Doctor Doctor

I have spent much of the last two days in the company of other GPs.

We have discussed lots of things - swing dancing, grief, the Toy Show, fatal medical errors, washing-up, destitution, mince pies, desertion. 

At a gathering of retiring GPs, the tone was one of hope and despair in equal measure. The feeling was that while things have been pretty grim in GP-land for the past few years, they may be about to improve. But there was no-one there to hear this, other than the old codgers who are on their way out anyway. The young ones have already left, to go somewhere, anywhere, where they will feel good about themselves for being intelligent and empathic and hard-working and paid well. Instead of feeling like the worst kind of banker for expecting to be paid more than the average industrial wage. 

I am always intrigued by the phone-in show comments about the fat-cat doctors, and sure them doctors is loaded, I sees them going round in their fancy cars and living in their big houses. I am fascinated to know how much the average punter thinks we should be paid. 
Should it be the around the average, we'll say 30 grand a year? Should it be twice that? Three times that? What figure would be acceptable to Joe Public, given our level of training and responsibility? If their son or daughter decided to do medicine, what would they hope that they would earn?

Yesterday I listened to a social worker describe the conditions that she had seen when she called to a client's house one day. The house was bare. Minimal furniture, no food in the fridge or cupboards. She was not offered a cup of tea, because there was no tea, and possibly no cup either. 
The client was a doctor. 
She works for the Royal Medical Benevolent Fund Society of Ireland, which was set up over 170 years ago to help doctors and their families when they find themselves unable to support themselves.

How could a GP be poor? Sure the world always needs doctors, they're like bloody undertakers, there'll always be work for them feckers.

Yes, there's always work, but shockingly it turns out that occasionally (very occasionally mind, they wouldn't be making a habit of it) doctors can become unwell, sometimes even what you might call "sick". I know. It's astounding. I can hardly believe it myself. 

And even more rarely, but it has been known to happen, a sick doctor will actually not be able to work. 
(Thankfully this is very rarely the case, as most sick doctors do the right thing and inject themselves with iv antibiotics in the morning and go to work for the day before coming home and hooking themselves up to the drip again while making the dinner and replacing the missing tile from the roof.)

So a tiny minority of GPs, will find themselves in a position where they cannot work due to illness. 
That's okay though, because like everyone else in our egalitarian society, they can call on the government to help them out. 

Ah. 

Turns out that's not true. 
Like all self-employed people, GPs are not entitled to illness benefit from the Social. This is because self-employed people make loads of money and pay very little tax, and can write off all their diamond shoes as expenses. Ahem. 

One of the Benevolent Fund's beneficiaries has been waiting 18 months to get Supplementary Welfare Allowance, which is a basic weekly allowance of €186 for people who have little or no income. Or it would be, if you actually got it. Otherwise it's €0 for people who have little or no income. 

A self-employed person in Ireland needs to have income protection insurance. Which is pretty expensive, and given that doctors don't get sick, you'd forgive the young doctors starting off for deciding to use the money towards a mortgage or paying off their college loan or buying a plane ticket to Canada. 

The myth of doctors not getting sick is propagated by the seemingly ingrained-at-DNA-level insistence of doctors to refuse to admit to illness. 

I have spoken in the past about the stigma attached to cancer in the general public. The general public aren't a patch on the medical profession. Nobody tells anybody anything about their health. And if by chance it slips out, it's all bravado like the "I had a hip replaced there on Tuesday afternoon but I was back at work on Friday morning" stories. We're like some fella off Homeland stitching up his own bursted abdomen with a shoelace and then running off after the bad guys again.
So young doctors never hear of other doctors getting sick, so naturally they make the assumption that it'll never happen to them either. 

Of course all this cloak-and-dagger stuff only adds to the stigma, and every "sick doctor" is assumed to be a porn-addicted morphine junkie with homicidal tendencies, instead of maybe just having a bit of Crohn's disease.

And doctors die from suicide, and alcoholism, and stress-related illnesses in greater numbers than people in other professions. 

We know this. 

Us GPs are mad for prevention. We love checking people's blood pressures, and cholesterol, and Framingham scores. Smear tests - mad for them. Vaccinations - mad for them. Primary prevention is what gives us a little smug feeling at the end of a busy day. Stick that in your secondary-care books, we say to our hospital colleagues. 

But god forbid we would apply the principle to ourselves. We know we are high-risk. We spot the odd early-warning symptom in ourselves. We notice the signs that things might be getting worse. And we tootle along, la la la, work work work, sure that'll go awa - THUD. Hit the floor.

Anyway. 

My point.

Young doctors: Get income protection. NOW.
All doctors: Get a GP. NOW. And tell them what's wrong with you.