Top Tips: When Doctors Become Patients

Dr Claire Davies Offers 10 Top Tips on How to Manage the Potentially Challenging Experience of Being a Patient as a GP

In his latest book, And finally: matters of life and death,¹ the neurosurgeon and author Dr Henry Marsh tells the story of how he struggled with his identity when he developed prostate cancer, finding himself a doctor and an anxious patient at the same time. ‘Please talk to me as a doctor,’ he told his oncologist during his first appointment. ‘That’s not how we do things here,’ the oncologist replied. Leaving the hospital, Marsh reflected, ‘I have crossed to the other side. I have become just another patient, another old man with prostate cancer, and I knew I had no right to claim that I deserved otherwise.’¹

Marsh’s experiences of the identity challenges that can occur when doctors become patients is well supported by the medical literature.^2–4 Although the standard mortality rate of doctors is low, doctors have similar rates of chronic illness to the general population.^2,3 In addition, doctors experience high levels of work-related stress; consequently, they are susceptible to mental health issues, alcohol-related problems, and substance misuse, and are at an increased risk of suicide.^3,5–7 However, some doctors are reluctant to seek care for illness,² and many fail to register with a GP or follow preventive health advice.³ There are many reasons for this; some examples are presented in Box 1.²

As doctors age, it is inevitable that they will become patients at some point. No manual exists on how to be a patient as a doctor; however, understanding the challenges to seeking care and how they can influence behaviour may aid doctors to safeguard their wellbeing. Caring for yourself is not self-centred—it is important for doctors and their patients, because healthy doctors are more likely to practise safely. This article provides 10 top tips on how to be a patient as a doctor.

1. Register With a GP

According to Professor Dame Clare Gerada, founder of the NHS Practitioner Health Service (www.practitionerhealth.nhs.uk), doctors in the UK are on a par with homeless people in terms of barriers to access to healthcare.⁸ Poor access to care is a particular issue for doctors in training, who frequently move between living places. Although checking that a doctor is registered with a GP is part of the GP appraisal discussion, the stress of a house move means that registering with a new GP can slip down the priority list, causing problems when healthcare is needed quickly.

The GP Dr Walter Anderson writes that doctors tend to choose their own GP based on who can conveniently provide immunisations for their children or treat trivial illnesses; however, he advises that doctors should choose a GP in whom they feel they can confide about the issues that commonly affect members of the profession, such as stress and mental illness.⁹

2. Seek Help as Early as Possible

Doctors are notorious for putting off seeking help for their symptoms, and presenting late with a serious condition is common.⁸ Marsh put off seeking help for his prostatic symptoms for many years.¹

Doctors tend to view themselves as people who treat the sick and do not get sick themselves.⁸ In one study, 71% of doctors reported feeling embarrassed about becoming a patient.¹⁰ In another, 70% of doctors reportedly felt unable to justify use of another doctor’s time unless they were ‘really ill’.¹¹ Issues such as mental health or addiction pose particular barriers to asking for help.¹²

3. Avoid Self-prescribing

The General Medical Council (GMC) states, ‘Wherever possible, you must avoid prescribing for yourself or anyone you have a close personal relationship with.’¹³ The guidance also says that, if doctors do self-prescribe, they must make a clear record of this, and also of the reason that it was necessary.¹³ Although this statement appears to offer some flexibility, in practice the number of referrals to the GMC concerning self-prescribing has risen in recent years, instigated mainly by pharmacists and their colleagues.¹⁴ The Medical Defence Union notes that self-prescribing of controlled medicines, particularly benzodiazepines, antibiotics, and opioids, is most likely to lead to criticism.¹⁵ Therefore, it makes sense for doctors to avoid potential problems with the GMC as part of their approach to looking after themselves.

4. Attend Consultations in an Appropriate Healthcare Setting

Asking a colleague about health issues in conversation (otherwise known as a ’corridor consultation’) seems inevitable when working in the health service. However, questions about anything that requires investigation or treatment should be asked in the proper setting—a GP consultation.

Dr Daksha Emson was a psychiatric specialist registrar with bipolar affective disorder who killed herself and her 3-month-old baby during a psychotic episode.¹⁶ An independent enquiry found that she had received a significantly poorer standard of care than she would have provided to her own patients.¹⁶ The enquiry found that, although the doctors who treated her had acted in good faith, they had not informed others who could have helped and supported her.¹⁶ For example, she was not a patient of the community health team at her own request.¹⁶

Consulting a doctor in appropriate surroundings allows a fuller and more objective assessment, with the relevant equipment and notes to hand, and with the necessary records kept.⁹

5. Be Aware of your Right to Confidentiality

Doctors can be well aware of the limits of confidentiality, especially in larger settings.¹⁷ Anxiety about confidentiality may be a particular concern for doctors with mental health problems.¹² Medical students can also be present in consultations; although perhaps not an immediate concern, students rotate around organisations, and doctors may end up being responsible for them elsewhere in a training capacity.

