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Healthy Doctor Initiatives

The RACGP has taken a proactive role in addressing doctor health issues over the past 4 years. The following outlines progress so far, and provides recommendations for future directions. We are asking members to tell us the things that you do to maintain professional and personal equilibrium over the course of your career. We are also interested in hearing from GPs who have had to reflect and revise their attitudes and approaches to work/life balance as a result of a particularly challenging experience.

If you are able to assist this process, please contact Pete Marshall on 03 8699 0559, or by email at peter.marshall@racgp.org.au.

Background

The Professional Peer Support Program Committee (PPSPC) of the Royal Australian College of General Practitioners (RACGP) was formed in 2004 in response to considerable concerns around doctors’ health and well-being. The committee is composed of representatives from a broad range of medical organisations, and operates under the Quality Care and Research Unit of the RACGP. It is an independent committee whose members report on the committee’s activities to their respective organisations. The primary objective of the committee is to promote health and well being amongst medical practitioners as a fundamental element of professional life.

• In 2004 the committee commissioned a literature review of doctors’ mental health. “The Conspiracy of Silence –emotional health amongst Medical Practitioners”¹ reported that the literature in the past fifty years consistently cites high levels of stress, burnout, dissatisfaction with work, high levels of psychiatric illness and depression amongst medical practitioners.
• Following the completion of the literature review, the RACGP commissioned the development of a self care guidebook “Keeping the Doctor Alive: a self-care guidebook for medical practitioners”². This provides doctors with information and practical resources to encourage them to identify the challenges they face and to assist in developing appropriate self-care strategies.
• In 2005 beyondblue and the RACGP invested in the beyondblue / Royal Australian College of General Practitioners (RACGP) Medical Workforce Initiative, which trialled a model of professional peer support as a strategy to address the issues identified in earlier work. The major challenge of this project was to promote a model of self care (peer support groups) to busy practitioners who had previously considered concepts of ‘support’, ‘mentoring’, and ‘supervision’ as an aspect of vocational training or a response to poor performance.
• In 2006 the RACGP distributed 19 000 copies of Keeping the Doctor Alive to our members and members of other medical colleges. This resource provides doctors with exercises to facilitate exploration and discussion about professional and personal issues.
• In 2007 the RACGP commissioned Creating a culture of care: Junior doctor well-being in Hospital settings³), which identified key issues for junior doctors as the lack of support, lack of training and the need for a systems-based approach to institutional reform.
• The RACGP is currently developing Who me? A quick guide for superdocs as a resource to better equip doctors to deal with stresses associated with their work to safeguard themselves, their patients and families. Doctors frequently combine a stoic work ethic with a complex career, and an increasing evidence base highlights the negative impacts of stress, anxiety and depression on doctors’ health and risks to professional performance. The booklet i ncludes suggested strategies for doctors to explore personal and professional stresses and self care strategies that best suit their individual needs.
• In September 2008 the RACGP introduced the GP Support Program in line with the college's commitment to foster a culture of self care amongst general practitioners. It is available to all Australian RACGP members who are registered medical practitioners. Members can access professional advice to help cope with life's stressors which may include personal and work related issues that can impact on their wellbeing, work performance, safety, workplace morale and psychological health. Members can access face to face and telephone counselling during business hours or counselling for traumatic incidents or crisis situations 24 hours, 7 days a week. Find out more

Future Directions

It is imperative that effective interventions continue to ensure a transformation of the culture and attitude of the profession towards its own health and wellbeing. This is not going to be achieved by one-off trials, but by a comprehensive and long range strategy supported by a broad range of programs. It is widely acknowledged in theliterature that medical practitioners have a distinct pattern of stress, anxiety, depression and substance misuse problems, and it is widely known that they have a reduced likelihood of engaging in prevention and early intervention practices. These are complex issues due to a deeply entrenched culture of neglect of personal wellbeing and emotional health, and require addressing from a range of perspectives including:

• Workplace pressures
• Personal interpretations of the doctor role
• Cultural factors within the medical community

Both the current research and the experience of this project strongly signal the need to:

• Expand and improve the promotion and delivery of programs and services to cover the diverse needs of individual doctors;
• Focus on improving access and removing barriers to acceptance of doctor support programs.

