Dr Mukesh Haikerwal Discusses the Health and Mental Wellbeing of Doctors

LINDY BURNS: Yes, it was an extraordinary reaction to my discussion yesterday about the tragic death of a trainee surgeon, who you probably heard walked into the Alfred Hospital and took his own life about five months ago. It's not clear why he did do that, but it sparked a tidal wave of calls from junior doctors, from their families and friends, rang in to talk about the marathon shifts worked by trainees. And the incredible emotional stresses, which come from dealing with the demands of a constant stream of patients, whose lives of course, simply depend on you.

And then the call you just heard was particularly powerful. It was from a doctor who reminded you and me, that if the emotional trauma did not take its toll on young doctors, it often caught up with medical practitioners, certainly in the end.

The Australian Medical Association has long campaigned for improvements, as you would have expected. And it's just done a survey of junior doctors across the country to get a snapshot of the kind of hours that they are working.

With me now is the AMA President, Dr Mukesh Haikerwal. Mukesh, good afternoon.

MUKESH HAIKERWAL: Lindy, good afternoon. How are you?

LINDY BURNS: I'm all right, thanks.

MUKESH HAIKERWAL: That's good.

LINDY BURNS: What did that survey find? Did that back up some of the things we've been hearing yesterday?

MUKESH HAIKERWAL: Well the final results haven't been processed, but certainly preliminary results show that there has not been a significant reduction since the last survey, which is over four years ago. And that's certainly a concern, because we've had lots of lip service to the AMA's code about safe hours of working, the AMA's provisions around safer rostering.

And they're the two keys, I suppose, to this workforce dilemma, is that making sure that people are working appropriately long … in shortened hours, that they have adequate break times, that they have adequate time to sleep, so they can go onto the next shift. And they're properly prepared and have time, not just to do the work, but also to do the learning they're supposed to be doing on the job and to prepare themselves for the next phase of their career.

LINDY BURNS: And patently, that's not happening, because certainly I think yesterday's calls, it was just the tip of the iceberg.

MUKESH HAIKERWAL: Yeah.

LINDY BURNS: Why is that, and whose fault is it?

MUKESH HAIKERWAL: Okay. The main problem is that the employing authorities, the hospitals, tend to expect their doctors just to keep going. And obviously it's a professional role that we do, so we don't leave things undone, so you do what you have to do. But unfortunately, that goodwill gets rolled on into an expectation, and often into un-rostered overtime, and often, not even paid for.

So people are working long hours, not rostered, and are prevented from even claiming that, not they should necessarily be doing those hours in the first place.

LINDY BURNS: I did get one call yesterday that suggested that legislation was needed to limit this, that that was what was happening in the UK and it had brought about some change. That if you're just trying to regulate it, or to put in recommendations, that's just not going to make any difference whatsoever, that there needs to be legislation in place. Is that the way forward?

MUKESH HAIKERWAL: Well we believe that it may well be something that comes in later on if things don't work. What we would prefer at the moment is a more … I suppose an aspirational view. What is it we're hoping to do, reduce the number of hours on the trot, make sure that proper times for in between shifts and proper time for sleep and R&R before getting onto the next shift.

Because by bringing in strict legislation, it can bring with it its own problems, the flexibility that is there within, I suppose, the doctor ranks and the professionalism might somehow be diminished. But it doesn't mean that we wouldn't think about it if things weren't improving, and obviously there's been significant change say in the last 10 to 15 years.

But there is still that mentality that, well I did it pretty tough, so you can do it too. And to me, that's totally unacceptable. I mean I did it tough, but I'm not going to put my brother through, or whoever is on the same scheme, and I'm not going to put anybody else through it.

As far as I'm concerned there has to be a reasonable expectation of a reasonable life, doing what is a very impassioned career, looking after people.

With all the humanitarian feelings that we all have about people that are sick and seeing them die in front of us and suffer, and try to be professional about it.

LINDY BURNS: I want to talk about the culture in that, because you've raised it slightly there, that came out yesterday. But just to finish up the discussion about enforcement, I contacted the State Health Minister, I actually contacted the Federal Health Minister, Tony Abbott's office, to get some sort of a statement, or at least to understand what his position is on this.

And basically, well quite frankly, in a paraphrased way, handballed it to the States, and Bronwyn Pike, who's the Victorian Health Minister, has made this statement, that the Ministry is keen to see any proposal that the AMA may have for mandated working hours. But issues around enforcement are problematic; when you start to require legal working hours it triggers enforcement issues, which also have to be addressed.

I mean well, she does have a point on that, but we may have to get to that situation.

