A medico-legal perspective on physician health and wellness: Removing barriers to treatment of physician patients
Originally published October 2012
In a profession where the culture has shifted significantly, one aspect of medical practice continues to endure: a physicians' ability to put the health and needs of their patient first, often at the expense of their own personal health.
The traditional cultural myth that physicians are immune to illness remains to this day, yet the reality is that doctors are as susceptible to health problems as their patients. Balancing the pressures of their job with the need to care for their personal health can place a huge strain on healthcare providers. Physical and mental health issues, alcohol and drug problems can be a reality, impacting a physician's ability to practise medicine.
At its 2012 annual meeting in Yellowknife, the CMPA assembled a panel to address physician health and wellness.
President of the Canadian Medical Association, Dr. Anna Reid, noted a recent study that found that 1 in 3 physicians feel their workday causes undue stress, and 1 in 4 physicians say they feel depressed. "Our system requires a national coordinated approach to physician wellness," said Dr. Reid, "in order to support sharing of knowledge, providing research, educating physicians, and enhancing the provision of services. The new Canadian Physician Health Institute will develop a pan-Canadian, multi-stakeholder and physician lifecycle program for physician health and well-being."
Dr. Michael Kaufmann, Medical Director of the Ontario Medical Association's Physician Health Program, brought his perspective to the discussion. "When we are well, we bring the message of health, wellness, and resilience to our patients much more readily, effectively, credibly," noted Dr. Kaufmann. "When we look after ourselves and each other, that makes a difference for our patients in terms of patient care."
CMPA Executive Director and CEO Dr. John Gray applauded physician health programs which provide an effective way for physicians to obtain confidential help. "It's important that we do everything we can to offer health programs that effectively treat physicians," he emphasized. With the increasing demands on physicians, every effort is required to support physician health. Balanced and effective measures, which respect individual privacy rights and provide reasonable precautions that protect public safety, are necessary.
Medical regulatory authorities (Colleges) have a key role to play in supporting physician health, both through their actions and the steps they allow others to take. However, some Colleges are proposing policies that would impose mandatory reporting of physicians with health conditions. As well-intentioned as these policies may be, the CMPA believes that such overly-broad mandatory reporting would have the unintended effect of inhibiting physicians with medical conditions from seeking the help they need.
Barriers for physicians
Physicians may be reluctant to seek help for a number of reasons. Primarily, they may worry that if they obtain treatment, their health status will be disclosed to their hospital or College. Such unintended disclosure can be detrimental to a physician's reputation and privacy, particularly in small communities, or in a university or hospital setting. It may also hinder their ability to practise in the future and earn a living. These concerns can drive some physicians to hide their condition.
On the question of whether enough is being done to lower the barriers for physicians to obtain confidential help, the CMPA has outlined a set of recommended actions to address existing shortcomings. These start with suggestions to the medical profession which, for its part, should be encouraging physician colleagues to get the treatment they need. "Friendly advice when it can make a difference is preferable to being placed in the difficult situation of reporting a colleague to a hospital or College," Dr. Gray said. "All of us in the medical profession need to support and promote available treatment options for our colleagues, and to encourage affected physicians to seek the treatment they need."
Colleges have a role in ensuring public safety. In fulfilling that role, they need to collect certain types of information. The CMPA urges Colleges to focus on collecting only relevant information that fulfils their regulatory mandate. For example, a College might ask if a physician currently has a medical condition that might impact the ability to practise, rather than asking if the physician has ever had such a condition.
The CMPA believes Colleges should encourage physicians to self-report medical conditions. Colleges should also provide assurance that such information will be handled appropriately and in confidence.
Hospitals and institutions
The CMPA believes that hospitals should refrain from collecting and using physicians' personal health information. Colleges are better positioned to undertake the collection, use, and safeguarding of information about physicians with a medical condition affecting their ability to practise. Colleges have the expertise to make evidence-based decisions regarding a physician's practice and can communicate those requirements to the physician and the institution more effectively.
Hospitals, clinics, and other institutions play an important role in creating a safe work environment where physician-patients may continue their practice within guidelines established by the physician health program or the College.
The CMPA believes governments can better support programs that make treatment options available. The cost of returning an experienced and capable physician to practice greatly offsets the cost to a community of losing even one physician.
The CMPA also encourages governments to develop programs to assist physicians whose ability to practise is impaired by a medical condition stemming from the practice of medicine.
The CMPA and physician wellness
Through its primary role of providing advice and assistance to physicians facing medico-legal difficulties, the CMPA understands the challenges physicians face — and the toll that these challenges can take on physicians' health and well-being.
View a webcast of the CMPA information session on physician wellness.
The CMPA has written on related topics, including: "Personal physician health information: Supporting public safety and individual privacy" and "Physicians with blood-borne viral infections: Understanding and managing the risks." The CMPA website also has a section on physician wellness which provides more information and links to resources for physicians.