Your health is important

  1. Doctor Roger Sexton, Board Director of Australian medical indemnity insurer MIGA, Chair of its Risk Management Committee and Medical Director of Doctors’ Health SA (DHSA)
  2. Doctors' Health SA Survey data (2008)

Eighty-seven percent of Australians have a general practitioner, but only 50% of Australian doctors have one, with surgeons being the least likely to have a GP²

Eighty-seven percent of Australians have a general practitioner, but only 50% of Australian doctors have one, with surgeons being the least likely to have a GP2.

The Medical Board of Australia has sought to reduce the incidence of health-related complaints by making substantial funds available from medical registration fees to independent local, state and territory doctors’ health service providers. These providers will offer educational and clinical support, in addition to the phone advisory services already in place for doctors and medical students.

This investment can assist in leveraging the capital and human resources within the profession for the common good, especially if there are complimentary efforts by medical defence organisations.

MIGA, as a leading provider of risk management education to the doctors, students, midwives and healthcare entities that insure with MIGA have significant resources available to assist and promote the wellbeing of doctors.1

Why doctors avoid the doctor

  1. Kay M, Mitchell G, et al. What doctors want? A consultation method when the patient is a doctor. Aust J Prim Health 16(1): 52-59, March 2010 View Link
  2. Clode D. The conspiracy of silence: Emotional health among medical practitioners. Royal Australian College of General Practitioners, (RACGP), October 2008

We understand two basic precepts that “prevention is better than cure” and patients will be healthier if they have their own doctor. While these are sound value propositions, doctors can be reluctant to apply them to their own personal circumstances.

There are many factors that contribute to this mindset, including the following perceptions:

  • The competitive culture of medicine
  • Fear of discovery and its consequences
  • Hostile, competitive working environments
  • Career jeopardy
  • Unsatisfactory doctor-doctor consultations that are not patient-centric1
  • Long working hours and consequent lack of time
  • Convenience and privacy of self-treatment
  • Poor recognition of illness in oneself
  • Reluctance to assist an unwell colleague
  • Lack of income protection insurance
  • The occupational health risks of drugs in the workplace
  • A view of a mandatory notification as a catastrophe and career-ending event2.

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A case in point


“Well, confidentiality is a big issue. It seems that if you are a doctor with an illness, its news for the medical grapevine. I’ve had my confidentiality breached repeatedly by the staff at my GP’s office, and even worse at the pharmacy where the word is non-existent. I remember being in a private hospital heading to the nurses’ station and they’ve got me down on the inpatient board as “doctor”. What’s worse is that a senior clinician who is not even treating me was going through my case notes. The most important thing is that we need to find a doctor who we can trust and keep our details confidential. That’s the most important thing”

Source: Doctors' Health SA © (Provided with permission) This video was produced by DHSA as part of two Rural Health Continuing Education Grant projects in 2014 and 2015, funded by the Australian Government.

How unwell doctors behave

  1. Clode D. ibid
  2. The Big Build: Hidden depression in men Brownhill S, Wilhelm K. Aust N Z J Psychiatry. 2005 Oct;39(10):921-31

Perceived barriers to having a personal doctor can encourage a whole spectrum of help-seeking behaviour, ranging from risky self-treatment for everything on the one hand, to formal consultations with the family GP on the other. Doctors commonly opt for a blend of the two.¹

Doctors may be reluctant to access formal health care to avoid the “waiting room experience” and the significance of taking time out during business hours to attend a consultation.

It is not surprising to find that a busy doctor has opted to take a drug sample for an incorrectly self-diagnosed problem and then proceeded to hastily run it past a polite or dismissive or disinterested colleague in the corridor!

Another example is of the doctor who, instead of visiting her GP for a repeat prescription, has concerns about being “the doctor in the waiting room” and writes the repeat prescription for herself.

