Issue 18 / 14 May 2012

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

11 thoughts on “Roger Sexton: Doctor disadvantage

  1. Anonymous says:

    Mandatory reporting applies to serious cases where the medical professionals’ skill or judgement might be impaired and thus might harm the patient. If it is (mis)used to undermine a competitor, it is not the ‘fault’ with the mandatory reporting itself but the decline of ethical, professional standards within the profession. I have witnessed alcohol induced psychosis in a medical professional (overseas), where he had to be taken away REPEATEDLY from his practice to hospital. On good days he was ‘just’ mildly intoxicated but coherent. In Australia I have witnessed a discernible case of Parkinson’s in a surgeon, shakes an’ all. He was still practising, no doubt confident and full of self-belief that his skills (and luck?) will not fail him. Self-belief of this kind is close to delusion, and the public has to be shielded from the dangers this poses.
    Loyalty (to colleagues) is understandable but this kind of loyalty, where silence, ignorance exposes others to harm is unreasonable. The fact that it keeps reappearing in discussion and that mandatory reporting has to be defended over and over is a cause for concern. I wonder if anyone would want to be on a plane where the pilot might have a drug problem, or be severely depressed… or both at the same time… I am sure I wouldn’t. If there is a problem that medical professionals are more prone to depression and suicide, then the causes of this should be explored and remedied, assistance provided. At the same time the public, the patients have to be protected. Mandatory reporting is not the enemy.

  2. William says:

    Mandatory reporting has to end, placing doctors on an equal confidentiality and human rights footing – with every other breathing human in Australia. This threat will continue to deny doctors who have professionally harmed no one, except themselves effective treatment.

  3. Anonymous says:

    It has been made quite clear that our mental health professionals might accede to our comfort and not verbally impose mental health labels on their colleague-patient who feels that their difficulties are sociological: Doctors who just feel it would help with debreifing these merely for objectivity.
    However some such accede that this is not what they will anonate in their files.
    That means that any doctor who short or long term finds themselves sociologically isolated might not reach for help.
    I have known one doctor to indicate that they would suspend their registration, try and resolve their sociological predicament and then reregister to ensure that something like that cannot occur.

  4. Anonymous says:

    This is a terrific resource..even though it may be naive at least it’s a start in the right direction to assist our profession stay well. Doctors are completely useless at looking after themselves so ANYTHING that can at least make it a teeny weeny bit easier to get help will help in the long run…we just need to keep chipping away at all the entrenched discrimination about “mental” problems (yes we are all “mental” to some degree! If you say you aren’t you are in denial) so that we don’t keep topping ourselves off when the going gets tough. A good GP is better than a good friend or corridor consult with a colleague because at least they may keep your business confidential.

  5. Ray T says:

    On the few occasions when I have needed medical treatment I have either referred myself to the private specialist of my choice, or researched the practitioners and if still uncertain of the ideal choice, discussed the choice among them with my GP – a GP I have chosen for myself too.

  6. Anonymous says:

    When I last had contact with the Tribunal there seemed to be no appreciation that depression is a normal reaction to chronic pain and to bereavement or the threat of bereavement, whether of spouse or offspring, or career, or marriage, in anyone of a bipolar reaction type even when they do not have bipolar disease.

  7. Anonymous says:

    For me the elephant in the room, is this is a full fee paying service, why can’t I go to a corporate and get bulk billed?

  8. Horst Herb says:

    Brave but naive article in this day and age of mandatory reporting and lack of protection of confidentiality of medical records.
    For that reason, should I ever need medical services myself, I would definitely go overseas where I can trust that my details will remain confidential and not “mandatory reported” to the Grand Inquisition.

  9. Peter Bradley says:

    What a good idea – well done South Australia. All State Govts take notice.

  10. Dr Mike says:

    I wonder how many large hospitals with over, say, 100 doctors and many more nurses still fail to provide for a “staff” doctor to whom all staff can go to with the assurance of confidentiality?

  11. Beris Konetschnik says:

    Couldn’t agree more. “Specific training in doctors’ health by interested doctors” sounds great. Tasmania needs this as well.

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