When I go to the doctor, I expect them to fix me. Occupational Physician Dr David Beaumont reckons this is the wrong attitude and it’s making doctors unhappy. At any point in time, 50% of New Zealand doctors are experiencing burnout. He believes this is primarily due to healthcare systems being predicated on the false belief that doctors fix patients. According to Beaumont, what doctors actually do is enable people to create the circumstances to heal themselves. The stress and extra work caused by this disconnect makes doctors miserable. ‘They are caring people, and they take this responsibility to heart, often to the detriment of themselves and their families’.
I zoomed Dr Beaumont last week at his Central Otago home to discuss his book Positive Medicine: Disrupting the Future of Medical Practice. He’s a lovely man, and we enjoyed a free and easy half-hour chat. There was, however, something odd going on. I’m pretty sure I saw a sheep wandering loose inside his house. I didn’t bring it up at the time, not wanting to disrupt the flow of the convo and have been wondering about it ever since. So I’ll fire him a ‘please explain the indoor sheep’ email now and get back to you at the end of the article on this crucial issue.
Dr Beaumont, are New Zealand doctors happy?
I don't think so at the moment. Doctors are not good at looking after their own health. Largely because they're compassionate and there is huge demands on their time and their expertise. I think they were stretched to breaking point even before the pandemic.
Why does it matter from a patient’s perspective if their doctor is happy?
There's clear evidence that happy healthy doctors give better care to their patients than unhappy, unhealthy doctors. I think what pushes doctors to breaking point is the principle that people expect doctors to fix patients. The system expects that too. So when it doesn't work, doctors get blamed. We forget the responsibility for our own health rests with us. If a doctor gives treatment for type two diabetes and that doesn't control the diabetes, we should be saying, ‘what is that person doing to make the lifestyle changes necessary to actually improve that health and how can the system support them to do that’? For doctors, there is unwritten collusion within the system that doctors take full responsibility for people’s health.
So you’re saying doctors are expected to fix patients, and that’s not always possible, which is stressful for the doctor?
The idea that doctors fix people is built on a false premise. We come to expect to go to a doctor with a huge problem and say ‘fix me’. Whereas even if I've got a chest infection and the doctor prescribes antibiotics. All the antibiotics are doing is supporting my own immune system to heal me. Everything that we do is healing ourselves. All a doctor does is create the circumstances for healing. It’s ok if there is a clear pathological process happening that we can address, but in something like 50% of cases presented there is no overt pathological process, the problem is psychosocial in nature. There is nothing that modern medicine can do to treat it and therefore medically unexplained symptoms, such as chronic pain, chronic fatigue are poorly managed by the system as they take time and they take multidisciplinary processes, which are resource consuming. So people with these conditions do feel let down and often angry. There is a wrong emphasis as far as I'm concerned.
So we should go to the doctor looking to work with them on our health?
It needs to be a partnership, a collaboration. We have the opportunity in New Zealand to look at the whole healthcare system in a collaborative way. Patients say they want more autonomy. A whole-person approach. I work on a Te Whare Tapa Whā model, which is health in every domain of our lives. Physical, mental health, family and spiritual. I think this should be provided by the system for all of us. So when I work with my clients, I spend time with them working through all four pillars and look at where the gaps are and what they need to do to actually take control of their health.
And you weren’t taught to do this as a doctor?
I was taught health is the absence of disease. Which is just totally wrong. The absence of a negative doesn't make a positive. Better to ask how we find the positives to actually make change in people's lives and health? The modern definition of health is the ability to control our lives. Health is the ability to adapt and self-manage in the face of life’s challenges. It needs to be an empowerment model so that people realise they can take control of their lives. They need the education and the health literacy to do that and that's exactly where doctors and healthcare should sit in helping people to achieve that.
Dr David Beaumont has had success in a pilot programme with workers from Fulton Hogan and is planning to take it further. He has developed a charitable trust – the Positive Medicine Institute and is set to roll out the programme into his local community. The plan is to test the hypothesis that “Together, we can develop a whole-person health and wellbeing programme to benefit all New Zealanders”. He believes now is the time to shift the social contract between doctors and patients: From doctors fix patients, to doctors partner with people to help them take control of their life and become experts in their own health’. If this happens he believes there will be happier outcomes for patients, health resources and doctors.
In response to my follow up question on the alleged in door sheep, Dr Beaumont had this to say. ‘That’s actually my golden retriever puppy, Lucy, but she is absolutely part of my personal wellbeing plan’. That’s good news. I wouldn’t be happy partnering with a doctor who runs live stock inside his house.