Practitioner wellbeing during Coronageddon

As one of the most significant world health crises in recent times, COVID-19 and its repercussions have had an unprecedented impact on the lives of millions of people across the globe ^[1]. Despite the significantly lower death and COVID-19 contraction rates in Australia compared to many other communities^[2], the adverse impact of the pandemic on the mental health and wellbeing of the public^[3], particularly healthcare practitioners (HCPs), is significant and well documented in literature.^[4],[5]

Mental health and wellbeing risks^{[6] [7]}

This pandemic has changed how many healthcare practitioners work and live. Insecurity, increasing workloads and feelings of fear, sadness, bewilderment or anger are becoming increasingly common and justified. These emotions may magnify in response to a number of pandemic-related scenarios including:

• lockdown restrictions, social disconnection and relentless media coverage
• anxiety about direct contact with confirmed cases of COVID-19
• job insecurity or increased stress and anxiety relating to necessary adjustment/s to different units and/or new roles
• dehumanised interactions with patients due to Personal Protective Equipment (PPE)
• stress of taking care of sick and dying patients without their families present
• long work hours, heavy workload, irregular schedules
• managing the emotional needs of patients, their families and patient death
• delivering bad news to patients without their families present to support them

As a healthcare practitioner, maintaining good physical and psychological wellbeing is pivotal to your role and critical to limiting your clinico-legal risk exposure. Practicing when you feel tired, overworked or burnt out and/or under the influence of alcohol or illicit substances will never be a defence to any medical or dental negligence claim, complaint, or investigation by AHPRA, the Medical and Dental Boards, Colleges, or State-based Healthcare Complaint Commissions.

It is in your best interest to take the necessary steps to adequately care for your physical, emotional, and mental wellbeing while you deliver care.

Balancing your wellbeing and your duty to care for patients

In the practice of medicine and dentistry, the duty of care to patients needs to be balanced with all the other ethical, legal, and moral values that are inherent to both professions, including a practitioner’s personal wellbeing.

Following a guide or framework^[8] that assesses the impact of workplace and personal stressors in your delivery of care, may help you strike the right balance when confronting challenging situations during the COVID-19 pandemic. It may help you reflect on what you can do to mitigate illnesses (get well), prevent harm (stay well) and perform at your best (thrive).

 Table adapted from The Thrive at Work Framework[9]

Limiting your exposure to clinico-legal risk

Your wellbeing has a significant impact on healthcare outcomes, patient-care, adherence to treatment and the interpersonal aspects of caregiving. The Medical Board – 11 Ensuring doctors health and Dental Board – 9 Ensuring practitioners health have set specific expectations regarding a healthcare practitioner's physical and mental wellbeing and their practise.

Your/Practitioner health

Good medical practice involves:

• Having a general practitioner.
• Seeking independent, objective advice when you need medical care, and being aware of the risks of self-diagnosis and self-treatment.
• Seeking help if you are suffering stress, burnout, anxiety or depression.
• Making sure that you are immunised against relevant communicable diseases.
• Not self-prescribing.
• Recognising the impact of fatigue on your health and your ability to care for patients and endeavouring to work safe hours wherever possible.
• Being aware of the doctors’ health program in your state or territory which provides confidential advice and support through the doctors’ health advisory and referral services.
• Knowing or suspecting that you have a health condition or impairment that could adversely affect your judgement, performance or your patient’s health:
• Not relying on your own assessment of the risk you pose to patients
• Consulting your doctor about whether, and in what ways, you may need to modify your practice, and following the doctor’s advice.

For your colleagues' health see Medical Board 11.3 Other doctors’ health and Dental Board at 9.3 Other practitioners’ health

Key messages

• Make your wellbeing a priority. Develop your own ‘wellbeing strategy’ by adopting an integrated approach to your physical, mental and emotional health while addressing risk factors in the work environment and personal life promptly and diligently.
• Commit to learning new wellbeing skills and regular practices. Learning to be well involves being, believing, feeling, doing, interacting, and adapting. Engage in relevant education and reflect on how you can best adapt the new knowledge to your own circumstances.
• Cultivate and nurture positive and respectful relationships with colleagues, care teams, patients, and family members.
• Ensure you understand protocols and policies in your workplace and any changes to your employment contractual conditions, obligations, and expectations due to the COVID-19 pandemic. Seek assistance from MIPS if in doubt.
• Identify how Work Health and Safety (WHS) laws and other employment requirements or conditions impact what is expected from you while delivering care during the COVID-19 pandemic.
• Always follow the AHPRA’s Code of Conduct expectations. In case of a clinico-legal claim, complaint or investigation, your actions, errors and omissions will be judged against the expectations set out in this Code.
• Deal with any physical or mental health issue promptly, do not delay seeking help. Reach out to MIPS clinico-legal advisory team early. Contact MIPS 1800 061 113.
• Do not self-treat or self-prescribe medications. Have your own GP. In Victoria, it is illegal for registered healthcare practitioners to self-prescribe any S4 or S8 medication. If found guilty, you may face not only regulatory actions from AHPRA but also have a criminal conviction recorded against your name.

MIPS resources

CPD Accredited webinars

• COVID-19: Protecting your assets - The personal and financial impact on your wellbeing
• Practising with care - Resolving difficult patient interactions
• Being the doctor’s doctor - My experience of practitioner health and welfare
• My job, my career – how to deal with challenges
• Hear me - A true story on the detriment of poor communication
• Practising under adversity - claims, complaints & investigations
• Taking care of oneself

Further reading

• Mental Health & Wellbeing
• COVID-19: Protecting your assets – personal and financial wellbeing
• Your wellbeing career and patient safety
• My job/my career – how to deal with challenges
• Colleagues in difficulty

Industry resources

Doctors' health services across Australia

RACGP              GP Wellbeing

DRS4DRS          Help for doctors and students to stay healthy

RACS                 Surgeon wellbeing

AMA                   Health-and-wellbeing-doctors-and-medical-students-2020