Ep83: Loving Medicine Again

Ep83: Loving Medicine Again
Date:
10 July 2022
Category:

Fellows of the College can claim CPD credits for listening to the podcast and reading supporting resources.

In the last episode we heard some powerful examples of the challenges faced by some practitioners in medicine. Every situation has its idiosyncrasies, but most people start out with a passion for what they’re doing. In today’s podcast we hear from doctor-career coaches Ashe Coxon and Sarah Dalton who help medics solve the workplace challenges, and remember what drew them to the profession. Associate Professor Peter Connaughton describes burnout as an occupational health issue, that needs to be solved organisationally. Those presentations were recorded at Congress 2021, but we also get a call from a listener wanting to share a simple gesture that can make a world of difference between colleagues stretched thin at a busy hospital.

Credits

Guests
Dr Stephen Philpot FCICM (Alfred Health, Cabrini Hospital)
Dr Ash Coxon FRACGP (Townsville Hospital; Medical Career Planning)
Dr Sarah Dalton FRACP (Westmead Children’s Hospital;
Associate Professor Peter Connaughton FAFOEM (Curtin University; University of Notre Dame)

Production
Written and produced by Mic Cavazzini DPhil. Written and produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes and ‘Exploring the Lake’ by View Points and ‘Into the Bone’ by Taylor Crane. Photo image licenced through Getty Images.

Feedback on this episode was kindly provided by physicians of the RACP’s Podcast Editorial Group; Vicka Poudyal, Michael Herd, Rhiannon Mellor, Nele Legge and Amy Hughes

Transcript

MIC CAVAZZINI:               Welcome to Pomegranate Health, a podcast about the culture of medicine. Steve, can you introduce yourself for us, please?

STEVE PHILPOT:                I can, yes. My name is Steve. I'm an intensive care specialist in Melbourne, I work across a couple of sites, Alfred Hospital and Cabrini Hospital. My other role is in communication training for healthcare staff. I facilitate the communication training program for the College of Intensive Care. And I work for Donate Life, the organ and tissue authority and I do a little bit of communication training for Monash University undergraduate medical students.

MIC CAVAZZINI:               Sounds like you should have my job.

STEVE PHILPOT:                I'm not covered in your job, it’s okay.

MIC CAVAZZINI:               So you got in touch with us after hearing the last episode called “Coming Back from Burnout”. And you've got your own remedy for workplace tension to share. But before we get to that, tell us what your gut reaction was to those stories in that earlier podcast.

STEVE PHILPOT:                It really resonated with me a lot. I think we've all experienced burnout at times and through the communication training workshops that I do. People often ask me about tips for staying well in the work that we do. And this is, I think, probably my number one tip now that I give to people when they ask me that question.

MIC CAVAZZINI:               Yeah, so go ahead, tell us how it began.

STEVE PHILPOT:                So I remember looking after a patient who had had very complex neurosurgery, posterior fossa tumor surgery. And it was high risk, everyone was aware that this was a high risk procedure. And unfortunately, it was complicated. The patient had bleeding intraoperatively and ended up having an unsurvivable outcome from the surgery. And the patient came to us in intensive care post op, really for end-of-life care. The family were well-supported by our team in ICU, the patient had, I think, the best possible death we could have provided in those circumstances.

About a week later, I got a phone call from the neurosurgeon out of the blue—I was on a ward round at the time. And the neurosurgeon essentially said, “I'm just calling to say thanks for helping to look after that patient last week.” And that was it. It was just to say thank you. And I turned to my registers. And I said, “I just had the weirdest phone call from one of the surgeons.” And we talked about it. And I remember then reflecting on it thinking, well, it was actually a really nice phone call, obviously. Often we are called on to help with patient management, and why don't more people phone us to say thanks?

MIC CAVAZZINI:               Is there some aspect to it where people don't want to admit the intensity of it? That it's just a job and everyone's just doing their job and no one's—no one's struggling any harder than they need to do? Does that make sense?

STEVE PHILPOT:                I mean, I think it is our job to help patients who need to come to intensive care, so I don't expect people to bow down in front of us and thank us profusely every time we do our job. But I think the reflection for me was just how nice it was to receive that out-of-the blue phone call.

