Sick Doctors

Do doctors have chronic illness? Of course they do! What happens to them when they have chronic illness but are not classified as disabled?

“Doctors who have chronic illness have a rough deal. As well as having to come to terms with their illness, they also face problems in their career. Inflexible working patterns, poor contingency cover, and colleagues who are “sympathetic until it affects them” often add guilt to an already difficult situation and leave ill doctors wondering whether they can continue working in a position that makes little allowances for their health needs,” says an editorial in the British Medical Journal (BMJ).

Even with chronic illness, most physicians are willing to provide limited service if allowed to do so.

In Britain, there are counselling lines for sick doctors but they do not get career advice. Now the BMJ has started Career Focus for chronically ill doctors. This service will “provide useful advice that will help them find a career option that suits their health needs.”

There is no such service in Alberta or Canada. In fact the situation is worse as most doctors are on fee-for-service contract with Alberta Health Care Insurance Plan (AHCIP). So, if a doctor does not see a patient then he does not get paid. If he takes a week off then there is no cheque in the mail from AHCIP. If he is not classified as disabled then his disability insurance policy does not pay him a dime!

The situation of chronically sick Canadian physicians was highlighted last August when a family doctor and psychotherapist, Dr. Suzanne Killinger-Johnson, clutching her six-month-old son, jumped in front of a Toronto subway train, killing them both.

Media and the people in general wondered why a bright, attractive, affluent, successful 37-year-old doctor would commit suicide and take her young son with her? After all physicians have it all! But if you don’t have good health then you don’t have it all!

There is a very high rate of depression among physicians. One study shows that from 1991 to 1998, the rate of suicide for British Columbia doctors was about 22 suicides per 100,000 people per year. The rate for the general population was just shy of 14 per 100,000 people. Female physicians commit more suicides than male physicians.

Is there help?

In Canada, there are several provincially based physician health programs that help doctors with stress related difficulties like depression, and other psychiatric, medical or substance abuse problems.

“From time to time we all face difficult or stressful events in our lives. Most of the time we can handle these challenges on our own. Other times they may interfere with our effectiveness, happiness, safety at home and work, or even our health,” says Alberta Medical Association’s Physician and Family Support Program document. The program provides confidential referral and counselling services for Alberta physicians and their families.

It is a good program. But is there help if a physician’s health is interfering with his career but he is not considered disabled or clinically incompetent? None! Who would want to give a physician hospital privileges if he cannot be on-call, cannot share the workload equally with his healthier colleagues, use health authorities’ limited resources disproportionately to the contribution he makes, block recruitment of younger and healthier physicians, and thus deprive the public of a “full meal deal” physician?

Few years ago, the Canadian Medical Association produced a document called “Charter for Physicians”. Under the item Quality of Life, in part it says, “Canadian physicians need access to appropriate resources for dealing with personal or professional problems that affect their medical practice.” But there is no mechanism in place to enforce the Charter!

Is there a solution to the problem? I haven’t seen any action provincially or nationally to help chronically ill physicians. It will have to come down to local level – a serious dialogue between the medical staff organisation and the health authority. And there seems to be recognition and some action locally to help doctors with chronic illness who are willing to provide limited service.

May the force be with them!

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