Log in with your email address username.

×

Doctors’ health: the wrap

 

All this month at doctorportal we’ve been highlighting the critical issue of doctors’ health and wellbeing.

The doctorportal website hosts the online resources of Doctors’ Health Services Pty Ltd, an organisation funded by the Medical Board of Australia and coordinated by the Australian Medical Association. Its aim is to ensure doctors and medical students, no matter where they live in Australia, have access to consistent and readily available services, including advice, referral and health-related triage.

Here’s a roundup of doctors’ health stories we’ve covered at doctorportal this June:

For more information about health issues for doctors, access a range of online resources from Doctors’ Health Services Pty Ltd.

Or phone:

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

How a stroke made me face up to my depression

It took a minor stroke before I was able to take much-needed leave from work. But it wasn’t the stroke I needed to most recover from – it was the severe depression I had that was many times worse. The stroke afforded me the time and space I had wanted, and needed, in order to recover.

– Geoff Toogood

 

In 2013, I faced major stresses at work and my marriage was ending. It got the best of me. I had experienced moderate depression a few years prior – moderate enough that I could work through it – but this time it was a lot more severe. I was so depressed and stressed that I had suicidal thoughts. I confided in some people at work; I told them I was suicidal. I told them I wanted to take leave. But it was the stroke symptoms that allowed me to get the leave more easily approved. I took about a month off. As a result, I had to make the decision to step down as head of my department for a while.

The culture of the health industry doesn’t offer the best support for health professionals experiencing mental health issues. That was certainly my experience anyway. Some health professionals frown upon taking sick leave. There’s a perception of weakness. beyondblue research actually confirms that perception from people in our industry.

According to a beyondblue survey of Australian doctors, approximately 40 per cent of doctors felt that medical professionals with a history of mental health disorders were perceived as less competent than their peers. Almost 59 per cent of doctors experiencing depression find it is embarrassing for them. Even more worryingly, almost 50 per cent of doctors feel those with mental health disorders could face setbacks in their career progression.

Additionally, beyondblue’s research showed that one in five medical students and one in 10 doctors had suicidal thoughts in the past year. It’s not difficult to see the significant issue of the health industry dealing with, or in some ways failing to deal with, mental health issues. Though it’s positive to learn from the research that doctors show great resilience, personally and professionally, to the negative impacts of mental health.

My road to recovery was gradual. It took me a while to summon up the courage to see my GP. Instead of booking an appointment I used natural remedies, such as taking B vitamins, as a way of self-medicating. It made little difference. What I needed was counselling and medication: professional help.

Admitting to myself that I had a serious illness and seeking help was a major turning point. Part of my self-admission came after a long-time friend texted me saying ‘I’m concerned about you’, and provided me with the beyondblue Support Service number. Having a friend recognise and voice the seriousness of my situation also reinforced my need to seek help.

I finally called my GP. She took control and told me what we needed to do so I could start to recover. Following her advice and treatment plan was pivotal. A compassionate doctor will understand exactly what you’re experiencing, as an individual and as an industry peer. Now I’m well and back working as a senior cardiologist at The Alfred and Peninsula Health.

I really feel for today’s junior doctors. I think pressures on them have increased since I was in their position. The health system has changed, which has increased pressure to get more things done in less time.

There are also so many challenges that haven’t changed: the pressure high achievers put on themselves to perform continuously at a high level; and the pressure to keep up with peers, whether it’s managing high workloads or giving accurate diagnoses the first time, every time.

The stress of the high workload for junior doctors can’t be ignored. You’re working 50- to 60-hour weeks and then studying for 20 or more hours. Exam study adds to the intensity. You always have that uncertainty of passing, which everyone goes through.

Throw in the unsociable working hours, as well as job instability due to short contracts and frequent rotations, and it’s easy to see the impact on young doctor’s mental health.

Still, even when doctors aren’t well, we often put our own health second.  You tell yourself to always put patients first. But we need to fit our own oxygen mask first. If we don’t look after ourselves, our patients won’t have a doctor to look after them. A doctor needs to be well to provide high-class care to their patients.

