Physician, heal thyself -- but
after rounds, ok?

Canadian doctors are burning out, but many don't seek help.
The pressure's on, but there is help out there

By Julia Cyboran

"There's that feeling you get after a long day at the hospital. It usually hits when you're sitting in your car with the engine idling," says Dr Paul Farnan, clinical coordinator of the Physician Health Program of British Columbia. "The hospital staff is upset because you left early -- even though you've just put in a 12-hour shift. You know that when you get home the family will be frustrated because you're home late. And here you are, sitting in your car, and the stress just builds. I can relate to that feeling. I've been there."

Most doctors have probably been there as well. It's not uncommon, in a profession that teaches its students to put the needs of others before their own, to have members neglecting their own health and well-being. In these days of doctor shortages, budget cuts, and rocketing stress levels, it's high-time for physicians to start looking after themselves. In the late 70s doctors in BC were the first in the country to realize that there was an issue concerning the health of their colleagues -- primarily drug and alcohol abuse. They set up a peer-review program that encouraged doctors, med students, and their family members and colleagues, to turn to other physicians for help, in a confidential and understanding environment. The program has since evolved to include psychiatric/ mental health issues, marital and relationship problems, substance abuse disorders, business and financial issues, physicians exhibiting dysfunctional behaviour and problems related to physical illness and the ageing process.

The need wasn't confined to BC, of course, and now all the provinces have their own version of the program. In 1998, the CMA acknowledged that there was a problem and set up the CMA Centre for Physician Health and Well-Being, which offers resources, links and support information through the association's website. The goal is to help doctors deal with their problems before they get out of hand and interfere not only with their practices, but also with their lives.

"Doctors are known to be obsessive," says Dr Farnan, who's been the clinical director of the BC program for the past two years. "They try to take care of themselves, but they don't do so well as patients. They still manage to go to work and do good work -- work is the last thing they hang onto. The role of a support group is to help the doctor get help earlier." He identifies five personality traits usually attributed to physicians than can lead to what he calls obsessive behaviour:

• Profound competitiveness
• Ability to chronically postpone gratification
• Like to be in control
• Perfectionists
• Inappropriate sense of responsibility

PREVENTION IS YOUR WATCHWORD
"[Many doctors] feel they need to do everything," Dr Farnan says. He goes on to add that regardless of the fact that a doctor is dying of cancer or dealing with a serious depression, he or she will always think, "I need to go into the office and work." He says that the BC program tries to focus on early identification of the problem. It encourages physicians to identify their own health issues, or to ask a colleague for help. It's important to catch the problem early before it truly ruins the individual, the director of the BC program stresses. (For more about control freak doctors, turn to page 38.)

Dr Anne Magnan, director of the Quebec Physician Health Program says their program tries to do the same. "The first step is prevention, and through that understanding, to help sensitize doctors to their potential weakness. It's often difficult for doctors to acknowledge that they have emotions, and that they can have problems. They rarely look at their own needs." She goes on to add that doctors often feel under pressure, not only from themselves, but also from the profession in general, the government and their patients. "I've had several doctors call me up and tell me that they don't know how to deal with all the world's problems. Everyone sees doctors as super-human, but they aren't."

FEELING THE PRESSURE
What happens when a doctor, who feels all this pressure, realizes that she has a problem and that she might not be able to live up to expectations? It's not easy, and physicians often feel ashamed and inadequate. "The two words you never want to use around a doctor are 'support group' -- they really run the other way," says Dr Ulla Nielsen, president of the Canadian Association of Physicians with Disabilities (CAPD). "It's in part because of the training they receive -- they are supposed to be the ones with the answers, even to their own problems. Physicians, traditionally, don't like going to see other physicians."

Dr Nielsen knows from first-hand experience. She suffers from MS -- and knows what it means to be treated by other doctors. "It's sometimes an uneasy relationship. I feel that my doctors expect me to know more than I do [about my disease]. I also feel that when I ask a question, they can get defensive. But as a patient, all I want is for my doctor to be honest. One of the things that I struggle with is not overstepping the doctor patient relationship. I don't want to push too hard, but that sometimes means I don't push hard enough."

Dr Nielsen has been director of the CAPD for two years. The association offers support to physicians who suffer from disabilities -- everything from MS, Parkinson's, visual disabilities to spinal cord injuries and amputations -- and to those who can no longer practice because of their disability.

Dr Diane Maier, clinical director of the Physician and Family Support Program of Alberta, has had to deal with many physicians who are doing time on the other side of the bed rail. "When a doctor is suffering, let's say having their first baby, they haven't learned about it all in school," she says. "They don't know how to get out of bed after surgery, but because they're a doctor, everyone assumes that they know. But they don't. They're just like all the other patients."