It prompted me to then think about my own practice and I recognized pretty quickly that I never phoned people to thank them either when they help us out. And that's not uncommon in ICU, we're often asking surgeons to come and see patients in the middle of the night or you know, we get helped by lots of people throughout the hospital.

So I reflected on that and I thought, well, maybe I should do the same, maybe I should pay this favour forward. And a few days later we had a patient who came in with an obstructed pyelonephritis and acute renal failure. From memory, their creatinine was in the several hundreds and they were very unwell. And we called an interventional radiologist in the middle of the night, it was about two o'clock in the morning, they came in and did a percutaneous nephrostomy tube. And the next morning when I saw the patient they were making urine, their creatinine was trending down, and their sepsis was coming under control. And by the next day, they were discharged from ICU without needing dialysis, and essentially, fully recovered.

And so I thought I had I'll try this out, and I called the interventional radiologist a couple of days later. And I said, “You know, I just wanted to thank you for coming in in the middle of the night. Because you did that, that patient didn't need dialysis, they've done really well. And they've gone out to the ward.” And I could almost hear the radiologist having the same reaction that I'd had when the neurosurgeon called me. Like, what is this phone call all about?

And then I hung up the phone, and I realized how good it had made me feel. And so it's become I've made it part of my practice. Now whenever I do a run of clinical shifts—we usually do three or four shifts in a row—at the end of a run of a clinical shifts, I will call at least one person that's helped me in some way, and thank them. And it's been fantastic for my own sense of wellbeing in the work, it gives me such a buzz when I make that phone call. And I do hope that ultimately we might improve the culture in our hospital.

MIC CAVAZZINI:               Is the camaraderie within your team already quite strong?

STEVE PHILPOT:                I would say it is I think the hospital system that I work in generally is free of conflict. And one thing I have noticed though, is when I call specialists outside of ICU, they have a they have a bit of a Pavlovian response to seeing my name come up on their phone. I called one of the general surgeons and, you know, they literally answered the phone with, “Oh, what's happening?” And it's because I'm usually calling them because I need their help in an emergency, or actually, quite commonly, because I want to initiate a conversation with them about limiting treatment or withdrawing treatment from one of their patients. And so it got to the point where every time I was calling them, it was for a bad reason. Whereas now when my name flashes up on their phone it doesn't necessarily mean that I want to have a conversation that they're dreading. And I think that's been really useful as well.

MIC CAVAZZINI:               Yeah, I mean, does it happen quite often that if you call in the interventional radiologist, the cardiologists or whatever, and then they do their bit, and then they leave, they might never hear about that patient again?

STEVE PHILPOT:                Absolutely. And we’re the same. We discharge patients from ICU, I don't know where they are six months later. But if someone called me and said, “Hey, you remember that guy who looked after I just saw them in clinic, they look fantastic,” You know, that would be such a great phone call to receive and I think it just builds a culture of camaraderie, as you say, and teamwork.

MIC CAVAZZINI:               And again, it might be just part of the job that you do your bit, you’re there with the patient for an hour, and then they're not your responsibility anymore. But if you constantly sort of dehumanize it all—it’s all just process work—do you miss some of the reward of the job when you don't hear what happened to that patient or how colleagues are doing?

STEVE PHILPOT:                Yeah, I think that's right. I think our work can become very transactional and very service provision-oriented and that is dehumanizing. I think also, we don't tend to give each other feedback in the work sense, particularly when things have just been routine. You know, when you attend a met call on the ward, and it just runs as all met calls do, there's never any feedback that results from that. And so, another example of this feedback is particularly after a code blue or cardiac arrest, I’ll often go back up to the ward a couple of hours later and just say, “You guys did a great job and the teamwork was terrific. This is what's happened to the patient,” and just close loop and give a bit of positive reinforcement for people who are just doing their job, and yet, it's an extraordinary job that we do. Some of the things we do are much more than just a job really, when you think about it.

MIC CAVAZZINI:               Well thanks, Steve, for reaching out. Appreciate the email. It's nice to a positive message at this time when every day there are quite bleak headlines about the pressure that the system is under.

