‘The job comes first’: For many doctors, their own health is secondary

Co Offaly GP Dr Velma Harkins is up-front about how she has overlooked her health while working as a busy doctor in general practice.

Following a knee operation in 2021, her orthopaedic surgeon said she had obviously been saving it up for some time. “It has been a life-altering procedure thanks to the excellent care I received. I had left it far too long to get done but I feel the research and the ‘pre-hab’ exercises I did prior to the surgery were key to help my recovery,” she explains.

More seriously, Dr Harkins recalls how a few years earlier she was extremely ill with a perforated bowel and sepsis. “I think as doctors, we often minimize our symptoms. If we think, ‘it could be something awful’, we think ‘I can’t deal with that so I don’t have it’. And, therefore the language we use when speaking to colleagues about our own health is often misleading and underplays the situation. For example, if we say that we don’t feel very well, what we mean is that ‘I think I’m dying,’” says Dr Harkins.

The tendency among doctors to minimize their own symptoms is well documented in medical literature with studies showing that they often feel too busy or stressed to look after their own health properly. The demands of the Covid-19 pandemic have undoubtedly exacerbated the tendencies among doctors to neglect their own health.

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The Irish Medical Council guidance on doctors' conduct states that doctors must not prescribe for themselves or their families

"For many GPs, the job comes first and you don't take time out to see someone for yourself. But medical knowledge and medical training doesn't give us immunity to fatigue, distress, disability, disease or even death. Doctors get migraine, angina, cancer, and depression too," says Dr Andree Rochfort, director of the Doctors' Health Programme at the Irish College of General Practitioners (ICGP).

Self-prescribing is another common habit among doctors that is strongly discouraged both by the ICGP and the Irish Medical Council. “Self prescribing is an occupational hazard but the question is, where does the boundary lie?” says Dr Rochfort. “Many doctors will self-prescribe antibiotics if they have a chest infection but what happens if they have muscle pain and prescribe stronger and stronger painkillers and sleeping tablets?”

Symptom management

The ICGP campaigns for every GP to register with a GP who they should consult for symptom management, medical investigations, prescriptions and referrals to other doctors and health services. The Irish Medical Council guidance on doctors’ conduct states that doctors must not prescribe for themselves or their families. Neither should they treat themselves, family members or close friends (except in emergencies) but instead have their own GP to consult with when they are sick.

“We specifically recommend that GPs have their own GP because otherwise they can send themselves to the wrong specialist,” says Dr Rochfort.

Seeking the opinion of colleagues on their personal health complaints is also discouraged because it can complicate relationships between staff in a general practice. So-called corridor consultations among hospital doctors can also result in a doctor not following up with a thorough investigation of something he/she is very concerned about.

Dr Rochfort is also adamant that doctors’ GPs shouldn’t be a friend or colleague, and that staff in general practices and families of doctors should be seen by a different GP rather than their family member or colleague. “The objectivity of the GP is important. The relationship has got to be a trusting, professional one. And, questions like ‘are you self-medicating’ have to be asked.”

Dr Harkins says that although doctors are told to have their own GP, it’s not always happening. And, when they do seek help from fellow professionals, it’s not that straightforward either. “We recognise how overburdened our colleagues are and feel guilty about adding to their workload. It is difficult for doctors to be treated like everyone else. There is a danger of them being under-diagnosed or over-diagnosed, under-treated or over-treated,” says Dr Harkins.

The ICGP runs a telephone helpline and text service for GPs (the number is 087 751 9307). “It’s not a therapeutic line. It just offers GPs a space to talk and find a way forwards. Some have great difficulty looking for a GP,” says Dr Rochfort.

Studies have shown that up to a third of doctors stated they had a condition that they felt they should consult a doctor for, but had not done so because they were a doctor themselves. Yet, other research has found that when doctors do have their own GP, the advantages include more objective care, having an advocate for their healthcare and co-ordination of complex healthcare needs, as well as practical issues like getting reminders for preventative health checks.

In a qualitative study of Australian GPs published in November 2011, Dr Margaret Kay and others noted that doctors said they were embarrassed and concerned about confidentiality when consulting with GPs about mental health issues.

The study also stated that during medical training, doctors learn to trivialise many bodily symptoms to help them cope with the anxiety that such symptoms can engender as they practice medicine.

Barriers

The Australian researchers concluded that training doctors to provide quality, patient-centred care for their peers will reduce the barriers and normalise the concept that doctors can be patients. “This training needs to start in medical school and should be reinforced through continuing medical education,” says Dr Kay, GP and senior lecturer at the faculty of medicine at the University of Queensland.

A UK study of doctors as patients published in the British Journal of General Practice stated that the training of doctors should include opportunities to consider personal health issues – and challenge the idea that illness belongs to patients – as well as how to cope with role ambiguity when being a patient and when treating doctor-patients.

That study also pointed to the tension of “being a good patient or a demanding patient” as a doctor, as well as how the illness process can give doctors key insights into the experiences of their own patients including fear, loss of control, uncertainty, hope and despair. Speaking from her personal experience as a patient, Dr Harkins adds, “often when doctors are patients, there are valuable lessons we can learn and put into our daily practice”.

As part of the Doctors’ Health Programme at the ICGP, Dr Rochfort holds monthly wellbeing webinars for GPs on the first Thursday of each month at lunchtime. “We specifically run these at lunchtime because GPs should be exercising, spending time with their families or reading a book in the evenings rather than doing administration work and attending committee meetings or webinars,” she explains. The wellbeing webinars are also recorded as a podcast that can be downloaded and listened to at other times.

“We had Covid webinars right through 2020 so we started these wellbeing webinars in April 2021 to help GPs switch off. Doctors have the knowledge of preventative and lifestyle medicine but the barriers to implementing them are the same as for everyone else – time, motivation and energy.”