Caring for yourself

We spend so much time thinking about the health of our patients that we often forget to look after our own. Doctors fail to prioritise their own healthcare and feel pressured not to miss shifts because of illness. The literature suggests that junior doctors are unwilling to admit that they are unwell or accept that they are not coping with the apparent demands of their career. This can lead to a failure to recognise, acknowledge and act on the early warning signs of illness.

Junior doctors’ mental health suffers

The mental health of junior doctors is deservedly receiving increasing attention. The beyondblue National Mental Health Survey of Doctors and Medical Students released in October 2013 highlighted that doctors report 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 [1]. However, the stresses of working in medicine are not isolated to internship or Australia as these disturbing articles illustrate. Both are personal stories: one of an English junior doctor who contemplated suicide and the other of a senior registrar describing the reasons why she is leaving medicine.

Both articles are highlighted in the Healthcare Network of the Guardian.

• I’m sorry, I can’t face being a doctor any more
• By the end of my first year as a doctor, I was ready to kill myself

More significantly, these stories demonstrate the impact that hospitals, supervisors and the rest of the ‘system’ can have on the psychological wellbeing and mental health of doctors. It also raises questions about how to allocate scarce resources aimed at improving the mental health of junior doctors. Should we focus on strategies at the individual level to support trainees, such as resilience or mindfulness workshops? Or should we concentrate our efforts on changing the organisational culture of hospitals that lie at the heart of much of the psychological distress felt by junior doctors? The latter is more difficult, the impact may not be felt for a generation, but it is perhaps the most sustainable solution.

Simple strategies to stay healthy

Despite the necessity for organisational change, I will focus on some of the simple strategies to keep yourself healthy that you can start today.

 1. Maintain (or try to) a work-life balance

Keep up your usual hobbies and in touch with friends, remembering to include friends who aren’t doctors. All of us benefit from de-briefing with colleagues but it is important to talk about topics other than medicine.

Exercise is important and you need to allocate time for it. It won’t just happen. Simple strategies for those that feel they spend most of their time at the hospital include walking or riding to work (or at least part of the way) or joining the hospital gym. Continue with whatever sport/activity you were playing during medical school. It can be difficult to commit to weekend team sports but with some swaps you should be available most weekends.

2. Diet

Don’t forget to eat and drink. When working on a busy weekend shift you may be more dehydrated than many patients for whom you are charting intravenous fluids. Try and sit down for lunch – this is also a great time to catch up with your colleagues. Go outside when the weather permits, as vitamin D deficiency is an underreported complication of internship!

Healthy choices are often difficult to find within hospitals although they are starting to acknowledge the need to provide nutritious food for their staff. When possible try to prepare your own food. Not only is it likely to be better for you but also for your bank balance.

3. Have your own General Practitioner (GP)

Part of looking after yourself is ensuring that you have your own GP. There is a tendency to self-diagnose or ask your colleagues about potential health issues but these are both poor substitutes for your own GP. Even more troubling is self-prescribing. Although legislation differs in each state or territory, as a general rule avoid self-prescribing or asking one of your colleagues to write a script for you. You should also avoid providing medical care to anyone with whom you have a close personal relationship because of the lack of objectivity, possible discontinuity of care, and risks to the doctor and patient.

Doctors’ health is explored in more detail in ‘Good medical practice: a code of conduct for doctors in Australia’, a document well worth reading.

A further resource available to doctors and medical students in NSW is the Doctors Health Advisory Service and there are similar services in other states. The service operates a telephone helpline to provide personal advice to practitioners and students facing difficulties. The service advice is used mostly in relation to stress and mental illness, drug and alcohol problems, or personal and financial difficulties.

What to do if internship is wearing you down

Internship is hard and stressful. All of us have bad days. Not knowing everything is expected. Wanting to flush your pager down the toilet is understandable. Tears are common. But if these feeling are pervasive and you feel that you are struggling, here are some initial steps.

• Speak to your JMO Manager, Director of Prevocational Education and Training (DPET), or Director of Clinical Training (DCT) – e.g. if you are having difficulties especially outside of work, a reliever may be arranged.

• Speak to your registrar or consultant in your team – e.g. can the rotation or roster be changed, improved supervision.

• Access your local services – e.g. all NSW Health agencies provide an Employee Assistance Program.

• Speak to your GP. They may suggest a referral to a psychologist or psychiatrist.

• Remember that you are not alone and medicine is a team sport. It is important to look out for each other. If you have concerns about one of your colleagues, speaking to your DPET or DCT is a good first step.

I have included a link to a valuable website that promotes the health and wellbeing of junior doctors – jmohealth.org.au

If at any time you are worried about your mental health you may also call Lifeline on 13 11 14.