Looking after One’s Own Mental Health – Advice for Doctors and Medical Students
Time to read: 7 minutes
The mental health of junior doctors and doctors in general has been of great interest in recent times. The National Mental Health Survey of Doctors and Medical Students by Beyond Blue showed that doctors reported substantially higher rates of psychological distress and attempted suicide compared to both the Australian population and other Australian professionals. Young doctors and female doctors appeared to have higher levels of general and specific mental health problems and reported greater work stress.
An article in the Sydney Morning Herald titled “Three of my colleagues have killed themselves. Medicine’s dark secret can’t go on.” A junior doctor from Sydney wrote about the stressors junior doctors often find themselves under –
In the year it has taken for me to complete my training as a junior doctor three of my colleagues have killed themselves…..Extremely long hours, little financial remuneration (particularly while training), discouragement to claim overtime, and extreme shortage of training places leave many doctors of my generation feeling as if we don’t have many options.
Further complicating the issue is stigma. Approximately 40% of doctors felt that medical professionals with a history of mental health disorders were perceived as less competent than their peers, and 48% felt that these doctors were less likely to be appointed compared to doctors without a history of mental health problems. Approximately 59% of doctors felt that being a patient causes embarrassment for a doctor. (National Mental Health survey of Doctors and Medical Students, 2013)
We speak to Dr Mahendra Perera, Senior Consultant Psychiatrist, Honorary Senior Fellow of the Department of Psychiatry, University of Melbourne and an international medical graduate originally from Sri Lanka. As a mentor for medical students and registrars, his extensive experience and wisdom will be valuable for doctors in navigating the work challenges in the field of medicine. Dr Perera had previously written for the hub about his extensive experience in the challenging field of ADHD.
A PREAMBLE
Stress is an ubiquitous phenomenon, part of the fabric of everyday life
Every age, every era has produced its own set of stresses and difficult life events. I agree with the dictum that it is easy to say, difficult to do.
However, there are decisions one must make and our life trajectory depends (in my view) to a significant extent on the decisions we make and the paths we choose to traverse.
1. CHOICES IN LIFE
Doctors choose medicine with the primary aim of ‘helping patients’? In medical school, there is very little training about the helping ourselves through the choices we make in life. What are your thoughts about that?
Is medicine a vocation, profession or a way of life? Views of the individual does, I believe change with the passage of time.
Certainly, the term altruism comes to mind but at the same time truism co-exists within this framework.
Let us examine our own motives for becoming a medical practitioner. I would counter your next question with my own rhetoric. Is it the role of the medical school to lecture about personal life choices?
A high IQ and entry to medical school does not automatically mean that wise choices are intrinsically part of our persona.
Students do have access to counselling services as well as peers with whom they can discuss. We need to learn to be discerning about the choices we make.
2. ACHIEVING A WORK-LIFE BALANCE
In survey’s at the Psych Scene Courses, difficulty in achieving work life balance is often quoted as a key challenge for psychiatry registrars. Work life balance is something every doctor knows that they need to achieve. Many would however say that it’s easier said than done. Any tips on how to achieve a reasonable work life balance?
- Look after your physical and mental health and if you are so inclined the spiritual aspect of your life.
- Leave work at work and home at home. Being human this is difficult. If there you are faced with a grave situation either at home or at work take it up with a trusted senior or colleague.
- Arrive at work on time and leave reasonably on time.
- When at work attend to your own tasks. You’re not Atlas, shouldering the weight of your colleagues. That does not mean you take a totally blinkered perspective and not help any other. There is a quid pro quo in operation here.
- Get on well with your colleagues. Your relationship with your consultant/supervisor, is a major factor in making life easy or difficult. Let not him/her take undue advantage of you. Learn to spot the early warning signals of any unhealthy situation.
- You play an important role in the system but this is also a job. Life goes on with or without any one of us and that includes you.
- Make sure you have affiliation/s with your trade union/college approved bodies. Take out medical indemnity insurance.
- Make contemporaneous succinct notes in relation to patients, your reasoning for the decisions and instructions you receive from your consultant
- Especially if you feel that you are being subjected to undue pressure (harassment bullying or whatever you may feel it is – keep a personal journal – for your eyes only, to be used later if necessary. Better to avoid loaded terms such as bullying rather say explain how you felt and the circumstances that precipitated the situation.
