Home' GP Pulse : GP Pulse February 2017 Contents Features
P4 : ISSUE 59 : February 2017
Being the doctor’s doctor
Distinguished College Fellow Janet Frater has cared for many
colleagues during her 35 years as a GP. She reflects on the challenges
this has presented and offers guidance on being both a good patient
and a good doctor’s doctor.
We often hear the comment that when
doctors have surgery they are much more
likely to have complications than the average
patient. Fortunately I am not a surgeon!
Nevertheless, when I reflect on being a
GP to quite a number of colleagues over
the years, I realise they often bring more
complex problems than my other patients.
Their problems also seem to take more
time to sort out. The illness experience of
doctors is complicated.
Doctors are often reluctant to admit to
illness and think of it as a weakness.
They present late when they have exhausted
all simple options. They have often self–
medicated inappropriately, for example,
grabbed the Augmentin from the cupboard!
They have no documentation for themselves
or their families. They tend to think of
the worst diagnostic possibility and have
researched it thoroughly before they present
for a 15–minute consultation. This can
make you feel anxious when you bring them
into your room and you wonder if your
competence is being assessed.
They may try to be a good patient but find it
difficult to relinquish control. As a profession
we have higher levels of depression and
substance abuse than the general population.
This can complicate the doctor/doctor
consultation, with the issues of fitness to
work and notification to the Medical Council.
There are also issues of privacy and
confidentiality, for example, sitting in a waiting
room where the doctor may be recognised.
An understanding of role ambiguity is
essential for being a doctor’s doctor.
The clear boundaries that exist with our
usual patients, who have less medical
knowledge and skill than us, are blurred
when we consult with our colleagues. The
patient-doctor has difficulty in surrendering
control and may find themselves going
behind their GP’s back and reverting to self–
referral and self–management rather than
openly questioning their opinion.
I have learned that it is best to acknowledge
the difficulties in the roles and raise these
issues when I first see the doctor as a
patient. Good communication skills are
essential to encourage open discussion. Here
are some of my recommendations:
Acknowledge the difficulty in switching
roles of doctor and patient. “In general
I will treat you as my other patients in
this consultation, but we obviously have
shared knowledge and collegiality and
this can make it more difficult for us
Encourage open discussion of fears and
concerns, however unrealistic these may
be. A helpful statement could be “Of
course as doctors we always think of the
worst. What have you been thinking this
could be?” Acknowledge that we may
disagree on investigation or treatment
options. I could say, “We all tend to
have our own ideas on what should
be done. What are your ideas on this
Encourage honesty by letting them know
your feelings. For example, “I sometimes
find myself over–investigating colleagues,
and they often find it awkward to tell
me when they have not done what I
suggested. I hope we can be honest with
Don’t assume the same level of medical
knowledge, particularly when a colleague
is from another specialty. I might say, “I
usually give the same detailed level of
explanation that I would give to my other
patients, so please let me know if this is
pitched at the wrong level for you.”
One of the more sensitive areas for discussion
is the fee. Traditionally doctors did not charge
colleagues. If doctors are to get good medical
care, paying a standard fee is important as
it creates a clear role definition between
doctors. It also avoids the embarrassment of
imposing on a busy colleague the dilemma of
finding an appropriate thank you gift, and the
tendency for corridor consultations.
I always try and discuss this issue with the
patient–doctor and point out the importance
of maintaining good professional boundaries
with colleagues. There is usually relief at being
able to discuss this openly.
Dr Janet Frater photo
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