16 August 2021

Physician, please don’t heal thyself

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Consider these two scenarios.

Dr A is a 27-year-old junior doctor who relocated to work in a small rural town a little over 12 months ago. She has established her own general practice surgery though she does not yet have a Fellowship.

She works largely independently, with little support or collegiality from her medical superintendent, who works in another GP surgery in the town.

Dr A develops intermittent abdominal pain, diarrhoea and night sweats. She lets it go for weeks and weeks because she has no one she feels comfortable confiding in.

Eventually, she reluctantly concedes to make an appointment, as a patient, with her supervisor. She sits in the waiting room for her appointment, face burning, the subject of scrutiny of other patients that she has herself treated in the past. After her appointment she leaves conspicuously with a stool jar in her hand – another indignity – to deliver a freshly collected specimen to the local pathology agent.

She feels humiliated by the experience and wonders whether she should have bypassed the appointment and ordered her own specimen for the lab. It turns out she shouldn’t have eaten that chicken that she knew was a little pink on the inside.

Dr B is a 39-year-old senior doctor who works in a busy tertiary hospital. She has a young family and a regular GP, whose knowledge of current evidence has always impressed her.

She has been subject to significant workplace stressors for the preceding months and it has started to affect her sleep and mood. Additionally, she has been experiencing an infernal itch in both her ear canals that she has been treating with steroid cream on a cotton bud, even though she remembers a lecturer advising “never put anything smaller than your elbow in your ear”.

Realising that she will never, ever be able to examine her own auditory canals, she concedes defeat and makes an appointment with her GP to have them looked at.

As she takes a seat in her GP’s office, her doctor states: “You look like sh*t. What’s going on?”

It is cathartic to finally admit how she is struggling to cope with the stress. Her journey back to psychological health begins. The GP also examines her ears, prescribes some steroid drops and gives a stern warning to stop using cotton buds immediately.

Two very different experiences describing doctors seeing doctors; doctors taking the courageous step admitting that they need help.

These stories are close to my heart because they are both mine.

Doctors make lousy patients. The Doctors’ Health Advisory Service estimates that 40-50% of doctors do not have their own GP. Doctors failing to look after themselves could almost be considered negligent, because there is clear evidence that doctors’ health contributes to the quality of the clinical care they provide. Doctors also frequently display dysfunctional sickness behaviour and work while unwell so as to not burden their colleagues who are left to pick up the slack. Perhaps one silver lining of the covid-19 pandemic is that medical staff have been forced to refrain from working with at least the respiratory conditions they would previously have tolerated at work.

Whilst AHPRA does not mandate that physicians retain their own GP as a registration requirement, the Australian Medical Board Code of Conduct states that “good medical practice includes having your own GP and seeking independent, objective advice when you need medical care”.

Additionally, the World Medical Organisation updated the Declaration of Geneva in 2017 and requests physicians to pledge “I WILL ATTEND TO my own health, wellbeing and abilities in order to provide care of the highest standard”.

Why don’t doctors seek help?

There are many barriers for physicians seeking medical or psychological care. These include embarrassment or shame about their condition, fear of a breach of confidentiality or being seen as weak, and access to medical services limited by either working hours or geography – the latter was certainly the case in my rural experience.

Significantly, misunderstanding the mandatory reporting requirements for mental health conditions acts as a major help-seeking impediment for doctors suffering with these issues.

Many doctors seek informal corridor consultations, which are replete with incomplete information, inadequate examination and a dearth of record keeping. These days, a new phenomenon of social media consultations has emerged, with virtual advice being sought on a daily basis on medical practitioner pages.

What does this mean for doctor-patients? Diagnoses can be delayed or inappropriately managed’ subtle subplots missed altogether. Had I sought a corridor consultation for my irritating ear dilemma, my underlying stressors may not have been revealed, putting not only my health, but that of my patients, at risk.

How can we help doctors to seek care?

