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MANY doctors would be familiar with Francis Peabody’s statement that “the secret of the care of the patient is in caring for the patient”.
In his landmark article, Peabody provides an authoritative voice that cautions us to remember the importance of the art of medicine. However, you may not be aware that when Peabody wrote these words, he was at the peak of his career in his early 40s and terminally ill.
It is interesting to consider how our personal experiences with health problems influence our delivery of patient care. There are anecdotes of doctors who find themselves with a significant illness describing it as crossing the thin red line or crossing a river.
Our biomedical perspective encourages doctors to visualise these issues through a Cartesian lens in which a person can only be a doctor or a patient; either healthy or sick. Yet, the doctor–patient embodies both concepts in one.
When perusing the medical journals it is clear why a doctor might prefer not to be labelled as “sick”. The term “sick doctor” is regularly used as a euphemism for the doctor who suffers with a mental health problem and who is often described a “problem doctor” or “wayward doctor”. It would appear to be “safer” to simply not cross that line in the first place.
When doctors do seek medical care, there can be awkwardness within the medical encounter when both doctor and patient are doctors.
There is a belief (though little evidence) that doctors make bad patients. Exploring the concept of what makes a good patient, the authors of a BMJ article described what a good patient was in this postmodern age, and the description would fit well with most doctors.
Similarly, few articles describe how to deliver care to the doctor‒patient, but those that do appear to advocate a Parsonian model of care, in which the doctor‒patient adopts the sick role. This model is not likely to result in the delivery of good care, nor is it likely to suit most doctors.
In recent years, a number of medical colleges and professional organisations have stated their commitment to the health of the profession. These steps are vital in enhancing the positive culture towards a healthier profession but there is still much more work to be done.
Currently, many of the educational sessions for doctors focus on the importance of a positive work‒life balance and the need to seek medical care for illness. While the individual focus is important, there is a need to consider the whole system that needs to be in place to support this.
Reducing doctors’ working hours may enable a doctor time to go to the doctor, but it is simplistic to think that this will happen unless other cultural issues are addressed. These include the stigma associated with illness, especially when doctors have mental health problems.
Good systems need to be in place to enable doctors to take time off when they are unwell without burdening their team or damaging their career prospects. Providing doctors with clear return-to-work pathways when they have been off work for a long period of time are also essential.
It is time to develop a clear evidence base for understanding the health of doctors (and of all health professionals). It is time to question the myths of the “wounded healer” and the assumptions we make about how best to manage these issues.
Developing this evidence requires a space to meet and share our knowledge. The Health Professionals Health Conference 2013, to be held in Brisbane next month, offers this opportunity to take purposeful steps towards a healthier future for the medical profession.
Dr Margaret Kay is the chair of the Health Professionals Health Conference and is a GP in Brisbane, honorary secretary of the Doctors’ Health Advisory Service (Queensland) and a senior lecturer at the University of Queensland.
I have worked at a busy regional centre as Obs/Gyn for 7 yrs. More then 1500 deliveries and lots of referrals from more remote areas. Only 3 Obs/Gyn but 2012, one of us, the Director went into private practice.He reduced his hrs to one day a wk for day time hrs so we slogged between the two of us many times going to the management that we better start recruiting for it is not easy to get doctors in regional hospitals.To make matters worse, the director wanted to hold on to the position and seeing me as his only threat he tried to humiliate and bully me. Finally I got strong and asked the mangement for a reason for such apalling behaviour – my 2nd night mare began – Obs/Gyn is well known for unpredictable, long hrs , unforeseen complications and they started witch hunting now, focusing and magnifying any complications. The front line staff ( midwives, nurses, junior doctors) and patients all like me but the onslaught by this so called powerful group is too much for me to bear.
What a wonderfully logical, sympathetic and empethatic article and responses. As one whose husband has been helped by the DHAS, promptly,confidentially and marvelously I hope there are more “out there” like you as I havre met plenty of “bullies” about other colleagues’ health issues.
I wonder how much tension, anxiety and burnout is directly related to the dissonance between wanting to do a good job and struggling under constrained circumstances. In general, medical practitioners are high achievers, with a strong sense of responsibility and a reasonable scattering of obsessive-compulsive features. This can lead to taking on too mcuh responsibility, but suffering in the face of not being able to do the job to one’s satisfaction – due to external factors. The only resolution can be to either disengage, or to implode. These issues must be magnified for the rural/remote practitioner, like the examples we have read in other posts. Workforce planning must be about all these issues – not just numbers.
As a first year GP registrar I suffered with generalised anxiety disorder luckily I had put some effort into choosing my basic term practice and my supervisor was a GP supervisor of the year. Thanks to the rapport we had developed I was brave enough to go to him and let him know that I was not coping. He was experienced enough to know that what I needed was help organising a doctor and psychologist who were comfortable working with a doctor patient but were not direct colleagues to minimise any perceived or actual stigma. With the support of my doctor, psychologist and gp training advisor (my medical family) and my non-medical family and friends I was brave enough to tell I am well on my way to recovery/ remission and have with much trepidation enrolled to sit my osce exam this semester. Whilst I am not quite yet able to say I am glad I have GAD I can say it has made me much more understanding of my patients
If you have ever gone the extra mile to help a colleague or patient I would just like to say thank you.
And if you think you might be the. GP supervisor you are probably correct
I can only agree with the issues expressed by the Obtetrician above. The person writing this article seems to have no insight into the difficulties rural doctors face often. I well remember the slog of being available 168 hours straight each second week for 12 years; and being guaranteed sleep-deprivation for 36 hours solid twice in that time. In frustration, I asked a lawyer at a medico-legal seminar to nominate a duration of sleep deprivation whereupon it would be legal not to attend an emergency. Blithely, I was told that I would be sued for non-attendance; and that if extra tired, there would be some consideration to limiting the sentence (in the event of a problematic outcome)!!!! It’s cute and lacking in credibility to have someone talk about getting the correct mix if one can be sued so readily!!
My partner had been working for the same rural victorian hospital for almost 10 years as the sole O&G specialist. He was employed Monday to friday and paid as such. In 10 years he was never paid any overtime for the hundreds of out of hours that he did during the night, weekends and public holidays. In total, he took about one month of annual leave in 10 yrs. He asked for the hospital to organise a locum so he could have a decent holiday, but was later told that it would be far too expensive, so he would take a few days off between patients due dates. I remember once he was called out at 12 midnight to do a caesaer, returned home at 2.00am, only to get up at 5.00am to start driving 2hrs north to do a theatre list. Eventually, after a family crisis, he had a breakdown. In his 10 years he had never taken any of his sick leave and had accrued four months of paid leave. Instead of been allowed to take this, he was forced to resign and was reported to AHPRA as “a danger to patients”. He took 4 months off (self funded) and then recommenced work. It is interesting to note, that even now the stigma of what happened is used by other doctors to belittle and humiliate him at times. I have been appalled by the way colleagues have shown up as good old fashioned “bullies” even though we are in 2013