By Dr Kate Johnson
When I was a medical student, I learned that telling people what to do to fix their lives is unhelpful. “Stop smoking,” “stop drinking”, “leave your abusive partner” to someone who isn’t ready or cannot is ineffective. I learned that a good therapist should support and guide a person to find their own path in their life, they should not provide unsolicited advice. This does not help, at best it undermines the agency of the patient, at worst the patient will become dependent on the clinician. If you are like me, it is easy to remember this guiding principle when faced with a patient. It is a bigger leap to realise that most of the time, we shouldn’t even provide unsolicited advice to our friends or family.
Most of us do it and we all know someone who does it chronically and doesn’t even question their supreme authority and role as saviour in the lives of others. As a recipient of unsolicited advice, we know it usually isn’t helpful, that it redirects the conversation when all we needed was a supportive and empathic listening ear and validation. At its most annoying, it can shut down further confidences and alienate the recipient.
Yet, the medical colleges and hospital executives institute wellbeing programs that essentially do the same thing – take on a role of supreme authority and act the saviour for the erring doctor. The worse thing is, this often constitutes a substantive proportion of their wellbeing program, with lip service paid to changing the culture of the college or hospital, while acting in ways that directly cause distress to doctors every day. Many of the wellbeing programs are poorly considered and untargeted, which means they probably don’t work. Yet umpteenth amounts of time and money are spent on them, instead of fixing the serious cultural problems within institutions and, as far as I have seen, no feedback is ever sought from participants.
Last year, my team received an email from the Health Network wellbeing committee educating us on burn out. The email informed us of the serious consequences of burn out for our health and clinical practice and then, featured a quiz that told staff their burn out level. My colleagues were labelled extremely burnt out, with the advice that they should take time off. On a positive note, the email did prove a source of humour for the coming days.
I usually feel hopeful when I see “pledges” from the medical colleges dedicating themselves to changing medical culture, when I see policies on “safe work environments” and committees of dedicated volunteers, committed to improving the experience of staff. The language chosen is usually passive though, without ownership, and my hope is usually short lived, after yet another dismissive email response and when committees choose, again, to do what is easy, not what is necessary. They often revert to models where members’ lack resilience and skills. eLearning modules help people to learn about self care, how to set goals and how to design a wellbeing plan and gain CPD points in the process (as if we need more work). No-one ever acknowledges that to struggle is in fact a normal response to stressors.
I strongly suspect that the people with power in many of these institutions and self-selecting into these committees are the wrong people. They either haven’t struggled (nor questioned their supreme authority) or have struggled, without developing self awareness. It is blazingly obvious to me, that even if modules on self care and goal setting have good reviews in one context, it probably won’t work when a college or executive sets it as mandatory learning or CPD. For instance, if I had sought out modules on communication skills, I may have been receptive to the lessons within. Instead this elearning module was set for me by the Training Support program, after being gaslighted, undermined behind my back and labelled as socially inept and incompetent by a supervisor. In this context, the module was insulting. Context matters.
Honestly, I am not sure that Colleges and Executives should EVER advise members on their wellbeing. Actual effective support for individuals comes from face to face interactions with, for instance, the local Director of Physician Training, mentors and supportive colleagues. For some, their support will be a family member, friend or GP – and doctors in distress will seek these people, if they are supported to do so. For many a local Director of Physician Training, the colleges make it harder for them to support their trainees, they worsen distress and create unnecessary problems. To support wellbeing, the Colleges and Executives simply need to stop the practices that cause distress, but is there any desire to do this?
During COVID, trainee physicians had to cope with extra work, cancellation of leave, risk of infection, lockdown and isolation from family, friends and limitations on hobbies. A study by Bismark et al showed that “10.5% of health care workers had thoughts of self harm and suicide during a 2 week period”. At the same time one college, for instance, delayed the clinical exam several times, failed to run a computerised written exam and continued(s) to demand absolute punctuality on deadlines for PREP tools and forms, on threat of having training unaccredited, despite the fact that these PREP tools and forms are low value, tick box exercises. How much better would it be if this college engaged with feedback, worked collaboratively and showed a reasonable level of flexibility, compassion and supportiveness in the face of an unprecedented pandemic? Yet this college is so out of touch, it continues to send self congratulatory news updates and dismissive excuses.
An anonymous doctor wrote in the SMH last year, “The crux of the problem is a lack of support from those in authority: the training colleges, the consultants and the executives who run our hospitals.” How long have these wellbeing initiatives been in place? A decade? Yet we still have a doctor expressing these sentiments anonymously out of fear. Do you think this person needs a wellbeing plan?
The medical colleges and executives running hospitals need to stop casting individual doctors as the problem. This is a delusion. They need to take ownership and stop making our lives worse now. They need to engage with us from a position of openness and respect. Then powerful people need to show some imagination when looking at restructuring and changing. If they can’t imagine this, they need to recruit people of diverse backgrounds into positions of power, instead of letting committee recruitment occur passively, given self-selection often favours the overconfident.
These are the only steps that will lead to effective change. I suspect they are the only steps powerful institutions can take that will improve “wellbeing”, but given the track record these institutions have so far – I won’t be holding my breath.
