Eyeworld

12 Ophthalmology Business • December 2016 said he doesn't think there is stigma in doctors becoming patients per se, but the fear of how it will affect them professionally is real. "I know several MDs who have hidden their medical conditions from others for fear it may affect how patients and/or colleagues perceive them," Dr. Goldman said. Dr. Goldman went on to describe a situation at a major meeting where an ophthalmologist was having a fundus photo taken as part of a demonstration. When the image appeared on the big screen, his friend said, "I didn't realize you've had a retinal tear." The doctor became visi- bly embarrassed, Dr. Goldman said. "Perhaps the issue with doctors getting sick is that it subconsciously suggests their identity has changed from that of a doctor to that of a patient," Dr. Klitzman said. "It's often hard for these doc- tors to switch roles like that because they're used to being in charge and having the answers," he added. "When you're the patient, you don't have the answers; you can't always cure it." Self-doctoring Another issue that might present when a doctor gets sick is self-medi- cating. "There's an old saying that any lawyer who represents himself has a fool for a client," Dr. Klitzman said. "It's often hard for these doctors to have someone else take care of them even when they need to." Self-doctoring can result in suboptimal care due to the lack of objectivity, Dr. Klitzman said. A review of 27 studies published from 1990 to 2009 found that in 76% of those studies, more than 50% (a range of 12–99%) of physicians and medical students had self-treated. 4 "Deeper analysis of studies revealed get a lot of praise for being a work- aholic," he said. "One doctor [in my book] said, 'When I got sick, I thought if I continued to work and took care of more patients, then I would be a super doc, and I wouldn't die.' Other doctors, even doctors with metastatic cancer, have con- tinued to work. It's hard for them to take care of themselves because they get so much praise for working." There are also "taboo" topics that doctors and those in non-medical professions alike have trouble talking about. "A few of these doctors said, 'I became depressed and it took 6 months for me to tell my doctor, I'm depressed and need treatment.' The same with sexual side effects. A few of these doctors said they had sexual side effects due to various medica- tions, but 'It took six visits and 6 months for me to say to my doctor … can we address that?' These are difficult topics to talk about for any- one, and it's hard for these doctors to talk about these issues, too." Stigma What will my colleagues think? What will my patients think? Diagnosis of an illness can raise these questions among doctors. "There is stigma and discrimi- nation," Dr. Klitzman said. "A few of these doctors said when word got out that they were diagnosed with cancer, colleagues suddenly stopped referring patients to them, or asking them to be on research grants or on projects or to help write papers like they used to. People are concerned that they are going to be periph- eralized because so much of their identity comes from being doctors, and 'doctor equals health.' If you're sick, it's very difficult." David Goldman, MD, Goldman Eye, Palm Beach Gardens, Florida, residency was "suboptimal because of [a] health condition and also felt sick but did not drop the call." Half of those in the survey were concerned about a possible psychiatric illness, but only about 17% had received an evaluation. Another survey of nearly 500 residents at an academic medical center—90% of whom responded— published in 2015 found that while 89% were aware of a policy that allotted them time off to take care of their health, only 49.7% used it. "The most commonly reported barrier to policy use was concern about the impact the resident's absence would have on colleagues." 3 Denial Dr. Klitzman said that many doctors, when presented with possible illness in themselves, minimize or deny their symptoms and continue to work. "A lot of doctors have been schooled to be workaholics. … You continued from page 11 Tips to keep in mind • Have a primary care physician • Avoid self-doctoring and self-medicating • Learn from your own patient experiences and apply to your practice • Take time to eat right, exercise, and spend time with family and friends • Don't forget: You're only human and that's OK

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