Roger Sexton: Doctor disadvantage

YOU may be surprised at the suggestion that doctors are a disadvantaged group requiring a special approach to their health care.

However, we do experience barriers that prevent us from accessing formal health care from another doctor and we need to find new solutions to address this disadvantage.

Doctors are regarded as well resourced, well connected, knowledgeable and really quite capable of looking after ourselves. It is generally assumed that we can easily arrange expeditious and affordable high-standard medical care when we need it.

The reality is quite different, with evidence that around 40% of physicians don’t have a family doctor. Many identify not one but multiple barriers to achieving this and a reluctance to present with mental health problems, even to their own family doctor. Embarrassment, and concerns about notification and the skill and confidentiality of the treating doctor are examples of such barriers.

Once in the consulting room, the formal consultation can be fraught with mutual discomfort, clinical and professional deficiencies and poorer clinical outcomes.

As doctors, we display an interesting spectrum of health care behaviour ranging from informal consultations at work or social gatherings to formal collaboration with our treating doctor. In between, we may self investigate and self treat and practise a blended form of care with selective attendance for certain conditions.

Presentations late in the course of an illness may ensue and follow a period of inferior self-care, which may have drawn the attention of unhappy patients and the medical board.

In South Australia in 2006, a series of such sentinel events within the profession, including suicides, unexpected departures from practice and presentations of ill doctors to the medical board for unprofessional behaviour triggered a statewide response.

A survey of doctors’ health in 2007 revealed how doctors lacked their own GP and identified multiple barriers to seeing a doctor.

Survey data also highlighted widespread support for a specific doctors’ health program with a preventive focus directed at the profession itself. The survey found that the profession as a whole needed access to a dedicated, confidential and profession-specific heath program that offered unhurried preventive checkups, delivered after hours by skilled and experienced doctors. Doctors just wanted what grateful patients receive — a patient-centric experience.

Specific solutions were needed for specific barriers, which required an emphasis on skill, professionalism and confidentiality at every point in the patient journey.

The SA program has sought to make it easier for a doctor to see a doctor by removing the barriers. It offers specific training in doctors’ health to interested doctors and has established a growing network of primary care practices for doctors across the state.

It also offers a new dedicated, profession-only clinic in the Adelaide CBD, which operates on week nights and weekends. A 24-hour phone service continues to support doctors who need anonymity and a tele-health service will be established for rural and outer-urban doctors this year.

The website offers online bookings at the after-hours clinic and a list of GPs in the network.

The profession must adopt a corporate approach to the health of its members and can no longer realistically expect that every individual doctor or student will find the formal health care they need.

The continuing tragedy of suicides and de-registrations due to ill health among our colleagues are true sentinel events that must drive our profession to offer clearer and timelier formal pathways of care for ourselves and our colleagues.

It is no longer ethical to regard the status quo as acceptable.

Dr Roger Sexton is a rural and urban GP and immediate past president of the Medical Board of South Australia. He is a board member of national medical indemnity provider MIGA, a member of the Pharmaceutical Benefits Advisory Committee, a tutor at the University of Adelaide medical school, and medical director of Doctors’ Health SA.

Posted 14 May 2012