Is someone taking care of your health?
Dr Roger Sexton
Medical Director, Doctors' Health SA (DHSA)
Published June 2016
References
- Maslach C, Burnout: The cost of caring. 2003 ISHK, Los Altos CA 94023
- Williams E, Konrad T et al. Physician, Practice, and Patient Characteristics Related to Primary Care Physician Physical and Mental Health: Results from the Physician Worklife Study, Health Services Research Vol 37, Issue 1, p119–141, February 2002
- SA Doctors’ Health Survey 2007
- ibid.
A case in point
Linda’s story
Linda is tired. Her general practice work is demanding and constant. She has acquired too many patients with complex problems and lately finds herself worrying about patients whilst in the shower. Working harder and longer hours has not made any difference.
Her caring and thorough approach has made her popular but there is never enough time to deal with all of her patients who wait weeks for an appointment and bring in lists of problems for her to sort out. Linda feels she is not practising good medicine.
She needs a break but knows it will create resentment amongst all of her practice partners who are working long hours too.
She feels her personal relationships are suffering at home as she is increasingly irritable, unloving and withdrawn. She has become cynical about her work and life in general.
She had an Implanon inserted 4 years ago by a gynaecologist and is overdue for this and her well woman checks.
She has a family history of colonic polyps. She has self-investigated her tiredness with an FBE and vitamin D, both of which were normal.
Source: This case study is fictional and depicts some of the health issues experienced by unwell doctors.
The health issues
Linda exhibits symptoms of burnout1, the effects of which include feelings of exhaustion, cynicism and ineffectuality in the setting of caring for chronically ill and complex patients. Obsessional doctors who practise thorough, caring medicine and are intolerant of uncertainty are more likely to experience this and to react by working harder in the hope that they can ‘get on top of it’.
She is also at risk of an anxiety disorder, depression and medical errors which can lead to a significant and protracted period of distress if the doctor is unsupported.
The culture of her workplace appears inflexible but it is likely that most of her colleagues are experiencing similar distress and would like to work differently if they could. Loss of control in the workplace is recognised as a significant work-stressor2.
Practice meetings where doctors can freely express their goals and needs can assist positive culture change and control in the workplace. Modifying the practice financial structure away from partnerships towards associateships may also address the issue of fair rewards for work performed.
Her tendency to selectively self-refer and investigate is shared by many colleagues3. The lack of an objective GP is a significant disadvantage for doctors who may continue to treat and investigate inappropriately. A GP who offers timely electronic recall systems and expeditious advocacy in the health system is highly valued.
The risks posed by her expired contraception, her familial risks and inadequate age-appropriate health screening are significant and important.
The general check-up is valued by the profession as a way of improving the health of doctors4 and is critical to the maintenance of personal and professional longevity.
A good outcome
Linda did book in to see her previous GP who over several appointments excluded pregnancy, reinserted Implanon and performed a full physical and age appropriate health screening. She was referred for a colonoscopy (which did reveal a polyp) and for CBT.
Linda also called for a practice meeting at which bookings and session times were discussed and subsequently rearranged to the satisfaction of all of the doctors in the practice.
