGHT BENEATH THE WHITE COAT: PROFESSIONAL STRESS, HELP-SEEKING BARRIERS, AND THE HIDDEN GRIEF OF DOCTORS" 

Arun Kishore NR^1*, Shaji KS², Mathew J³

1. Consultant Psychiatrist, Sussex Partnership NHS Foundation Trust. UK, 2. Dean of Research, Kerala University of Health Sciences, Thrissur. Kerala, 3. Professor, Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala

*Corresponding Author: Consultant Psychiatrist, Sussex Partnership NHS Foundation Trust. UK

Email: nrarunkishore@outlook.com                                                                                                    

Dear Editor,

We want to thank the authors for their thoughtful and well-considered review of our paper.¹ We agree that supervision, when well organised and practised, could address several of the issues we raised in the paper. We would also like to point out that supervision that is unhelpful or absent could have adverse consequences on stress and help-seeking behaviours in doctors. The RCPsychiatrists define supervision as being “...designed to: ensure safe and effective patient care, establish an environment for learning and educational progression, provide reflective space to process dynamic aspects of therapeutic relationships, maintain professional boundaries and support development of resilience, well-being and leadership.”² At times, the focus of supervision is on the normative aspects to the neglect of its formative and restorative functions.³ Indeed, the concept of clinical supervision is often lacking in medical training in India. We agree that Balint groups and other reflective spaces can significantly help reduce professional stress. One of us (AK NR) is an accredited Balint Leader in the UK. We have experience introducing Balint groups to clinical practitioners in India and within several psychiatry training programmes. We have established an organisation called the Balint Foundation India. It aims to promote the integration of Balint groups into undergraduate and postgraduate training. We have documented our experience in a forthcoming paper. Like the authors, we hope that faculty and trainees in other specialties will also recognise the importance of initiatives that help lower stress levels and promote the well-being of doctors.

Conflict of interest: All three authors are members of ASHA (Accepting Support, Helping Another), a voluntary initiative committed to supporting doctors through peer dialogue and advocacy. There are no financial interests or conflicts of interest.

Declaration regarding the use of generative AI: The authors attest that there was no use of generative artificial intelligence (AI) technology in the generation of text, figures, or other informational content of this manuscript.

REFERENCES

1. Arun Kishore NR, Shaji KS, Mathew J. The Weight Beneath the White Coat: Professional Stress, Help-Seeking Barriers, and the Hidden Grief of Doctors. Kerala Journal of Psychiatry. 2025 Sep 15. [Link]

2. RCPsychSilverGuide.https://www.rcpsych.ac.uk/training/curricula-and-guidance/curricula-implementation/curricula-documents-and-resources [last accessed 3rd November 2025]
3. Proctor B. Supervision: A Cooperative Exercise in Accountability. In: Marken, M., Payne, M. (eds.) Enabling and Ensuring –Supervision in Practice. National Youth Bureau, Council for Education and Training in Youth and Community Work. 1986. Leicester, UK.RCPsych Silver Guide 2022:42. [Link]