- Take your breaks, enjoy your time and do try to engage is social activity with your colleagues. Eg go out for lunch or tea break and make this a regular feature.
3. DEALING WITH EXAMS
The Yerkes-Dodson curve tells us that a certain amount of stress is beneficial and can facilitate optimum performance. (this was covered in our return on effort post). Exams pose probably the greatest amount of stress. Any tips for dealing with exams?
Exams are considered as the bane of one’s life when faced with the monster. I have done many, failed some but quickly returned to getting through. I have also examined and been involved at various levels of setting questions and participating in the processes. It is in this context that I make the following remarks.
An examination is but one way of assessing your knowledge and more importantly the pathway of obtaining licence to practice. May I say there is no gain without pain.
There is the popularly held belief in some quarters that exams are designed to find out what the student does not know – this is a myth I would like to debunk.
Exams may not be always fair and as has been seen in recent times there have been 100% failure rates in some evaluation procedures. I think these situations are the exceptions rather than the rule.
A failure on the part of a student may reflect on inadequacies of supervision as well as lack of preparation.
Yes, it is important to remember the Yerkes Dodson’s law or the relationship between anxiety and performance.
4. SOURCES OF WORK STRESS
What, in your opinion, are the potential sources of work stress; things that can easily be overlooked by psychiatry registrars? (Work Load/ Time pressures/ deadlines e.g. CTO reports telephone calls, inability to get off for teaching sessions)
This has already been alluded to in my answers to Q 2.
Let me start with “Inability to get off for teaching sessions.”
Personally, I advocate my junior doctors to attend the teaching sessions. I think the registrar needs to inform the boss, in advance so that there are no surprises.
Registrars may be easily coerced by nursing staff or even other allied health to prescribe certain medicines or doses. While one needs to be part of an understand the ward culture, remember once you sign off it is your responsibility.
Listen but If you do not agree DO NOT COMPLY. Seek assistance from your supervisor.
5. ROLE OF THE SUPERVISOR
What is the role of the supervisor in assisting registrars?
I am almost tempted to not answer this question. I have met a few trainees who have been traumatised by their supervisors/consultant.
I guess 80-90% benefit but if you are in that unlucky 10-20% then you will need all your wits about you. This is not a throwaway line but there is a silver lining in every dark cloud.
You need to come out stronger for the experience rather than weakened by it. If necessary take a break in training. I have been involved in the College mentoring program.
Perhaps you need to take this up with your mentor, significant and sensible other/s and if necessary (and how much we profess to dislike them), a friendly lawyer.
With regards to improper or inadequate supervision – Please take it up with your, Co-ordinator/ Director of Training (DOT)/ or the College Branch. I am sure you will find people who understand you.
6. DEALING WITH CLINICAL CHALLENGES
How should registrars equip themselves for the psychological stressors of dealing with clinical challenges (e.g complex patient cases)?
We must listen to our patients. Hear what they have to say. But remember we are not their saviours. They must work it out for themselves. Insight (in psychiatric parlance) relates primarily to mental illness process, not necessarily to existential issues.
7. ADDICTION IN DOCTORS
Addiction is another issue that is known to exist at higher levels amongst doctors.
Addictions are biological illnesses or are a biological illness with a significant social overlay. Adopting a healthy lifestyle ameliorates the risk. If there is a genetic propensity be extra careful. We can minimise risk by recognising the early warning signs and once more a healthy lifestyle approach.
If you are addicted then acknowledge, own up and seek help. Addictions or dependencies need not necessarily be to drugs. I have seen gambling addictions and various other forms in trainees as well as senior medical colleagues.
8.LANGUAGE DIFFICULTIES FOR INTERNATIONAL MEDICAL GRADUATES
Australia has a large number of migrant doctors where English isn’t their first language. How can registrars overcome these language difficulties?
I am a Specialist International Medical Graduate (SIMG) myself. If we are to work in Australia we need to learn not only the language but also their mores and cultural values.
If a registrar is not confident of his ability to speak in English she/he needs to address this issue. Look for the solution now that you have identified the problem.
Thank you for sharing your wisdom with the hub.