We spoke with Clinical Professor Leanne Rowe AM – a GP, former RACGP Chair, author and mental health advocate for the profession - about the health pressures doctors face, the barriers that can stop colleagues from getting help and some practical steps for better self-care.
What can make doctors vulnerable to poor mental health?
Professor Rowe points to the stress factors characteristic of medical practice including the very high expectations of competence, sensitivity, and concern placed on doctors by patients and the community. In addition, a tendency towards perfectionism imposes internal pressure to maintain standards can be exhausting, especially when dealing with grief, death, and trauma. High-pressure work environments and chronic sleep deprivation increase the risk of burn out and poor mental health.
Professor Rowe has identified stages in professional life when these pressures are likely to come to the fore. Transition points from student to intern, resident to registrar, registrar to specialist and senior doctor to retirement are times of higher stress that may trigger mental health concerns.
Moments of crisis in professional or personal lives may also precipitate mental health issues for doctors. Dr Rowe includes a patient complaint to regulators as a potential major stressor for a practitioner at any stage of their medical career.
I WILL ATTEND to my own health, well-being and abilities in order to provide care of the highest standard.
Extract from the Physicians Oath (Declaration of Geneva) 2017
Burn out is not normal
Burnout is not normal nor easy to admit. “Burnout can predispose doctors to depression so we ignore this at our peril", she says. When doctors are struggling with their mental health, personal and workplace culture factors may discourage them from seeking help.
As a result, depression and suicidal thoughts are common among doctors.
A Beyond Blue survey released in 2013 poignantly illustrates the scale of the problem in Australia
- Over 11,000 Australian doctors experienced suicidal thoughts, and
- 6,600 doctors self-medicated with antidepressants.
Nevertheless “practitioners can be concerned they may be seen as weak or not pulling their weight if they admit they are struggling, or worse if they have diagnosed mental health problems.”
The mandatory notification myth
Many have highlighted the mandatory notification regime as a source of significant and damaging fear amongst medical practitioners concerned about their health or that of a colleague. Many still believe that if they seek help for depression or other mental health conditions they may be the subject of a mandatory notification that ends or limits their career.
Prof Rowe says while these concerns are very real they are misplaced.
She points to her analysis of mandatory notifications which indicates the threshold for mandatory reporting of doctors in Australia with a mental illness to regulators is rarely met.
In order to meet the threshold for mandatory reporting because of mental health issues, a medical practitioner must have an impairment that fits the definition of “notifiable conduct’.
Only serious health conditions that place the public at risk need to be reported. A doctor seeking treatment from a psychiatrist for depression, for example, is unlikely to meet the threshold for mandatory notification because he or she is not placing the public at risk of harm.
If the Medical Council receives a mandatory notification and the public may be at risk, the objective of any regulatory action is to provide safeguards, ideally with the agreement of the practitioner, and to support recovery whilst maintaining the doctor in practice wherever possible.
Doctors need a GP too
Only 50% of Australian doctors have their own GP, compared with 87% of the general population. Some may perceive themselves as too time-poor or be uncomfortable in the patient role. However, self-diagnosis and medication through ‘corridor consult’ deprive the doctor of the level of assessment and care to which he or she is entitled.
It is crucial for doctors to have a regular GP. A supportive relationship with a regular GP or practice provides routine mental health screening and physical check-up as well as a trusted partner if they experience stress-related difficulties.
If the source of stress is a patient complaint or clinical incident, Prof Rowe also encourages practitioners to make full use of the knowledge and resources provided by their medical indemnity insurer.
- Healthy doctors provide the best patient care.
- All doctors should have their own GP and have regular physical check-ups.
- Burnout should not be your new normal.
- Tailored help that is sensitive to the needs of doctors is available.
- Doctors’ Health Advisory Service (NSW & ACT) – 02 9437 6552 (24-hour helpline)
- AMA (NSW) List of ‘Doctors for Colleagues’
- AHPRA video – a practitioner subject to a patient complaint talks about his experience and dealing with stress
- Dispelling myths: doctors can disclose mental illness without fear Dr Leanne Rowe (MJA February 2019)
Dr Leanne Rowe is the co-author of ‘Every Doctor: Healthier Doctors = Healthier Patients’ with Professor Michael Kidd. More information about the book can be found at https://everydoctor.org/
Co-author of 'Every Doctor' Professor Michael Kidd also features on the podcast series 'The GP Show' where he discusses the concepts of self-care, the carers paradox, how we can develop the relationships with ourselves, our family and our work, and some of the principles and foundations of resilience.
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