Listen to the audio

A case in point

A young IMG doctor’s perspective of the system

“I really feel for my fellow colleagues. They’re struggling. They’ve got young families. Low salaries and high insecurity. For young doctors it takes time to understand the systems used in Australia; and this leads to frustration. Often the good work of these doctors goes unnoticed and they are brutally criticised for cases of adverse outcomes. This leads to these doctors being on edge most of the time for fear of making mistakes. A nervous doctor is not a settled doctor. There should be easy access to care if one has any health problems even developing acute problems. At present if I’m sick I don’t know what to do. In my country if I’m sick, well I’ll ask one of my specialist colleagues and they’ll help me, but here, I just think it would be difficult, even if I’ve got a minor problem. I don’t know what to do if I, or a family member, falls sick.”

Source: Doctors' Health SA © (Provided with permission) This video was produced by DHSA as part of two Rural Health Continuing Education Grant projects in 2014 and 2015, funded by the Australian Government.

Recognising the issues

  1. Recognition of symptoms and signs of impairment in oneself and colleagues can be poor
  2. Medical workplaces present specific occupational health and safety risks for doctors which include ready access to drug samples, ability to self-investigate and prescribe and access to informal corridor advice from medical colleagues
  3. Impaired doctors can place the health of their patients and their own careers at risk
  4. Risk-taking in men can be a presenting symptom of depression2
  5. Timely intervention, assistance and removal from the workplace can be career-saving
  6. Knowledge of the appropriate triggers for mandatory reporting is essential.

Listen to the audio

The impairment progression

  1. Nash L, Daly M, et al. Psychological morbidity in Australian doctors who have not experienced a medico-legal matter: cross- sectional survey. Aust NZ J Psychiatry 41(11): 917-25 View Link
  2. See Medical Board of Australia, Good Medical Practice – A Code of Conduct for Doctors in Australia View Link
  3. Medical Council of NSW, Guidelines for Self-Treatment and Treating Family Members View Link
  4. See for example Medical Board of Australia – ‘Information on the Management of Impaired Practitioners and Students View Link
  5. Mabel website View Link

Doctors can appear to function professionally while imperceptibly drifting along a pathway from wellness through illness to impairment. Efforts to conceal symptoms may intensify as impairment progresses.

Recognition of illness and impairment is less likely among mentally unwell doctors who lack sufficient insight and judgement and are frightened of what’s happening. This is significantly compounded when the doctor is junior, female, remote, high-profile, solo, culturally inhibited and/or professionally disconnected.

Listen to the audio

A case in point

The troubled surgeon

Scene One:

A 45 year-old surgeon, Doctor John Taupe, has stayed back at work to complete letters and case notes. He looks fatigued and troubled. As he sips from a glass of spirits, he reads a legal letter advising him that a patient has made a formal complaint.

“We represent your patient in relation to the matter of her missed diagnosis of bone cancer and seek your detailed response to the following allegations” 

He groans, puts the letter down and looks into distance, troubled. His mobile phone rings. It’s his wife:

“Where are you?”

“Still at work…. last one on the list was really difficult… bled lots…. took ages… OK now though………what’s the matter?”

“Oh, John. I’m here at the school. You’re meant to be here!…the teacher interviews….did you forget?……..we’ve got five of them, starting in a few minutes. Didn’t you remember..? “

“Look, Julie, today hasn’t worked out at all. You know what it’s like. I can’t just drop everything in the middle of an op and excuse myself for that….come on…!”

“No, that’s fine, John ….you just come home when you find the time!” (Hangs up loudly)

“Damn it!

Scene Two:

Theatre tea room. Anaesthetist in scrubs, talking on the phone:

“What do you mean, he’s still in bed? This list should have started 20 minutes ago. What the hell!  Julie, get him in here as soon as you can…..please! This is the second time……..yes, you heard me……the second time!…………’s just not on……! (Hangs up angrily)

Scene Three:

Anaesthetist and Dr John in the theatre tea room, talking tersely.

“John, what’s going on? What’s the matter with you? This has stuffed up the whole list, again and this afternoon’s list as well. What the hell happened?”

