Overcoming adversity in medicine

Doctors often experience a profound sense of distress and isolation when facing an adverse outcome that can be difficult to overcome.

Three Avant members who faced extraordinary challenges working during crises, share their perspectives on coping with adverse outcomes and maintaining wellbeing, when you can’t see the wood for the trees.

Dr Lydia Johns-Putra, a urologist who was part of a team who rescued a man during the 2011 Christchurch earthquake, Dr Richard Harris, anaesthetist and Thailand cave rescuer, and Dr Dan Pronk, a GP who served in the SAS and Commandos as a Regimental Medical Officer, spoke at Avant’s Q & A series ‘The Quake, The Cave and the Commando.’

Self-reflection and forgiveness

Dr Johns-Putra, who performed a bilateral leg amputation on a man trapped in a collapsed building using only a hacksaw and pocket-knife, admitted it has taken her a long time to be able to deal with adversity.

“We’ve all had bad outcomes and I’ve always said it’s the loneliest place on earth when you’ve had a complication and you believe no one wants to know you and they’re all talking about you behind your back in the corridor,” she said. “But they aren’t, they are just too embarrassed to reach out and say, ‘Are you okay?’”

Dr Johns-Putra believes the building blocks of resilience reside in all of us, and by reflecting on your experiences, you build, train, and learn more through your resourcefulness.

“It goes back to having your own resourcefulness, to believe in yourself and be kind to yourself. When you give yourself the advice you tell somebody else,” she said.

Awarded joint Australian of the Year in 2019, Dr Harris recounted a complaint he experienced three months into working as an anaesthetist. The complication occurred during a WorkCover case, where the patient had an aspiration event on a laryngeal mask airway while undergoing an elective knee arthroscopy.

“It was a profoundly distressing period of time for me and of course my immediate assumption was I was completely incompetent to practise and should never have been given a licence in the first place,” he said. “It took a long time to realise that actually, the last thousand anaesthetics I gave for arthroscopy in overweight patients with sleep apnoea didn’t aspirate.”

“These things just happen unfortunately, so we need to learn not only to forgive ourselves, but to gather around our colleagues when something like this happens,” Dr Harris said. “Because for some doctors it actually costs them their lives and certainly has a great deal of impact on their mental health.”

Dr Pronk, who has served in Timor-Leste and Afghanistan, identified the sense of isolation doctors can feel after experiencing a bad outcome and highlighted some techniques he has used to make sense of what has happened.

“I have found that in the military environment where we lost guys, I’d have their teammates or the other medics who might have been trying to help coming to me for that support and reassurance, so you sort of had to be stoic,” he said. “But at the end of the day, you do need someone to be there to have that debrief with.”

“It’s a challenge but I think trying to have a group of peers in other organisations perhaps or tapping into some of these groups for that support is very important to be able to debrief yourself,” he said. “I’ve found journalling to be a really useful tool. I think that ability to force yourself to write a whole event out is very cathartic because otherwise you tend to just fixate on the key negative points and ruminate on those.”

Strategies to maintain wellbeing

After successfully rescuing 13 people who became trapped in a Thailand cave in 2018, Dr Harris knows a thing or two about managing stress and identified running as his de-stressing strategy.

“I find running so much better for every aspect of your life,” he said. “I’ve found that I can meditate while I run because once you get fit enough to just go for a run your brain starts to not think about the running. It starts to think about the stuff that probably happens while you’re meditating … and I do all this problem solving and thinking.”

“By the time I’ve got back from my run I’ve solved all the world’s problems,” he laughed. “So that has been a revelation for me over the last five years or so.”

Similarly, Dr Johns-Putra said she finds running regularly and prioritising eight hours of sleep each night, helpful to maintaining wellbeing.

“Exercise is important, and I run with a group of friends. They ground me and really, it’s the human connection on top of the exercise that is my rock,” she explained.

Acknowledging that it’s very easy in medicine to get bogged down in the stress of the day to day and lose sight of the bigger picture, Dr Pronk reiterated the importance for doctors to be kind to themselves.

“We tend to beat ourselves up and only see the negative but occasionally I think it’s healthy to take a step back and think, ‘Hey, you know what?’ I’m doing a bit of good here,’” he said. “So be kind to yourself and take some time to focus on the good things that you’re doing.”

You can watch the full recording of the Sydney event, hosted by Avant’s Chief Medical Officer, Dr Michael Wright.

Resources

The Q & A session raised the importance for doctors to prioritise their wellbeing and seek support if needed.

Visit our website for a wealth of health and wellbeing resources or for more highlights from the speakers' extraordinary stories and insights on building a resilient mindset, watch our short video:

• The Quake, The Cave, The Commando - tales of mental agility and resilience.

Avant members can access six confidential external counselling sessions through Avant’s Personal Support Program on 1300 360 364. A range of confidential peer support services are also available for doctors.

Assess your wellbeing

To support members and help with the challenges associated with a career in medicine, Avant is pleased to provide access to the My Well-Being Index (WBI) app.*

Customised for Australian doctors, the app is 100% anonymous and uses the WBI developed by the Mayo Clinic for doctors to help them identify burnout and increase awareness of their wellbeing.

Download the app