In this third article, Dr Rhona Knight describes the challenges of ‘doctoring doctors’ and talks about the RCGP pilot programme: Health for Healthcare Professionals
The doctor as patient
One of the joys of clinical practice is the diversity of patients that we encounter – each with his or her unique story. Each patient we meet presents us with new challenges, some of which we take in our stride, others requiring us to reflect and develop new skills. Caring for patients who are healthcare professionals is one area where reflection and skill development are often needed, particularly when we are dealing with doctors who are also patients. As outlined in the first article in this series, doctors are not only a hard to reach group, but they are also a high risk group. They can find it very hard to move from the doctor’s chair to the patient’s chair – to move from one end of the stethoscope to the other. Adding to this their ability to find interesting ways around the healthcare system, for example in having ‘corridor’ conversations with colleagues and their ability to self-prescribe and treat, doctors are a complex group of patients. The complexity increases further when we realise that the person we have seen as a patient in the morning may well be sitting with us as a colleague in a management meeting that afternoon.
How do you doctor a doctor? In some ways the answer is ‘like any other patient’. The truth is that doctors, like any other patient, have their own unique health narratives, ideas, hopes and thoughts. In that medicine is an occupation, like other occupational groups, there are particular illnesses or health problems that doctors are more at risk of developing. Just as someone who develops epilepsy might pose a risk to society by driving, doctors’ health can impact negatively on others. In short, doctors do need to be treated like any other patient – with patient-centred care that takes who they are into account, including their fitness to practise 1,2 . The same shaped care does not fit all. The problem is that if you talk to most practicing doctors, they will identify that doctoring doctors is not easy.
In his JAMA letter responding to an article by Schneck 3 on doctoring doctors and their families, Lipsitt humorously crystallises the problem facing the doctor’s doctor in quoting the following tongue-twister 4 :
If a doctor is doctoring a doctor,
Does the doctor doing the doctoring
Doctor the doctor being doctored
The way the doctor being doctored
Wants to be doctored,
Or does the doctor doctoring the doctor
Doctor the doctor being doctored
The way the doctoring doctor usually doctors?
The doctor’s doctor
Within the context of increasing concerns about the issue of doctors’ health, and its impact on the care of patients, on healthcare costs, on the lives of the doctor’s colleagues, family and friends and on the lives of the doctors themselves, improving the health of doctors has taken a higher profile. 5,6,7,8
Initiatives to address this complex issue include the development of services, like the British Medical Association Counselling and Doctor Advisor Service 9 , House Concern 10 , MEDNET 11 and more recently the Practitioner Health Programme 12 . What has also been happening more recently is an acknowledgement that doctors caring for doctors need further training and skills development.
As a result the Department of Health have funded the Royal College of General Practitioners (RCGP), the Royal College of Psychiatrists and the Faculty of Occupational Medicine to develop training programmes for their members. In the case of the RCGP this is a pilot programme that is due to finish at the end of July 2012.
The RCGP pilot programme: Health for Healthcare Professionals 13
The RCGP has based its training on the Health for Health Professionals document Guidance and Competencies for the Provision of Services using Practitioners with a Special Interest 14 . This document was put together as a result of a series of meetings which included the RCGP, the Royal College of Psychiatrists, the Association of NHS Occupational Health Physicians and the British Medical Association.
The aim of the programme was twofold. The first aim was to provide a Continued Professional Development programme for all GPs in the area of health and wellbeing of doctors who are patients. The second aim was to train a cohort of GPs from England and Wales, with a specialist interest in practitioner health, equipping these GPs to work in varied area specific, locality-based practitioner health programmes. The programme is divided into two parts: the Certificates in Practitioner Health Part 1 and Part 2. Part 1 aims to develop the skills of all GPs. It consists of two e-modules and a face-to-face training day. Part 2 consists of further face-to-face training and collating a portfolio of evidence. The online modules are available on the RCGP website where you can sign up for free access.
You may still be questioning: is such training needed and should it be recommended? The feedback of a course participant provides a succinct answer.
"Yes – learning about practitioner health is so important, as doctors and other health practitioners do have some unique needs as a result of their vocation, and deserve to receive high standards of care so that they can provide this high standard to their own patients."
- Ipsos MORI Fitness to Practise: The Health of Healthcare Professionals, 2009.
- General Medical Council Good Medical Practice: Health.
- Schneck SA “Doctoring” Doctors and Their Families. JAMA 1998; 280(23):2039-2042.
- Lipsitt DR Doctoring Doctors. JAMA 1999; 281(12):1084.
- Department of Health The White Paper: Trust, Assurance and Safety: The Regulation of Health Professionals in the 21st Century, London: the Stationery Office, 2007.
- Department of Health Good Doctors, Safer Patients, 2006.
- Harvey SB, Laird B, Henderson M, Hotopf M The Mental Health of Health Care Professionals, A review for the Department of Health, 2009.
- Department of Health Invisible patients: Report of the Working Group on the health of health professionals, Crown, 2010.
- British Medical Association. About Doctors for Doctors and BMA counselling.
- Support 4 Doctors. House Concern.
- London Deanery. Mednet.
- NHS. Practitioner Health Programme.
- Royal College of General Practitioners. Health for Healthcare professionals (HHP).
- RCGP, RCPsych, ANHOPS Guidance and competencies for the provision of services using practitioners with special interest: Health for Health Professionals, 2010.
Read previous articles from the Health for Health Professional series: