Health Professional Wellbeing

Many studies have documented stress and higher than expected rates of psychiatric morbidity in doctors and medical students. Doctors are particularly subject to substance misuse, and one study found suicide rates in male doctors to be about double those expected. The impact of this morbidity on doctors and those around them is profound and serious.

A 1998 national survey of doctors found that work was the major stressor in their lives. 12.8% of doctors had scores indicative of severe psychiatric disturbance. Fifty per cent of respondents had considered leaving their current workplace and 53% had considered abandoning general practice because of occupational stress. Doctors working 6 or more sessions per week were more likely to be moderately or severely stressed than those working part-time. Those who had considered leaving their current workplace or careers were also more likely to be moderately or severely stressed.

Applying psychoanalytic theory, Johnson has looked at doctors’ personalities and suggested that a subset of doctors at least is especially vulnerable to a poor sense of self and low self-esteem This may result from “childhood experiences of parental impotence and emotional neglect”. Attempts at reparation by the individual may lead to “dependence on patients, emotional detachment and denial of personal vulnerability”. This proneness to dependency also commonly affects impaired doctors. If dependent traits dominate, then a doctor will be too prone to appease patients, including unreasonably demanding patients, and unable to priorities demands, particularly those of family, and the need for recreation. This type of doctor may enter a cycle of increasingly using patients as the primary source of self-affirmation and avoiding deteriorating relationships at home. A doctor in this situation becomes at risk of boundary violation.

Assoc Prof Riley, Head of School of Psychiatry and Clinical Neuroscience, UWA states:

“What should we be doing as a profession? Prevention should be the first priority. The issues of health and wellbeing of doctors -self-care, stress management and so on - should be part of undergraduate curricula and kept on the agenda in continuing professional development programs. Australian medical schools have incorporated these topics, and most branches of the established profession appear to have taken up the cause also……we must be better prepared as individuals and as organisations to respond to the early signs of distress. The major barrier here is not knowing what to do. The old adage “I only diagnose what I know I can do something about” is apposite. Collusive avoidance is common and usually based in a lack of knowledge and confidence about how to respond. Accordingly, relevant professional organisations need to devise and become familiar with pathways for responding.”

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