STEVE PHILPOT:                I guess the thing I hope people think about is that this is just a really simple thing that you can very easily implement into your workplace. Partly for team building and relationship building, but also for your own personal wellbeing. It really has made me feel much more connected at work and I think it's going to protect me from burning out again with any luck.

MIC CAVAZZINI:               You can email us, like Steve Philpot did, via the address podcast@racp.edu.au. It’s always great to receive feedback and ideas on making the show better. Original content will be a little slower over the next few months as I take some time out to look after a screamy infant. But you’ll still hear outstanding seminars and podcasts from RACP physicians and other medical minds.

Continuing on the theme of workplace culture and personal mindset, I want to go back to a session from last year’s RACP Congress. It was co-hosted by paediatric emergency physician Sarah Dalton, who we briefly heard from in the last episode. Sarah Dalton has had a career-long interest in clinical leadership, with a Fulbright Scholarship and a term as president of the RACP Paediatric and Child Health Division. She’s currently Director of Clinical Engagement at eHealth NSW and shares her insights with other health practitioners needing career advice.

At Congress she joined GP Ashe Coxon for a demonstration of professional coaching. Contrary to what many people imagine, it isn’t about remediation for underperformance, it’s about helping people bring their best to the workplace in a way that’s sustainable over the long term.

ASHE COXON:   So my name’s Doctor Ashe Coxon. I’m a general practitioner, a career development practitioner, and I work as a deputy director of clinical training at the Townsville hospital as well. I am the founder and director of Medical Career Planning, and I've been doing that for about five or six years now. And I'm also one of the administrators of creative careers in medicine, which is a large, very supportive network for doctors who are considering non-traditional or creative ways of going about their medical career.

Probably the main thing that I do—and I've worked with over 600 doctors over the last few years—is talking to lots of doctors who aren't sure if medicine is the right thing for them anymore, or aren't sure if they're heading down the right direction in medicine. Or a lot of the time they want to leave medicine and they want to talk about the best methods of going about that. So what I tend to spend a lot of time doing is talking about the reasons behind that decision and unpacking why they might not be particularly enjoying their career at that time.

But how did I get here? I guess I got here based on my own journey. And I was a very enthusiastic, inspired excited medical student all those years ago, knowing that medicine was just going to be everything I've ever dreamed it would be and I was just going to be so happy. And I was going to help people, because that's why I got into medicine. But I got also got into medicine, to have a pretty fulfilling professional career.

So junior doctor years came around and I sure was helping lots and lots of people non-stop, much to my detriment at times. And I felt like all I was doing was helping people. And I often wondered if I was actually enjoying my job and where that enjoyment in my own professional career was. And I realized that I wasn't. And I thought, “well, the solution is obvious. I'm in a hospital. So obviously hospital medicine is not for me. I should be a GP.”

So I did my general practice training. And you know what, I really enjoyed my general practice training, and I really love being a GP. But as I was going through the process of training as a GP, I thought, “Oh, here I am spending so much time training to be a doctor so much energy, so much money, so much study time, and I don't really like my job.” And at that stage, it was very difficult for me to open up to anyone and say, “Do you know what? I don't really like my job.”

But I decided to start saying to people, “I don't really know if I like medicine as much as I thought I would. I thought this would be everything. And I certainly enjoy many parts of it. But it's not everything for me. What do I do? Do I have to leave? Do I have to go back and find another career?” And what I found was that the more I spoke about it, the more doctors said to me, “Actually secretly, I don't know if I love it either.” And I went through this process of thinking, well, if there's many of us that don't know if we love medicine, or many of us that aren't particularly happy in our career, why isn't there anyone out there to speak to about this? And so I did a lot of investigating about who there was and I found the London Deanery that did career coaching and career counselling for doctors had been doing it for many years and had a very successful program. So I thought that's what I'm going to do.

There’s a difference between a job and a career, right? You've got your job, which you go to day in, day out. And then you've got your career, which is a long-term thing that you're working on. And if you're not careful, you can kind of muddle the two in together. If you start not enjoying your job, sometimes you start to think, “Well, maybe I don't enjoy my career. So therefore maybe I should leave, instead of actually compartmentalizing what your issue actually is, and then working on that.

