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Doctors’ Health Services Around the World

Doctors’ Health Services Around the World. 10th July 2004 Dr Julie Sladden MBBS(Hons), BMedSci. Why Doctors’ Health Services? UK. Common mental disorder 28% Depression (major) 10% Newcastle junior doctors: -60% exceed safe limits of alcohol intake -36% males, 20% females use cannabis

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Doctors’ Health Services Around the World

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  1. Doctors’ Health Services Around the World 10th July 2004 Dr Julie Sladden MBBS(Hons), BMedSci

  2. Why Doctors’ Health Services? UK • Common mental disorder 28% • Depression (major) 10% • Newcastle junior doctors: -60% exceed safe limits of alcohol intake -36% males, 20% females use cannabis -13% males, 10% females other illicit drugs • Estimated 1:15 doctors dependent on drugs.

  3. Why Doctors Health Services? Australia • 30% of GPs had mild psychiatric symptoms. • 13% severe psychiatric symptoms. • Suicide rate for female doctors x6 general female population

  4. Why Doctors’ Health Services?Canada • “One in 10 physicians will become dependent on psychoactive drugs or alcohol sufficient to impair their practice at some time during their careers.” • “One in every 100 physicians will become a narcotics addict at some time during their career” Saskatchewan Physicians at Risk Committee, Canada

  5. CMA 2003 Physician Resource Questionnaire: • 46% of respondents (n = 2,251) reported symptoms suggesting advanced stages of burnout. Canadian Physician Health Program

  6. Why doctors’ health services?-a unique group • Often don’t have own physician • ‘Corridor consultations’ • Self prescribe • Denial • Access • Trust and confidentiality • Stigma, guilt, shame and remorse • BUT highly motivated to recover!

  7. UK Doctors’ Health Services

  8. Voluntary National Services 2004 • Association of Anaesthetists' Sick Doctor Scheme • BMA counselling service • BMA Doctors for Doctors service • British Doctors' and Dentists' Group • British International Doctors’ Association • British Medical Journal Careers websites • Clinicians' Health Intervention Treatment & Support • Doctors’ Support Network and SupportLine • National Counselling Service for Sick Doctors • Royal College of Surgeons’ CSAS (pilot) • Royal College of O&G mentoring scheme • Royal Medical Benevolent Fund • Sick Doctors’ Trust

  9. UK - Local Services • Local Medical Council • Occupational Health Services • Postgraduate deanery • Local Support Services

  10. UK - History • 1970s - Sick Doctors Scheme of the Association of Anaesthetists of Great Britain and Ireland • 1980 - General Medical Council Health Procedures

  11. GMC Health Procedures • Four main stages: -preliminary consideration of the evidence -medical examination of the sick doctor -medical supervision and rehabilitation -the Health Committee

  12. UK - History • 1985 - National Counselling Service for Sick Doctors - (NCSSD) • 1995 - Sick Doctors’ Trust • 1996 - BMA Counselling Service • 1997 - Doctors Support Network • 2001 - BMA Chronic Illness Matching • 2003 - BMA Doctors for Doctors Service • 2003 - Clinician’s Health, Intervention, Treatment and Support - (CHITS)

  13. NCSSDNational Counselling Service for Sick Doctors • Independent organisation • Confidential, 24/7 telephone access to professional contact point. • Panel of medical advisers from all specialties, distributed throughout UK

  14. NCSSD ‘To assist doctors access appropriate health care’ • Callers (sick doctor or colleague) given name and number of an adviser. • Confidential help and advice within defined ethical framework • Onward referral if indicated.

  15. NCSSD • No. of calls to contact point now c. 200 per year (peak of 400 in 1994) • Yr 2000 • 65% male callers • Over 30% by or about career grades • Single contact with adviser in 46% • In 60% adviser reports +ve outcome

  16. Sick Doctors’ Trust • Addicted Physicians Program - est. 1995 • Self-help organisation for addicted physicians. • Provides early intervention and treatment • Protects patients whilst offering hope, recovery and rehabilitation to impaired colleagues.

  17. Birdsgrove House, Derbyshire

  18. Sick Doctors’ Trust • Treatment Centre for Health Professionals -Birdsgrove House • 12-step program consisting of re-education, counselling, group work, AA/NA attendance • Practical help with lifestyle and livelihood • Family support • Follow-up support groups

  19. Sick Doctors’ Trust • 290 doctors treated so far • 46% family practitioners, 25% psychiatrists, 25% anaesthetists, 4% other hospital drs. • 86% sober after 2 years • 96% return to medical employment • Relapse rate of 4% for 5-year follow-up for those who attend centre. • Special referee status

  20. Doctors Support Network • Self-help group for doctors with mental health problems • Peer support network • Meetings, newsletter and email forum • Website - www.dsn.org.uk

  21. Doctors’ Support Network • Doctors’ Support Line • Confidential and anonymous service • 36 hours/week (most evenings) • Staffed by volunteer doctors trained in active listening skills • Topics covered include mental and physical health problems, personal issues, work issues, bullying and discrimination.