“Look Fiona, I just slept in. Big list yesterday and I had to work late last night. (defensive and insincere) So, I’m sorry……I’ve got a lot on at the moment.”

“Like what..?!”

“I got a letter from lawyers, and one from the Board, about a misdiagnosis….. The renovations are taking way too long and costing twice as much….. Julie’s on my case about a whole lot of stuff and I feel like shit! (Angrily and pulls off his theatre mask)………………Any more questions!!?”

“Why don’t you take a break then? Obviously, that is what you need. A week would make all the difference. You cannot be late like this………..and your operation notes lately have been crap, by the way……….John, have you been drinking? (She leans forward in disbelief) “Have you??!” 

“Go to hell! I’ll see you in there.”  (Puts mask on and walks out)

Source: MIGA ©

The warning signs

Warning signs of “impairment progression” can be missed by busy colleagues or deliberately masked by wary doctors who, cognisant of the potentially catastrophic cost of discovery, are trying to resolve their health issues privately in their own way.

Warning signs of mental illness include:

  • Poor interpersonal behaviour, disruption or irritability
  • Risk-taking with boundaries, reputation, career, billing, notation, clinical scope of practice and guidelines – in particular, risk-taking can be a symptom of depression
  • Odd, secretive or unusual behaviours
  • Absenteeism or working excessively long hours
  • Overt use of alcohol or drugs
  • Cynicism and a focus on income
  • “Compassion fatigue”
  • A dismissive and trivialising attitude to patients1.

Such behaviour can trigger significant patient dissatisfaction and a complaint when expectations are not met. South Australian experience suggests that complaints derive from 4 common categories of unmet need. These are the “4 Ts”:

  • Time: lack of time, excessive waiting time, tardiness of a clinical response, delayed decision-making
  • Talent: exceeding one’s scope of practice, lack of clinical skill contributing to a poor medical or surgical outcome, diagnostic errors
  • Trust: misleading information, suboptimal consent, failure to follow up or recall
  • TLC (tender loving care): lack of concern or empathy, dismissive attitude, desertion, and insistence on payment despite a bad outcome.

Listen to the audio

A case in point

From the MIGA case files

Cheryl McDonald, National Manager – Claims & Legal Services

“I have been managing medico-legal claims and providing advice to doctors for over 16 years. In my experience, overworked doctors face the real risk of suffering physical and mental illness which can cloud their clinical judgement and impact on their personal and family life.

I will always remember one case in particular.

An orthopaedic surgeon who couldn’t say no. On most days this particular surgeon was performing up to 20 complex procedures and relying on 2 theatre teams. The number of adverse incidents and complaints from dissatisfied patients he reported to MIGA far exceeded the normal reporting experience of his peers. When this was disclosed to him, he was surprised and quite shocked. This was a very skilled doctor.

We arranged for one of our Board members, a fellow orthopaedic surgeon, to spend some time with the doctor to seek mutual insight into what was going on.

The end result was that the doctor re-addressed his work-life balance. He reduced his surgical load, he took Wednesdays off to take his children to school and to play golf. He shared with us that his wife had been planning to leave him as he had not been available to the family and when he was at home he was grumpy and unhappy. The surgeon has since found a family GP and now has regular health checks and someone to talk to about his well-being. He was no longer at high risk of claims and complaints and that was subsequently proven.”

Source: MIGA case files ©

From the patient perspective

While many internal and external factors may be involved, the contribution from a doctor’s illness cannot be ignored. Consider a patient’s reaction to being treated by a:

  • Depressed doctor who lacks energy, concentration, empathy and thoroughness
  • Burnt-out doctor who is dismissive, lacking compassion, and is instead cynical about medicine and focused on income
  • Anxious, hesitant or obsessional doctor with poor time management skills
  • Exhausted, lonely, overworked and estranged doctor who seeks comfort in the arms of an appreciative, dependent patient.

