I RECENTLY was able to host a Grand Round at Peninsula Health to discuss doctors’ mental health.

The panelists included Dr Mukesh Haikerwal, Dr Helen Schultz and the federal Health Minister Greg Hunt.

There were a number of issues discussed, but I would like to focus on normalisation – the process of bringing, or returning, something to a normal condition or state.

In the hospital workplace, “normalisation” would be being able to discuss our mental health like we would a broken leg.

The medical culture normalises the conversations about abnormal behaviour all the time. The list is endless – how many hours we can work without sleep, how many operations we can perform exhausted, how many patients we can see, how we can leap over tall buildings in a single bound. We wear these as medals of honour on our chest and dare – and sometimes intimidate – others, especially juniors, into following, implying that if they don’t, they are not made of the right stuff. It’s a baptism of fire for most doctors, and, sadly, it can be a fatal one.

The result is destructive internal self-talk. But doctors are humans who, like all humans, can be vulnerable. It’s that vulnerability we need to embrace to become better doctors and better humans. Normalising our vulnerability would be a good step forward in the medical culture, perhaps much more so than “resilience building”. Vulnerability is an enduring signature trait in any person, but especially doctors.

Minister Hunt called for a normalisation of mental health of doctors, indeed, of all people, and he shared his own story about his mother, a nurse dealing with bipolar disorder.

I followed with my own story about how seriously ill I was with depression, the barriers I faced, and that I am now recovered, working and glad I am alive.

What is my story?

In brief, I was battling severe depression and constant suicidal ideation. I needed help.

There were many barriers to seeking help. Some were internal, though far more were external – the fear for my career (mandatory reporting loomed large), what would happen if my colleagues found out, would they support me, would they treat me differently?

An abnormal magnetic resonance imaging scan revealed that it was a neurological episode – perhaps transient global amnesia, perhaps a stroke. That diagnosis allowed me some much-needed space to recover, because now I had an organic, visible, neurological problem and not an invisible mental health disorder. Before the diagnosis, it was not clear to me how I would get assistance, but having the abnormal scan gave me that space, albeit briefly.

Lying in that emergency department bed I was seeing my life flash in front of me, and I vowed that if I recovered I would not to allow a similar dilemma to happen to others.

I became a beyondblue speaker. I also speak at and organise Grand Rounds – not for fame or fortune, but as an attempt to get others to seek help much earlier, to make it normal in everyday conversation, not just in medicine but in everyday life.

This openness comes at a cost to me still. For me it’s is a double-edged sword. Countless individuals seek me out after talks and share their own story. They are much too afraid to do so in public because they fear for their career. This can be confronting for me and I may seem distant at these events, but please understand.

The other side of that sword is that being so open can lead to me being targeted and discriminated against, but little of this has come from patients.

Which brings me to the issue of tea rooms for doctors. Or rather the lack of them.

In my residency days, we had quarters where we were able to retreat for some space. They had tubs of almost undrinkable coffee, milk that needed the sniff test and stale white bread. Hardly elitist, but very much an informal sanctuary.

I now have come to understand how very important this space was to our wellbeing in those days. It was the informal debrief of the day or night on call. We normalised and shared our experiences. I have little doubt that this helped my mental wellbeing at a difficult time.

These tea rooms have gone largely in our modern hospitals, where committees in charge of effective space utilisation see this empty space as “high-yield” space. Is this space utilised for clinical work? Rarely, I would suggest.

Our country has an obesity crisis, with ever-expanding waistlines. In health, it’s the administrative waistline that is expanding and filling these precious voids.

I have no doubt that at some stage this will be realised and interest in the need for these safe areas will be rekindled. A consultancy company no doubt will provide the details of how they should be implemented, at great financial cost, of course.

Let’s stop the abnormal conversations.

We must normalise the conversations about mental health. The barriers for this to effectively and safely occur need to be smashed down and those tea rooms returned to their most useful state.

Dr Geoffrey Toogood is a cardiologist and a long-time advocate for mental health. He has swum the English Channel. He came up with the idea of crazysocks4docs day.