Here is what I’d advise young doctors do to stay well:

  • Look after yourself by doing what you can to develop work-life balance. This could mean making extra effort to catch up with family and friends, establishing an end-of-day routine to unwind, or planning a holiday;
  • Develop interests and passions outside work. I’ve taken up ocean swimming. What I love about swimming is the need for minimal equipment, getting time to myself so I can practice mindfulness, and I always feel great afterwards;
  • Realise that you’re more than a doctor, you’re human. Yes, we too can be ill, and we need to follow the advice we give our patients about self-care;
  • If you’re struggling, seek help early;
  • Make sure you have your own health professionals, especially a GP, that you trust and can be open with;
  • If you see a colleague struggling, reach out to them. Offer to catch up over coffee or just offer support. When hospital culture is positive, it can feel like you’re working in a small town or community so you notice and react if someone isn’t well. beyondblue has a range of resources to help you have these conversations;
  • Show leadership at work by not tolerating poor behaviour towards mental health issues;

As a beyondblue speaker, I’m proud that our education and research tools have helped break down stigma surrounding mental health conditions. There are also other great resources such as ‘Keeping Your Grass Greener: A wellbeing guide for medical students’.

I definitely encourage doctors who might be experiencing mental health issues to talk to someone. It might even be best to speak to a trustworthy friend outside of the workplace to ensure confidentiality. If you need to speak confidentially to a professional, your state Doctors Health Service and employee assistance programs can provide support. beyondblue has several confidential support options for doctors. The Support Service provides free impartial, solutions-focused counselling from mental health professionals by phone 24/7 on 1300 22 4636, online at www.beyondblue.org.au/get-support or via webchat from 3pm to midnight AEDT.

Sharing my experience of depression with other medical professionals has shown two sides of the industry. I have doctors approach me at conferences to thank me, and to share their own mental health issues. Unsurprisingly, they often tell me they haven’t spoken to anyone else about their struggles. That in itself speaks volumes about the relationship between mental illness and our profession.

When senior executives from our industry attend and engage with my beyondblue advocacy talks – including Grand Rounds – that’s when change and improvements most often happen. Support from the top is imperative. Leaders must walk the positive talk.

beyondblue provides organisations free practical information and resources about how to create mentally healthy workplaces. The Heads Up website is developed by beyondblue in collaboration with the Mentally Healthy Workplace Alliance. Heads Up has specific resources for doctors and medical students to support their mental health at work. To learn more, visit http://www.headsup.org.au/doctors.

Dr Geoff Toogood has been working in medicine for 30 years, specialising as a cardiologist for the past 20 years. He works at The Alfred Hospital and Peninsula Health, at which he has held director roles.

This blog was originally published on www.onthwards.org.  Read the original article here.

onthewards is a website dedicated to delivering practical, high quality free open access education for medical students and junior doctors.

 

For more information about health issues for doctors, access a range of online resources from Doctors’ Health Advisory Services Pty Ltd.

Or phone:

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

 

New focus on Top End doctors’ health

Practising medicine in the Northern Territory can be as rewarding as anywhere else, but it has its own particular challenges. Many NT doctors work in remote and isolated regions where they have to be able to rely on themselves, without the kind of support they’d find in the capital cities.

Until recently, there were very limited health services for NT doctors and no dedicated support network. But in 2016, a group of Adelaide-based health professionals stepped into the breach and set up Doctor’s Health NT, which offers a 24-hour advisory helpline, telemedicine and a network of local GPs trained to see doctors and medical students as patients.

“The NT medical community is small, with only about 1000 doctors,” says Adelaide-based GP Dr Roger Sexton, who as director of Doctors’ Health SA was instrumental in setting up the NT satellite.

“There are interesting challenges in doing medicine out there. There’s a wide range of workplaces, from aboriginal communities to work out on the islands or in remote communities, and doctors are expected to be well-rounded and pretty self-reliant. But when it comes to their own health, one solution doesn’t always work for all doctors.”

Dr Sexton says it’s easy for NT doctors to get isolated because they personally know most of the other doctors in the Territory, which means they can’t easily get treated anonymously.

