Published June 2016

References
  1. Nash L, Daly M, et al. Psychological morbidity in Australian doctors who have not experienced a medico-legal matter: cross- sectional survey. Aust NZ J Psychiatry 41(11): 917-25 View Link
Coping with isolation

Many doctors work in isolated settings. Doctors can be isolated geographically. They can even feel personally and professionally isolated in their work environment where they do not have easy access to collegiate or peer support.

The following case study is from the Heads Up website. Headsup was developed by the Mentally Healthy Workplace Alliance and beyondblue. The organisation has resources and tools for promoting the mental health of doctors and medical students.

A case in point

Diana’s story

View transcript

Well, in 1977 I arrived in Australia with my family and my then husband to a regional centre, and I was the only anaesthetist there, and I had young family. So, that was a lot of work, a lot of call, a lot of work. Well, I think there were several reasons why I became depressed. I think there was just a lot on my plate, and then I suffered a few losses. I think a lot of it is nature and certainly there’s a lot of depression in my family, and in fact my mother killed herself. And I think I was under a lot of strain. So, I think all those factors combined to make me become depressed.

Doctors are pretty clever at hiding things. I thought that I had hidden it, not for any conscious reason, but just because I was going on working and I didn’t want it to interfere with my work, and I could be in my distracted moments quite my normal self and cheerful. The supports were not… People at work, there were no mechanisms in place to support people at that time and this was 25 years ago. I don’t think any of them would’ve either known what to say or how to intervene, ’cause it takes some courage to go up to someone, ask them, “How they’re going?” and perhaps offer some help and support.

I don’t think I was at all able to talk about it in those early days. However, by the time after my colleague and I founded the Welfare of Anaesthetist group, we decided that we would put this forward for new trainees. So, since then I have certainly mentioned it quite a few times particularity when… In my job now where I have distressed doctors and if I disclose that I have also been depressed, hopefully they’ll understand that I can have some sort of idea what they’re feeling. And I think the other thing is that there are now processes in place to deal with doctors who are distressed in the workplace, so there are support systems like the one I work in.

Well, I’m the deputy director of clinical training and our role is to look after the education of junior doctors, but we also get quite heavily involved in support which is maybe pastoral care, might be identifying mental health issues, it’s performance management, so we do all that as well. It’s important to know what resources are available.

I have a very supportive partner. I have a lovely family, I live in a good place, I live in a great place, and I have lots of hobbies, have lots of friends. So, I do very many things that I enjoy, which is great because of course when I was depressed I didn’t enjoy anything.

What advice would I give to someone who’s in a similar situation? Well, I think the first thing to do is to recognise it, even to think that it might happen to you, to know that being a doctor is stressful, and that there are ways of handling that, but if you are not… That you’re not surviving in a good way, then you need to recognise that and seek help. The other advice I would give is that if you… If someone comes after you and says, “How you going?” that you need to understand that that person might be concerned about you, and to listen to what that person says.

Source: This video, transcript and information were sourced from the Heads Up website, developed by beyondblue in collaboration with the Mentally Healthy Workplace Alliance, using funding provided by the Commonwealth Department of Health. For more information and resources please visit www.headsup.org.au.

Areas of vulnerability

Isolation can give rise to physical and mental stress.

Doctors feeling overloaded and alone can fail to recognise symptoms and signs of impairment in themselves.

Medical workplaces present particular risks for doctors which can include access to drug samples, ability to self-investigate and treat yourself, limited social and professional interaction with medical colleagues and ability to access informal “on the run” advice from those colleagues. Impaired doctors can place the health of their patients and their own careers at risk. Risk-taking can be a presenting symptom of depression1.

Healthy doctors practise better medicine and promote their positive lifestyle habits to their patients.

Doctors need to be proactive in managing their health and wellbeing.

Tips

  • Look for opportunities to meet to discuss practice and professional issues in the group practice or departmental setting. Working as a team (even if that team is dispersed geographically) can have personal and professional benefits and can assist with:
    • Rostering and call arrangements
    • Arranging leave and locums
    • Receiving advice and support from colleagues
  • Schedule regular personal time, holidays and leave for continuing professional development (CPD)
  • Plan ahead by connecting with a locum service to arrange cover for when you will be away from the practice and have strategies in place for alternative care arrangements for patients receiving treatment
  • Structure and complete your CPD by participating in interactive sessions wherever possible (even if via teleconference or over the internet) rather than through self-directed activities
  • Regularly attend regional, College and special interest group meetings that foster peer support
  • Connect with support programs for isolated practitioners
  • In group practices or hospitals, be part of regular meetings with your medical colleagues to discuss your practices
  • Respect your private time and have a strategy for triaging calls on your time – don’t be available 24 hours a day, 7 days a week
  • Unless very urgent and there is no other option available, don’t give advice or treatment outside the professional setting. Set personal and professional limits by insisting on formal consultations
  • Find a GP to manage your health and the health of your family
  • Avoid giving professional advice or treatment to close friends and your immediate colleagues where there is someone else you can refer them to
  • Explore the technology available to enable video consultations and regular catch ups with other doctors
  • Recognise your need for help and moral support
  • Be conscious that isolation places you at greater risk of burnout.

Resources

Your Medical College can provide assistance and resources. The Australian and New Zealand College of Anaesthetists has an excellent publication for the isolated anaesthetist View Resources

MIGA has the following additional resources:

Risk management strategies

MIGA has invested in doctors’ health as a risk-mitigation strategy and supports the health of its doctor members with: