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  • Wellness: what does it mean for doctors?

    The World Health Organisation defines health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. It’s an ideal that you work diligently towards for your patients, but when it comes to ensuring your own wellness, the evidence indicates that you might fall short.

    Research indicates that healthy, well balanced and content doctors make better healers: you are more likely to provide better patient care [1], are more likely to impart healthy lifestyle messages to your patients [2], and importantly, more likely to offer more empathy[1]. Another consideration is that you are also less likely to make mistakes due to stress, fatigue and boredom.


     

    A picture of health

    The limited research available on doctors’ wellbeing tends to focus on mental health issues with little emphasis on the comparison between doctors’ health status and that of the general population. However, it appears a high level of health literacy and socioeconomic advantage mean doctors have lower than average mortality rates and are less likely than the general population to suffer lifestyle-related illnesses, such as smoking-related disease[3, 4].

    In relation to mental health, it appears doctors are at greater risk than the general population of stress-related illnesses, including anxiety and depression and substance abuse. [5] Partly as a result of access to means, knowledge and opportunity, the suicide rate among doctors is significantly higher than that of the general population (26% higher risk for men and 46% higher for women)[6].

    Like everyone else in the community, it is estimated about 40% of doctors have long-term health issues, says Dr Margaret Kay, Secretary of the Doctors’ Health Advisory Service Queensland[7]. But what sets them apart is an entrenched reluctance to seek support for either physical or mental health issues.

    Avoiding the sick role

    Doctors are less likely than the rest of the population to have their own GP and are more likely to self-diagnose and self-medicate, driven by the lingering misperception that to admit illness is to admit failure[8].

    “It’s the idea of the wounded healer – doctors don’t talk about being sick they feel embarrassed, they feel they have crossed the line and become one of ‘them’, a patient,” Dr Kay says.

    Awareness is the key – a model of wellness

    “The fundamental issue for doctors generally is they need to have self-awareness. To maintain optimal wellness, they need to be aware of the different domains in their lives,” says Simon Willcock, Professor of General Practice at the University of Sydney. Professor Willcock and others who treat health professionals advocate the following model for wellness.

    Physical health – avoid the pitfall of self treatment

    Doctors are responsible for their own physical health, including lifestyle management, as well as proactively seeking treatment and establishing a continuing therapeutic relationship with their own GP. Regular self-diagnosis, treatment and prescribing are discouraged both for doctors and their families.

    “Doctors are terrible patients and unless we are experienced at treating doctors, the doctors they see often collude in providing poor health care to their colleagues with limited explanations, shortcuts in investigation, avoidance of awkward questions and all the pitfalls associated with being a ‘special patient’,” says psychiatrist Dr Michael Diamond, who treats many doctors in his Sydney practice.

    Dr Stephen Jelbart, a Melbourne GP and Medical Director of Medical Services Australia, a practice which treats a number of health professionals as patients, says doctors should follow the advice they give to their own patients.

    “There is a general lack of self-care among the people we see, with very poor lifestyle management. They are often very unfit, they tend to be overweight, they find it hard to fit in exercise, and they are often drinking too much. They need to take a really proactive approach to these issues,” he says.

    The workplace – manage the demand

    Isolation is a key risk factor for poor health amongst health professionals – and that isn’t confined to geographic location[9]. Many medical practitioners experience stress not so much from dealing with distressed patients – which they are well trained to manage – but more from the day-to-day burden of workplace relationships, finances and home life. A recent study indicated that 25% of the Australian medical workforce had encountered bullying during the last 12 months, which was strongly associated with poorer health and wellbeing[10].

    Health system changes are gradually reducing the need for doctors to work long hours and take work home. However, it’s essential to have a supportive workplace, whether doctors are employed in large hospitals or solo general practitioners.

    Social and emotional health – have a plan

    Rates of anxiety and depression are relatively high in medical professionals. Research suggests marital dissatisfaction is higher amongst doctors, while their families receive a poorer quality of health care[1].

    To foster resilience, doctors should surround themselves with social support beyond their nuclear family and workplace.

    “Becoming grumpy with patients, staff and colleagues is often a sign of depression. It’s not a sign of failure, but it is important that it’s dealt with,” says Professor Willcock.

    “If things went pear-shaped, who would you talk to? If you don’t know, then your social health is in peril.”

    Establishing or participating in local professional support networks is one way of ensuring you have good social supports

    Consider your cognitive health

    Most doctors know about the importance of work-life balance, but it can be hard to fit extra-curricular pursuits into busy lives. A Monash University study of nearly 4000 GPs found only half felt they had the balance right between their personal and professional commitments, with baby boomers and male doctors feeling they did not achieve good balance[11].

    “It’s important to stop yourself getting bored, not to feel like you are on a wheel and not to become a victim,” says Professor Willcock.

    That might mean learning a language, taking up a musical instrument, or keeping up to date professionally. It is also important to maintain spiritual health to confer meaning and purpose, he says.

    References

    1. Royal Australasian College of Physicians. Health of Doctors Position Statement. RACP: Sydney, 2013.
    2. Frank E, et al. The association between physicians’ and patients’ preventive health practices. Canadian Medical Association Journal 2013; 10:1503.
    3. Frank E, et al. Mortality rates and causes among US physicians. American Journal of Preventive Medicine 2000; 19(3): 155-9.
    4. Frank E, et al. Health practices of Canadian physicians. Canadian Family Physician 2009; 55(8): 810-811.
    5. Elliot L, et al. The Mental Health of Doctors: A Systematic Literature Review Executive Summary, beyondblue: the national depression initiative, 2010.
    6. Elliott L et al. The mental health of doctors, a systematic literature review. beyondblue 2010.
    7. Kay M, et al. Doctors do not adequately look after their own physical health. Medical Journal of Australia 2004; 181:368-370.
    8. Kay M et al. Doctors as patients: a systematic review of doctors’ health access and the barriers they experience. The British Journal of General Practice 2008; 58(552): 501–508.
    9. Australian Medical Association 2011. The health and wellbeing of doctors and medical students.
    10. Askew D et al. Bullying in the Australian medical workforce: cross sectional data from an Australian e-Cohort study. Australian Health Review 2012; 36(2):197-204.
    11. Shrestha D et al. Aspects of work–life balance of Australian general practitioners: determinants and possible consequences. Australian Journal of Primary Health 2011; 17(1):40-7.