Editor's choice

All about doctors

Though unemployment among doctors is commonendemic evenin some countries, it's unusual in Britain because the training of doctors, from undergraduate level onwards, is planned to meet the needs of the NHS. Inevitably such planning goes wrong from time to time, and that's when doctors may become unemployed. A recent miscalculation has led to a glut of specialists in obstetrics and gynaecology, so Career Focus this week (classified supplement, www.bmj.com/cgi/content/full/319/7210/S2-7210) has an article on the legal position when a doctor is made redundant. As Judith Firth explains, it's complicated.

Construction workers the world over are used to periods of unemployment, and on p 600 Leino-Arjas et al have used this fact to explore prospectively the question of whether ill health causes unemployment or whether it's the other way round. They studied over 500 Finnish construction workers in work in 1991 and followed them over four years. Long term unemployment was predicted by, among other things, current smoking, high alcohol consumption, frequent stress symptoms, mental disorders, and skin diseases. Perhaps surprisingly, those who were long term unemployed had fewer incident diseases and made some improvements in their lifestyle: they drank less and took more exercise.

At least when construction workers are ill they have a straightforward relationship with their doctors. Not so doctors. In 1995 the BMA produced guidelines on doctors' responsibilities towards themselves, their families, and other doctors as patients. Forsythe et al examined how well consultants and general practitioners in one English region were following this advice. The answer is not well (p 605). Most of the 1100 or so doctors who answered their questionnaire were registered with general practitioners, though they didn't use them much, and most admitted that they prescribed for themselves and their families. Few of the respondents were satisfied with the services available to them. In general these doctors preferred to treat themselves, to carry on working in the face of ill health, and to consult informally, and the authors suggest that if the barriers to doctors accessing care were removed doctors might have better health.

Yet there's always a counter-example, and this week's personal view by Chris Wilson provides it. After years of non-specific symptoms and being labelled a malingerer by unsympathetic doctors, he diagnosed his own Lyme disease (p 649). "It was luck that the discussion about Lyme took place and that I happened to be in the right profession." Yet, "it seemed odd that the first time that a proper history was taken was when we knew the diagnosis."

Footnotes

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