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.