A Wellbeing Charter for Doctors

The Royal Australasian College of Surgeons (RACS) in conjunction with several other medical colleges and more to come, has just released a Wellbeing Charter for Doctors. This is a great first step in acknowledging the importance of self-care in healthcare professionals and the need for this care to be a shared responsibility for all of us.

The complete document is reproduced at the end of this article, but I have highlighted a few areas for comment.

AIM

The Wellbeing Charter for Doctors aims to define wellbeing and describe the principles that guide the wellbeing of doctors in Australia and New Zealand. The Charter also describes the shared responsibility of wellbeing for the medical profession. The Charter demonstrates a unified approach to doctors’ wellbeing so that we can advocate with one voice to institutions, governments and policy makers.

I love the acknowledgement of a shared responsibility. For too long there was no focus on the health and wellbeing of the people who cared for the health and wellbeing of others – we were just expected to do our job and if we became ill, dropped out of medicine or died, we were collateral damage in the war against disease. Only recently has our health become a focus, but the onus has been on us as individuals to maintain our health and fitness to practice, in a system that provides less than zero space to do so. For any true change to take place, there has to be a massive shift in the cultural paradigm of medicine, and the ingrained thinking that if you crack under the strain of overworking, you are somehow weak, rather than a symptom of a broken system.

FUNDAMENTAL PRINCIPLES

• Maintaining wellbeing leads to the performance of high quality and effective health care delivery and optimises patient care.
  •Doctors who maintain and maximise their health and wellbeing are able to manage the physical and emotional demands of medicine.
  •Wellbeing is essential to achieving the competencies required for good medical practice.
  •Wellbeing is beneficial to the individual and to the medical community in which doctors work.
  •Jurisdictions, hospitals and medical colleges must support the wellbeing of doctors and provide an environment that is safe, accessible and inclusive for all.

The recognition that our personal wellbeing affects our professional performance and patient care is key here. This is a great starting point for true change.

It is also great that the problem is addressed at all levels – personal, collegiate and systemic.

It is tempting to say that the systems need to change first and that we cannot care for ourselves and live a balanced healthy life if we are working excessive hours in a brutal environment, but the truth is we can only change our systems from within and by our living example.

Our systems were created by us and are sustained by us. They are only able to be uncaring because we don’t care deeply for ourselves and each other. They are only overwhelmed because we as a humanity refuse to care for ourselves and then expect ‘the system’ to fix us, or at least patch us up so we can go back to doing whatever made us sick in the first place!

Caring for ourselves first and foremost and showing that it is possible, even within an uncaring system, can inspire another, and another and another, until there is a groundswell effect that eventually changes the system as a whole. Those in power who benefit from having us overworked and underpaid and who are paid big bonuses for saving the hospital money are not going to want to make these changes, so how will they happen?

We have to show that it is cost-effective to care for ourselves, which it is.

Doctors who care for their bodies and beings are less likely to get sick, take time off, underperform, make mistakes, burn out and leave the profession, all of which costs money in one way or another.

It is well recognised that doctors who care for themselves are more able to care for others in a sustained way. And they serve as a living example of self-care which can inspire their patients to care for themselves, helping to turn the tide of the ocean of lifestyle-related diseases that we are currently swimming in.

DOCTORS
1.Practise self care and continually evaluate what works best to thrive. This includes basic needs – adequate sleep, exercise, nutrition, hydration, regular breaks/ leave, setting boundaries and engaging in enriching activities that bring joy and purpose: e.g. learning, giving, hobbies, spiritual practice, mindfulness and social connection.
2.Have a General Practitioner and have regular check-ups.
3.Foster a personal network of support that may include colleagues, family and friends to share with in good and difficult times.
4.Are aware of and access professional support services that provide doctors with advice, a safe space to share concerns and assist with acute issues.
5.Acknowledge the benefits of kindness and compassion towards self, colleagues
and patients.
6.Show compassion and encourage colleagues to seek help in difficult times.
7.Prepare in advance for the changes that punctuate a career in medicine.
8.Are aware that we are a role model to colleagues and the community.

I love the focus on the body here and on the practise of self-care. We are trained to be experts in fixing the human body and yet that training by and large does not include teaching us how to care for ourselves, or other people. Making this an integral part of the training of medical students and young doctors would change our profession, from the inside out. The more we learn and practise the art and science of caring for ourselves, the more fit we are to care for others in a healthy, sustained and enjoyable way, and the more able we are to serve as role models to inspire other people to care for themselves too.

Seeing ourselves not as lone wolves or islands in a sea of sickness, but an integral and vital part of a community of colleagues, family and friends is also critical in supporting us through the inevitable tough times that we all face in our personal and professional lives. And when we see ourselves as part of a community, we support each other too.