So the five simple questions I love to ask, “What do I like about my job? What don't I like about my job? What do I like about medicine? What don't I like about medicine? And what can I do about it?” You might realize that actually, “I don't like running late. I don't like that particular nurse unit manager I'm working with. And I really don't like managing conflict.” Once you've established those key things, what you do and you don't like, you can then go move into your day knowing, “I've identified I don't like conflict, I know I'm going to have a difficult conversation coming up with the patient and their family. I'm going to go into that knowing that this probably isn't going to be the most amazing 15 minutes of my life. But at the end, it's over. I move on to move on with my day. That doesn't mean that I don't enjoy my career.”

Because there's many things in medicine we don't like. And I think it's really important to then say, “What can I do about it? Is this big enough for me to actually move hospitals or move units or move careers or give up medicine? Or is it something that's modifiable?” You know, “I'm really struggling with exams” Well that's going to get better. “I don't like this nurse unit manager.” Well I'm going to move on to another rotation.  How long am I happy to put up with it? Or is there something I can do to change my own situation? If it's non modifiable, and I can't change anything about the situation, “Am I willing to stay here? Or do I need to go and pursue a different direction?”

Interestingly, when I got into career development work, I really thought I was just going to be talking to interns and junior doctors about them not enjoying medicine. But in actual fact, the majority of the people I work with are senior registrars and new Fellows. Because as you probably all know, it's a transition period, which can be really difficult. So transitioning from a senior registrar to a new consultant, there are so many things that are changing at that time in people's life. So when you're coming up to a period in your life where you are going to go through a big transition at work, perhaps be prepared that it might start bringing up some questions in you. And then you can go back to my little exercise and say, “Well, what do I like about work?” and focus on that.

So Sarah, and I briefly going to go through a bit of a coaching conversation and show you guys how it might work. I'm the coach, Sarah’s the coachee. Sarah is a 47 year old paediatrician who's booked an appointment, wanting to leave medicine and knowing what non-medical career options to pursue. She works in a public hospital. And this is what she's written to me when she's booked the appointment. She's got a good reputation in the community. She used to love her career, but now she's feeling overwhelmed and no longer enjoying it, and she wants to discuss alternative options about moving out of medicine.

ASHE COXON (mentor role play): Hi, Sarah, how you going?

SARAH DALTON (mentee role play): Hi, Ash, I'm okay.

ASHE COXON:   Thanks for booking in today. So I know that you haven't been enjoying work and that you are thinking about leaving medicine or what other options might be out there for you. Are you able to tell me a bit more about that about why perhaps you're not particularly enjoying work at the moment?

SARAH DALTON: Oh my gosh, it's just I just really don't know what to do because I love seeing patients and I really enjoy being able to help them and understand them and being a paediatrician and watching them grow up and their brothers and sisters come along. I love being able to give the care to the whole family but it's just it's just too stressful. My clinics are absolutely back to back but I can't give them the care that they want. There's always someone asking me to do another quick referral and can I just quickly pop someone in this clinic, and so I do end up working into my breaks and running late for other things and I’ve just ended up taking work home. I’m not up for it, you know? I did this partly cos I really care about being to be a holistic person and to care for people and I just can't give that care to my patients.  I just feel like I’ve done my bit and I think I've had enough.

ASHE COXON: Okay, I'm really sorry to hear you're feeling this way, Sarah, because obviously you have a huge passion for your work in paediatrics. I know you wanted to find out just more information about leaving medicine but I'm just going to focus on what's currently going on in your work situation if that's okay. What was work like five years ago when were you as busy as you are now and we you enjoying it any differently?

SARAH DALTON: Yeah actually makes me feel happy to think about it. When I first moved to this hospital and I was getting to know the staff I really enjoyed it and I enjoyed living in this new place. My personal life was really good. It just great because I was getting to know the local families, I had time to spend with them, and I started to learn who went to school with each other and what their connections were. So yeah, five years ago was great and I really did think I'd done the right thing.

