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The World Medical Association is taking steps to put doctors’ wellbeing front and centre with a review of their Statement on Physicians’ Wellbeing, writes Professor Steve Robson.
The World Medical Association (WMA) Council met in Montevideo, Uruguay, in April this year. The topics discussed were, as might be expected, diverse and thought-provoking. One document, in particular, should be of special interest to all of us: the WMA’s Statement on Physicians’ Wellbeing. In the post-pandemic landscape, and with unprecedented pressure on health systems globally, work on a fresh look at the statement is underway.
The issue of wellbeing resonates with doctors at a global level because if we are not functioning well, it not only can put our patients at risk but, as the WMA puts it, can “compromise physicians’ relationships with patients as well as colleagues, and undermine public trust in the profession.”
This is the latest in a series of steps taken by the WMA to put doctors’ wellbeing front and centre. Things began in 2017 when the WMA gave its Declaration of Geneva a major update. The Declaration – one of its oldest and most revered policies that builds upon the Hippocratic Oath – now contains the pledge: “I will attend to my own health, wellbeing, and abilities in order to provide care of the highest standard.” The issue of doctors’ wellbeing has moved over the last decade from being a somewhat peripheral consideration for many of us to becoming an issue at the very heart of our profession.
The WMA envisions “physician wellbeing” as encompassing “the optimization of all factors affecting biological, psychological and social health, and preventing or treating acute or chronic diseases experienced by physicians.” If that sounds like a lot – it is. The statement is broad and deals with mental illness, disabilities and injuries resulting from work hazards, and occupational stress and burnout too.
Shaping better regulatory experiences
The statement points out that, “one reason physicians may delay seeking care or help is their concern about confidentiality and professional repercussions.” For those who thought that concerns about mandatory reporting and regulatory responses from Ahpra and the Medical Boards were a uniquely Australian experience – think again. Similar regulatory hazards abound in health systems around the world. Indeed, the issue drew the WMA to be very specific in its statement: “Prevention, early assistance and intervention should be available separately from any disciplinary process.”
At the beginning of April this year, I attended an Ahpra forum held in Melbourne dealing with how to shape “better regulatory experiences.” A large proportion of the meeting was devoted to that critical two-way dynamic – how regulatory experiences affect doctors and how doctors with personal health or other issues are more likely to have notifications made against them. The severe distress associated with an Ahpra notification is well recognised, as is the fact that a number of doctors have taken their own lives during the course of Ahpra investigations.
The WMA document comes down heavily on the side of fairness and ensuring that draconian regulatory processes do not discourage doctors from seeking help when they need it. “Workplace support for all physicians should be easily accessible and confidential. Physicians evaluating and treating their medical colleagues should not be required to report any aspects of their physician-patient’s care in any manner not required for their non-physician patients.”
Safe workplaces for health care workers
The WMA statement also recognises the importance of workplace conditions in contributing to doctors’ wellbeing. “Working conditions must not put the safety of patients or physicians at risk,” says the statement. “Working conditions, including workload and working hours, affect physicians’ motivation, job satisfaction, personal life and physical and psychological health during their careers.”
It goes on to detail that “physicians, physicians in postgraduate education and medical students have the right to work in a harassment and violence-free workplace. This includes freedom from verbal, sexual and physical abuse.” One of the important recommendations is that doctors have a say in how workplaces should run: “physicians should be engaged in establishing safe conditions within medical workplaces.”
“Constituent members should support the right of physicians to have working conditions that help limit the risk of burnout and empower them to care for their personal health by balancing their professional medical commitments and their private lives and responsibilities,” the statement continues. “Optimal working conditions include a safe and reasonable maximum number of consecutive and total working hours, adequate rest between shifts, appropriate number of non-working days, and targeted system-wide efforts to reduce non-clinical work burdens.”
The importance of providing a safe workplace for Australia’s health care workers is hardly rocket science, and the National Occupational Health and Safety Code of Practice (2022) makes it clear that workplaces are responsible for managing the psychosocial hazards of their employees. In 2023 the Queensland Government took its lead from South Australia and amended the Hospital and Health Boards Act 2011 to strengthen the legislative framework that holds hospitals responsible for the psychosocial wellbeing of their staff. Similar legislative guidance is in place at a global level. The International Labour Organization, and World Health Organization’s Guide for the Development and Implementation of Occupational Health and Safety Programmes for Health Workers presents key elements and deliverables of national occupational safety programs that help promote physician wellbeing.
The WMA is alive to the importance of workplace culture. “Like all human beings, physicians experience illness, and they also have family obligations and other commitments outside their professional lives that should be considered. Fostering a supportive and accepting culture is critical to successful early referral and intervention for physician wellbeing,” the statement reads.
It goes on to point out that, “the medical profession often attracts highly driven individuals with a strong sense of duty. Successfully completing the long and intense educational requirements often confers upon physicians a high degree of respect and responsibility in their communities [and] physicians are subject to high expectations from patients and the public. These expectations can contribute to prioritizing the care of others over care of self and feelings of guilt and selfishness for managing their own wellbeing.”
The WMA statement is specific regarding concerns that “physicians in postgraduate education and medical students can be victims of harassment and discrimination during their medical education in part because of competition inherent in medical education healthcare systems. Due to their position within the medical hierarchy, they may feel powerless to confront these behaviours.”
The WMA statement also hammers home the importance of autonomy. “Physician autonomy is one of the strongest predictors of physician satisfaction,” it states. “Increasing external regulatory pressures such as undue emphasis on cost efficiencies, administrative and technical aggravations, and concerns about consequences of reporting medical errors may unduly influence medical decision-making and diminish a physician’s autonomy.”
Taking care of ourselves
Most of us are aware that we can be our own worst enemies, and the WMA deals with this tendency explicitly. “Even though medical professionals recognize that it is preferable to identify and treat illness early, physicians are often adept at hiding their own illnesses and may continue to function without seeking help until they become incapable of carrying out their duties,” it states. “Fear of disciplinary action, potential loss of practice privileges … because of these obstacles, doctors are often reluctant to refer themselves or their colleagues for treatment.”
We have to be kind to ourselves. “To preserve the quality of their performance, physicians have a responsibility to maintain personal health and wellness, broadly construed as preventing or treating acute or chronic diseases, including mental illness, disabilities, and occupational stress.” Yet the hospitals and other workplaces at which we provide care for our patients are not let off the hook: “Difficult practice situations, lack of human and material resources, and the pressure of fast-paced decision all contribute to an elevated risk of physician burnout and a challenging work environment.”
The WMA statement will provide important guidance not only on why doctors’ wellbeing is important, but on ways in which we can make things better. This has the potential not only to make for a better system but for a less fragile workforce at this time. With our hospitals and clinics under pressure like never before, we should be doing everything we can to offer Australians the health care system they deserve – and that means high-functioning doctors. The statement is undergoing a refresh and finishing touches will be published on an update later this year.
Professor Steve Robson is Australia’s delegate to the WMA.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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