Abstract
When was the last time you had to treat a patient who was also a doctor?
When did you last go and see a doctor as a patient yourself?
Doctors make interesting patients. They often do not access medical help appropriately, they self-prescribe, they have corridor conversations and they find a variety of innovative ways around the health care system. Yet, at the same time, the attributes that make a good doctor often predispose them to illness. It appears that the nature of medicine as a career is one in which those who do the job well are often at more risk of stress, illness and burn out.
If one looks at those doctors being reviewed by the General Medical Council (GMC) for health reasons, physical health problems contribute to a very small percentage of the cases concerned. The large majority of these doctors have problems with mental health or substance and alcohol misuse. If we assume that this is just the tip of the iceberg, there will be many doctors currently working who have compromised health and well-being.
At the other end of the stethoscope, caring for doctors as patients is not always easy. How do you manage the consultation with the ear, nose and throat (ENT) consultant who comes to see you, when your last contact with him was in your foundation post? How do you cope with the confident GP mum wanting a referral for her child to have a tonsillectomy that you do not think is needed? And, in all of this, how do you make sure you increase the chances of staying healthy yourself?
Both nationally and internationally, concerns about physician health are being voiced as poor physician health adversely impacts on the care of patients, health care costs, the lives of the physician's colleagues, family and friends and on the life of the physician himself or herself. Pilot programmes such as the Practitioner Health Programme demonstrate the cost effectiveness of treating doctors as a hard to reach minority group. Other models over the country also demonstrate the benefits in ensuring that doctors can access health care. In this current climate of change, where financial constraints are increasing, striving to improve the health of doctors is needed and is both wise and prudent.
In response to this need, in 2010, the Department of Health provided funding to three organizations to develop, in their professional groups, further expertise in the area of practitioner health: the Royal College of Psychiatrists, the Faculty of Occupational Medicine and the Royal College of General Practitioners (RCGP). Things are now beginning to move forward. For those of you who have read Martin Gladwell's book, The Tipping Point, or for those of you who have seen the Guinness advert, where the domino effect is demonstrated very effectively, it appears that the tipping point has been reached.
One of the results of reaching the tipping point is that the RCGP is developing a two-part Certificate in Practitioner Health. Part 1 was launched in March this year, and Part 2 is due to launch in August. Part 1 consists of two e-modules and a face-to-face training day. Part 2 is a more intensive year-long programme.
The part of this programme that is suited—and I would say essential—for Associates in Training at the beginning of their GP careers is the first e-module. This is on the RCGP e-learning platform and is entitled Health for Healthcare Professionals Part 1. This e-module comprises seven lessons (see Box 1) and is slightly different to many e-module resources in that it promotes reflection on practice and application to practice throughout. It also creates a downloadable document of the thoughts and comments that you note down on working through each lesson, which you can save and attach to your eportfolio as evidence of reflective learning.
While the lessons are based on the RCGP core curriculum statement ‘Being a GP’, there are curriculum links with many other curriculum statements including:
The GP consultation
Patient safety
Healthy people: promoting health and preventing disease
Clinical ethics and values-based practice
Management in primary care
Care of people with mental health problems
Drug and alcohol problems
This will populate your eportfolio and help you to consider how to apply your learning to the care of patients who are doctors and, by extension, to the care of other health care professionals.
Health for Healthcare Professionals e-module 1
Lesson 1 gives an overview of the issue of practitioner health and helps you assess your own knowledge and skills
Lesson 2 helps you to identify the kinds of problems practitioner patients get and how work and home can help and hinder
Lesson 3 looks at the whole issue of accessibility
Lesson 4 looks at overcoming obstacles to care and provides some additional resources for small group discussions
Lessons 5 and 6 look at consultation skills and the practitioner patient. This is useful for Clinical Skills Assessment (CSA) preparation. There is also a role-play scenario in the resources section for this lesson, but to maximize learning, try not to use the role-play scenario till you have done the lesson
Lesson 7 gets you to reflect on your learning and to plan an ongoing personal development plan
Why do the e-module?
As a Programme Director, I know the old adage ‘assessment drives learning’. Indeed, regulation could come up in the Applied Knowledge Test (AKT). A practitioner patient could turn up in the CSA. Perhaps, more importantly, in the workplace, you will be looking after doctors who are patients and you will be a patient yourself. As an older GP, mentor and appraiser, who have seen many medical friends and colleagues become unwell in a variety of preventable ways, I would encourage you to do the first e-module. It will help you care for your practitioner patients. It will also enable you to reflect on your work as a doctor and how this impacts on your own health.
Make time to do it. Why? In the words of the L'Oreal advert: ‘Because you're worth it’.