Craig Hassed: Why self-care for doctors isn't selfish

THERE has been an enormous amount of published literature regarding poor mental health, substance abuse and suicide rates among medical students and practitioners.

Despite this there is little emphasis on providing the knowledge and skills to prevent such problems.

What programs there are tend to be elective only and are on the periphery of the main curriculum with its emphasis on biomedical knowledge and procedural skills.

An Australian study on NSW interns found that 75% would have qualified as having burnout at 8 months into the first year of their working life and that 73% would suffer significant psychiatric morbidity at some point during their internship.

This points to a major deficiency in medical education and the way we prepare young doctors for demanding careers where a high and sustainable level of performance is expected.

An American study found that the 20% of hospital resident staff suffering from clinical depression made more than six times as many significant medication and prescribing errors as non-depressed doctors doing the same jobs.

The fact that such issues are well known among the profession and yet are not addressed in any substantive way may point to a culture of denial which would not be tolerated in other industries where high demands and safety are equally important, such as among airline pilots.

Since the introduction of the new medical curriculum at Monash University in 2002, a Health Enhancement Program (HEP) in first year has been included as core curriculum.

It is possibly the first program of its kind to be integrated into core curriculum.

The most obvious reason to introduce it was to help foster the physical and psychological wellbeing of the students.

This experiential program is based on a model published in my book The essence of health (Random House), with Essence being an acronym for Education, Stress management, Spirituality, Exercise, Nutrition, Connectedness and Environment.

The model also incorporates mindfulness training.

Evaluations of the HEP suggest that it achieves its aim of enhancing student wellbeing and quality of life even in the high-stress pre-exam periods, although effects on long-term wellbeing are not yet known.

The HEP in first year is reinforced in later years with further time dedicated to self-care, clinical performance and mindful practice.

Student and doctor wellbeing is important in its own right. But the teaching and promotion of mindfulness and self-care skills goes well beyond us feeling good — it also goes to the heart of core clinical skills, safety and performance.

For example, with what we know about the relationship between inattention, performance and depressive rumination it is not surprising that mindfulness-based strategies enhance psychological wellbeing at the same time as fostering self-monitoring and preventing errors.

A recent American study of primary care physicians indicates that 8 weeks of mindfulness training was associated with improvements on all measures of wellbeing, clinical attributes and competencies including:

• reduced burnout
• improved empathy
• less total mood disturbance
• greater physician understanding of psychosocial aspects of patient care
• greater conscientiousness and emotional stability.

Considering the benefits of mindfulness and self-care training not just for us but also for the patients who trust in our care, rather than it being challenging making a case for dedicating core teaching time to this training, it is far more challenging to make any rational case for not including it.

Dr Craig Hassed is the Deputy Head of the Department of General Practice at Monash University.

Posted 8 November 2010