Healthy Doctors: Better Medicine - AMA President Dr Andrew Pesce, Speech to 6th National Doctors' Health Conference

SPEECH TO 6th NATIONAL DOCTORS' HEALTH CONFERENCE. ADELAIDE, THURSDAY 3 SEPTEMBER 2009
AMA PRESIDENT DR ANDREW PESCE

Healthy Doctors: Better Medicine

Good evening.

First, I thank AMA South Australia which has worked closely with the South Australian Doctors’ Health Advisory Service to bring this Conference together.

Healthy doctors, healthy patients or indeed healthy doctors better medicine is a well-known maxim of the medical profession.

It is clear that doctors need to be well themselves to be able to provide high-quality health care to their patients and the community, and to experience medicine as a rewarding and satisfying career.

There has been a welcome increase in the awareness of doctors’ health issues in recent years.

The AMA has been active in improving working conditions for doctors.

We have developed the safe hours code of practice for hospital doctors, which sets out internationally recognised principles for managing the risks of fatigue.

The code is now accepted as the gold standard for safe working hours for hospital doctors in Australia.

We continue to lobby for flexible working and training arrangements that enable doctors to meet their aspirations for work-life balance.

Many individual doctors as well as organisations within the profession are encouraging doctors to understand and adopt a healthy lifestyle throughout their medical training and professional careers.

The AMA is doing its bit to improve the health and wellbeing of doctors.

In 2007, AMA Victoria established its Victoria Peer Support Service –  'peer support for doctors by doctors'.

It is a phone counselling service for doctors and is staffed by volunteer counsellors who are experienced doctors trained in the skills of peer support telephone counselling

These counsellors have broad experience in medical practice and they  represent a wide range of specialties.

In 2008, we surveyed over 900 junior doctors in Australia on the their health and wellbeing.

It was the first time that the AMA had done a national survey on this issue and is one of the largest surveys of its type undertaken.  More details on that survey shortly.

In 2008, the AMA Council of Doctors in Training, which is passionate about the health and welfare of doctors, prepared its doctors’ health posters.

These posters remind doctors of the importance of having their own GP and they list contact details for the doctors’ health advisory services that are available to assist doctors who are concerned about their health.

The posters are displayed in communal areas within hospitals.

The AMA’s Federal Council is taking the issue of doctors’ health seriously and is exploring the feasibility of working with the doctors health advisory services to conduct research into suicides of doctors and medical students.

I'll return now to the AMA’s 2008 national survey of the health and wellbeing of junior doctors.

The AMA undertook the survey to get a picture of how well junior doctors are looking after themselves and are coping with the pressures of working in the demanding public hospital system.

We have known anecdotally for some time that the health of junior doctors is a concern for individual doctors and for the medical profession as a whole.

The survey aimed to increase the awareness of junior doctor health issues in hospitals, with governments and within he profession.

They all have a duty-of-care to ensure the health and wellbeing of our junior doctors.

The survey revealed that junior doctors have a rewarding and satisfying career in medicine.

More than three-quarters reported that they had enjoyed working as a doctor over the previous year and were looking forward to their work in the coming year.

It was reassuring that virtually all of the respondents indicated that they are committed to continuing in the profession.

However, junior doctors are struggling to cope with excessive workloads.

The conditions in our public hospitals have led doctors to feel compromised as they try to meet patient needs.

Junior doctors are finding it difficult to manage a balanced lifestyle and maintain appropriate lifestyle behaviours.

They are experiencing high levels of stress at work.

The results of psychometric testing incorporated in the survey showed that over half displayed risk factors for compassion fatigue and job burn-out.

The findings are further evidence that insufficient funding by governments is the root cause of the stresses and strains in our public hospitals.

The survey also shows that doctors must get better at caring for themselves – doctors are relying too much on self-treatment rather than consulting their GP.

There is an unambiguous case for ensuring that junior doctors have much better support structures in place.

These range from staff health clinics in hospitals through to ensuring that doctors are able to take time off to see a GP for check-ups, or treatment when they are unwell.

It is generally recognised that doctors have an above-average health status, similar to others in advantaged socio-economic groups.

The literature suggests that doctors are less likely to suffer lifestyle-related illnesses such as heart disease and smoking-related illnesses than the general population.

At the same time, research suggests that doctors are at greater risk of mental illness and stress-related problems and are more likely than the average to have drug and alcohol dependence and suffer from depression.

Suicide is a big issue for the profession in this country.

Anecdotally, we believe that one doctor in a majority of States commits suicide every year.