“A lot of the doctors find the convenience of self-treatment too easy. If you’re a dermatologist in Melbourne, you’ve got a very good choice of who you can see. But in the NT the options are limited. Many doctors have concerns about confidentiality, and there’s always the issue of notification sitting in the background.

“When they do seek help, they often do it selectively. They’ll see a GP for some issues but not for mental health. Often they practice a form of blended care where they do a bit of self-investigation, self-prescribing and self-referral.”

Doctors’ Health NT has a 24-hour helpline, but Dr Sexton says the penetration is pretty low, which means things have to be done a little differently.

“We’re running a trial for GP teleconsults, which gives doctors the chance to consult with a doctor who is not necessarily part of their personal network. We’ve had very strong support for that model: it’s a great way for an initial talk about an issue and some follow-up.”

He says telemedicine is an excellent way to break down isolation, particularly for doctors who pride themselves on being tough and are reluctant to admit they’re struggling.

But Doctors’ Health NT has also established a network of GPs on the ground who are trained to treat other doctors and medical students.

“We’re trying to grow that network. We have ten GPs at the moment which we hope to expand to 30.”

Dr Sexton says having a GP-centric model for doctors’ health is critical because it can address both physical and mental health issues.

“With a psychiatrist-based model you miss out on all the physical stuff, which can be very important. GPs are also a non-stigmatising way of getting a foot in the door. You can say to doctors that the approach is physical, and along the way we’ll be asking you about your life as a doctor.”

You can access the services of Doctors’ Health NT here.

For more information about health issues for doctors, access a range of online resources from Doctors’ Health Services Pty Ltd.

Mandatory reporting: the “low hanging fruit” in doctors’ health

Mandatory reporting came under fire at a panel discussion on doctors’ health at the AMA National Conference held in Melbourne late last month.

Currently all states, with the exception of Western Australia, have regulations which require health practitioners to report colleagues who they feel may be a threat to their patients to AHPRA or the Medical Board of Australia.

Although mandatory reporting requirements are well-intentioned efforts to protect patients, many professionals worry they are a major barrier to doctors seeking help for their mental health issues.

Speaking on the panel, Dr Bav Manoharan, a Queensland-based radiology registrar who has been involved in resilience building projects, said there was confusion around mandatory reporting legislation and what the threshold was for reporting colleagues to AHPRA.

“That is a real concern,” he said. “There’s a stigma around a doctor approaching a health service and asking for help in environments where there is mandatory reporting.”

He said that changes to manadatory reporting requirements and a clearer understanding of them were the “low-hanging fruit” in the debate around doctors’ health.

Dr Janette Randall, a Queensland-based GP who is chair of Doctors Health Services Pty Ltd, noted that the threshold for reporting was actually quite high but there was a lot of subjectivity and doctors were getting inappropriately reported.

“We have a strong sense of fear and reluctance to present for care and this is one of the barriers. I do think the time has come to remove the onus on treating practitioners to report. That’s not to say we don’t all retain an ethical and professional responsibility in that space, but we’ve got to be able to create safe environments for people to seek care.”

Marie Jepson, who has been involved in research into depression in the legal community, said mandatory reporting tended to drive mental health issues underground.

“We found there were lawyers who would deliberately not go to the doctor, even though they were quite ill, so they didn’t have to lie on their application for a practising certificate. It meant that they complied with the regulation, but it was a timebomb waiting to go off.”

The issue of revamping mandatory reporting requirements does seem to be gaining traction, particularly in New South Wales, where Health Minister Brad Hazzard has announced he will review the legislation.

Mr Hazzard met with health stakeholders at a forum this week in Sydney to discuss measures to improve the mental health of doctors, after several high profile cases of doctor suicides in the state.

“It’s really critical for people with mental health issues to be able to talk to someone with absolute confidence and know that person is there to help and not to judge them – that’s the critical problem with mandatory reporting,” Mr Hazzard told the forum.

“Having listened to the young doctors it may be that the mandatory reporting requirements are technically not the problem, but practically they are, because that perception among young doctors is by seeking mental health help they may be damaging their career. It looks to me that mandatory reporting provisions do need changing.”

For more information about health issues for doctors, access a range of online resources from Doctors’ Health Services Pty Ltd.