  22. BMA Counselling Service - 1 • Established 1996: telephone service • Telephone counselling by qualified counsellors for doctors and their families Ave No. of Calls per month

  23. BMA Counselling Service - 2 % Male and Female callers % Year

  24. BMA Counselling Service - 3 Average call length Year

  25. BMA Counselling Service - 4 • Jan 2002 Calls: -161 calls in total -40 (25%) of these mental health related -18 (11%) marital or couple related -5 calls (3%) physical health and welfare -1 call alcohol related

  26. BMJ Careers - CHILL - 1Chronic Illness Matching Scheme • Simple concept • Peer support • Web based • International • Doctors and medical students • All illness and disabilities

  27. BMJ Careers - CHILL - 2 • apply by completing electronic form • held in secure database • state preferences for matching (illness, specialty, grade, country) • when suitable match applies, each are sent the other’s e-mail address • manual matching, confidentiality assured

  28. BMJ Careers - CHILL - 3 • 578 doctors and medical students on the scheme • 139 matches (i.e. 278 doctors matched) • No systematic feedback due to confidentiality • Anecdotal feedback all very positive Information from Dr Rhona MacDonald

  29. Initiatives - BMA Doctors for Doctors Unit • Help for doctors in employment difficulties especially in relation to mental health problems and abuse of alcohol and drugs • Sign-posting service for doctors/concerned colleagues to most appropriate area of help • Data and information collection about existing services/initiatives • Co-ordination and facilitation of existing services (neutral)

  30. Initiatives - CHITSClinicians Health, Intervention, Treatment and Support • Confederation committed to meeting needs of staff affected by alcohol or drug misuse • Advises on program development • Negotiates for financial assistance • Local network building • Education • Employment policies

  31. Australian Doctors’ Health Services

  32. History • 1896 - Medical Benevolent Society - NSW • 1982 - Doctors’ Health Advisory Service • 1998 - AMA publish Position Statement on ‘The Health of Medical Practitioners’ • 1999 - 1st National Conference on Doctors’ Health. • 2001/3 - Further Conferences

  33. Structure • National Database • State-based services (DHAS, MBA, other) • Regional programs (over 30) Local Support • Australian Medical Association (AMA) • Medical Board • Colleges

  34. State-wide Services

  35. DHAS - 1 • Began in 1982 with AMA/MBA support • Independent, confidential service • Doctors, dentists, veterinarians, students • 24-hr help line • Caller put in contact with panel member • Advice given • Referral if necessary

  36. DHAS - 2 • ‘No problem is too serious or too trivial!’ • Problems: -alcoholism -physical illness -drug addiction -financial -psychiatric disorders -legal problems -stress -career advice -marital breakdown -help finding a GP

  37. Victorian Doctors’ Health Program (VDHP) • Began 2001 - joint initiative of Medical Board of Victoria and AMA (Vic. Branch) • Independent body - confidential service • Program based on north american model: -education and prevention -early identification and intervention -evaluation and treatment -rehabilitation and monitoring

  38. Profile of cases – 2001-02 • (Insert report of Level of involvement)

  39. Total Contacts by type of medical practice performedfrom 1 May 2001 to 31 October 2002 (total contacts 165) Doctor Type Number Doctor Type Number General Practitioner 59 Other Specialists 6 Radiologist 6 Hospital Medical Officers 19 Psychiatrist 5 Non-clinical 5 Pathologist 3 Students 6 Anaesthetist 13 Overseas Graduates 3 Physician 6 Dentist 1 Surgeon 9 Unknown 19 Ob/Gynaecologist 3 Non-practising 2

  40. VDHP - Service - 1 • Referral: -self (voluntary-self or family) -Board Mandated (referred by medical board) • Team: -Full-time doctor/director -2 Counsellors

  41. VDHP - Service - 2 • Intervention • Assessment and referral • Case management • Aftercare and monitoring • Support and monitoring groups • Family support • Advocacy - work, MPBV, Courts

  42. 1. Abstinence agreement 2. Treating doctor 3. General Practitioner 4. Psychiatrist 5. Counsellor 6. Support groups - AA, NA, VDHP 7. Workplace monitoring 8. Self-medication prohibited 9.Restricted prescribing VDHP - Service - 3Case Management, Aftercare and Monitoring Program - ‘CAMP’ Agreement

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