ASHE COXON: Oh, that's lovely to hear. So obviously, you're talking about how much you really like working with your patients, you like the type of medicine that a paediatrician sees, and you really like helping families. What you are not liking is being busy, being stressed and being overworked. Is that correct?

SARAH DALTON: Yeah you're right, that's the hardest part. And I just feel like that's just the system, you know? Like, what can we do about the system?

ASHE COXON: What do you think is different from when you started five years ago, to now. What's changed?

SARAH DALTON: I’m just so busy, I have so many referrals. You know, I'm so glad people want to see me, but I just can't give them the care that I used to be able to.

ASHE COXON: So we know that referrals to you in outpatient clinics ultimately means having more inpatients if patients are under your direct care. So with this large burden of referrals just to you, are other doctors seeing the same volume of patients?

SARAH DALTON: No, no , that's not how it works, because you get a named referral. And so you see them, and I have been able to extend my clinic time a little bit, because everyone could see that I was getting really busy. But we just have a system where you get the call about the patient if they’ve been in clinic. So I do get more calls than other people. And I just don’t know that that’s fair.

ASHE COXON: From an outsider looking in, I can see that you're really overworked and you're at the point where you're actually thinking of leaving a career that you absolutely love. So can you think of anything, that if you changed, it might make your work more enjoyable?

SARAH DALTON: What I really want to be able to do is have time with my patients. And I don't have time. I have so many referrals, and that just means that I can't give them quality care.

ASHE COXON: Well is the solution needing more time, or perhaps seeing less people?

SARAH DALTON: I have to say if the referral stopped coming, it would help a lot because it would mean I could just focus on the patients I have.

ASHE COXON: So what can you do about that? I know that you love seeing new patients. But if you're getting to the stage of burnout and wanting to leave work, then ultimately you're not going to see any patients. If you're going to try and give everything to the patients you currently have, what can you as an individual do at your hospital to stop the amount of referrals coming in specifically to you?

SARAH DALTON: The referral process is one where patients are referred to me with my name on it and the appointment is then made for me. But you know, there is actually another new paediatrician in town. And as we’re talking I'm just wondering, maybe there's a way of sharing some of the workload. I'd have to talk to the hospital about the whole process and the billing and that sort of thing.

ASHE COXON: That sounds like a really good solution, Sarah. I mean, I know it might be hard to do. But I think you should go away and think about talking to your director about actually implementing this. And maybe we'll have a follow up appointment in a month or two when you've made some changes. And then if you're still really unhappy in the job, we can talk about what else there is to do in medicine. How does that sound?

SARAH DALTON: Okay, no, I haven't thought about talking to my director about changing referrals. But honestly, if I think about the fact that this new doctor could probably take some of my patients, and then I didn't have to worry about the tsunami of patients that feels like it's overwhelming me every day, then that would actually make me quite happy.

ASHE COXON: So that's just an example. That was actually a true-life case that I had with someone and you know, we spoke with referrals you went away discuss with her director and they were distributed evenly, discussed time and boundary settings and focused on positive aspects of work. I spoke to her a year later, and she's still in the same job absolutely loving it.

SARAH DALTON: Thank you. Coaching is about asking people what they've learned and what they want to commit to. My invitation for you is to think about what’s been in your mind as you've been listening to us talk today. What sort of things have you taken away that maybe weren't thought about or prioritised beforehand. And what are you going to do about it? Because if not you then who?

But if you're interested in knowing more about coaching, my suggestion is look for people who have established links to the healthcare industry and understand healthcare. And look for people who are offering the kind of coaching that you're after. So today we've mostly talked about professional coaching and career coaching. There are lots of different qualifications for coaching and there's not really a gold standard. But there's things like the International Coaching Federation, it's a very well recognized and a global institution where if people are accredited it really does mean they’ve met a standard.

So honestly, I have mentors and some great mentors. In particular I have mentor that I've known for 10-15 years and I often go to my mentor. But it's sometimes good to get a different perspective and I think coaching helps you think more broadly, and more divergently about what your options are. One thing for me to say is that the London Deanery model deliberately matched doctors from one particular specialty with a very different specialty. So they would match GPs with orthopaedic surgeons. Because we do get into groupthink, and if you have a mentor who's very similar to you it's pretty likely that they will say something that you've already thought of. Whereas a coach might help you think outside the square and think about something differently in a different way. What do you think, Ash?

