When Stress is Unbearable: Doctors help one another cope in daily life-and-death world
by Sherri Borden Colley, Staff Reporter
Herald, Halifax, Nova Scotia
In Dr. Bob Fredrickson's first decade of practising family medicine, 10 of his patients died. Over the next decade the number swelled, reaching 300 to 400.
To say that took a toll on him is an understatement.
"I mean, when that situation (arose), I worked harder," the Halifax doctor recalled, "and I would be in my back office crying in between patients. But I'd go out to the waiting room and I'd be fine ... because I knew the role to be in. "I was confident in that role and I'd see the person, take care of them, let them go, and go back and cry."
At the time, Dr. Fredrickson, who specialized in HIV cases, hadn't had a vacation for two years. He couldn't get anyone to fill in for him. Finally he realized that he needed to take some time off, so he closed his office for one week. ''And of course, the first three days of that week you're feeling guilty," he recalled in an interview.
The day before he was to return to work, he went in to check his mail. But when people walked into his office to say hello and tell him what had gone on that week, the words did not register. "I stood there; I listened to them," Dr. Fredrickson said. "I could hear the sounds, but I could not assimilate what they were telling me and it scared the hell out of me."
Dr. Fredrickson called a friend who was a therapist, and she bluntly told him it was unsafe for him to continue to work. Her advice, though scary; "was important and freeing to hear," said Dr. Fredrickson, who gave up his practice in 2000-0l.
"The idea of me being unsafe to practice was devastating .... Even today it's difficult. And yet when I see people in the same boat, they need to be told that. It's almost that shock that has to happen unless you admit there's a problem." Being told the truth was "the best thing and the worst thing" that ever happened to Dr. Fredrickson.
The overwhelming stress he described is not uncommon among physicians. Through Doctors Nova Scotia, the professional body representing the 2,100 doctors in the province, Dr. Fredrickson and his colleague, Dr. Jan Goodwin, counsel other physicians on ways to manage or alleviate stress. They are co-ordinators of the association's professional support program, a 24-hour provincewide confidential service launched in the mid-1980s to deal with drug and alcohol abuse among doctors.
In the past eight years, problems with these substances have accounted for 30 to 35 per cent of the people they see. The service receives 150 to 160 calls a year from physicians and their families.
"It's increasingly difficult to practise medicine these days," he said, referring to greater de mands and fewer resources to offer patients. "As physicians, we're human; we get into the same shit that other people get into."
Dr. Fredrickson misses his patients but does not miss the stress of the office. He was a sole practitioner for 25 years. "I myself, when I was in family practice, it was very difficult to tell a patient that they had to wait four months before that breast lump could be dealt with."
An aging population with more complex diagnosis and more health issues means the amount of knowledge necessary for doctors "has grown exponentially;" Dr. Fredrickson said.
For many; keeping skills sharp means 10 to 12 hours of weekly reading on top of 60 to 70 hours in the office. Despite cases of extreme exhaustion, some doctors just keep on "because you don't know anything different," he said.
Asked whether the public should be concerned about the care they are receiving from overworked physicians, Dr. Fredrickson emphatically replied: "We are a safe group."
"I see a skewed population in this job," he said. "By and large, people get good health care here' - when they get it."
An increasing need to improve physicians' health led Dr. Rob Rutledge, a radiation oncologist who specializes in breast, prostate and pediatric cancer, to establish a web-based research project offers a set oftools for as sessing and improving the mental, physical and spiritual health of physicians.
"Physicians are unlikely to get mentors, and that's one of the things I actually hope to change," said Dr. Rutledge, who works at the Queen Elizabeth II Health Sciences Centre and the IWK Health Centre.
"We should set up a system where young physicians seek out the older physicians for their advice. I really think that we need to start a mentoring system or at least find a colleague within the department - somebody you can go to and say; 'Jeez, I'm having a really tough day. That was a sad case' or those types of things."
Research shows this type of social support at work alleviates stress levels.
"I hope that people understand that the culture of keeping it to yourself just isn't very effective," Dr. Rutledge said.
Through the Capital district health authority's physician health committee, Dr. Rutledge and Dr. Lynne Robinson, an assistant professor at Dalhousie University's school of health and human performance, along with some psychologists, developed the confidential MD Health e-Coach site, which was launched last year .
On the site, physicians can have their health assessed and then compared with other phy sicians who have used the site. Once assessed, they are directed to different pages and other web resources to help them set up their own healthy-habit plan.
Physicians often do not consider their own health important, but Dr. Rutledge calls it the foundation for providing good health care to their patients.