Doctor's orders

Amanda Bryan
Med J Aust
Published online: 3 September 2012

Healthy doctors have healthy patients — and ultimately a healthier bottom line

If you want to improve the health of your practice, visit a general practitioner on a regular basis and encourage your colleagues to do the same, doctors’ health experts say.

The idea isn’t exactly new. The professional colleges and medical boards have been beating this drum for years.

The premise is sound though: doctors have the same risk of chronic illness and need for preventive health screening as the rest of the population.

But only half have taken the advice and found a regular doctor, according to estimates by South Australia’s Doctors’ Health Advisory Service.

Even when doctors take the plunge, the doctor−patient relationship can often be strained — and this comes at a price.

Dr Patrick Tan, president of the Doctors’ Health Advisory Service (NSW), says if a doctor’s health isn’t managed properly, it may have a negative impact on his or her performance in providing good care to patients and in generating income.

“We know patients who have been unwell for some time do fall into financial difficulty and doctors are no different”, he says.

“We often refer doctors [with health problems] to the Medical Benevolent Association of NSW for assistance.”

In fact, physical illnesses have almost taken over from mental health problems as the most common source of financial hardship in those approaching the Association for help, says its social worker, Mrs Meredith McVey.

“We’ve been approached by some doctors with distressing and complicated diseases recently”, she says.

Dr Margaret Kay, a senior lecturer in the discipline of general practice at the University of Queensland, who has done a PhD on doctors’ health, has noticed a change.

Although much of the focus in the past has been on the mental rigours of the profession, Dr Kay says the small amount of data available suggests that doctors’ physical health issues are a bigger problem.

“Further investigation is needed to clarify these issues”, she says.

So when should you see a GP?

Dr Kay suggests you find a doctor while you are healthy. That way, if you become ill, you know you have the right person coordinating your care and you can get the right screening tests for your age and sex, just like the rest of the population.

Another advantage of having a regular GP is that you will have your medical history recorded.

A lot of doctors don’t have a medical record or health summary, says Dr Roger Sexton, medical director of Doctors’ Health South Australia.

“A good practice is to write down your own health summary, including your history, your family history and your medications — all those things you do for your patients — and then take it to another doctor. Things stand out when you do that”, he says.

While self-care gets a bad rap, Dr Sexton says it is okay in some circumstances, such as with a sore throat or a minor chest infection where there is no real risk.

However, he says some problems can be hard to recognise in oneself, such as feelings of being overworked, flat or easily overwhelmed, which may be early signs of burnout, stress or underlying illness.

“If you want to perform at your best, an independent medical opinion is a great start and it’s even better if you can build it into life so you have a regular and ongoing review”, Dr Sexton says.

Instead, a natural tendency for doctors is to consult medical family members or colleagues in “corridor consultations”, which are not thorough.

“The history is inadequate, the examination is inadequate, there is no note-taking, and they are not done in a fully professional way”, Dr Sexton says. “They tend to be cursory, a bit dismissive and they can trivialise a problem.”

Dr Kay suggests that if you are on the receiving end of a corridor consultation, bear in mind that it’s a normal impulse.

“Don’t tell the doctor what to take or arrange a chest x-ray. Instead say, ‘go to a doctor, because I do’ ”, she advises.

Dr Lindy Roberts, president of the Australian and New Zealand College of Anaesthetists, says the college’s stance is clear: doctors should not take on a therapeutic role with colleagues. Instead, they should advise them to consult a GP and other specialists trained to deal with these issues.

“As anaesthetists, we recognise we need to seek help from those who have specialised skills in dealing with doctors’ health”, she says.

Dr John Quinn, executive director for surgical affairs at the Royal Australasian College of Surgeons, says it becomes even more important for doctors to have their own doctor as they get older.

“That’s when surgeons need a doctor to check and treat their hearing, eyesight or hypertension and to provide guidance. These surgeons may think they are doing well, but they might not be”, he says.

How do you find the right doctor?

The ideal doctor has three key traits: great medical skills, a consulting-room manner that suits you, and experience in treating doctors.

Unless doctors are trained in treating colleagues, Dr Kay says, there can be mutual awkwardness on both sides during the consultation.

Without training, unusual things may happen. “We panic and we don’t do the normal stuff”, she says.

“Also, we don’t tell them to come back. We therefore never get the opportunity to make a relationship.”

However, she notes that doctors really want what the rest of the patient population wants: a patient-centred, shared decision-making model of care.

For those wanting to track down a doctor with experience in treating doctors, a starting point is the Doctors’ Health Advisory Service in your state, the Victorian Doctors Health Program, or Colleague of First Contact in Western Australia.

These services are staffed by GPs who are trained to care for colleagues. They can refer callers to experienced medical professionals or other sources of help.

The Royal Australian College of General Practitioners (RACGP) runs a program called GPs for Doctors, which operates through Divisions of General Practice. The RACGP also has lists of GPs who are experienced in treating other doctors and has a free GP support program that allows its members to access professional advice.

The state-based Medical Benevolent Associations provide social and financial assistance to medical students and doctors who are impaired or unwell.

In Adelaide, doctors can attend a clinic that caters specifically to doctors. It is staffed with GPs who have been trained in providing treatment to fellow doctors (see box).

Moves are also afoot to boost the number of doctors who are trained in this way.

The Doctors’ Health Advisory Service (NSW), with the help of the AMA and the RACGP, has kicked off a learning program called Caring for Colleagues (see box).

Dr Kay believes all doctors need the skills these programs offer.

“The reality is that the average doctor needs to be trained to do this in medical school — and I do that when I teach”, she says.

Meanwhile, Dr Kay says senior doctors can help promote a culture that encourages medical colleagues to see a doctor.

“They could for instance say to junior colleague: ‘sorry I’m 5 minutes late, I’ve been to the doctor’”, she suggests.

Tailoring training

The Doctors’ Health Advisory Service (NSW) has created a course to train doctors how best to care for other doctors.

The Caring for Colleagues pilot program, which kicks off next month, will also prepare doctors to be better patients, says the president of the service, Dr Patrick Tan.

Topics will include doctors’ health behaviours, mental health issues, dependency on alcohol and other drugs, self-harm and barriers to seeking health care. The course consists of two seminars plus a home-study exercise. GPs who complete it can claim Category 1 RACGP continuing professional development points.

Looking after their own

In May this year, a new medical clinic with a difference opened on the fringe of Adelaide’s central business district. This practice operates after hours and its patients are doctors.

The clinic operates 2 nights a week and on Saturdays. Doctors can make online bookings to suit their schedules.

It is staffed by 13 accredited GPs who share the roster, with plans to expand the number of GPs, says Dr Roger Sexton, who works in the clinic and is medical director of Doctors’ Health South Australia.

“The emphasis is on check-ups. We get doctors to complete a detailed history that forms the basis of a good discussion about their health. From there we can work out a plan”, he says.

Dr Sexton says the service emphasises professionalism and confidentiality, and has been well received by doctors who have attended.

The next step is to build a network of specialists who understand the needs of doctors, he says.

  • Amanda Bryan



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