 

If this article has raised issues for you, help is available at:

Doctors’ Health Advisory Service:

NSW and ACT … 02 9437 6552
NT and SA … 08 8366 0250
Queensland … 07 3833 4352
Tasmania and Victoria … 03 9495 6011
WA … 08 9321 3098
New Zealand … 0800 471 2654

Lifeline on 13 11 14

beyondblue on 1300 224 636

 

To find a doctor, or a job, to use GP Desktop and Doctors Health, book and track your CPD, and buy textbooks and guidelines, visit doctorportal.

 

 


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Doctors need safe spaces where they can debrief with colleagues
  • Strongly agree (84%, 136 Votes)
  • Agree (11%, 17 Votes)
  • Neutral (3%, 5 Votes)
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6 thoughts on “Normalising the conversation about doctors’ mental health

  1. David Quigley says:

    During my early years, the doctors’ mess was a wonderful haven for a few minutes down time to escape from, and to try to make sense of the insanity of the job. On a ‘high yield’ note, clinical problems were always discussed over lunch to the benefit of the patients. The mess would spit out calmer, more focussed juniors, with a sensible plan for the rest of the shift, be it six or seventy six hours.

  2. Ian Relf says:

    The difficulty with improving doctors mental health- is that it is most needed when the person in trouble is least able to talk about it and of incapable of understanding themselves at the time.

    Yes to tearooms – which were hounded out ‘because all those elitist doctors were comparing BMW’s’- in fact were settling difficult issues and developing comradeship after being frequently confronted with decisions that no-one else was capable of making nor wanted the responsibility for.

  3. Anonymous says:

    Thanks for this article.

    Yes, indeed just alike nurses have their “tea-coffre-lunch room” used as well for debriefing informally,

    a “tea room” for medical doctors is an essential to maintain sanity and specially informally debrief,
    just talk about non medical issues, or the odd administrations decisions !
    It helps to go thru the day, when faced some of the very long days, and with difficult issues.

  4. Venita Munir says:

    It’s very important for all doctors to have safe spaces to debrief. I found, working in emergency, the doctors usually had different issues than the nurses and allied health staff to particular incidents, so that debriefings instigated by nursing and allied health was not always relevant to what the doctors wanted out of it. Debriefing with a colleague was always subject to who was on that shift. If you shared empathy with your co-worker you’d feel safe to discuss it, but if you felt belittled or a lack of sympathy, you’d keep it to yourself and take it home with you.
    It’s so dependent on your life circumstances too; I remember being totally overwhelmed by a 29-weeker born in a car outside the ED. Our ED was neither Paediatric nor O&G and I happened to be 29 weeks pregnant. I did not cope with that situation well, but managed to cry on the psych triage nurse’s shoulder in the staff tearoom. Less than optimal, but I was glad he was there.

  5. Dr Danielle Noutz says:

    Thanks Geoffrey.
    I recently shared my own story in The Medical Republic
    http://medicalrepublic.com.au/stigma-stings-one-doctors-story/1368
    Smith is my maiden name
    It has been shared on the closed FB site for the Emergency Department in which I work, the class reunion FB page of my graduating class and also on the GPDU site.
    I have had nothing but positive feedback and also already been asked for advice.
    My colleagues who didn’t know have shown an outpouring of love, support and respect and all voiced an opinion that they wished they’d know to offer support at times I’d been struggling.
    .
    We are fortunate in my ED to have a Tearoom, for all staff though not just doctors, where a lot of confidential debriefing occurs.

    I have met with The Commissioner of MH in SA and he very much shares the view that Doctors and other health professionals need to be able to openly talk about these issues in a safe environment without fear of stigma or jeopardizing ones career, or for the young Doctors, career prospects.
    The changes to mandatory reporting are encouraging. Although in SA they are slow to take effect.

    Hopefully with senior doctors like us starting to open up, fight the stigma and discrimination and push for things like “The Medical Tea Room”, our generation can start to make the changes the profession need.
    If we could prevent one more doctor suicide, it would be a great start!

  6. Robin Chan says:

    Thanks for this important contribution to doctors health. The tension between resilience and vulnerability is ever present umongst we rural generalists. In small remote communities we recognise the symptoms in ourselves and colleagues, and are faced both with the challenges of isolation and overfamiliarity just the same. http://islanddocs.com.au/professional-burn-out-am-i-enough/

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