Doctors as patients and boiled frogs

Are doctors good patients? Or are they a danger to themselves? Doctors, as legend has it, are apt to downplay or mistreat their own symptoms. Stories abound of cardiologists self-diagnosing heartburn and dying from a heart attack, general surgeons disregarding their acute abdomen. Being in the know can be hazardous. Even if they survive a misdiagnosis doctors can be awful patients, asking too many or too few questions about their welfare, interfering too much or too little in their own care. Andrew Elder, president of the Royal College of Physicians of Edinburgh, reminds us that medicine is difficult (doi:10.1136/bmj.q2163)1—as is being a doctor when illness strikes you or your family (doi:10.1136/bmj.q1486).2

The first question is whether to rely on your own diagnostic powers. Should you self-treat? If you weren’t in the know what would you do? The next is whether you should disclose your medical background—will it help or harm? This is a particular challenge when a family member falls ill. Should you disclose your credentials? Should you interfere? If you know a relevant hospital specialist should you message them? Is this seeking preferential treatment, or is it better that they know you’re a professor of gynaecology or editor in chief of The BMJ? What’s hard for the doctor-patient is also hard for the patient’s doctor.

The UK’s General Medical Council offers at least two pieces of advice. First, avoid seeking care from a family member or a close colleague. Second, do take care of your health and wellbeing needs. Doctors need to be on top of their own welfare if they’re to do the best for their patients—a simple truth that’s easy to forget when submerged by workload. A new survey finds that GPs spend as much as 30% of their time on non-clinical tasks such as those related to patients’ housing applications and benefits (doi:10.1136/bmj.q2233).3 Few people become doctors to fill in forms. Funding and staffing—factors that influence wellbeing—feature prominently in a new BMA “vision document” on how to fix general practice (doi:10.1136/bmj.q2230).4

Doctors need time and space to tackle the deep rooted clinical challenges of this crisis ridden world: the impact of government policies on poverty and consequently child health (doi:10.1136/bmj.q2131 doi:10.1136/bmj-2024-082022)56; the evolving pattern of infectious diseases and the persisting phenomenon of vaccine hesitancy (doi:10.1136/bmj.q1819)7; inequalities in access to primary care (doi:10.1136/bmj.q2235)8 and in maternal mortality outcomes by ethnicity (doi:10.1136/bmj.q2252)9; strategies and best evidence for managing chronic kidney disease (doi:10.1136/bmj-2024-079937 doi:10.1136/bmj-2024-080257)1011 and diabetes (doi:10.1136/bmj-2024-080127 doi:10.1136/bmj.q1792 doi:10.1136/bmj-2024-080122)121314; and delivery of optimal clinical care through medical leadership (doi:10.1136/bmj-2024-080576).15

The boiled frog syndrome, as Helen Salisbury reminds us (doi:10.1136/bmj.q2251),16 describes how people fail to act when their environment changes gradually—such as the decade long erosion of a health service. If you drop a frog in boiling water it will jump out; heat it up slowly and it won’t act, even as the heat rises. When a health secretary says that the health service is broken, it’s hard for staff not to take it personally (doi:10.1136/bmj.q2130).17 Understanding what to do in a broken, overheating health system is a skill. Being a good patient is a skill, as is caring for a medical colleague. And—like comedy (doi:10.1136/bmj.q2219)18—these are skills that nobody will teach you in medical school. Perhaps they should.