Picture of Declan FoxDeclan 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. Getting showered and dressed by 1pm each day was a major achievement for me, that’s how bad I was and that was after eight weeks in the psych unit, medication and the first few sessions of what eventually totally changed my life for the better–cognitive therapy with a first-class therapist. But it was all looking pretty grim, for a time. At the age of 43 I appeared to be a washed up burnt out wreck of my former self.

I went from über-active rural family physician to zero with no realistic prospect of ever working in clinical medicine again.

Yes, it was really that bad. It was probably worse than you can imagine. Remember, I lived for my work. This was my second bout of major depression and the dogs in the street knew I worked far too hard. I thought I had learned from the first episode, to cut down the work, to put a little emotional distance between me and the awful problems some of my patients suffered. Even before that first bout, I had been trying to cut down, to say no more often. Clearly, that hadn’t worked.

And not too long after that, we got a new out-of-hours (OOH) service going, we went from doing one in four rural on-call and traipsing round the countryside doing home visits to a much easier rota based in a large health centre.

So things should have been better, especially with my colleagues protecting me somewhat.

It wasn’t, not for any length of time and a year later madness washed over me one Sunday when a patient died on my watch. That was the final straw, I suppose, I had been up and down mood-wise for a few months before that but had seen my family doctor and a psychiatrist who both thought me safe to carry on working.

So, what has changed? Well, I learned, eventually, that far too many of us get sucked into the health care system, we get chewed up, bled dry and spat out when we’re of no further use. That’s the way it goes, everywhere. Some places are worse than others; some of us are more vulnerable than others.

Is Canada better? Or have I learned to handle it better? Probably a bit of both. The family doctor system in Canada is much less bureaucratic and comes with very few institutional balls and chains; the load on our backs is more due to our sense of professionalism, of responsibility to our patients. Thanks to cognitive therapy, I found ways of lightening the load. I had 13 years of doing locums, mostly in PEI with nothing worse illness-wise than one bad bout of sinusitis and after that I felt confident enough in my own self-care skills to sign up for something a bit more permanent.

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* 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