AMA Federal Council has proposed research on coronial and other reports of completed suicides of doctors and medical students to ensure system failures are identified and rectified.

We would also like to see the establishment of an epidemiological database of doctors and medical students at risk of suicide, and completed suicide.

Some sub-groups of the medical profession may be at greater risk of poorer health and wellbeing because of their particular circumstances.

Junior doctors, for example, face additional pressures as they establish their careers, cope with the demands of each new clinical placement, and endeavour to succeed in their ongoing medical studies and career progression.

Doctors work in demanding environments, such as public hospitals, which would test the emotional and physical resilience of most people.

The literature suggests that doctors give their own health care a low priority and feel pressured not to miss shifts or cancel appointments due to ill-health.

This can lead to a reluctance to act on the early warning signs of problems.

Fortunately, the AMA’s recent work on the attitudes of doctors to work-life balance suggests that they are becoming less willing to accept the personal costs that have been traditionally accepted by those who have come before them.

Our health system cannot afford to lose doctors because of the prevailing culture of poor self-care in medicine.

Most importantly, healthy doctors mean healthy patients.

Like everyone, doctors experience ill-health.

Nearly three-quarters of the junior doctors surveyed by the AMA last year reported that they had been concerned about their physical or mental health during the previous year.

Nearly two-thirds had been concerned about the health of a colleague.

Doctors make the worst patients.

They tend not to practise the advice that they give to their own patients and do not seek appropriate medical care.

This paradox is often attributed to the culture of the medical profession, which is very competitive and has high expectations of dedication to work and unlimited resilience under stress.

The stigma of ill-health that prevails among doctors discourages the open admission of medical problems or personal difficulties to colleagues.

The complexities of doctors treating doctors in a professional relationship is another barrier that can hinder proper treatment.

This culture can result in self-care by doctors, a poor cousin to the medical care that they offer their patients.

It includes inadequate preventive care and inappropriate practices such as self-diagnosis, self-treatment ,and delayed presentation to other practitioners.

Doctors are often reluctant to have a GP for independent medical advice.

Similarly, they may not adhere to routine preventive health measures such as screening tests and vaccinations that they expect their patients to follow.

It can be difficult for junior doctors to meet the emotional and physical demands of the early years of their medical careers and maintain their health and wellbeing as they are joining a profession which has traditionally fostered a culture of self-reliance and extreme altruism.

Doctors can be reluctant to admit illness and seek the help of a treating doctor because they feel inhibited about complaining and taking time off work.

This attitude to health care means that it is even more difficult for doctors to seek help for a stress-related illness, a mental health issue or for substance misuse, as these are not seen as 'real' illnesses.

Many will try to work through their problems or illness.

There are also practical issues which act as barriers to proper self-care.

These include insufficient numbers of GPs willing and able to treat doctors and inadequate staff health services in hospitals, particularly in rural areas.

Doctors may also have difficulty in finding time to leave work for check-ups or treatment.

The reluctance of doctors to consult a GP about their medical problems can lead to self-treating.

This includes doctors diagnosing and treating their own illness and self-prescribing medication.

Self- treatment can also include informal ‘corridor’ or ‘kerbside’ consultations and self-referring to a specialist.

The literature suggests that the practice of self-treatment and self-prescription is common.

There are many external and internal stressors in medicine.

It is suggested that the stress and associated vulnerability to depression in doctors is a product of the interaction between the demanding nature of their work and their obsessive, conscientious and committed personalities.

Internal stressors may come from the very nature of the individual that chooses to practise medicine.

These qualities include dedication, commitment, a sense of responsibility, competitiveness and altruism.

These attributes can become a source of pressure in a doctor’s working or study life and increase the risk of anxiety and depression.

There are also a large number of external factors that are considerable causes of stress for doctors.
The culture of the medical profession has traditionally expected doctors to deal with these challenges.

Compared to most other professionals, doctors are expected to work long hours coupled with heavy responsibilities.

This is compounded by the insufficient staffing levels and inadequate resources in over-stretched health care environments.

Junior and senior doctors alike will continue to face challenges to balancing their personal and professional lives.

While the number of medical graduates is doubling over the next decade, many baby-boomer doctors will be retiring.

The population is growing and getting older.

Doctors are working in a health care system with heavy clinical workloads, more regulation, and ever-changing technology.

Doctors are expected to manage high patient expectations about demands on their time.

In closing, may I suggest some simple tips for doctors to look after their own health.

Simple messages to doctors on looking after themselves