It was interesting to read Clare Gerada’s editorial ‘Doctors and suicide’.1 The majority of doctors manage their health alone for several reasons: neglectfulness or denial, self-prescribing, the desire to present a picture of good health to others,2 fear of causing their colleagues difficulty,3 or fear that medical confidentiality will not be respected.
Questions on intimate subjects such as sexuality or addictive behaviours are rarely approached, or not at all.4 This is also true of clinical examination,4 often because the question of knowledge or hierarchy between the treating doctor and the doctor–patient comes into play.
We carried out a survey of 375 GPs who treated doctor–patients, using an online self-administered questionnaire based on elements identified in the literature as likely to affect management. The three main barriers to the relationship between treating doctors and doctor–patients from the perspective of the treating doctors were the difficulty in making the doctor–patient accept the patient role, the fear of error and of being judged, and competency in another specialty. The three facilitators were confidence shown by the doctor–patient, an equal level of medical competency, and the relaxed atmosphere of the consultation.
Medical management of doctors is a problem that is common to all countries, and one on which there is currently no helpful consensus. According to the British Medical Association,5 a doctor–patient must be treated just like any other patient. The creation of dedicated health services would seem also to be a possibility. Canada and Spain are leaders in this field. A joint European initiative has been set up through the European Association for Health Physicians (http://www.eaph.eu/) and shows the need for research to aim for optimised and coordinated management.
- © British Journal of General Practice 2018