The doctors are not alright
“Recently one of my colleagues told me that they are emotionally incapable of caring for their patients any more. How can I help them?”
This question, or something very similar, was put to one of the plenary speakers at the recent Prevocational Medical Education Forum in Adelaide. It highlights the crisis affecting junior doctors around Australia and, importantly, the direct effect it could have on patient care.
A recent beyondblue survey contained a number of important findings lifting the veil on the true state of mental health among Australia’s doctors and medical students.
The survey reported a number of telling findings, including:
- that psychological distress was greater among trainee doctors than than those in the later stages of their careers, and that doctors generally reported significantly higher levels of psychological distress compared with the general population;
- that signs emotional exhaustion, cynicism, feelings of depersonalisation and low professional efficacy – all symptoms of burnout – were greatest among younger doctors: 40 per cent of trainees and 45 per cent of interns displayed high emotional exhaustion;
- the general work experience for Australian doctors is stressful and demanding. Work-related factors such as hours worked, training stage and burnout were associated with high likelihood of psychiatric distress, reflecting the significance of work-related factors; and
- stigma regarding the performance of doctors with mental health conditions persists.
More reassuringly, a significant proportion of doctors with mental health problems sought advice and treatment. Similarly, doctors suffering mental health distress appeared to be relatively resilient to its effects.
Overall, these statistics are an indictment of the conditions that junior doctors work in. What other profession would accept similar levels of work-related distress?
It is unclear whether this is a longstanding situation, or is the manifestation of increasing pressures within the health care system more generally. Similarly, it is unclear whether such widespread distress is because today’s graduates are more susceptible or more poorly prepared than their historic peers.
Of the conclusions of the survey, the reflection that transitioning from study at medical school to working as a junior doctor in a public hospital is a period of significant stress is particularly powerful. This recognition implies that greater efforts should be made by both universities and hospitals to support doctors through this time.
Recommendations that address the stressful working environment must be acknowledged and acted upon.
Given the current workforce situation, the raw materials are present to easily increase human resources, enlarge the workforce and improving work-life balance.
Increasing the role of mentors and role models, and improving their accessibility, will also be an important part of the solution.
Providing sufficient resources to medical education departments, including recognition that medical education officers provide crucial pastoral care for junior doctors, must also be a priority. Appreciation of the role these individuals play in public hospitals is long overdue.
Similarly, the survey should act as a driver for medical schools to improve the preparedness of their graduates for the demands of work, especially in terms of improving their ability to cope with stress. This should include emphasis on the importance of seeking support when needed. Indeed, one of the priorities for AMA Council of Doctors in Training in coming months will be ensuring that both medical schools and public hospitals recognise their responsibilities in responding to the recommendations of the report.
Returning to question at the beginning of the column, the answer given by the speaker, Dr Robin Youngson, was an innovative yet obvious one: compassionate care, for both doctor and patient.
Dr Youngson was speaking on behalf of Hearts in Healthcare (heartsinhealthcare.com), a movement attempting to increase the humanity in health care.
In a powerful lecture, he reflected upon the importance of fostering compassion, which delivered measurable benefits in terms of both patient care and the enhanced wellbeing of doctors, especially in terms of stress and burnout.
A key conclusion was the importance of being ‘valued’, especially for junior doctors and students.
While being valued by patients is probably beyond our control, being valued by peers, more senior medical practitioners and the institutions in which we work, is part of the culture of the workplace, and often neglected in resource-poor, busy departments.
So, next time you work with a junior doctor, make them feel valued. Bring compassion to your workplace, not just for your patients, but for the doctors you work with.
After all, if we don’t care for our junior doctors, how can we expect them to care for patients?
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