Call for national health strategy for doctors

A CALL has gone out for the development of a national heath strategy for doctors, including reducing barriers to help seeking, such as confidentiality, concerns about career progression, impact on registration, time and stigma.

Published by the MJA late last week, authors from the University of Notre Dame, the University of Sydney and the University of Queensland wrote that “coordinated systemic change and enhanced access to care are needed to improve doctors’ wellbeing”.

“Over the past decade, there has been growing recognition of the prevalence of psychological distress across the medical profession and that practitioner wellbeing has significant implications for patient safety,” wrote Wijeratne and colleagues.

“The fact that burnout, anxiety, depression, suicidal ideation, and completed suicide are higher in doctors than in the general population is a problem requiring urgent and novel interventions.”

The authors cited the Beyond Blue National Mental Health Survey of Doctors and Medical Students, which found that “the level of very high psychological distress was significantly greater in doctors in comparison to the general population and other professionals (3.4% vs. 2.6% vs. 0.7%),” and that “young doctors and female doctors appeared to have higher levels of general and specific mental health problems and reported greater work stress”.

Also cited was MJA research published in 2016 by Milner and colleagues, which found that age-standardised rates of suicide were higher for female medical practitioners, and for male and female nurses, than for other occupations. The rate of suicide for health professionals with access to prescription medicines was higher than for health professionals without ready access to these means.

Wijeratne and colleagues wrote that the proposed national strategy should promote concrete interventions, enhance access to doctor-peer support and ensure independent governance.

Included should be a national curriculum for medical students’ and doctors’ health.

“Improved education will include self-care, wellbeing initiatives, supporting colleagues, health access including an understanding of the potential barriers to care, delivery of care to doctor-patients, and the intersection of leadership and doctors’ health in enabling safe care,” they wrote.

Top of the list for change is the mandatory reporting requirement for doctors practising with an impairment.

“Even though regulation is essential to support impaired practitioners who refuse care, the requirement for treating practitioners (except in Western Australia) to make a mandatory notification to the medical regulator if their doctor-patient is thought to be practising with an impairment remains a significant potential barrier to health access,” Wijeratne and colleagues wrote.

The 2020 legislative change which raised the threshold for mandatory reporting to “substantial risk of harm to the public” had done nothing to reassure the profession.

“Doctors need better education about the Health Practitioner Regulation National Law, concurrent with legislative reform to standardise the WA amendment.

“Therefore, reducing the perception (and potential reality) that help seeking is a threat to career progression or registration is essential. Doctors’ health care matters and requires an independent, comprehensive, well connected, well resourced and well governed national response,” they concluded.

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