Perhaps it could be argued that AHPRA needs to mandate that all doctors name a responsible GP. However, the evidence from the United Kingdom, where everyone is required to have a named GP, shows that 96% of doctors DO have a GP yet little use is made of their services. Perhaps in addition to a named GP, a mandatory annual visit might provide a ticket of entry for physicians who might not otherwise seek independent, objective care.

Dr Elin Olaug Rosvold, Pro-Dean of Medical Studies at the University of Oslo, suggests physicians consider the following questions when they are feeling ill:

Am I uncertain about what my symptoms might represent?

Am I deep inside afraid that I am seriously ill?

Do I explain away my symptoms?

Do I need medical tests or examinations?

Do I need prescription drugs?

Do I need to discuss my case with another physician?

Is my spouse or are my friends worried about my health?

If you answer “Yes” to at least one of these questions, you should make a formal appointment with your personal physician.

Another component to increase physician confidence in seeking care might be building trust in the knowledge that the doctor from whom care is sought is cognisant of the potential challenges in a doctor-doctor clinical relationship. Drs4drs is an Australian service funded by the Medical Board that exists to “help doctors and medical students stay healthy”. Their module “A Healthy Medical Profession – Caring for Ourselves and our Colleagues” is a thorough, easy-to-navigate learning tool aimed at helping clinicians to “be a doctor for doctors”.   

I feel so strongly about doctors having their own doctors. My GP has been my saving grace on more than one occasion. So grateful was I, that last year I nominated her for the RACGP GP of the Year award. And she won. Rightly so.

Dr Bethany Boulton is an emergency physician and founding member of WRaP EM (Wellness, Resilience and Performance in Emergency Medicine)

Image by Thomas Hawk, flickr.com

References

  1. Wallace, J., Lemaire, J., & Ghali, W. (2009). Physician wellness: a missing quality indicator. The Lancet374(9702), 1714-1721. doi: 10.1016/s0140-6736(09)61424-0
  2. Doctors’ Health Services: Log in to the site. (2021). Retrieved 6 August 2021, from https://training.drs4drs.com.au/
  3. Forsythe, M., Calnan, M., & Wall, B. (1999). Doctors as patients: postal survey examining consultants and general practitioners adherence to guidelines. BMJ319(7210), 605-608. doi: 10.1136/bmj.319.7210.605
  4. Doctor, Don’t Treat Thyself. (2021). Retrieved 6 August 2021, from https://psnet.ahrq.gov/web-mm/doctor-dont-treat-thyself#table

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4 Comments on "Physician, please don’t heal thyself"

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Adrian Sheen
Guest
3 months 12 days ago
The Mandatory Reporting requirements are easy to be “misunderstood” given that they are 37 pages long. In Western Australian they are lucky enough to have their own solution to the issue which should be adopted nationwide. As a family doctor with a practice 40 years old which is to be knocked down by the Berejklian Government I am fully aware of the stress that doctors live with daily. If it is not dealing with the depressed, the dying, the demented and the diseased, then it is peddling hard to keep everything afloat. Add to that mix, a phone call from… Read more »
Dr Frank McLeod
Guest
Dr Frank McLeod
3 months 13 days ago

I don’t think too many of us have issues seeking help when symptomatic. I suspect many feel like I do – a lack of enthusiasm about seeking a GP for ‘preventive maintenance’ when asymptomatic. That’s the bit I find very difficult. Being somewhat of a coward, when I was working in General Practice, one of the doctors in that group, whom I greatly admired, asked me to be her GP but I demurred. A doctor certainly doesn’t do another doctor a favour when claiming that person for their GP. It might be a compliment, but a favour – it ain’t!

Kate
Guest
Kate
3 months 13 days ago

Is there any research to back this up? Any evidence base? I know it’s received wisdom that one should have a GP but in this day and age is that good enough?

Shannon
Guest
Shannon
3 months 21 hours ago

Obviously no overwhelming pile of EBM, but maybe some questions of ethics don’t require evidence… or maybe that’s the consensus. I know the insecure part of me wouldn’t want another GP as my patient, but I think that comes from a selfish, self protective part of me rather than a helpful place

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