Although all healthcare professionals should respect confidentiality, being treated in the institution in which a doctor works can mean that it is difficult to retain full confidentiality. In general, it is desirable to be treated elsewhere, but this may not be possible in remote communities. For issues around mental health and addictions, NHS Practitioner Health (www.practitionerhealth.nhs.uk) offers a confidential service, stating on their website that those accessing the service can use a pseudonym, and can list any professionals they know within the service whom they would like to avoid seeing.¹⁸

6. Choose Whether to be a ‘Lay’ or an ‘Expert’ Patient

Dr Kate Granger, a specialist registrar in geriatric medicine diagnosed with incurable cancer, said: ‘It is so difficult when a doctor turns into a patient. We have baseline knowledge and skills, professional contacts, specific ideas and expectations that perhaps “lay” patients do not have and these need to be considered when caring for us.’¹⁹

Deciding whether or not to reveal that you are a doctor at the outset of a consultation is a matter of personal choice. It is worth noting, however, that this is likely to slip out in time. Professor Irene Tuffrey-Wijne, an associate professor of nursing diagnosed with grade-2 breast cancer, states that healthcare professionals who are patients have multiple perspectives that need to be taken into account. These include those of:²⁰

• ‘a patient
• a critical analyst, studying themselves being a patient
• an observant healthcare professional, assessing how other healthcare professionals do their work
• a researcher, processing and analysing the healthcare structures and procedures affecting them as patients.’

Doctors who have developed more serious illnesses have reported becoming more passive, dissociating from the fact that they are a doctor.⁴ However, this experience is by no means universal; Granger described herself as ‘always … thinking about my care with my physician head on’.¹⁹

It can be helpful for doctors to acknowledge if they are feeling awkward, and to state from the outset whether they would like to be treated like any other patient. Alternatively, they may wish to explain that they would like to be considered a patient, but that they may have some extra questions based on their medical knowledge.

7. Resist and Prevent Presenteeism

According to Dr Keith Hopcroft, a GP in Essex, ‘Battling on through illness and not letting the side down has traditionally been seen as an attribute—and therefore taking time off as a weakness’.²¹

Doctors are much less likely than other healthcare workers to take time off sick.²² Concerns about letting colleagues and patients down and service pressures contribute to this phenomenon.²¹ An objective conversation with a healthcare professional can help to frame a more sensible decision about whether time off is needed and for how long. Those that do take time off may be prone to carrying on doing some activities at home—depending on the situation, this may or may not be helpful.

8. Consider the Adverse Impact on Patients

Ill health can adversely affect performance and functioning, as well as the ability to be compassionate.^23,24 In addition, burnout doubles the risk of patient safety incidents.²⁵ Being ill with a potentially transmissible disease, such as gastroenteritis, COVID-19, or influenza, can also pose risks to patients. This is particularly important when working with vulnerable or immunocompromised patients.

9. Understand the GMC Guidance

The GMC states that action must be taken ‘if … patient safety, dignity or comfort is or may be seriously compromised.’²⁶ If you are unsure whether your health is or may be affecting your work, it is essential to consult your treating healthcare professionals, a senior colleague, or your medical defence organisation.²⁷ Although doctors who are patients are entitled to have their health information treated as confidential, their treating physician is obligated to report the matter to the GMC if they feel that there is a risk to patients arising from a doctor’s health issues.²⁶

However, the GMC states on its website that: ‘There is usually no need for us to be involved where a health concern is being treated and does not impact on patient care.’²⁸

10. Seek Further Support if Necessary

Being ill can be difficult and distressing for doctors, whether the illness is physical, mental, or related to addiction. Concerns about confidentiality or any associated stigma can make it harder to discuss sensitive problems. Doctors should be aware that further support for issues related to addiction or mental ill health is available (see Box 2 for useful resources), and seek additional support if necessary.

Summary

Being a patient as a doctor can be straightforward—it can even hold certain advantages. However, it can also involve feeling vulnerable. Given the implications of being unwell, it is in the doctor’s best interests to seek help early to remain well. Doctors must understand that they have a right to confidentiality in a healthcare setting, while being mindful of professional guidance and how to access further support.

Dr Claire Davies

GP, London