Treating doctor-patients

Every doctor can treat a doctor, using their comprehensive skill set, framed by some foundational considerations. The ‘Ts and Ss’ model is a great example of a set of practical tools, drawing on the work of Doctors’ Health SA, Dr Roger Sexton, and Associate Professor Jill Benson’s DRS4DRS Doctors’ Health Education Module: Caring for ourselves and our colleagues.

The 6 Ts:  Cornerstones of effective consults

1. TRUST: Work on forming a trusting therapeutic relationship – noting that stigma, fear of judgement, confidentiality, and perception of employment implications can undermine trust. Addressing barriers head-on and myth-busting privacy concerns can allay fears.

2. Time: Anticipate the need to make time at short notice. Doctor-patients may present late in the course of their illness, or in complicated situations require time to explore fully. Longer consults reduce shortcuts, promote robust assessment, and build rapport. Discuss this with your doctor-patients when not in crisis.

3. Talent: Recognise your clinical skills – you are the informed and objective expert on the person in front of you.

4. Target: Establish clear guidelines on your approach to management and your boundaries from the outset. Start with mutual expectations. Guide the consultation with purpose and structure.

5. Tailor: Recognise that every doctor-patient is different in their ideas and expectations of consults and the information they receive. Avoid assumptions – ask about shared decision-making and information preferences. Some prefer a technical explanation supported by evidence accessed in real-time. Others, especially those at an earlier career stage from a discipline separate to their presentation, or those in distress, prefer a simpler explanation.

6. TLC (tender loving care): Doctor-patients often benefit from validating their presentation, symptoms and vulnerability. Let them know you are present beside them as they learn to accept the ‘patient’ role. Reinforce that help-seeking is a sign of strength, not failure.

The 7 Ss:  Common pitfalls in doctor consults

1. Selective information: Doctor-patients may minimise elements of history or omit symptoms out of embarrassment, denial or fear. Be attuned to gaps and avoid assumptions.

2. Self-sabotage: Doctors can behave in a way to reduce their own discomfort, intentionally or unintentionally. This includes not engaging in appropriate referral, treatment or follow-up. Be aware of obstacles early, and work with the individual to manage these behaviours.

3. Social intrusion: ‘Talking shop’, and seeing doctor-patients whose professional role intersects with yours significantly, can intrude and derail consults. This can also reduce the ability of the doctor-patient to be honest and vulnerable. Exercise caution when treating personal contacts, facilitating a different doctor if there is too much professional crossover or conflict of interest.

4. Special treatment: Assess and manage with a business-as-usual approach. Use your standard clinical reasoning pathways. Don’t avoid difficult questions, examinations or hard conversations. You have the right to decline some aspects of management if you feel it is clinically inappropriate.

5. Style of consult changes: Maintain your usual consult structure, attending to physical examination, documentation and a definitive follow-up plan.

6. Self-management: While doctors in WA can prescribe, refer and manage their own health conditions themselves, this is inadvisable. Negotiate the terms of self-treatment.

7. Self-projection: Be aware of your own emotions in the consult room. Be it intimidation, or over-identification, your reactions can cloud judgement. Stay objective and seek peer advice if needed.