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Independents' Day

Doctor as a patient

It's a privilege to treat a colleague but Murphy's Law will inevitably operate, says

Dr Stefan Cembrowicz

Doctors are an at-risk group. We have jobs that are bathed in other people's life stresses and strains and we toil to operate the creaking machinery of the NHS in our patients' interests. We have easy access to medication such as analgesia and psychotropics that are forbidden to the public. Our training has taught us to ignore personal discomfort to get the job done, and eating, sleeping and care of ourselves takes second place. That may be all very well for macho-doc but data shows that our families are also affected and share our poor health statistics for depression and alcohol use.

How they will feel

Remember it is a privilege to be asked to treat another doctor. When you see a fellow doctor as a patient remember Murphy's Law will inevitably operate. Your doctor patient may have ignored serious symptoms, regarded them as psychological, self-medicated inappropriately, or may focus great anxiety on to symptoms of half-remembered diseases.

He or she may be nihilistic or over-anxious about their own health and may refer himself or herself to secondary care or take corridor advice from colleagues without giving them the chance to make a whole-person diagnosis.

The last generation of consultants who had also had GP experience are mostly retired now and nowadays our hospital colleagues may be considerable experts in their fields but may

remember little from medical school days about ailments arising in unfamiliar departments.

What you should do

Do it by the book when seeing a doctor: be extra-professional. Sometimes you may feel they just see you as an obstacle to secondary care, but check their health parameters properly. Carry out formal examinations (DRE, smear, swabs) even when you feel you don't really need to bother or feel slightly embarrassed, keep proper records and make sure they are happy with what you have written.

Think physical-psychological-social just as you would with any other patient. We doctors are only human, subject to the same woes and weaknesses as our patients.

Ask about units of alcohol and non-prescribed medication (official or otherwise). Well-meant attempts at short cuts are likely to lead to complications. Shortcuts are risky, but make your colleague at ease by phoning to avoid queues, bypassing waiting times and smoothing out the little annoyances that we all know to expect on the road through our health system. Health staff are given priority by the NHS and we need it.

Avoid being intimidated by other doctors' hierarchies or being drawn into an unhealthy work culture. One consultant whom I had until then respected phoned me to ask why his houseman was off sick as the firm was feeling the strain in her absence. This was none of his business.

Make sure your doctor colleague knows the best way to get in touch with you. Remember that their families may have mixed feelings about their vocation and may present to you for common-sense advice on surprisingly minor matters: 'I want to see a proper doctor, not you Mum, all you know about is kidneys.'

Keeping doctors healthy

Doctors now have access to occupational health ­ independent third parties who can help make the job fit the worker rather than vice versa. Encourage contacts with the occupational health department when work issues or longer-term health problems arise.

Illness and death may be regarded as day-to-day work colleagues, and when it is our turn to become unwell we may regard this as impertinence, or go into denial ­ just like our patients do, as once again we are merely human. Some of us are prone to continue working when we should not, and cling to the very routines that are too much for us; should you come across this situation you have to consider the patients' welfare too.

Doctors should not be at work if they are stressed or unwell as they risk creating what has been termed 'metastatic trouble'.

If you are concerned that patients may be put at risk by a doctor's ill-health and cannot resolve matters by giving clear advice to the doctor concerned, take careful advice from a more

experienced partner or LMC member in the first instance.

Most of the time your doctor patients will not exhibit the above woeful pathologies, and demonstrating your best consultation skills to them

will be a pleasure.

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