Physicians Heal Thy Colleagues
By Allison MacLachlan, MA, staff writer
The issue of physician health and well-being is not a new one. It has long been recognized that physicians are often the last people to consult with their doctors when they feel unwell or are worried about their mental or physical health. However, what was once a rarely discussed taboo is now being talked about more openly.
Some physicians, predominantly psychiatrists, choose to specialize in the care of their colleagues. In order to better understand the topic of physician health and well-being, it would be beneficial to examine what characteristics or competencies are required for doctors to successfully treat their fellow physicians. Three prominent Canadian psychiatrists create a picture of what it takes to be a doctor's doctor.
Setting the scene
Although physicians are extremely well-equipped to deal with the health problems of their patients, they often allow their own medical concerns or problems to go untreated. According to Michael Myers, MD, FRCPC, director of the Marital Therapy Clinic at St. Paul's Hospital in Vancouver, British Columbia, doctors have a tendency to ignore signs or symptoms of illness in themselves that they otherwise would easily diagnose in their patients. To illustrate this problem, Dr. Myers says that he "often gets calls from physicians who say they have been feeling depressed and have put themselves on anti depressants and, now that they are feeling better, they are able to call and discuss the situation and get some help." When he asks why the doctor did not call earlier, Dr. Myers is confronted with a range of answers from feeling too ashamed to worrying that the phone call or visit will take up too much of the treating physician's or the doctor's own time.
Most doctors will eventually become patients and, while this transition is not easy, it can be facilitated by a caring professional who is well equipped to deal with the needs of the physician patient-needs that often go beyond ensuring the appropriate tests are ordered and the correct medication is prescribed.
Characteristics and competencies
There are currently many physician and faculty wellness programs across the country; however, only a few physicians focus their practices on the treatment of physicians. Both Drs. Myers and Mamta Gautam, MD, FRCPC, assistant professor, Department of Psychiatry, University of Ottawa, have practices whose patient population solely comprises physicians, residents, medical students and their families. What characteristics, compe tencies and qualities must a physician have in order to make their physician-patients feel comfortable and willing to undergo assessment and treatment?
While all doctors have the medical training neces sary to treat their colleagues, not all are comfort able accepting physicians as patients. According to Derek Puddester, MD, FRCPC, associate professor, Department of Psychiatry and director of the University of Ottawa's Faculty Wellness Program, helping to ensure another physician receives the medical care that he or she needs is very rewarding, but can also be very difficult. "Physicians need to be very comfortable with the idea of treating other physicians and the responsibilities that go along with providing that kind of care," Dr. Puddester says. This can often involve dealing with doctors who, due to stress, depression or substance abuse, are no longer capable of continuing their practices. "Doctors have to abide by the law," he says. "This sometimes means that we have to report doctors to the proper authority or suggest medical leave-never an easy situation to be faced with."
Asking the right questions
Most doctors recognize that they are reluctant to relinquish control of situations at the best of times and the same reluctance applies when dealing with their own minds and bodies. Physicians responsible for the care of their colleagues must keep this fact in mind during treatment. For example, Drs. Myers, Gautam and Puddester all state that many physician-patients continue to self-medicate or alter their prescribed medications or therapies while under the care of another physician. According to Dr. Gautam, physicians who treat other physicians must be able to ask the right questions and be proactive. "It is impor tant to be able to ask your patients if they are still taking their medications, if they are still taking it the way it was prescribed or if they have changed the dose," she says. This ability comes with expe rience and familiarity with the unique challenges that arise when treating physician-patients. Dr. Puddester notes that professional development courses on treating colleagues are very popular and highly subscribed.
Doctors who treat fellow physicians must also be prepared to work with patients who may be senior staff, or who were once or continue to be mentors or even heroes to the treating physicians. Dr. Gautam explains that respect plays a large part in being able to successfully treat physician patients, no matter who they are. "Doctors need to know that just because they have now become patients and are in your care doesn't mean that you don't still admire and respect them."
Along with maintaining respect, however, two additional transitions must take place when a physician becomes a patient. First, the treating physicians must be able to help the physician patients feel comfortable in their new roles as patients. Second, the treating physicians must be able to let go of the relationships they once had with their fellow physicians in order to become their doctors. "As a physician who is treating other doctors, you must be aware of conflicts of interest," says Dr. Myers. "You also have to be able to accept that the relationship that you once had with this person is now over. You are now their doctor and that will change everything."
In order to avoid conflicts of interest, maintain a sense of privacy and obtain the kind of care required, doctors are sometimes required to seek assistance in an area far removed from their own professional practices, For example, Or, Puddester confirms that doctors have travelled from Newfoundland and Manitoba to get help from the Faculty Wellness Program at the University of Ottawa, While this situation speaks highly of the kind of care available to physicians in Ottawa, it could also be indicative of a larger problem wherein doctors are reluctant to seek care and find it difficult to access the kind of care they need in their own communities.
Need for specialization
Although the physician population is not large enough to require formal subspecialty restricted to the care of physicians, there are reasons for physician-patients to seek this kind of specialized care, According to Or, Gautam, one of the main reasons is the level of experience specialists bring to the care of their physician-patients, "Over the long term we have been able to build the level of trust patients have in us, We can show our physician-patients that we can help them even though they themselves are skilled and knowledgeable."
Drs. Myers, Gautam and Puddester speak positively about the increasing visibility of physician health and well-being in the health care community, it seems that new, younger physicians are more aware of the health issues that face doctors and are more willing to discuss them and lobby for the care they need, The physician health movement has definitely gained momentum, awareness and visibility, which Or, Puddester states is clearly reflected in the number of students, residents and doctors who have taken advantage of his program over the past few years, He mentions that all the students who received help from the program were well enough to graduate and attend convocation-a testament both to the program and the young doctors' willingness to seek help when needed.
In addition to being more open about their own health requirements, perhaps this new generation of doctors will also be more willing and able to take on the challenge of treating their peers, mentors and teachers. As the physician popula tion ages there will be a greater need for doctors to share the workload when it comes to opening their practices to their colleagues. Fortunately, Canada has always been a leader on this front. And, as we continue to lead the way in working to ensure physician health and well-being in our own country, Canada is becoming a role model around the world.