Australia has one of the best health services in the world, it is precious and we should be willing to fight for it.
Our healthcare staff are already experiencing intolerable levels of stress, working to maintain the standard of care that is expected, and that they would like to deliver. It is of paramount importance that their welfare is taken into consideration when making any changes in healthcare policy.
In healthcare planning the following questions need to be asked when making any changes
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Does this improve the standard of care to individual patients?
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Does this improve the health and wellbeing of the population?
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Does this take into consideration the health and wellbeing of all the staff working in our health services?
If the answer to any of these questions is NO then cuts in the healthcare budget will be a disaster for Australia. The health and wellbeing of our staff is of paramount importance.
Our health service will only ever be as good as the staff that run it.
Health care is more than bureaucracy, it is more than ticking boxes, it is more even than evidence based practice.
It is, as it says:-
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about caring,
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about compassion
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about treating people with respect, dignity, and loving tenderness and offering all this at the highest standard possible, whoever they are.
If this is what we ask of our staff, how can we possibly expect them to achieve it if they too are not treated with respect, dignity and compassion by the health service that employs them.
Stress and burnout among doctors
The figures published by Beyond Blue in 2013 confirm an unacceptable level of stress among doctors. Doctors reported substantially higher rates of psychological distress and attempted suicide compared to both the general population and other professionals in Australia. ( National Mental Health Survey of Doctors and Medical Students. Beyond Blue reported 2013)
It has been show that doctors suffering from mood disorders and burnout
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perform less effectively,
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are more likely to make errors of judgement and
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provide a lower the standard of patient care.
(Arnetz BB (2001) Psychosocial challenges facing physicians of today. Social Science and Medicine. 52 (2): 203-13.)
The reasons for stress and burnout are multifactorial, but working conditions which influence their ability to care for themselves, are the employers, the health services, responsibility. Creating a supportive compassionate working environment is of vital importance for all our health staff.
Even though there have been positive changes in my forty years working in Medicine, doctors are still expected to work long hours at high levels of stress. We are expected to be altruistic - the patient comes first - before ourselves, our relationships or our own health care. Does this make us caring and compassionate? Unlike psychologists, doctors have not been encouraged to have a mentoring system, despite working regularly in complex emotionally charged environments.
Many doctors do not look after their own physical or emotional health, many not being able to identify a doctor who is their own GP. Doctors take less sick days than the average person, this is not because they do not need to but rather because they work through it. Studies show that doctors find it very difficult to admit to or seek help for psychological issues, despite having higher rates of clinical depression and anxiety than the population in general.
Medicine is a stressful profession which one study looking at occupational health statistics equated to the level of stress in the armed forces. (Mental Health and Ill Health in Doctors. DoH UK 2008)
As an employer the health service needs to ensure this stress is not increased through budget changes. We cannot ensure compassion in caring by making uncompassionate decisions based on the needs of bureaucracy.
Conclusion
A healthy doctor is a more effective and efficient care giver, a role model for patients and an advocate for health.
The health department is about health, if we fail to look after the health of our staff we have failed right from the start.
If doctors are ever to effectively care for other people, they must first give their own health care priority. If they are ever to teach others to take responsibility for their health, as we must surely do if we are to practice true patient-centered care at the core of which is fostering responsibility for our own health, then we as doctors need to role model this.
Recommendations
We can learn compassion and caring of others by being caring and compassionate towards ourselves. To foster an environment of healthy doctor /healthy patient we should promote self-care in healthcare, encouraging doctors to care for their own health, physical, psychological and spiritual. Establishing and validating courses in health and well being for medical students and doctors at all levels is imperative if we are to make changes. These courses should aim to help the students and to recognise the signs in their body and emotions that indicate that all is not well and to offer them tools to address this. We should encourage dialogue between doctors themselves, and doctors with management to identify ways of better supporting doctors and reducing stress.
How do we fund this?
We have created a monster for ourselves in medicine. By giving funding priority to end stage disease at the expense of funding and supporting effective preventative disease we have overburdened the health service, providing expensive high level care for patients suffering from diseases that may have been prevented by simple life style changes. The escalating costs of modern treatments mean that any health care cuts often involve staffing levels, making it impossible for remaining staff to meet patient needs, and causing them to suffer the consequences of work related stress and burnout.
By diverting only a small proportion of the funding used in sometimes inappropriate end stage care- I have heard it quoted that 30% of hospital budgets go on the last 30 days of life-by looking more critically at the wisest ways to allocate healthcare funding, appropriate support and training could be given to doctors. The outcome could be that not only doctors health and wellbeing improve and that doctor job satisfaction improves but that a higher level of patient care is attained.
