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  • How to be a better patient

    One of the greatest threats to doctors’ health is a reluctance to visit a doctor. Although the focus on doctors having regular contact with a GP is increasingly being promoted as both personally and professionally important, barriers remain. Here, two experts discuss why it is crucial doctors look to overcome them.

     

    A story of role reversal

    The healthy, 50-something Queensland GP decided to do the right thing and find his own doctor. After months of searching, he selected a GP outside his practice that he thought would fit the bill. He took the afternoon off work and chose a good book to read so he wouldn’t get stressed in the waiting room, and was feeling good about his choice as the treating doctor invited him into the surgery.

    Without thinking, the patient-doctor sat down in the treating doctor’s chair. “Er, you might be more comfortable over there,” the treating GP smiled, and despite the patient’s mortification their therapeutic relationship was off to a good start.

    A serious threat

    The patient-doctor’s embarrassment epitomises one of the most serious threats to doctors’ wellbeing – their reluctance or inability to negotiate a consultation with another doctor, says Dr Margaret Kay, Secretary of the Doctors’ Health Advisory Service Queensland.

    “We are [also] less likely to go to the doctor with something that is trivial,” Dr Kay says. “The key difference between doctors and the general population is health access.”

    Special physical health risks

    Doctors’ physical health is generally good due to their high level of health literacy and lower engagement in risky lifestyle behaviours such as smoking[1]. However, there are threats to doctors’ physical wellbeing inherent in the practice of medicine.

    These risks include exposure to infectious diseases, especially tuberculosis and influenza, accidental needle-stick injuries and exposure to unsafe levels of radiation and chemicals[2].

    Shift work, working long hours and isolation in rural and remote areas have also been shown to pose health risks[3].

    Despite the need for careful monitoring and regular assessment, half of doctors are self-referring and many are self-treating for acute and chronic conditions, according to a survey conducted by the Doctors Health Working Group, South Australia. The 2007 survey showed that doctors are self-treating even if they have their own GP, while other literature shows that prescription drug use is more frequent among doctors than in the general public[3,4].

    Self-treatment

    Self-treatment can be chaotic and poorly documented and doctors are notorious for failing to finish courses of antibiotics, for taking medicines piecemeal out of the cupboard, and for using medications prescribed to their families, says Dr Kay.

    “We are less likely to go to the doctor with something that is trivial – that’s not necessarily a bad thing, but it might mean the relationship isn’t built because we go less often.”

    Hurdles to jump

    Dr Kay’s research has shown that treatment barriers exist because of the patient-doctor’s embarrassment, a sense that to admit ill health is to admit weakness, concern over lack of confidentiality, fear of mandatory reporting and an expectation within the profession that doctors will keep on working even while they are unwell[1].

    The recent Beyondblue National Mental Health Survey of Doctors and Medical Students have backed her concerns in relation to mental health issues. It found that, when it comes to seeing a doctor about a mental health problem, 37.4% of the 40,000 doctors and 6,600 medical students surveyed identified embarrassment as a barrier to help seeking. Concerns about privacy and confidentiality and risks to registration were also ranked high as barriers to treatment[5].

    “We are measuring ourselves against the model learned in medical school of the ideal patient, who walks in and walks out without asking any questions. But sometimes doctors don’t understand it’s not being a bad patient if you ask whether you have a brain tumour,” Dr Kay says.

    Consultations can also be fraught for the treating doctor, especially if the doctor-patient doesn’t believe he or she is practising good medicine or if the treating doctor doesn’t feel he or she has total control, says Dr Kay.

    Even whether to charge the doctor-patient is an issue that needs to be negotiated to prevent discomfort.

    “Doctors do access care differently. For example, their GP might tell them to see a surgeon but then not go on to organise things for them as they would another patient. Follow-up is often missed and patient-centered care is not always done when the patient is a doctor,” Dr Kay says.

    A proactive approach

    Dr Stephen Jelbart, whose Melbourne practice, Medical Services Australia, treats a number of doctors as patients, says one of the most significant threats to doctors’ physical health is a lack of time to exercise, eat well and to visit the doctor himself or herself.

    “Doctors really just need to take a proactive approach to their personal lifestyle management – it’s a matter of biting the bullet, getting out of bed early and going for a walk,” he says. It’s not just doctors’ health that will benefit – it’s the health of the whole community[6].


     
     

    Cautionary Tale

    Tips

     

    Maintaining better health – be proactive

    • Have a good General Practitioner and see them regularly– avoid treating yourself
    • Take regular leave – plan it annually
    • Have a life outside medicine
    • Find a mentor you trust and respect
    • Ensure you have a support network
    • Make an effort to ensure you have regular sleep, exercise and a healthy diet
    • Look after your colleagues
    • Debrief after significant events
    • Focus on having good time management
    • Know there is help out there if you need it
     

    References
    1. Kay M et al. Developing a framework for understanding doctors’ health access: a qualitative study of Australian GPs. Australian Journal of Primary Health 2011; 18: 158–165.
    2. Royal Australasian College of Physicians. Health of Doctors Position Statement. Royal Australasian College of Physicians: Sydney, 2013.
    3. The health and wellbeing of doctors and medical students, Australian Medical Association, 2011.
    4. Doctors Health Working Group, South Australia survey, 2007.
    5. National Mental Health Survey of Doctors and Medical Students. (2013). beyondblue.
    6. Kay M, et al. Developing a framework for understanding doctors’ health access: a qualitative study of Australian GPs. Australian Journal of Primary Health 2011; 18: 158–165.