Wellbeing Charter for Doctors: righting wrongs

CLINICIAN health and wellbeing has been an issue which has deservedly gained a great amount of attention over recent times. We have seen and heard many tragic stories that have resonated with many clinicians.

Individuals such as Dr Steve Robson, Dr Yumiko Kadota and Dr Geoff Toogood have been incredible in their courage and leadership, highlighting the stresses, pressures and turmoils that many doctors face. There are many others who have moved away from medicine to other, less demanding, less pressured careers.

As we are all aware, there continues to be a distressing level of suicide within the profession. There are many of our colleagues who have secrets they keep, unable to address their mental health through fear of falling foul of mandatory reporting rules, being ostracised, or being perceived as a “failure” or “weak”.

Despite all of this, we remain determined to seek efforts to provide the right supports and find solutions that will improve doctors’ wellbeing. The culture of medicine is slowly changing, but there is a long way to go.

Our health systems are under increasing pressure to meet key performance indicators, come in under budget, and do more with less. Clinicians, from doctors-in-training through to the most experienced and seasoned, are feeling significant pressure from the systems in which they work.

We rush people through the health system like “widgets on a conveyor belt”, dehumanising the doctor–patient relationship while trying not to miss a diagnosis. We compete with colleagues for training positions and move our families around the country to complete training requirements. We try to satisfy our bosses, work long hours and don’t claim overtime, while being open to criticism and legal threats. Among all this, we then try to find a life outside of medicine which allows us to maintain our health and wellbeing. It is a personal “supply versus demand” mismatch which many are finding very hard to fulfill. Finding our personal Ikigai is difficult at best, and seemingly impossible work at times.

The COVID-19 pandemic presents further challenges. We now work in an environment where the personal risk, both physically and psychologically, is pervasive across the entire health system. There has never been a time when reaching out and supporting colleagues and friends has been more important.

From Crazy Socks to Drs4Drs, employee assistance programs, Black Dog smartphone applications and Hand-n-Hand Peer Support, there is much support available. Many people and organisations offer their services to assist clinicians who find themselves needing mental health support.

The Royal Australasian College of Surgeons, along with other specialist medical Colleges and medical organisations, has been invested in supporting the wellbeing of clinicians and established a Wellbeing Working Group to identify what they can do not only for their fellows, specialist international medical graduates, and trainees, but also for the broader medical community. The group was tasked, among other things, to develop a Wellbeing Charter for Doctors. In the spirit of true collaboration, the Charter is being released this week, coinciding with the Australasian College for Emergency Medicine’s Wellness Week.

Dr Ruth Bollard is the Chair of the Wellbeing Working Group and says: “Doctors who maintain and maximise their health and wellbeing can manage the physical and emotional demands of medicine, and the Charter seeks to promote the importance of wellbeing for doctors”.

“The Charter helps us understand the roles and responsibilities of the organisations we work for, the Colleges where we seek our education and ongoing support, our colleagues and ourselves. It gives, I think, a clear framework which ties all this together.”

The Working Group is made up of representatives from a number of medical bodies, including the Australian and New Zealand College of Anaesthetists, the Royal Australian and New Zealand College of Psychiatrists, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and the Australasian College for Emergency Medicine.

The Charter has been endorsed by those Colleges and the Council of Presidents of Medical Colleges (CPMC). The Chair of CPMC, Dr Kym Jenkins, feels that the Charter “unites us as medical professionals, whatever our specialty or career stage, in the recognition that the wellbeing not only of our colleagues but also our own wellbeing is paramount”.

“The practice of medicine is inherently stressful: if we are to be effective as doctors, we must endeavour that we, as individuals and the organisations we work for, are not agents for poor health in others.”

The Australasian College for Emergency Medicine President, Dr John Bonning, tells me the Charter very much aligns with his personal views.

“We must build a safe system, achievable goals, workforce growth and retention, resilience, conflict resolution, trust, and a safe and just culture,” he says.

“A connection with peers, support and a sense of belonging is vital. And wellness has physical, emotional and spiritual components, which will be different in everyone”.

He feels “that there has never been a more important time to think about looking after ourselves as well as our colleagues and our patients”.

Australian and New Zealand College of Anaesthetists Councillor, Dr Scott Ma, says that the Charter “is a positive acknowledgement that medical Colleges are committed to doctors’ health and wellbeing and will assist organisations to prioritise actions that meet the intent of the document”.

“This Charter will sit alongside our college’s Doctors’ Health and Wellbeing Framework to support our commitment to promote wellbeing through our accreditation standards, training and continuing professional development,” Dr Ma says.

“The Australian and New Zealand College of Anaesthetists and the Faculty of Pain Medicine have recently approved changes to their continuing professional development (CPD) program, asking participants to consider how they will develop a greater understanding of their own health and wellbeing and providing CPD credits for recognised wellbeing activities.”

Of course, any Charter, any plan, is only effective if it is given life and meaning. To do this, we hope that this will be discussed in staff meetings, in College meetings, in conferences and at hospital board meetings. We hope everyone who reads the Wellbeing Charter will see the meaning and join in a collaborative effort to ensure that clinicians, doctors, nurses, allied health, all embrace and support its goals.

Dr Simon Judkins is an emergency physician, the Immediate Past President of the Australasian College for Emergency Medicine and recently became a divisional representative for the Australian Medical Association Victoria.

Members of the Royal Australasian College of Surgeons (RACS) Wellbeing Working Group:

Specialist medical colleges: Dr Simon Judkins (ACEM – immediate past President), Dr Scott Ma (ANZCA – Councillor), Dr Paul Howat (RANZCOG – Chair, Wellbeing Committee) and Dr Kym Jenkins (FRANZCP and Chair, Committee of Presidents of Medical Colleges).

RACS: Ms Ruth Bollard, Dr Eric Levi, Mr Phil Truskett, Mr Pat Alley, Mr Tony Dunin, Ms Kate Martin and Dr Aoife Rice.

Doctors’ wellbeing experts: Dr Margaret Kay (Academic Lead, Doctors’ Health in Queensland), Associate Professor Marie Bismark (Head of the University of Melbourne’s Law and Public Health Group and RANZCP trainee).

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.