It is therefore, essential that strategies are implemented that realign professional values to recognise the importance of self care and mental well being in providing high quality and ethical care to patients. Doctors have a moral and legal obligation to care for their own psychological and emotional health. New evidence emerging from Canada suggests that patients benefit when doctors model desired behaviours and it increases the authenticity of their counselling.

Recommendations

Professional and Personal Development Unit

Education alone cannot build healthy, strong general practitioners; the College can and must do more. Based on the research undertaken and resources developed over the last few years of the program, it is recommended that the RACGP establish a Professional and Personal Development Unit as a way of incorporating both new and existing programs into a framework that that supports the journey of the doctor, and has carriage of a range of existing and new programs including:

1. Professional development: structured pathways for general practitioners to build satisfying work practices over the span of their professional life.
2. Healthy doctors: self care and resilience approaches to minimise stress, depression, anxiety and burnout. The College could develop a program to prevent suicide, reduce burnout and trial strategies that build resilience in current and future general practitioners. Develop structures that encourage all doctors to have a GP.
3. Prevention program: It is important that College leaders speak positively of the importance of seeking help, and of each GP 'having a GP'. Mentoring and supervision should be promoted as part of healthy practice, rather than the remedial program it is currently considered by the profession. Peer support groups will continue to be developed as a viable strategy.
4. Workforce and national advocacy: I nternational research confirms that there are ethical and moral dimension to a doctors emotional health. Healthy, well balanced doctors provide better care to patients and those doctors are likely to remain in the workforce longer. There is, however, limited research on national approaches. The RACGP could partner with leading medical organisations and universities to seek funding under the Australian Research Council grant scheme. The ethical, moral and legal dimensions of the statement “patients have a right to a well doctor rather than a burnt out or disturbed doctor” need to be explored.

The Program will create a structure and focus to look after members in different ways. For example, some practical suggestions that build on current College programs are:

1. Explore options for including standards that are markers for emotional health and wellbeing in the next edition of the Standards for General Practice.
2. Follow the lead of some fellow colleges and introduce the option of supervision as a Category 1 activity into the QACPD Program.
3. Develop an enduring program that provides GPs with knowledge and strategies to address ineffective stress management strategies with a gplearning unit.

The Program would create structures and approaches that provided members with a variety of non-threatening but evidenced based strategies to build health professionals and healthy individuals.

Collaborative strategies

On a broader level, the College can lead the profession with an integrated, thoughtful and evidence based program of interventions to build a robust profession. T he beyondblue / Royal Australian College of General Practitioners (RACGP) Medical Workforce Initiative provided a strong conceptual and strategic base from which a range of industry wide initiatives have been developed. These are all dependent upon funding, and are outlined in the next section as recommendations coming from this project.

Developing a leadership vision

Recommendation: That the RACGP and beyondblue jointly host the “Table for Ten” workshop at the start of the WONCA / RACGP conference in Melbourne, October 2008, to provide a national vision and leadership on doctor health.

Rationale: The ‘Table for Ten’ event represents an opportunity to bring together key leaders within the Australian community to think about new perspectives to reduce stress, anxiety and depression. It is intended to promote national awareness across a range of industries and sectors to benefit not only the medical profession but the broader Australian workforce.

Normalising doctor self-care

Recommendation: That the RACGP seek funding to explore strategies that encourage general practitioners and other specialist medical groups to frame self care as a positive and important adjunct to providing high quality clinical care.

Rationale: Doctors currently conceptualise ‘doctor health’ programs negatively and link them with impaired doctors. It is essential to normalise self care, especially in relationship to stress, anxiety and depression and focus programs on building better health outcomes for the doctor and the Australian community.

Targeted education

Recommendation: That the RACGP develop a range of education and training activities that focus on improving quality of patient care through a focus on doctor’s health.

Rationale: The development of educational material would facilitate greater collaboration among medical specialty colleges to address doctor health and also help in de-stigmatising help seeking behaviour. The interest from the other colleges in the RACGP publication Keeping the Doctor Alive is the beginning of this process.

References

1. Clode, D. (2004) “The Conspiracy of Silence: emotional health among Medical Practitioners”. A review of the literature for the Royal Australian College of General Practitioners.

2. Clode, D. (2005) “Keeping The Doctor Alive: A self-care guidebook for Medical Practitioners”. The Royal Australian College of General Practitioners.

3. Clode, D. (2007) Creating a culture of care: Junior doctor well-being in hospital settings, Royal Australian College of General Practitioners

Publication Date: 8 October 2008