Enigma of physicians who can't heal themselves

from the refusal of some surgeons to operate on cigarette smokers. Now

that one of the victims of this policy has died of a heart attack at the

age of 47 the row has resurfaced with new fury.

When this column dealt with the issue last May it noted that doctors

are deeply divided and that the legal and moral case for not operating

on smokers had still to be tested. Presumably that moment is coming

nearer. The doctors involved may yet have to defend their clinical

freedom in the courts. Any question of professional ethics is for the

medical royal colleges to answer.

In the middle, the Government claims to be neutral, though the

Department of Health willingly countenances doctors who discriminate

against smokers -- just as it conversely accuses the majority of doctors

who drink of not taking the problem of alcohol abuse seriously. If they

did, it is argued, they would reduce their own excessive consumption.

At least that was the department's line at the time when Edwina Currie

was in full sail as a health minister. Since then the profession has

tried to play down its reputation for hard drinking, except apparently

for Scottish male doctors who along with trawlermen are recorded as

being three times more likely than normal to be diagnosed as

alcohol-dependent.

What is the truth about doctors, drink, and their other health

problems? Last year a study by the British Medical Association suggested

that the high level of alcohol abuse and suicide among doctors reflects

only ''those who may have reached the extremes of failure''. It argued

that many more doctors are suffering adversely from stress.

The BMA then ordered a study into whether the doctors' workload is the

real killer. The report, now published, goes against the grain by

failing to establish a clear link between workload and ill health among

doctors, even though many doctors remain concerned that their long hours

and stressful work must have consequences upon their health.

In fact, the evidence is that doctors enjoy healthier lives than the

rest of us, a good fortune they share with dentists, judges, teachers,

and the clergy. That merely confirms that good health goes with being

comfortably off. But high rates of mental illness and suicide do set

doctors apart from other professions. Overwork and emotional stress may

be factors in this phenomenon, though this is unproven.

A recent study compared the health and lifestyle of GPs and teachers.

It found that fewer of the GPs smoked and they were the less heavy

drinkers. Fewer doctors than teachers reported exhaustion after work.

Teachers took more exercise but were still the more likely to be

overweight. They also showed more symptoms of anxiety and depression

than did doctors.

Even the evidence of excessive drinking by doctors is equivocal. More

lawyers than doctors die from cirrhosis. And despite the boozy

reputation of medical students, they don't drink any more (or less) than

other students.

Such findings may debunk earlier theories about sick doctors, though

not concerning mental ill health and emotional distress. Psychological

problems begin early, with nearly a third of medical students showing

emotional stress. This rises to half by the time they are qualified,

with women suffering most. The reported causes include serious treatment

failures and the stress of talking to distressed relatives.

As for the effect on patients, the BMA thinks this goes further than

emotionally disturbed doctors giving a poor level of care. It may be

that doctors with the very qualities of empathy and understanding needed

by a caring profession do not have the emotional stamina to complete

their training because of the continual emotional onslaught that

confronts them. They then seek a career away from patient contact. The

consequence may be that those doctors who make the grade are emotionally

tougher but lack the attributes vital to a caring profession.

In the end the BMA study concludes that it is not at present possible

to establish a precise link between sickness and death in doctors in

relation to their workload. It suggests that the Government should set

up and fund a comprehensive study in order to identify preventable

deaths and illness within the medical profession.

Let's hope the Government thinks twice about that. If physicians

cannot heal themselves, who else can? Because of their knowledge of

disease, doctors should be the healthiest people of all -- if only they

would apply that knowledge to their own behaviour. Until that manifestly

happens, taxpayers -- especially those who smoke -- should refuse the

doctors any further diagnosis of their own condition on the grounds that

it will do them little good.