Recent research from Beyondblue suggests doctors and medical students are at great risk of experiencing mental health conditions, such as anxiety and depression. In this article, Dr Graham Emblen, GPTQ’s Senior Associate Director of Medical Education, offers tips to help your mental wellbeing.
1. It’s OK to seek help
Registrars often don’t seek help because they fear being stigmatised. Graham has encountered this many times in his career, but feels there’s a fallacy in this line of thinking.
“This is a fear that all doctors carry, so you’re no different if you feel this way. The reality is that you have to overcome it and seek help to get better,” he says. “Medical boards and the wider medical fraternity are not interested in doctors who are appropriately seeking help. They’re more concerned about doctors who refuse to because they’re the ones that are more likely to put the public at risk.”
A good first step is to seek out a GP with the right skills to help you.
“The health professionals that see doctors with anxiety have a very high level of compassion as many of them have been through it themselves. They know seeking help is not easy but it’s the best thing you can do for yourself, your family and your patients.”
2. Be prepared for change, especially if you’re a rural registrar
According to Graham, six weeks after starting a new job is often a highly stressful time for registrars. For the first few weeks, you might find yourself running off adrenaline fuelled by new challenges but around the six-week mark, routine starts to kick in and sometimes, so do the anxieties.
“If you move rurally, this is the time you may notice the loss of your old life. You start going through a bit of a grieving process for things you used to do,” he says. “In the early stages, friends and family will ring or come out to visit but after that they can start pulling back and re-organise their life so you’re less part of it.”
But Graham has some tips for dealing with this.
“Prepare yourself before you go rural. Do some research about the town and work out what sort of things you’d like to do there or how you can keep up your hobbies. That preventative stuff can greatly alleviate that feeling of loss.”
Graham says he sees lots of rural registrars travel excessive distances on weekends to visit home which has a big impact on them during the week.
“Driving 300kms each way every weekend is dangerous. Think about your safety and the effect it will have on you. If at all possible, take your family with you to your rural placement. The benefits of having that support network with you far outweigh any cons the move may present.”
3. Don’t ignore the warning signs that tell you things may not be right
Graham says: “Feeling excessively fatigued or noticing your fuse is getting shorter are two [warning signs]. Turning to alcohol or comfort food for a quick pick me up when you normally wouldn’t is another. Stopping exercising or experiencing feelings of loneliness or isolation are a few others.”
While everyone is slightly different, Graham recommends reflecting back on a time when you were particularly stressed, such as during uni exams. Then ask yourself: did you cope well at that time? Are things worse now?
4. Know your options for getting psychological support
If things aren’t going well, there are a number of avenues of support, aside from your own GP.
“The doctors helpline is a 24-hour telephone service that can direct you to an appropriate support service. Your training organisation has an employee assistance program which gives you access to a psychologist. You can also ask your supervisor or ME for a referral as chances are, they have helped other registrars in the same boat as you,” Graham says.
5. Connect with family regularly, and be honest when you do
“If you have to balance work and study, don’t let your family or social time go to the bottom of the barrel. Make it a priority and schedule it if you have to,” Graham says. “I’m in Darwin at the moment and I make sure I speak to my wife every day. It’s essential to make contact with the key people in your life.”
It’s also vital to honestly express how you are feeling when you do connect with them.
“Let your partner or loved one know how you’re going, especially if you’ve had a difficult day. You don’t have to go into the details but at the same time, don’t bottle it up.”
6. Schedule your downtime
Many of you will schedule study and work but what about your downtime? Graham highly recommends doing this.
“I had one registrar recently give me a schedule and the only thing on it was work, meals, study and sleep. That’s just not sustainable. You delude yourself if you think you can live like that for any length of time. You might be able to do it for a week, but after that, you’ll quickly find you actually reduce your study or work effectiveness, and you’ll destroy your relationships.”
7. Find a debriefing partner
Graham believes the very nature of GP work lends itself to feelings of angst.
“General practice is the most intellectually difficult of all of the specialties. You don’t know what you’re dealing with when you open your door. For many specialists, it’s already pre-sorted. General practice can also be very isolating. Specialists often work within a team but GPs can consult for the whole day and hardly talk to anyone other than their patients.”
“When you’ve given bad news, reach decision fatigue or had a run of heartsink patients, connect with someone you trust and debrief,” Graham says. “When I was in trauma, I used to regularly meet with a friend who was a school chaplain. He understood about confidentiality so we would both unload together. One week I talked more than him and the next, it was the other way around. It was rare to find that we both needed substantial support at the same time but it truly was sanity-saving.”
8. Maintain some life normalcy when doing shift work
Graham says: “Exercise or get outside for some sunlight exposure. This will help regulate your sleep patterns. Try to spend time looking into the distance as this allows your brain to shift focus from the ‘up-close’ work we do.”
“Keep up with your hobbies. Also be prepared to get creative when connecting with your social group. With shift work, you’ll often find you’re working when your friends are off. Try lunch or coffee catch ups instead. The key is to be more formal with your planning to ensure these things still happen.”
9. Learn from your mistakes
Graham says it’s common to fear making mistakes when you’re starting out as a doctor.
“This fear is much higher when you’re a registrar because it’s all so new. But every doctor and registrar will make mistakes. The most important thing is how you deal with it. If you do recognise the mistake, ensure you talk it through with your supervisor.”
10. Look out for decision fatigue
Consider delaying a decision if you’re too tired to make one. Graham says: “The first thing is recognising it. If at all possible, take some time out and minimise the important decisions you have to make until you feel regenerated. Stick to some smaller decisions so you might just do a basic patient check-up and then call them back for the bigger decisions at a later date when you know you can fully focus.”
11. Reframe your thinking about heartsink patients
Graham says: “I’ve learned to reframe my thinking about heartsink patients. I now focus on what my role is with them. So you can ask yourself ‘What are they really expecting of me? Can I deliver it and if so, how best can I do that?’. You might find you lack the skills for dealing with these patients and it just takes time to build them.”
12. Address bullying, as it’s never OK
Bullying in the medical workforce has been given a lot of media attention lately. We need to all contribute to stamp out bullying, so don’t ignore poor behaviour if you see it or experience it.
Graham says:“Yes this [bullying] does happen and it’s one you really need to talk about with your RTO and medical educator. You also have to be willing to provide us with the information and allow us to act on it. It takes courage.”
13. Show compassion when you give bad news to a patient
“You’re not a bad person for giving bad news. It is hard work but if you do it well, it’s very rewarding. The key is to show compassion,” Graham says. “For me, to have a patient walk out of the consulting room saying ‘thank you’ when I’ve told them they’ve got a terminal illness is an indication I’ve done my job well.”