UNITING PHYSICIANS & PATIENTS AS A VOICE IN HEALTH CARE
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What steps can physicians take to improve access to needed medical services for themselves or their colleagues?
Seek and accept help from colleagues. Oftentimes help or an intervention is prompted by patient complaints about a physician's inattention or inappropriate behavior. Thankfully, colleagues and clinic administrators are becoming more comfortable encouraging their medical colleagues to get help from other doctors and professionals, while saving face with clinic personnel and patients. Usually a doctor’s work colleagues are the first to celebrate and praise the physician for getting help and to offer support, whatever the illness or malady.
Most organizations assist their physician and health care colleagues in obtaining help with alcohol and drug problems. As these beneficial efforts are expanded, it is vital that the clinic physician or health care professional be allowed to and encouraged to seek professional help outside of the clinic provider network. This means extending work-based health care coverage to cover the costs of out-of-network care so that physicians and other health care personnel need not be treated by the same doctors with whom they work each day.
Diversion program for impaired physicians. Doctors who get appropriate medical attention for psychiatric, substance abuse, neurological, or medical conditions related to physical or cognitive impairments can set up a plan of evaluation, care, and monitoring with the Minnesota Health Professionals Services Program (HPSP). Physicians or other health care professionals eligible for and accepted by the HPSP diversion program can usually remain in practice when they adhere to their negotiated plan of care with HPSP. More information about HPSP and the Minnesota Board of Medical Practice may be found at www.hpsp.state.mn.us and www.bmp.state.mn.us.
Treating physicians who file quarterly reports to HPSP must attest to the physician-patient's compliance to a plan of care monitored by the HPSP staff. Thus, HPSP diversion provides a pathway to treatment for impaired physicians, but HPSP monitoring introduces a level of scrutiny that can detract from open disclosure and partnership in the doctor-patient relationship.
A healthy doctor-patient relationship requires the treating physician and the physician-patient to consider their comfort levels about the quality of their communication and to share their views about the following aspects of therapy:
If either the treating physician or patient is uncomfortable during this process, this discomfort should be discussed, understood, and resolved in short duration. If this is not possible, the doctor should recommend referral of the patient to another physician.
The physician-patient. Although doctors often experience anxiety when switching their role from the treating authority to the recipient of medical care, it is not true that doctors make poor patients because they know too much. Like most patients, doctors greatly appreciate frankness and honesty from their treating physicians.
Physician-patients should view their tendency to self-prescribe and their failure to adhere to a plan of care with their doctor's advice as an occupational hazard. They should inform their treating physicians when they have disagreements or doubts about receiving "formal" medical care or when they disagree with the care recommendations.
The treating physician. The treating doctor needs to be fully aware of the physician-patient's attitudes toward being ill and being treated for illness. To set the proper tone and structure for the physician-patient relationship, the doctor should treat the patient in the usual clinical setting. Treating doctors must maintain their professional boundaries with their patients who are professionals. In this regard, the general rule is, "Why would I consider treating this patient differently than any other?" A warning signal is the thought (whether expressed or not), "I don't do this with other patients, but for you, because you are a doctor, I will."
Treating doctors may feel angry with their professional patients. They may not understand this anger. It may be born of anxiety for the fate of the patient, identification with the patient, or a feeling that the patient has behaved stupidly or brought on his troubles; or it may come from the doctor-patient's nonadherence to treatment recommendations.
Increasing media attention to and public dialogue about health issues such as depression and other mental health issues, alcoholism, and chemical abuse highlight the need for physicians to seek treatment for these conditions. Physicians often are more reluctant than their patients to seek treatment for any condition that may be associated with impairment or social stigma, for reasons related to both professional and personal circumstances and characteristics.
The American Medical Association has recommended that professional attitudes and institutional policies be changed so that physicians with health problems can more easily seek and find appropriate medical care. This entails a clear understanding between treating physicians and their patients about special aspects of the doctor-professional relationship; clarity of legal requirements concerning reporting impairment; and access to physicians and mental health professionals outside of the doctor's clinic.
Lee H. Beecher, M.D., is a clinical associate professor in the Department of Psychiatry at the University of Minnesota, immediate past president of the Minnesota Physician-Patient Alliance (MPPA), and a psychiatrist in private practice in St. Louis Park.
The author references Michael H. Gendel's article "Treatment Adherence in Physicians" (Primary Psychiatry, Vol. 12, No. 6, June 2005, pp. 48-54) in preparing this article.
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