Doctors' physical health ignored

THE pendulum may have swung too far towards emphasising mental health issues and unsafe working hours for doctors to the detriment of their physical health, says a leading medical defence adviser.

Dr Sara Bird, manager of medicolegal and advisory services at MDA National, said the impact of physical illness, particularly acute illness, on doctors and their ability to work was often overlooked or not considered as important as mental health problems.

Dr Margaret Kay, a senior lecturer in the discipline of general practice at the University of Queensland, agrees, saying that some doctors will have mental health issues but probably all at some time will suffer with a significant upper respiratory tract infection (URTI) or other physical health issue.

Dr Kay, who is currently completing a PhD into doctors’ health, said medical educators currently teach about doctors’ health issues with a focus on impairment and mental health. This contributed to  junior doctors’ reluctance to address their physical illness and often made them unwilling to take a day off when they were ill.

“Doctors’ health needs to be considered from a broader focus than [impairment and mental health]”, Dr Kay said.

Dr Bird said it did not help that most doctors treated physical illness with a sense of bravado — an attitude that was often passed onto junior doctors.

AMA president Dr Steve Hambleton said doctors had a professional obligation not to expose patients and colleagues to infection if they were ill.

“We tell patients to stay at home when they have the flu so they don’t infect us and our other patients, and the same should apply to doctors”, Dr Hambleton said.

The comments follow the publication of a research letter in Archives of Internal Medicine on presenteeism — working while ill — among physicians. (1)

A survey of 150 residents found that among those who chose to work when sick, the reasons most frequently given were an obligation to colleagues (57%), an obligation to patient care (56%) and fear that colleagues would think they were weak (12%).

An editor’s note on the research said that working while sick might demonstrate an admirable sense of responsibility to patients and colleagues, but doctors should worry about the real danger of infecting vulnerable patients as well as colleagues and staff. (2)

Dr Bird said a professional obligation not to work when ill was clearly laid out in the Medical Board of Australia’s code of conduct. It stated that doctors should not rely on their own assessment if “you know or suspect that you have a health condition or impairment that could adversely affect your judgment, performance or your patient’s health”. (3)

She said the code made it clear by referring to “health condition” that it was not just referring to mental health issues, and doctors should not be working when ill if it could adversely affect their patients' health.

Dr Kay said doctors had a responsibility to “first do no harm”, although the difficulty was to determine the harm that could be done if a doctor had an URTI.

She said while all workplaces should have appropriate backup systems to enable a sick doctor to take time off, most places had very little capacity to offer support to doctors when they were ill, forcing doctors to decide whether the risk of attending work was greater than the risk of creating a staff shortage.

This was particularly unfair on junior doctors who could not be expected to be across all the issues to make such a judgement. “The person making this decision is also unwell and acculturated through years of medical school to soldier on”, Dr Kay said.

“Education around managing these issues in a holistic manner is important. When focusing on training issues, mentoring of healthy behaviours is equally important because most doctors learn their health behaviours through the hidden curriculum.

“Medical schools should ensure that doctors who teach junior doctors and students are aware of the importance of their personal health behaviours in their mentoring.”

Dr Kay said the issue highlighted the need for all doctors to have their own GP.

However, she said if doctors could not take time off to see their GP when they were ill, they could have the best GP but fail to benefit from this.

“Workplace interventions need to support doctors in maintaining their health”, she said.

- Kath Ryan

1. Arch Intern Med 2012; Online 18 June
2. Arch Intern Med 2012; Online 18 June
3. Medical Board of Australia: Good medical practice: A code of conduct for doctors in Australia

Posted 25 June 2012