ASHE COXON: I absolutely agree. If you've got a lovely mentoring relationship, then that's gold so keep the mentoring relationship. Where you might go and get some extra work with the coach—there's a few situations; It's independent, impartial coaching. That's the that's one of the beauties of it that you're speaking to someone who doesn't know you, who's not in your circles, who doesn't have anything to do with your references. You can say whatever you like about someone, it's confidential, and it's independent, impartial. And so many times I've had appointments where people just need one appointment, and they're like, “Oh, wow, I didn't realize I actually just needed to get a lot of this stuff off my chest. I didn't realize it's actually normal to have blips in your career. It's actually normal to not love your job every minute of the day, I'm fine now.” So that's probably the benefit of a coach.

When you're working with a mentor—sometimes mentoring relationships, if you're not careful, can almost feel like you're trying to impress a parent. So it's got to be mutual mentoring, you’ve got to feel comfortable and really safe with what you say to your mentor. If you're in a mentoring relationship, and you're just trying to impress them to get onto the training program, or to for them to help you in your career development that's great. But that is very different to what a coaching conversation or coaching environment would be. So I guess one of the main things I wanted to say to the audience today is, if you're really not feeling fantastically fulfilled in your career, please know that the answer isn't what I thought it was ten years ago, and that was “Obviously I should leave medicine.” There are actually many ways about going about finding a really exciting, interesting fulfilling career within medicine and coaching and counselling is what really helps that process.

MIC CAVAZZINI:               Another eye-opening presentation from Congress 2021 was given by Associate Professor Peter Connaughton. He is Past-President of the Australasian Faculty of Occupational and Environmental Medicine and on the board of the International Occupational Medicine Collaborative. He consults primarily to the mining industry in Western Australia and carries out academic work through Curtin University and at the University of Notre Dame, Fremantle. As well as this well-honed professional perspective, Peter Connaughton shared an episode experienced early in his career that crystallised the importance of safe and supportive workplaces.

PETER CONNAUGHTON: I was about halfway through my training, and I had a health condition at that time. And I recall struggling with trying to describe the symptoms of it, I remember thinking, “I really must go and see someone about this, but I'm not sure what I tell them, because I'm not sure how to describe the symptoms.” And I remember thinking really strongly that I would need to be able to put a sentence into words that a doctor would understand and recognize and diagnose. And I spent quite a number of months trying to put the feeling into words and I could visualize the emergency department up the road, which was only a couple of kilometres away, and thinking, “when I go there, and they say what's wrong with you? I'm going to say I don't know. But I'm not quite right.”

It was never accurately diagnosed by a doctor, and it was never accurately diagnosed by a psychologist. And the reason for that was I never went to a doctor, and I never went to a psychologist. It wasn't until about six months later that I realized that major sleep disturbance and diurnal variation and lack of interest in studies and change of appetite and loss of weight and not going to lectures—it was only when I came out of that, that I realized it was an episode of reactive depression from a concussion I’d had. And it was years later that I reflected on what impact could that have had on patients that I was seeing. I didn't think about that at the time at all.

And I think it's really a helpful conversation with doctors and healthcare providers to perhaps reframe some of the discussion in terms of cognitive function. Are you functioning sufficiently well, to do your job safely and effectively because it impacts patient safety. And by reframing it that way, for a lot of healthcare providers, it changes the way they think about their health and wellbeing.

[The International Occ Med Society Collaborative did a survey an international survey in 2019. And we had 30 countries respond. Different countries use different terminology but in Australia about 32% of doctors were estimated to have high levels of emotional exhaustion; Canada about 30% of physicians suffering burnout; Ireland about 30%. United Kingdom 22%; US 54% at least one symptom of burnout. These are significant numbers, this is not just an Australian challenge.]

