Multiple sclerosis in a postgraduate student of anaesthesia: illness in doctors and fitness to practice.
A 29-year-old previously healthy woman, a doctor, was diagnosed with remitting relapsing multiple sclerosis after fulfilling McDonald’s criteria for the diagnosis of definite multiple sclerosis. Despite 22 months of immunomodulatory treatment, the feasibility of continuing to train in a stressful specialty of medicine became an ethical and practical dilemma. Fitness for practice and career advancement among doctors with illnesses or having cognitive and physical decline from disease and/or ageing is a global problem. The need for addressing this issue in a compassionate and comprehensive manner is discussed. Cognitive and physical fitness are required in doctors and other healthcare workers since medical errors/adverse events are commonplace in medical practice. The public welfare is equally important in this global problem.
House MD: “Are you comparing me to God? I mean, that’s great, but just so you know, I’ve never made a tree.”
Dr Greg House (played by Hugh Laurie), is an egotist medical genius who entered into our small screens and changed the way we think about the medical profession, something which ER and Grey’s anatomy have failed to achieve. But, even House is not infallible to the ravages of illnesses, and his fitness to practice comes in to question in a number of episodes.
But, are we ready to accept a physician or surgeon suffering from a long term condition? The answer is an emphatic no (to paraphrase “the public welfare is equally important…”), and in this case study written from Trinidad and Tobago addresses this uncertainty in medical professionals life when they themselves are diagnosed with an illness, in this case multiple sclerosis. I have witnessed this on several occasions, as a trainee and as a qualified doctor. There is nothing worse in a medical or surgical professionals career when the roles are reversed – you now sit across the table, really not listening to a word that is said (since you already know what it means), as you re-evaluate your career options, on who to tell, whether to take time off…
It is such a taboo, that clinicians discuss such matters only when trust has been established and in hushed tones. And, if they choose the most aggressive treatment option who am I to argue with them?