Physician – care for thine own health
BY PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR, PUBLIC HEALTH, UNIVERSITY OF SYDNEY
The suicides of several young doctors recently have activated concerned discussion about how to do better in preserving and protecting the health of caring professionals. If there were a simple solution it would have been applied decades ago.
It is not only mental health that is a concern, complicated by illicit drug use or not, identity crisis or relationship upheavals. Doctors’ health more generally is a worry. That such is the case is clear testimony to the insufficiency of knowledge about health and illness alone to empower the individual to choose wisely.
Recently I spent 10 days in a Sydney teaching hospital receiving intravenous antibiotics for a nasty episode – my first – of diverticulitis. The literary genre of ‘I am a doctor and I got sick and I will tell you all about it’ contains the occasional interesting account but much dross, so I won’t bang on about my experience. But reflecting on my illness confirms insights. I doubt that I took action soon enough and instead used symptom-denial and fantasy to justify delay. It was lucky I did not have an enteric rupture.
I discussed this experience with my friend Peter Arnold, a retired general practitioner who has served on boards and committees concerned with doctors’ health and impairment. Writing in Australian Medicine in 1997, Dr Arnold put the proposition that every doctor should have their own general practitioner.
“Despite regular advice to this effect to the profession at large, from bodies concerned with doctors’ health, it is patently difficult for doctors to accept another doctor as their GP. It is, of course, more difficult for doctors in small towns, but, in an age of modern telecommunications [to which may now be added Skype] and air travel, it is possible to have a one-to-one relationship with a GP, distance notwithstanding.”
Why does this not happen? Arnold advanced several reasons derived from his experience with doctors who were impaired or ill. A fear of ridicule if the ailing doctor’s own diagnosis is wrong, a denial of the import of symptoms (I can identify with that one), a loss of ‘doctor authority’ as one becomes a patient, the question as to whether one doctor can trust another who may not be as expert, making an appointment and sitting in the waiting room, and concerns about the confidentiality of my record in a group practice.
“Each of the reasons has some validity,” Arnold wrote. “Added together, they constitute a formidable obstacle to having your own GP. But against this, the downside must be considered carefully.
“By not having a GP, you leave yourself open to a lack of preventive care, missing the onset of insidious illness and the opportunity of early intervention, objective assessment and appropriate management of your problems, psychological support when under stress and all the other ‘good things’ about having that continuing, monitoring relationship with a GP which makes you recommend them to all your patients.
“If there is one universal piece of advice which we give to doctors presenting with problems at the NSW Medical Board, it is: ‘Get yourself a GP’.”
I was embarrassed, when I fronted up to my GP with my discharge papers in hand, to realise how irregularly I had attended. Was my most recent colonoscopy five years ago? “Actually seven!” I was told politely. The list of meds in my record was wildly out of date.
A further barrier to seeking medical assistance for our own ills has been the requirement for mandatory reporting of impairment. This is a two-edged sword, the self-destructive edge being that it may prevent doctors from seeking necessary care because of fear. Recent changes to the law have diminished this problem and Minister Greg Hunt is taking positive action,
Another trick I used when ill was an imaginative reinterpretation of my symptoms that I think owed more to my interest in poetry than in rational prose! In retrospect I was surprised that I could have spun such a confected set of interpretations around apparently minor bodily dysfunctions. In reality they weren’t! I swear that I will not fall into this trap again – but then…
The message is clear. Don’t treat your family and don’t treat yourself. When it comes to your own health seek external interpretation and treatment, preferably from a practitioner who knows you well. Try your GP.