There may be a presumption that doctors and nurses know when they're sick, and that they know what to do, and that they know where to go and that they’ll do it. And that presumption isn't always correct. Doctors often don't know when they're unwell, and they often know what they should do, but they don't. And a couple of years ago, I was coming back from a college meeting and Sydney and one of the pilots came out and we got talking. Hhe asked me what I did, and I was passionately sort of talking about the health of healthcare providers. And he said, “Well, you know, in the aviation industry that's just taken for granted. The health of pilots is central to safety and flying.” But the QANTAS pilot said to me, “the difference stock with us and you is that if we make a mistake, we go in first and you don't.” But the thinking needs to be similar, and the investments in safety and health and wellbeing for pilots, I think is a lesson that would be well translated to healthcare professionals.

The other issue is, is it's ethically responsible. We have a responsibility to the wellbeing of junior doctors. We have a responsibility in terms of people's employment and the place they work and the environment that they work in. And there are legal obligations of employers to provide healthy and safe workplaces. Obviously, it's going to improve patient and worker experiences if they're working with happy, healthy healthcare providers. Do you really want your appendix taken out by someone who's really tired, or really angry or really hungry? And doctors talk. So money spent on healthcare provider wellbeing is going to assist in keeping and attracting the best workers. Doctors are not going to recommend to junior doctors or their friends to go and work in an environment which they feel is unsafe.

[So there's a great paper from the UK, and this paper was commissioned by the GMC, and the quote from that is “Medicines a tough job, but we make it far harder than it should be, by neglecting the simple basics in caring for doctors wellbeing. The wellbeing of doctors is vital, because there's abundant evidence that workplace stress in healthcare organizations affects the quality of care for patients, as well as doctors themselves.”]

So what are the effects of burnout? Reduced work performance and efficiency; loss of interest; loss of job satisfaction; negative attitudes to patients; cynicism; decreased empathy; increased alcohol and drug use relationship; difficulties at home and increased absenteeism. This is a safety problem. Some of the research findings: Doctors with high stress are four times more likely to provide substandard health care. Doctors with high levels of burnout, the figure is between 45 and 63% higher odds of a major medical error in the following three months.

So this is recognized globally, now. The World Health Organization on the 17th of September has their world Patient Safety Day. And you'll see that goal number two is work reducing work-related stress and burnout. And goal four is reducing or promoting zero tolerance of violence against healthcare workers and they refer to the Universal Declaration of Human Rights.

And my personal opinion is that there has been an overemphasis on resilience. I'm not discounting that resilience is important—I think it is. But doctors are resilient. They've got high results in their school exams; they've got through four or six years of university education; they've got through an internship; they've competed. I think they are resilient. And I think to overemphasize resilience is misguided and incomplete. And when you look at it through the lens that occupational physicians look at workplaces, it would be like telling someone who works in a dusty environment to go swimming because it's good for your lungs. It's just missing the mark.

I want to talk about something else also is—obviously mental health is a journey. I may be perfectly fine this year the year after that, I might not be well for three months. I might be terrible for six months. We can't view individuals as static and so the systems need to allow for individual variation. The systems need to allow that I might be having a really bad week. There's an assumption when I talk to employers—primarily not in healthcare—they have a conceptualization that people with mental health problems can be identified, treated, fixed, and then either removed from the workplace or safely got back to work. But it's not that simple. A proportion of the population is going to be experiencing mental health challenge at any given time. There is no workplace with no one who's having no mental health problems. Every workplace of significant size will have someone who's struggling at that time. And some of those people will have sought treatment. And some of them will be fortunate enough to get effective treatment. But those who haven't recognized that they have a problem, or haven't sought treatment, or haven't received effective treatment are still out there working.

I'll briefly touch on outcomes of improving the work environment for doctors. And one of the studies is a meta-analysis of 65 International Studies, looking at the protective and detrimental factors of burnout amongst doctors. And anyone who's worked in a healthcare system would intuitively know some of these answers; workload; organizational structure; flexibility of work arrangements; professional values—do the values of the organization match within with the individuals values; the demands on the individual; organizational factors; how the teams function; and looking at their individual roles.

