Sick docs get cold comfort from colleagues

The medical profession's ideal of invincibility makes it tough for physicians to seek help from their peers when they fall ill. Most don't even have a GP

By Bonnie Bowman

Like most of his professional colleagues, Dr Michael Paré, a general practice psychotherapist, knows his stuff. He went to McGill and earned his Masters, then went on to complete his med studies at U of T. He has a fulltime clinical practice in Toronto, teaches students and residents, and works part-time as a physician coordinator for the Ontario Medical Association's Physician Health Program (PHP). Dr Paré comes off as tireless and in control — like a good doctor should.

But unlike most of his colleagues, Dr Paré can indirectly offer his patients something else of value. He not only talks the talk, he has walked the walk. Dr Paré has suffered from, and been successfully treated for, depression. It is a battle he has fought more than once, before university and again during medical school, and at his lowest point he endured a bout of severe clinical depression. He says it was "about as bad as it can be." Since starting his practice over 12 years ago, Dr Paré has not suffered from clinical depression.

FIGHT THE STIGMA
"I have mixed feelings even now, talking about this," Dr Paré admits, but overriding any personal reticence is his commitment to helping other physicians through his work with the PHP. If opening up about his own situation can lessen the stigma, he's happy to give something back.

"I feel like I'm the poster boy for mental illness in medicine," he jokes. What's not so funny is the fact that there's still a taboo attached to doctors seeking help from their peers or programs like PHP.

"I think the concept is that doctors have trouble thinking of themselves as both the doctor and the patient, they're either one or the other," says Dr Paré. "Doctors can't be sick because they're the healers."

DOCTOR AS ORPHAN PATIENT
This reluctance to seek help is compounded by the fact doctors are notorious for not having their own GP. "The statistics of doctors having their own doctors are pretty pathetic," notes Dr Paré. "I didn't even have a doctor until five years ago."

And even now, with physician health groups proliferating across the country to address doctors' emotional and physical wellbeing, Dr Paré still finds resistance.

"For me, having come out in a sense and saying I've had mental illness, I've been a little surprised by the response," he says. "Several of my colleagues have been very supportive, but many, many, many less than I would have thought."

"One doctor actually said, 'Oh, so you're not going to be practising medicine anymore? How are you going to get referrals after admitting you've been depressed?'" he adds.

Dr Paré's response? "Well, I guess I'm a human being. You think that would stop patients from coming to see me?"

A SUCCESS STORY
That callous doc couldn't have been more wrong about Dr Paré's prospects, who now says he has "more referrals than I can possibly handle." But Dr Paré is quick to point out that having a successful practice isn't everything. Indeed the emphasis on always putting the patients first is lost when the roles are reversed. A doctor's well-being is taken seriously only because it could ultimately affect patient care.

"That is exactly the kind of thinking that leads to a kind of perfectionism and a denial of the doctor's own life," says Dr Paré. "In other words, everything comes back to the patient. The physician is a human being and they do have rights. I think physician health is important not only because it helps the patient indirectly, but because it helps the doctors."

BOTH SIDES NOW
Having been personally helped by a program that pre-dated the PHP, nobody could deny that Dr Paré understands firsthand the value of such support. Not only did he end up specializing in psychotherapy, his current work with the PHP allows him to share his expertise and his passion with his colleagues.

But sharing is easier said than done. PHP's medical director Dr Michael Kaufmann concedes physicians are still hesitant about approaching each other with their problems. "It's also very difficult for a doctor to go to another one saying, 'I'm worried about you,'" says Dr Kaufman. "There is so much resistance to doing that ... they're afraid to insult them, they're afraid there will be denial and they'll dismiss them, they're afraid of being wrong." But he emphasizes that doctors are "critical" in their own front-line role.

THE PHP WAY
"In conditions that can impair or result in lack of insight, it is essential that a colleague be willing to approach another," says Dr Kaufmann. And PHP offers the skills to help physicians do just that. Launched in 1995, initially focusing on drug and alcohol problems, the PHP's mandate has now broadened to embrace all manner of personal problems faced by a doctor or their family. As Dr Kaufmann notes, the stressors faced by today's physician are overwhelming. And as physician surveys attest, advanced burnout is prevalent.

"The workload, the demand, the bureaucracy, the conflicts with administration, government, the disenfranchisement they feel, and the powerlessness they feel as systems change and they don't feel like they have control ... and let's face it, doctors like to be in control," he says.

Changing the system, acknowledges Dr Kaufmann, will take a long time. But changing one's personal resiliency and ability to cope — "that can happen tomorrow."

It can start by picking up the phone and calling the PHP's confidential line, where skilled onsite clinicians will help meet the caller's needs, no matter where they live. Similar programs are available across the country.

"Inside every doctor, underneath every white coat, is a real person who has all the same basic human needs that our patients do," says Dr Kaufmann. "I fully believe that doctors, being the intelligent people that they are, know this already — it's just that they sometimes need someone else to remind them."