I love the Disc World series by Terry Pratchett. It is just silly enough to be a great distraction after work and just serious enough to make me feel like an adult while reading it.
There are many witches in the series who act as the health providers in this world - there are doctors too, but those are usually men who are in the city rather than in the mountains where illness is actually happening.
In the stories of Tiffany Aching, an up and coming witch from a sheep farm, we get introduced to the culture of witching and what is expected of witches. These books are rich with, what I consider to be but could very well be far too self centred, analogies to being a physician in a rural setting.
A good example of this is "cackling" which is mentioned in several books and warned against, lest you turn into a Black Aliss and get stuffed in your own oven.
In "Wintersmith", page 17, Pratchett explains cackling:
'When you got right down to it, it was all about cackling. No one ever talked about this, though. Witches said things like "You can never be too old, too skinny, or too warty," but they never mentioned the cackling. Not properly. They watched out for it, though, all the time.
....
"Cackling," to a witch, didn't just mean nasty laughter. It meant your mind drifting away from its anchor. It meant you losing your grip. It meant loneliness and hard work and responsibility on other people's problems driving you crazy a little bit at a time, each bit so small that you'd hardly notice it until you thought that it was normal to stop washing and wear a kettle on your head. It meant you thinking that the fact you knew more than anyone else in your village made you better than them. It meant thinking that right and wrong were negotiable. And, in the end, it meant you "going to the dark," as the witches said. That was a bad road. At the end of that road were poisoned spinning wheels and gingerbread cottages. '
The witches of the Disc World visit each other to keep an eye on each other. Physicians work in similar circles and hear stories about one another though they are frequently not as forceful as Pratchett's witches who will tell a sister witch that they are beginning to cackle. Physicians tend to hope that their fellow docs will figure it out.
We have the CPSO for patients and doctors to report inappropriate or self destructive behaviour. I don't know, because I can't imagine how one would go about doing this research, but it seems that we are likely missing quite a few docs who have begun to cackle.
Looking at the back pages of the Dialogue magazine you see many examples of physicians who have let their minds "drift away from it's anchor". A compassionate person can look at the examples of narcotics mis-prescribing as easy to fall into. It can start with someone who is having a bad time and needs help with pain and with escaping their reality. You've done it once, why not do it again? Bit by bit this can escalate to trafficking - thugs on the street are doing it, why can't I?
Self prescription and self doctoring is extremely easy to fall into. I know enough to take care of these 2000 patients, of course I know enough to take care of myself! I can prescribe just what I need. But, we need someone else to keep us honest. Having a doctor as a physician is essential and I think works very well to keep our thoughts on track - if this doctor will treat us as a patient who is a doctor, not as a doctor who is a patient, by which I mean will take the time to explain a thought process and why they suggest a treatment rather than simply asking what medication the patient wants and dutifully writing a script. If you haven't seen the movie "The Doctor", it's worth checking out for this. There's a scene where the hero has hoarseness and his physician isn't worried because his patient isn't worried.
Taking care of patients without reflecting on what a wonderful privilege this is or how much they give back may leave some docs feeling empty and spent and looking for a way to fill their lives again. It may make them feel entitled to certain allowances such as not keeping proper records, charging extra fees not acceptable by their college or possibly, unfortunately, taking advantage of patients. There are far too many stories in the back pages of the Dialogue about sexual abuse of patients by doctors. To be honest, one story would be too many.
While I never expect to see a doc wearing a kettle on her head, I have seen docs who are a little bit lax on rules, guidelines, and expectations. I have yet to let these docs know that they are beginning to cackle. I hope this is because of my position as a lowly resident without any authority rather than not having the back bone to keep my colleagues from "going to the dark".
It would be awful to lose a friend to being shoved in an oven by a couple of kids.