[And there is some world-leading research in Australia—Maureen Dollard in Adelaide—has designed this tool, which is an assessment of psychosocial hazards in the workplace. It goes into a workplace and does an evaluation. And her research showed that by looking at a range of workplace and organizational factors, she could predict a year or two in advance, which workplaces were more likely to have workers compensation claims for mental health. So it's an occupational health, risk-based approach of proactively looking at workplaces for documented and demonstrated risk factors for mental health. Maureen's work on this is recognized around the world, but unfortunately, not as implemented as much as we'd really like.]

I was involved in a study a few years ago, where we looked at about 1500 Fly-In Fly-Out resource workers and it was around the time that there was an enormous focus on FIFO suicide. And we looked at whether it was remote communities; Perth communities; Fly-In Fly-Out or residential; indigenous or non-Indigenous; relationships with supervisors. The strongest single predictor was the worker’s relationship with their supervisor. And that changed the way that we approached mental health in FIFO people. We changed the focus from resilience, to mental health training for supervisors. And I'm very proud and delighted with what the RACP has done in that area in terms of providing supervisory training, I think it's tremendous achievement and advance.

In occupational medicine we often think about the adverse effects of employment. It's really important to focus on the health benefits of good work. And it's good for their health, if it's safe, and it's rewarding, and people like going to good work. So would a really good workplace look like? And the College has done this—the College and the Australasian Faculty of Occupational Environmental Medicine—one of our most robust and most successful policies, is the Health Benefits of Good Work. It’s available on the RACP website. And simply, if you had to whittle it down to the three core needs, it talks about Autonomy and control, Belonging and Competence. And in Belonging, it talks about feeling valued, respected, and supported and that really gets to the culture of the organization. You can have as many policies and procedures as you like but what underlies all of this is the culture of the organization. And that's the responsibility of leadership and the responsibility also the workers within the organization.

And this policy on the health benefits of good work has been taken up by hundreds of organizations in Australia and New Zealand. And this is insurance companies and, and emergency services and a whole range of organizations including the Reject Shop, who say this is a policy endorsed by the College of Physicians and the Faculty, based on evidence, and it guides what they do. It has been taken up by very few healthcare providers.

And finally, it would be remiss not to mention compassion and kindness. In terms of providing care for patients, it's expected that we're compassionate and kind. And the UK document talks about the importance of having compassion and kindness for co-workers. And that applies to other areas in terms of bullying, harassment, sexual harassment, and other behaviours in workplaces, which are intolerable. I would encourage you if you only do one thing in the next couple of weeks, if you're with a colleague, and it's quiet, and you can sit down and talk to them, say “How are you going? How are you going? Are you okay?” It's very powerful. The power of peer support is incredibly important. [My colleague, Dr. Roger Lai, who was the Occupational Physician for Royal Perth Hospital and his colleagues there set up a fantastic peer support program and you can look at the feedback in terms of junior doctor reporting on that hospital and it's spreading to other hospitals.] But at the simplest level, I encourage us all to work towards a future where the health and safety of healthcare providers is just as important as the health and safety of our patients. Thank you.

MIC CAVAZZINI:               That was Peter Connaughton ending this episode of Pomegranate Health. I’ve edited down his presentation but you can some of the research on burnout that he referenced in the original linked at our website racp.edu.au/podcast. It’s embedded in the transcript for this episode. Thanks also to Sarah Dalton and Ashe Coxon, and Steve Philpot for their contributions. You’re always welcome to get in touch and to share the podcast with your colleagues. There’s also a comment section at the episode webpage where you can keep the conversation going.

For heaps more resources on physician mental health, go to racp.edu.au/fellows/wellbeing. Most importantly, please look after yourself and your colleagues. The Doctor’s Health Advisory Service is available 24/7 and so is the RACP’s partners for member assistance called Converge International. I’ve listed their phone numbers in the notes to this episode  at racp.edu.au/podcast.

Another way to feel you’re not alone is to join the RACP Online Community. It’s basically a social and professional networking tool developed just for you. You can log in right now from your mobile by searching for the app called “RACP- the ROC.” Android or iPhone. I’m Mic Cavazzini, and this podcast was produced on the land of Gadigal people of the Eora nation. I pay respect to those storytellers who came before me.




 

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12 Aug 2022
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