Risk Management
Doctors’ health

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.

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.

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.

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.

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.

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.

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.

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

• A significant annual 10% premium discount for doctors who undertake a comprehensive, evidence based medical health check-up and participate in an interactive workshop or activity
• Quality face-to-face and online risk management education that focuses on the health and wellness of doctors
• 24 hour support for medico-legal issues including an emergency telephone service
• Collaboration with existing doctors’ health service providers so doctors can access a physician trained in treating doctors
• Peer and mental health support programs for our members experiencing complaints and claims through our Practitioners’ Support Service.

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.

• Australasian Doctors’ Health Network – for a contact list of doctors’ health service providers
• Heads Up – Information, action plans and useful links promoting the mental health of doctors and medical students
• Medical Board of Australia – Guidelines for mandatory notifications and Good Medical Practice – A Code of Conduct for Doctors in Australia, Section 9 – Ensuring Doctors’ Health
• Australian Medical Association (AMA) – Resources on doctors’ health

MIGA resources:

• Comprehensive health assessment and checklist – for your next GP visit
• Practitioners’ Support Service – for support from your peers
• Risk management education – CPD Points and MIGA premium discounts for participating in workshops, activities and completing a comprehensive health assessment.

Published June 2016 ©