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IT’S a tough gig working in medicine today. It always has been but the speed of action and huge strides in available care accelerate the frantic pace at which we live.
Stressors range from securing a position, passing exams, practice accreditation, running a business, meeting patients’ needs and expectations, working long hours under pressure and working in demanding and competitive environments, which are sometimes peppered with bullying, physical and sexual harassment. The stress in health care is no better than the rest of society and no more acceptable.
While doctors are a resilient lot, we are as vulnerable as any other human being and are as at risk of mental health conditions as anyone else. Add burnout, emotional exhaustion and cynicism and you have a toxic combination. Seeking help for these issues seems an obvious thing.
Our profession should be at the vanguard of making a difference.
The stigma of illness, any illness, causing absenteeism or, more pointedly, “presenteeism” – when somebody is at work but not shouldering their load – does not go down well with our colleagues.
Further, illness – particularly mental illness – is seen as a weakness by the affected and their professional colleagues.
Poor mental health among doctors and medical students has far-reaching consequences. As well as the personal ramifications for the individual and those close to them – colleagues, peers and patients can also be affected. We owe it to ourselves, our loved ones and our patients to look after our mental health.
The beyondblue Doctors’ Mental Health Program started in 2009 at a personally challenging time for me. I was requested, while under rehabilitation from a head injury after an assault, to guide and chair this work. The recovery journey for me was confronting and made me strive to get the work right.
I was asked by the beyondblue board to chair a taskforce that was diligent, expert, committed and provided guidance that helped craft the components of the beyondblue Doctors’ Mental Health Program, leading to a roundtable, systematic literature review, a national survey and publication of a ground-breaking, sentinel report on doctors’ mental health.
Despite valiant efforts by many good people, the state of doctors’ mental health especially, and doctors’ health in general, remained parlous.
Our efforts were redoubled when a tragic set of suicides involving three trainee psychiatrists and a hospital intern occurred in a matter of days in Victoria in early 2015.
Chairman of beyondblue Jeff Kennett threw down the gauntlet: change – targeted, effective and irrefutable – had to happen.
I joined the board of beyondblue just weeks after those tragic deaths and chaired a taskforce of representatives from beyondblue, the Australian Medical Association (AMA), the Australian Medical Students’ Association, Monash Health and mental health advocate Dr Helen Schultz to push for action by colleges, peak bodies, hospitals and health services.
A significant head of steam has built up and beyondblue, AMA Victoria, the Victorian Minister for Health, the Department of Health and Human Services and Victorian Doctors Health Program are contributing in various ways to forging a way forward.
- Related: MJA InSight — Mandatory reporting: cure worse than illness?
- Related: MJA — Hospitals should be exemplars of healthy workplaces
In Victoria, at least, there has been considerable movement on this issue. Other states, too, have been moving to change.
The emergence of a consistent doctors’ health program is under way. The Victorian Doctors’ Health Program, which has provided ground-breaking and first-rate services ahead of the curve, was a model of choice in my book. Time will tell what the final model will look like and how it will stack up.
I am more committed than ever to renewing my efforts after decades of advocacy to see through to the end a better, more empathetic and supportive medical and health workplace for our current and future generations of doctors and our patients.
Stigma and discrimination too often thwart the effectiveness of good mental health practices. As health professionals, we need to show leadership by seeking support when our mental health is at risk and by encouraging and backing colleagues who are prepared to speak up.
After all, that’s what we’re asking the general public to do.
We also need to tackle the roots of the problem through better attention to work-life balance and impacting on the factors that contribute to job stress – bullying and harassment in particular.
This is not just in the hospital sector but also in private practice. There is physical bullying and what I would term fiscal bullying.
Regulatory authorities and compliance methodologies in use today are archaic and exploitative and remove many of the safeguards expected in decent legal processes.
beyondblue is committed to creating mentally healthy workplaces – particularly in hospitals – but not just for doctors.
The goal must be good mental health practices for all hospital staff because you can’t help doctors without improving the environment in which they work. I am pleased that this methodology is being used by some health practices.
If we as knowledgeable medical professionals don’t get it; don’t understand it; don’t recognise its effects; don’t walk with our peers; don’t shun the stigma, the quick sneer, the snub or admonish underhand judgmental comments and if we don’t actively support our colleagues to dispel the myths of invincibility, we will continue to lose colleagues from the workplace, from the agenda, from the profession and from life.
Good mental health is not just for everyone else.
I am very interested in hearing how these issues may have affected you or people close to you. We have to support our colleagues so they can continue to support the community.
Dr Mukesh Haikerwal, AO, is a Melbourne GP, and former federal president of the Australian Medical Association. He is Chair of the beyondblue Advisory Committee for the National Doctors’ Mental Health Program.
If this article has raised issues for you, help is available at Lifeline on 13 11 14, and beyondblue on 1300 224 636
I would be extremely anxious and reticent about disclosing my struggles with depression and anxiety (depression a few years ago, anxiety now). As a psychiatry trainee myself, you hear the way other specialties approach patients with mental health illnesses and while most doctors I know are lovely, I know it would be on my record and fear it would affect the my perceived ability to practice and have repercussionsor jobs to come. We know the harsh reality of hospitals is that occupational health and safety policies and practitioners are to cover the hospital’s own arse rather than look after their own employees health. Luckily I have found excellent GP but would still be nervous talking to her if things ever got really bad for fear of mandatorily reporting, which I know is in place for a very good reason but would still potentially have far-reaching consequences for my career
Doctors need to be taught work-life balance, that healthy eating, adequate sleep overnight and exercise are extremely important in the maintenance of wellbeing. Perhaps this should be done in the early part of their medical training. Accessing acupuncture to help manage stress and burn out needs to be explored much more: acupuncture is neuromodulation, restores functional connectivity post -trauma and very importantly increases physical and emotional resilience. With a high therapeutic index, it is one of the most undervalued under utilised treatment modalities in this country, lagging behind other first world countries. The other concerns have been Post traumatic stress and also grief in bereavement being misdiagnosed as depressive illnesses..
