Doctors’ Health: overcoming our Great Expectations and pathological self-reliance

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.

We learn more and more facts during our career progression; this learning goes on in parallel with developments in our own personal lives. We may not recognize our own personal needs at times when we should, and when we do we do not communicate them or we communicate poorly, despite our reputation for excellent communication skills – instead we focus on our work and plow through it with blinkers on. It is so easy to be consumed by the medical job. Each day and at each and every transitional phase we can make choices. For example, we can select our role models, sustain our hobbies, implement healthier lifestyles, learn to say no and manage our time and energy. This type of self-care is not formally taught in medical school or beyond and it is not easy to process when preoccupied with professionalization, assessments and career building; “I must” and “I have to” take precedence. We are taught we are needed, we believe we are needed. Consequently we have difficulty taking leave from the medical job for sick leave, annual leave, and compassionate leave even in cases of personal bereavement. We do not conform to pre-operative routines - we come into hospitals on the morning of the procedure when other patients for same procedure are in from the previous night, we are discharged early from hospital and we do not practice what we preach, follow our own advice or clinical routines. We comply with professional standards for our patients yet bend the rules when we get sick. Where are the boundaries in our own lives? Are we are a doctor 24/7, a doctor on holiday, a doctor in the supermarket, alongside the sports field, outside the school? We are switched on in doctor mode mentally and emotionally, with a continuous level of on-duty readiness. When do we switch off the job bit, the image bit, the responsibility bit, the mobile phone, the laptop? Do we even recognize our option to switch off?

For many reasons we still don’t accept we could get tired or sick. If we do we often self-direct our own care with supreme self-reliance. We work hard at displaying invincibility, so nobody reaches out and nobody reaches in. We wonder why we receive little verbal or practical support from colleagues. They say doctors make difficult patients; doctors also have difficulties treating patients who are doctors, and relatives of doctors. I have witnessed all this so often in my almost thirty years since graduation, have you? I really hope that this culture is changing, with promotion of healthcare services for doctors in recent years, in particular healthcare for doctors based in general practice / family medicine.

We can all learn so much from listening to patients –not just about medical issues but about being a patient.

Can we teach and learn about this in medical school and in postgraduate education and in continuous medical education?

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

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