Further exacerbating the unhealthy situation are workplaces that expect doctors to:

  • Work when hungry, dehydrated, unwell, sleep deprived or fatigued
  • Complete detailed documentation in time-poor and under-resourced departments and clinics with little time for detailed clinical handover
  • Perform flawlessly during prolonged unrelieved periods of stress.

These unhealthy workplaces can sow the seeds of illness in doctors and discontent in patients.

Listen to the audio

From the Regulator perspective

The Medical Board of Australia and the NSW Medical Council have published guidelines advising against doctors treating themselves (not to mention those close to them such as family members and friends)2,3.

Doctors can face disciplinary action for self-prescription and other treatments.

In serious situations involving long-term self-prescription of addictive medications, or drug and alcohol misuse, disciplinary action could lead to restrictions on practice, or even loss of practising rights.

Regulators are responsible for ensuring that doctors are not suffering a physical or mental impairment which adversely affects their practice, particularly the safety of patients.

However, it is recognised that many doctors suffer from a variety of physical and mental health issues, but can still practise safely and competently.

Regulators have developed ‘Health’ programs to assist doctors who suffer from medical conditions to continue practising as appropriate, with necessary supports4.

In MIGA’s experience, it is generally better that doctors who may be suffering from a physical or mental ‘impairment’ which may affect their practice to be in a regulator health program, with its openness and accountability, than trying to practise safely outside such an environment.

MIGA and its solicitors are experienced in assisting its members through such issues, and members should let them know when they are concerned physical or mental health issues may be affecting their practice.

Listen to the audio

Ten key points

  1. Healthy doctors practice better medicine and promote their positive lifestyle habits to their patients
  2. Doctors are healthier if they have their own doctor
  3. Unwell doctors can become patients without a doctor
  4. Sick doctors are at risk of not meeting the needs of patients for time, trust, talent and TLC
  5. Self-treatment is very common
  6. There are multiple barriers that prevent doctors from seeking help
  7. Mental illness is twice as common among female as compared to male doctors
  8. Clear and confidential pathways of care for doctors are needed
  9. Troubled medical students become troubled doctors
  10. Doctors are least satisfied with life at 40.7 years of age5.

Listen to the audio

Professional strategies to well-being

There are a number of strategies for promoting personal well-being, enjoying your profession and providing the best care for patients.

These include:

  • Recognising the pressures on you as a professional and take a preventative health approach
  • Support a wider culture change for the medical profession that encourages every doctor and student to accept preventative health checks as a professional responsibility
  • Find a GP and undertake regular comprehensive health checks
  • Participate in fitness programs
  • Re-evaluate your work-life balance, including your workload and opportunities for holidays
  • Encourage your colleagues, who have not previously seen another doctor, to do so
  • Encouraging colleagues to be open about the professional and personal challenges they are facing
  • Being available to support colleagues experiencing professional and personal challenges
  • Develop an Action Plan for illness in colleagues at work
  • Seek information and assistance from the doctors’ health service providers.

Listen to the audio

Benefits of your own GP

  1. Advocacy in the health system
  2. Independent referral networks
  3. Continuing comprehensive and impartial care
  4. Preventative care
  5. Recall systems
  6. A comprehensive medical record
  7. Phone advice
  8. A trusted confidante.

Listen to the audio

Risk management strategies

MIGA has invested in doctors’ health as a risk-mitigation strategy and supports the health of its doctor members with:

Doctors’ Health SA (DHSA) is one such provider in South Australia that offers:

  • A 24 hour colleague-to-colleague phone advisory service
  • An after-hours medical clinic for doctors and medical students in the Adelaide CBD
  • Website links and online appointments
  • Education and training
  • A network of trained doctor-friendly GPs across the state

DHSA will soon introduce resiliency training for junior doctors and telemedicine consultations for rural doctors.

MIGA continues to work with DHSA to promote doctors’ health to all of its members across Australia.

Listen to the audio


Click on the following links for access to additional resources:

MIGA resources:


Published June 2016 ©