MUKESH HAIKERWAL: Well we may well do, and I suppose the thing that's always been a concern in the past is we don't have the manpower. But what we're seeing through the system is an increasing number of students being trained, so we're going from about 1,200 to 1,500 students graduating in Australia to about 3,200 in about four years time.

So we will have the numbers coming in behind us. It doesn't help the situation now, I understand that, but it means we can work towards a better, more supportive culture, where people can actually get proper R&R time, proper time to do their ongoing learning, which they have to do for their careers, whilst having a normal life and providing that high level of care that people expect, the academic knowledge, the knowledge of the medicine, and the professional way of putting that across.

LINDY BURNS: Well let's talk about that culture. You did mention that one of the issues is that those who are looking after or running these rosters these days, running these hospitals, probably had to do it pretty tough themselves. And you mentioned that you had to work some pretty significant shifts, but you're of the opinion you don't want others to go through that.

I'm sure that you're in the minority in that, though.

MUKESH HAIKERWAL: Well I would hope not, and I would hope that certainly the processes, people are much more aware of the lifestyle that was expected of myself when I was going through training. And it's not that long ago, believe it or not. But it was pretty strict and it's not … it's lead to pretty poor outcomes in the terms of the health and welfare of my generation of doctors and doctors who went through before me.

And people in the younger generation are saying, we're not going to go there. We don't think this is right and we don't want to have the same outcomes that you had with your health and your relationships, and so on.

So there is a push from the junior doctor ranks themselves, there is a push from doctors who have already trained, as we've heard from your phone call earlier, who recognise this as being an issue.

And this more supportive, nurturing way of looking after all of us within the profession, has to be promulgated. So in Victoria we've got a very good scheme called the Victorian Doctor's Health Program, which looks after doctors from the time they're students till the time they retire. And very much is a much more supportive regime to help them through these very difficult crises that they'll often face.

LINDY BURNS: There's a couple of points here that I want to raise. One is, should we lower the entry scores to universities, in terms of … for medical courses. Increasing the number of doctors that we have in the system, to take the pressure off those who are already there?

MUKESH HAIKERWAL: Well the number of doctors is going to increase, and I suspect that that will relate to a change in the score required to get in. And certainly, one of our universities has an interview system, which may well reduce the score required of some people, and those things are really quite important.

Obviously it's important to have a certain academic ability, but there are questions asked about do you really need 99 point however many it is to get in. And that's a reasonable point.

But no matter what your score is, once you get in you've still got the arduous workload to do the training to become qualified, and then there's the ongoing situation, once you're qualified of going through your different career hurdles until you become a GP or other independent specialist.

LINDY BURNS: So is it fair to put that on young people who are 18, 19 years of age? And there are some courses here in Australia and overseas where you've got to have a bit of life experience behind you before you go onto studying medicine?

MUKESH HAIKERWAL: Well I mean, there's an increasing number of people in the workforce … sorry, in the undergraduate courses, who are actually postgraduates. So many of the new university courses are after an initial degree. I don't think that … I think people of 17 or 18 can do this, and honestly have done it for generations now, but the way in which it's done has to change. Because it's been very much a macho atmosphere that you've just got to get on, head down, bum up, do whatever you can do, get across the line, and suffer the consequences quietly.

And I think that of each of those levels now, we're seeing now, that you've got to work proper hours, you've got to learn properly. You can't learn when you're deadbeat on your feet, so by doing 80 hours on the trot's not going to help you.

And you've got to make sure that you do have a chance to debrief, you do understand that it's okay to feel sadness and loss when patients in front of you are suffering or dying. All those things used to put onto the back burner and forgotten about. That's no longer necessary. That's something that you should be able to get some support from a place like the Victorian Doctor's Health Program, from your senior colleagues and your equals and your peers.

Because that sort of environment needs to be much more compassionate now.

LINDY BURNS: So a long way to go, but perhaps a few steps in the right direction.

MUKESH HAIKERWAL: A few steps in the right direction, a long way to go, but I think that the push from all the profession and indeed the support from the public, is overwhelming. The people want their doctors to be safe, to be working effectively and safely on their behalf, and to stay well so they can be looked after better.

LINDY BURNS: I couldn't agree more as a person who relies on that. Thank you for talking to me. We'll watch this with interest over the next few weeks, to see how it turns out.

MUKESH HAIKERWAL: Thanks Lindy. Good afternoon.

LINDY BURNS: Dr Mukesh Haikerwal, who is the President of the AMA. And just to remind you that if you are experiencing emotional difficulties, doctor or not, you can ring the Suicide Help Line, which is 1300 651 251, 1300 651 251. And doctors experiencing difficulties can also contact the Victorian Doctor's Health Program, as Mukesh was mentioning. And that number is 9495 6011, 9495 6011.

Ends