By Kay Ansell
The waiting room is full, a couple of emergency patients have jumped the queue and the doctor is feeling as ill as any of the people waiting to see him. But it is easier for the doctor to pop a couple of painkillers and keep going than to admit to being sick and dealing with the consequences.
Where do doctors go to be treated when they're sick? Who heals the healers? The effects of doctors' illness ripple throughout the community and could have major social and economic costs.
Monash University's Department of Com-munity Medicine and General Practice is researching the impact of illness on doctors through a range of projects including surveys such as 'Occupational stress among metropolitan GPs' and 'The troubled doctor'.
The occupational stress survey by Dr Peter Schattner and Mr Greg Coman, which aimed to find out how metropolitan GPs were coping with their careers and work-related stress, found that about half suffer moderate to severe stress. Dr Schattner, the department's director of research, says personal illness can affect the way doctors practise medicine, although how, exactly, is still being explored.
Doctors do not make good patients and many don't have their own GPs. "When it comes to psychological problems, most of us feel we ought to handle that stuff, Dr Schattner explains. "We've learned about it, we deal with it in our practices - it's not something we could easily go to another health professional about."
That also applies to physical illness, which doctors often self-diagnose, perhaps following up with an informal corridor conversation with a colleague. If the illness is more serious, they refer themselves straight to a specialist, bypassing a GP, he says. Without a treating GP to provide an overall picture of the health of the doctor as patient, specialists are left in the difficult position of having to rely on the patient.
That stress poses a danger to doctors has long been recognised. But for those willing to take it, help is at hand. Stress reduction programs have been offered for many years, including those run by Monash's Dr Craig Hassed. More recently, says Dr Schattner, informal peer support groups have been started by professional support groups.
Unwillingness to seek help with problems is, ironically, a major problem. When early symptoms of stress are ignored and self-medication becomes a crutch, doctors can find themselves before the Medical Practitioners Board. While previous studies have found that only a minute percentage of Victorian doctors are drug abusers, writing themselves prescriptions for drugs such as pethidine, anecdotal evidence suggests the numbers may be far higher.
This particular issue forms the basis of 'The troubled doctor' study, which is based on interviews with doctors who have been before the board, mostly for abusing drugs. The study, whose findings will be released later this year, focuses on doctors who have psychiatric difficulties or problems with drug or alcohol abuse. Qualitative in-depth interviews are the study's main method of data collection and the aim is to find out how professional support could have been pro-vided sooner, before the doctors' problems became severe enough to get them into professional trouble.
Dr Schattner says wider referral options are needed for doctors. There are organisations such as the Doctors' Advisory Service offering a telephone counselling line, which is run as an offshoot of the Royal Australian College of General Practitioners. It takes calls from GPs who refer themselves. While the anonymity of the service has its advantages, it can also be too remote. Some doctors need more personalised assessment and counselling, he says, a catch-22 situation if they feel uncomfortable about 'coming out' about their problems.
Dr David Overklaid is a counsellor on the service, representing the College of General Practitioners. He calls for better coordination of programs to support GPs. Dr Overklaid is well aware of the resistance doctors have to seeking help, citing one case where a doctor suffered a stroke after treating his own hypertension.
For the 'superdoc' syndrome to be quashed, a change in culture is needed, he says. Such a culture change requires a multi-pronged approach that starts early in medical school. It should follow through to internship in hospital (suicides among pressured young interns are not unknown), and into general practice, he says. Some hospitals offer mentoring to young doctors, but there is still a reluctance to admit an inability to cope with the increasing emotional and financial pressures of the average GP's life.
In addition to the human cost, there is the economic bottom line. Dr Overklaid believes impaired doctors may incur a significant cost to the community, for example, through inappropriate referrals: "I suspect this is a problem that costs the government a lot of money, both directly and indirectly," he says.
Monash's Dr Craig Hassed and Dr Peter Schattner are involved in a range of projects and programs addressing the health and well-being of GPs.