Doctors’ health

Andree RochfortDr Andrée Rochfort is Director of Quality Improvement at the Irish College of General Practitioners, Dublin

I frequently wonder how we can best prepare young doctors for their future medical roles and responsibilities, and how we can best support those already doing the doctor job.

We set out to care for others, to help others, to help others recognize their options and choices. We are set apart from patients during training. We learn to feel the expectations that “others” have of us; our peers, other health professionals, managers, professional bodies, medico-legal bodies, media, patients, patients’ relatives, our own relatives and non-medical friends. To this mix add in our self-expectations of ourselves. Combine these ‘perceived pressures’ then add our intrinsic sense of perfectionism and our pledges to others to do everything possible and we have a recipe for internal conflict! We feel guilt and failure when we cannot deliver perfect care with the selflessness we believe is expected of us. In reality we have to remember we are ‘human’ and we cannot work miracles. We do not have a magic wand. ...continue reading

declanfoxDeclan Fox is a Family Doctor in Tignish PEI (that's Prince Edward Island, Canada, for international readers)

 

How did I get here?

With apologies to Talking Heads, I wonder sometimes, myself. How DID I get here? Resurrecting this family medicine practice in Tignish, PEI, is what I'll be doing for the next few years. At the ripe old age of 59 I'm taking on something I wouldn't even have attempted 25 years ago. And I'm doing it 2500 miles away from home in a health service that is very different from the UK NHS I once loved with a mighty passion.

So what's so great about moving to Tignish? A little history might help. 17 years ago this month I was mooching around home, three months after a suicidal breakdown due to my second bout of major depression. ...continue reading

Rich-Roberts preferredRichard Roberts is Professor and past Head of the Department of Family Medicine at the University of Wisconsin School of Medicine and Public Health. He is immediate past president of the World Organization of Family Doctors (WONCA) 2013-2016. He is a family physician and an attorney.

During my term as President of WONCA, I toured hundreds of hospitals and clinics in more than 70 countries. I never expected to be a patient in one.

In June 2012, I was excited to be attending another national conference of the Spanish Society of Family and Community Doctors (semFYC). I looked forward to reconnecting with good friends and mingling with the several thousand family doctors in attendance . My three flights from Wisconsin, USA to Bilbao, Spain were uneventful. The real excitement began as I was settling in to my hotel room.

About 7 pm, I had the sudden onset of several fleeting episodes of lightheadedness. There were no other symptoms and I felt well between episodes. With a regular rhythm and heart rate in the 60s, I concluded that I had jet lag and dehydration. I pushed fluids and rested the remainder of the first evening.

Although I felt well the next day, I was determined not to be the stereotypical physician trying to be his own doctor. I sought the advice of the semFYC President. Within moments, I was ushered to a nearby health center where my exam and electrocardiogram were normal.

The following day, I had several more episodes while touring another health center. A quick electrocardiogram revealed atrial fibrillation with a controlled ventricular response of 92 beats per minute. My rhythm converted spontaneously to sinus in a few minutes. Even so, my hosts insisted on driving me to a major teaching hospital. Their faces betrayed a mix of sincere concern and worry that an esteemed guest would die on their watch.

My memories of my experience in the Bilbao hospital remain vivid. The 4 hours I spent there seemed an eternity, and yet passed by in a flash. I remember the 40 minute registration process, for someone with an acute cardiac condition! Bureaucracies are the same everywhere. The bright ceiling lights all seemed positioned strategically to make it impossible to keep one’s eyes open while supine. These minor annoyances were much less memorable than the people who looked after me.

Mostly I remember the nurses. The emergency physician breezed by me several times, but it was the nurses who made certain that I knew that someone cared, that I was in good hands. Perhaps that is why I found myself humming the Leonard Cohen song “Sisters of Mercy.” I did so quietly, not wanting to add to the suffering of those around me.

My exam, blood tests, chest x-ray, and electrocardiogram were all normal. The hours of waiting enabled me to call my wife, my family doctor, and a cardiologist back home to inform and to seek advice. Even before I left the hospital, they made arrangements for a more extensive evaluation on my return home.

I later reflected on the miracle of modern telecommunications and on the privilege of being a physician. Mobile telephony instantly connected me across the world to those at home, where I really wanted to be. My colleagues at home made certain that my eventual treatment was swift and skillful. The paroxysmal atrial fibrillation resolved after catheter ablation. Yet, it did not feel right that the system moved faster for me than I was able to make it move for my own patients.

Writing this blog prompted me to look back on the lessons learned and on the priorities I reset for myself as I went through the first major health episode of my life. As a physician, I understood well my condition and the murky state of the science that guided therapy. I was annoyed at the interruption in my busy life and anxious about the risks and possible failure of treatment. As a patient, I assumed and received clinical competence and technical prowess. Better communication and empathy were the two qualities that were sometimes lacking.

As a result of this experience, I resolved to work harder to spend more time with my family and to listen longer, and better, to my patients. A candid self-assessment confirms that I remain a work in progress.

 

* This blog is part of a series that CMAJBlogs is publishing in the lead up to the International Conference on Physician Health #ICPH2014 to be hosted by the British Medical Association September 15-17 in London, UK