In fact doctors are their own enemy. Psychiatric assessment being so subjective and many doctors think they are right in their diagnosis simply based on subjective interpretation and subsequent treatment options. Failing to follow their path at times leads to mandatory reporting and spoiling ones career. APHRA is useless in detecting these problem. We all go through ups and downs of life so do doctor and unless the sickness jeopardise patient safety why any doctor should be vindicated but helped to cope with social stresses? Many cases reported to APRAH should not have been reported and actually leads to the sickness for many of your colleagues. Do you have the statistics on that? By the way “Beyond Blue” is useless in addressing the real social problems that you doctors tag as mental disorder.
Great article Mukesh. The biggest threat to the mental health of doctors is AHPRA. They preach patient saftey as a cover for bullying. Guess what. A highly stressed medical workforce reduces patient saftey.
Well said Mukesh
As Drs we need to show leadership in our culture and behavior
And we must show support to Drs that say they are struggling with mental health issues
It is that courage to seek help that should be lauded .
I for one wished it had been different for me and will continue to ask for change
Like it or not we are viewed as leaders in health advocacy lets behave as such.
I have paraphrased an extract from a brilliant book titled “An everyone culture. Becoming a Deliberately Developmental Organisation” by Kegan and Lahey.
“Most people (doctors) are spending time and energy covering up their weaknesses, managing other people’s impressions of them, showing themselves to their best advantage, playing politics, hiding their inadequacies, hiding their uncertainties, hiding their limitations. Hiding.
We regard this as the single biggest loss of resources that organizations suffer every day. Is anything more valuable to a company than the way its people spend their energies? The total cost of this waste is simple to state and staggering to contemplate: it prevents organizations, and the people who work in them, from reaching their full potential.”
We are a long way from becoming an “everyone culture”
I was diagnosed with chronic melancholic depression as a student 40yrs ago. In those days there was discrimination and it didn’t take long to come to the conclusion it was best to keep it quiet, take the medication and get on with life. I even found Dr’s criticising my psychiatrist as I was kept on antidepressants longterm (now common practice but wasn’t then). I was fortunate in responding to TCA’s well (SSRI’s not yet available but unsuitable for my type of depresson).
As I struggled as a student while untreated, by the time I started hospital work I thrived (despite short dips every 3 months). I found I needed to recognise triggers and patterns and avoid what I could and accept what I couldn’t. It was helpful to swap overtime for Friday nights so I could get adequate catch-up sleep the following day. My psychiatrist pushed me to live a normal life as he recognised I was at risk of becoming an invalid.
Suicidal thoughts was something I eventually outgrew.
The biggest surprise has been improving over the age of 50 – probably due to the aging process rather than menopause. The dips now so much gentler they take longer to recognise.
Dear Mukesh, you are very correct about this issue for health professionals. There is real double standard about how differently some of us treat patients but can at the same time be uncaring and even toxic to colleagues and other health professionals. Many of us have seen the consequences for psychological damage and worsening of psychiatric illness in colleagues who have been bullied or harassed in the workplace. So far AHPRA refuses to act on vexatious complaints and also, both Colleges and our various professional Associations have been slow to condemn or censure members who engage in these complaints or who spread rumour and innuendo in the workplace to harm their Colleagues. In addition to your admirable efforts there is now a new national organisation called Health Professionals of Australia Reform Association (HPARA) which had its first National meeting in Sydney in April. For the first time we had the opportunity to see first hand the widespread and horrifying consequences of this problem in our workplace. The denial of the problem and the inaction about it will unfortunately take years to correct, but our committed members and Board of HPARA have accepted the challenge. We now have so much evidence of this, including suicides, and would be keen to engage with you and others. Well done and congratulations on your article,
Excellent article confirming bullying and harrassment as a main culprit of poor doctor’s health – and yet where is the change in culture, where are the negative consequences for the perpetrators? We do not just need support and carrots for the victims of this widespread communicable disease but also a much bigger stick and structural change to stop the vectors from spreading that virus and prevent offenders from re-offending.
All good in theory, however……
9 mths ago I was in the depths of a severe depressive episode. Like too many of us, I had self managed it for >12mths, but it had continued to spiral reaching the point of no return.I finally admitted that this was bigger than me, so then the hunt to try and find a psychiatrist willing to see me began. 3 psychiatrists later, and I found one willing to see me, but the earliest I could be seen was 1 mth down the track! Accepting this as “just the way it is”, I steeled myself clinging to the hope that if I could survive the next mth, perhaps there was hope. It was not long before this hope was swamped by the depression……Thankfully, my partner (an ED acute mental health nurse who says that even with his 20+ yrs in mental health,he was extremely worried) stepped in. Trying to respect my confidentiality, he phoned the Rural Doctors Help line (we live very rurally) and they quickly swung into action – within a week, I was in the city seeing a psychiatrist. I am now well.
I share this to highlight the difficulties of obtaining help when needed. By the time a Dr reaches the point of admitting/ accepting they need help, it is a long way down the progression of the illness. To then have so much difficulty obtaining help doesn’t encourage Drs to get help. Perhaps our psychiatrist colleagues could be more accomodating in “squeezing” in an extra pt when it is a fellow Dr?
Well said. The role of regulatory bodies and complaints bodies that assume guilt rather than innocence play a big role. Vexatious claims against doctors without doctors having recourse to sue or be compensated. It’s hard enough to keep up with our clinical work let alone be hounded by desk dwellers