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20 July 2022

Many doctors find it hard to access the support they need. This impacts their wellbeing and ultimately their ability to provide care for patients. There are some common barriers to help-seeking for doctors, including some which reflect the culture of medicine.
 

Identity as a doctor

The term “physician heal thyself” mirrors the belief many doctors have of feeling they should be able to manage their own health and wellbeing. For many, it is hard to set aside their identity as a doctor and to become a patient when they have expert knowledge and all the tools at hand, such as the ability to order various tests and prescribe medications (note that in Victoria self-prescribing is illegal). To be a patient is a vulnerable position for someone who is used to sitting on the other side of the consultation, diagnosing and treating. Doctors tend to have a strong internal locus of control, and this also makes it hard to be a patient who is reliant upon another.

It is also tricky for doctors to treat another doctor. Uncertainties arise, such as: how much explanation is required and to what extent should guidance about treatment options be provided? Corridor consultations are unfortunately too common. This puts both parties at risk if something is missed, and then who is liable?

The concept that “the doctor who treats himself has a fool for a doctor” reflects the lack of objectivity in self-diagnosis and self-treatment. Every doctor needs to have their own general practitioner (GP), who they consult for regular health checks throughout life.

Allow your GP to tell you when to take some time off, to prescribe medication and to make a referral to a specialist when it is needed. In your relationship with your GP, allow yourself to be a patient, albeit a very knowledgeable patient.
 

Stoicism and pushing on

A common attitude held by many members of the medical profession is that “doctors don’t get sick”. This is often augmented by a sense of being indispensable. These are doctors who ignore their own symptoms and keep working. Often, they are concerned about letting their patients down. In recent times the isolation requirements for COVID-19 have forced doctors to take a break when unwell.

Doctors need to lead by example and take time to rest and recover when unwell. Doctors are human too and like everyone else do become sick. Looking after your own health is essential if you want to be fit and able to look after others.
 

Competitive culture

The world of medicine is very competitive. This starts with the best and the brightest student cohort entering medical schools. These top students then compete during their studies for prizes and awards and subsequently to secure the most favoured intern positions. The next step is competition to enter training programs and the best training positions. 

Likewise, the medical profession is very hierarchical and there is a power imbalance between early career doctors and those who have progressed further in training or have senior roles.

This sets a scene where it is very hard to admit any vulnerability or express any weakness. It makes it very hard to ask for support or assistance and anyone who is struggling can feel isolated and alone.
It is imperative that leaders in the profession create a culture where it is safe to seek help and acceptable to talk about vulnerability. Normalising help-seeking behaviour and minimising the stigma that has been associated with mental health issues is essential to save the lives of doctors who may be considering suicide.


Time

Doctors and all healthcare professionals are time poor. The demands of medical practice including often long hours of duty can make it difficult to set aside time to make an appointment, let alone set aside time to consult a health professional or a counsellor. The need to take time off when it is difficult to find locums, or you know it will impact on the workload of your colleagues are also significant barriers to looking after your own wellbeing. However, time spent seeking help or support or time taken to recover fully are important investments which will ensure you are able to continue in your role and look after your patients in the future.


Concern about confidentiality and impact on career

Most healthcare professionals including doctors are very concerned about confidentiality when seeking help. There is fear of damage to your reputation, risk of impact on your career pathway, effect on life insurance and concern about mandatory reporting. Any visit to a health professional is confidential. The services provided specifically for doctors take particular care to maintain confidentiality in all aspects of providing a service to you. 

While many registered health professionals are concerned about the risk of mandatory reporting when they seek help, there is a very low instance of situations when mandatory reporting applies. Ahpra regulations about mandatory reporting state that there are four reportable conditions: impairment, intoxication, departure from standards, and sexual misconduct. Mental health concerns fall under the impairment category and only relate to placing a patient at substantial risk of harm. This risk of harm usually reflects a lack of insight by the registered health professional. A doctor or other health professional seeking treatment is not placing a patient at risk of harm as they are taking steps to recover. Hence for those seeking help fears about mandatory reporting are not justified.

There are other barriers which doctors face when seeking help, such as lack of access in rural locations. Fortunately, telehealth is an option now. In the same way other barriers are not insurmountable and doctors can be assured that seeking confidential help without an impact on your career is possible.

For help and support, there are options which specifically cater for the needs of doctors. It is essential that every medical student and doctor has a trusting relationship with their own GP.


Kay Dunkley
AMA Victoria Coordinator of Doctor Wellbeing
 

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