Stress and the family practitioner – the toll on your family………………
Poorly devised and badly thought through Managed Care Regulations have singularly being responsible for more private practitioners leaving medicine in 2018 than the majority of other causes, according to a number of different fora which have been held during the course of 2017. The multiplicity of Medical Schemes which still provide plans to the industry (currently over 80 schemes with more than 400 sub options) is enough to frighten the bravest heart.
“To have and to hold, in sickness and in health……”
Not only are the Medics negatively affected but also their wives and families.
McCue writing in the New England Journal of medicine asserted that marriages and sexual relationships are often unsatisfactory for physicians and that a doctor's home life can evolve into nothing more than a professional support system with progressive emotional separation from family life in the early years of practice, becoming a factor for divorce later in life.
He also mentions that physicians suicide rates were 3 times higher than the general population and drug addiction up to 100 times more common than in the general population.
Dr Robert London of the New York University Medical Centre commented that to susceptible physicians, the needs of their wife or children seem pedestrian, dwarfed by the need to rescue seriously ill people.Classic Signs of Stress:
We all advise our patients on how to recognise and cope with stress whilst frequently ignoring the clear warning signs in our own bodies.
Just for the fun of it, tick the following chart and mark yourself out of 12:
We all know how to make the diagnosis of stress in our patients and often refer to tension in shoulders, neck, in hands and fists etcetera but how do we deal with it ourselves and how can we change our lives?
One of the things we can do is change our attitude to our practice, our practice style, our business administration, and our highly self-critical level of self-esteem. We spend more than 50% of our life in our practices.
Make the workplace comfortable for you and inviting to your patients. Consider carefully whether or not you have set realistic goals both at home and at work. The benefits of exercise, reading, relaxation, meditation, etc. cannot be overemphasized. Sports groups and hobbies offer you a more rounded life. Eat and Sleep in a well-balanced manner avoiding alcohol and prescription medication wherever possible for stress but rather use deep breathing exercises which can be done anywhere. Remember that should the pressure become too much call a colleague and discuss your problems with him or her.Manage Care and Stress in Family Practice:
Stresses in your practice related to Managed Care will unfortunately not ever go, however exercise your practice autonomy. You do not need to sign every managed care contract which comes your way in the fear that you may not be considered for National Health Insurance when it eventually arrives. Know your practice and its allocated costs, then you can quickly know whether a Managed Care Contract is worthwhile or not. If clients leave your practice because you require cash settlement then so be it. Your accounting fees will drop, your bookkeeping fees will drop, your practice management administration fees will drop, and your income will improve, slowly at first and within 6 months you well never look back.Remember ‘CASH IS KING’
Telemedicine is the latest new source of stress as many up-and-coming entrepreneurs have identified it as an easy way to get doctors to work for the system. The HPCSA is very clear as to how telemedicine and video medicine may work. It does not entail merely contacting a doctor and requesting a telephonic consultation. Telemedicine needs to be booked, has to be between an existing patient and his nominated practitioner, must be inclusive of the knowledge from a previous last consultation and is definitely not something which is open to the general public for a first consultation by anyone.The Promotion of Access to Information as well as the POPI act have stressed many practitioners unnecessarily.
You have to redo your PAIA manual to comply with the POPI Act BUT, the POPI Act is not fully in force yet and only certain aspects have been passed into law. Its regulations are still being debated and once published for comment, you will have a year to comply Certain attorney firms have added to Family Practitioner stress by emphasising the fines and penalties of non-compliance of an act which is not yet full in force and whose regulations are not yet completed. In the interim watch the CPC website and mass emails, ensure that you protect the confidentiality of your patient , their notes and records , at all times. Stress in small doses is good for us all, but 2018 could be a year where you need to learn how to cope better with this necessary evil, as we predict that things will become more stressful before they get better.
Tony Behrman and the QC team
Dr Tony Behrman