Clinicians as Patients

This is something that seems to be a novel concept to some people!

We are human. We also get ill.

The GMC has clear guidance on our responsibility to care for our own health as doctors:

GMC Guidance: ‘Risks posed by your health’

Most of us, as clinicians, find it hard to get the balance right when it comes to looking after our own health. Two different aspects spring to mind:

1. Taking care of ourselves day to day
2. How we handle our own illness when it occurs

Why are some of us not so good at this?

Many of us in the medical profession are natural carers and this is what led us onto this career path in the first place. Giving of ourselves is part of the vocation. In general, as a profession, we are notoriously bad patients!

Certainly, I have found it hard to make the ‘right’ decision about whether to go work or not when ill. How do you work it out?

It really comes down to feeling well enough; and being safe. The other aspect to consider slightly overlaps with the second point above; taking care of ourselves adequately enough to be well long term i.e. taking an extra day to recover properly may help to prevent recurrent illness.

Clearly, just a mild cold or similar is not an issue. The other extreme will also be obvious. But other illness may not be so simple such as viral illness with fevers or conditions such as bad back pain.

There have been times when I have thought ‘If I could just work at my own pace in an office, I could manage.’ But doing the job of a GP puts a different perspective on it. It is fast-paced, emotionally intensive and highly responsible. There is no choice but to make sure we act in the best interests of patients; first do no harm and so on. Illness can cloud our decision-making processes.

But what always dominates in my mind when I am on the verge of phoning in, is the impact it is going to have on other people.  There is the feeling of not wanting to let people down and guilt when illness necessitates missing work. You know that reception staff are going to be frantically trying to phone many patients to re-book them, other doctors will be picking up extra work and the patients may find it hard to get another suitable appointment especially in a appropriate time frame.

Since qualifying as a doctor in 2004, I have had to gradually learn to get the balance right; and I still haven’t completely sussed it. My chronic condition started in 2005 at the end of my house officer jobs (coincidence?!). It wasn’t until 2007 when things started to properly get sorted with it but still with symptoms for many months at a time since then. Even with this, I have rarely missed work; more for unavoidable appointments rather than directly from the illness.

Since then, I think it has affected my overall wellbeing to a degree. Whether it is the illness itself or the medication, I am not completely sure. Certainly, I have felt more fatigued in the last 10 years than I did before that (more than just ageing!). But although the medication leaves me partly immunocompromised, it hasn’t generally seemed to leave me too susceptible to illness more than I ever was.

What has had the most negative impact on my health is having children! Of course this is not great surprise. Life is exhausting so I am more run down. Then there is ‘nursery-itis;’ viral infection after viral infection.

Unfortunately, I started my job at my current practice when my oldest child was 3 months old and I have been off sick more in the last 3.5 years than I have in a lifetime before this! It’s getting embarrassing…and this affects my feelings each time I need to make the decision about going to work or not.

Of course, we shouldn’t be trying too much to assess and treat ourselves anyway more than this single decision. We should attend our GPs and use the health system in patient role as needed. And the same applies for our approach to our own family members and friends. I’m afraid to say there have been instances in the past when I have been expected to sort things out myself rather than letting me just be the patient.

So, physical health in ourselves is hard enough to assess….what about mental health? Even harder it seems.

Mental health is much more difficult to define. You can’t see it. It’s hard to examine objectively. It’s hard to measure. It is almost impossible to see properly from within ourselves even with the best possible insight. And then there’s the stigma….it still exists, even if this is sometimes more perceived by ourselves than it is portrayed to us by others.

Due to the nature of Medicine as a career, we as doctors are highly susceptible to stress responses and a detrimental effect on mental health. Personally, I find being a GP much more challenging in this respect than I did as a relatively senior hospital medic. Simply due to the fact that there are many one-to-one interactions each day, often with highly emotional content and all done on a ridiculously tight and precise regimented schedule. It is utterly demanding and draining. Some of what we do, other specialities would have half an hour or more assigned to do it in. The hospital environment generally has a different set of stressors which are equally valid but did not affect me in this way as much, apart from a few very upsetting exceptions which I will never forget.

I have found it very hard to accept the diagnosis I have been given of a ‘major depressive episode’ having hit crisis point a month ago. As I sat there in utter despair in the surgery at the end of that Thursday, my wonderful colleague told me I wasn’t coming back to work until things were better. I still didn’t really recognise what was going on myself and didn’t think it was deserving enough to be off work. But she rescued me that day; I was declining fast. It was the right decision.

I knew I wasn’t coping before this but didn’t see how significant it was. I was doing bits and pieces to try and make life easier. I was looking into changing my working pattern and trying to share the load more at home. Even silly things like buying new kitchen gadgets to make cooking easier and a new washing machine. But actually finding any opportunity to refresh and recharge myself was lacking.

There’s learning points here. Maybe I could have let myself acknowledge sooner that there may have been a deeper problem and accepted it. I have wondered how I would have fared on a depression screening tool had I done one a few months ago. When I did it a month ago once I actually recognised what was happening, I scored 24/27 on the PHQ9 score (‘Severe depression’). As I recover and get back to ‘normal,’ I know there needs to be significant changes. Otherwise, it will all happen again.

I think we as GPs need to reflect on our own wellbeing regularly, both the physical and mental health aspects. We need to make sure that we look after ourselves well; and ultimately this will then result in us looking after others more effectively. We also need to consider if things are slipping and actively make changes to prevent further decline before it’s too late. I tried, but failed to do this; I think I was already well on the way down the slippery slope. Also, with our own health, we need to be patients, not doctors; let somebody else look in objectively if you think you need help.

A message I have picked up from this experience so far is that it is important, for self-preservation, to be authentic to ourselves; rather than just focusing on everything and everyone else around us.