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.
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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.