HOSPITALS AND JURISDICTONS
1. Have a role to support a work environment that is open, inclusive and accessible for all, including those with disabilities and chronic illness.
2. Have an obligation to provide a safe and healthy working environment including cover for sick leave, reasonable working hours and flexible work options.
3. Support doctors’ wellbeing by creating a culture of care and compassion.
4. Have doctors’ wellbeing at the core of healthcare strategy and leadership accountability, enabling compassionate leaders, measuring staff wellbeing regularly and confidentially, identifying and acting on risks including organisational factors, team factors and job design.
5. Provide practical and emotional support to teams and individuals.
6. Offer and promote targeted initiatives to enhance protective factors that affect overall wellbeing.

We can care for ourselves as individuals, but for true and lasting change to occur, the culture of medicine needs to change. The culture is brutal in its current form and this brutality is enforced by those who make money the bottom line. Medicine is about people, first and foremost, and the care of those people has to include the care of those who care for them.

Seeing doctors as superhumans who can go without adequate food, water, rest, sleep and time away from work and also as expendable if all that self-abuse takes its eventual toll, is not an economically sustainable way, let alone a humane way to run medical environments.

When we factor in the quality of life of the doctors and nurses and other health care practitioners and the high cost of making mistakes due to fatigues and overwhelm, absenteeism, presenteeism, burnout, sick leave, stress leave and people leaving the profession early after all that training and commitment because their working conditions are untenable, or people leaving the planet early because they tried to continue working under intolerable conditions, self-care makes not only common sense, it makes financial sense.

But all this will not change until we are willing to let go of seeing ourselves as special, superhuman, all-knowing, all-powerful, as invincible, able to work all hours for ever, fix everyone all the time, and never be imperfect, vulnerable, fragile, delicate or tender… human, in fact.

We need to be willing to ask for help if we are struggling, and not be too proud to say we don’t know or we have made a mistake, and to treat ourselves with the same care and compassion that we treat our fellow humans … as if we were human too, which we are!

It is so inspiring to see initiatives such as this one taking shape, and it is up to us now, as individuals, as colleagues, as colleges and as institutions, all working together with shared responsibility, to turn these fine words into fleshy realities that sustain us personally and professionally, and support our medical systems to rebuild, from the inside out.

Reference:

https://www.surgeons.org/-/media/Project/RACS/surgeons-org/files/reports-guidelines-publications/manuals-guidelines/2021-07-19-PUB-Wellbeing-Charter-for-Doctors—Final.pdf?rev=95d91e7df15d435ca0213c24ea1cccea&hash=C48FC6D39BBCE733BA719F1D5FF8D470

A WELLBEING CHARTER FOR DOCTORS

AIM
The Wellbeing Charter for Doctors aims to define wellbeing and describe the principles that guide the wellbeing of doctors in Australia and New Zealand. The Charter also describes the shared responsibility of wellbeing for the medical profession. The Charter demonstrates a unified approach to doctors’ wellbeing so that we can advocate with one voice to institutions, governments and policy makers.

DEFINITION
Wellbeing encompasses physical, mental, emotional and cultural health. It also includes the cultivation of healthy relationships at personal and professional levels based on appreciation, kindness, gratitude and compassion. At a professional level, these attributes are reflected in interactions with patients and the teams we work with and are at the heart of the competencies required for good medical practice.

FUNDAMENTAL PRINCIPLES

• Maintaining wellbeing leads to the performance of high quality and effective health care delivery and optimises patient care.
  •Doctors who maintain and maximise their health and wellbeing are able to manage the physical and emotional demands of medicine.
  •Wellbeing is essential to achieving the competencies required for good medical practice.
  •Wellbeing is beneficial to the individual and to the medical community in which doctors work.
  •Jurisdictions, hospitals and medical colleges must support the wellbeing of doctors and provide an environment that is safe, accessible and inclusive for all.

RESPONSIBILITY FOR WELLBEING
Almost all medical practitioners will face health and wellbeing challenges at different points in our career. Doctors’ wellbeing is a priority for doctors, the patients that we serve and the teams that we work with. It is therefore a shared responsibility between individuals and system partners: workplaces, medical colleges, medical schools, regulators and quality improvement bodies.

DOCTORS
1.Practise self care and continually evaluate what works best to thrive. This includes basic needs – adequate sleep, exercise, nutrition, hydration, regular breaks/ leave, setting boundaries and engaging in enriching activities that bring joy and purpose: e.g. learning, giving, hobbies, spiritual practice, mindfulness and social connection.
2.Have a General Practitioner and have regular check-ups.
3.Foster a personal network of support that may include colleagues, family and friends to share with in good and difficult times.
4.Are aware of and access professional support services that provide doctors with advice, a safe space to share concerns and assist with acute issues.
5.Acknowledge the benefits of kindness and compassion towards self, colleagues
and patients.
6.Show compassion and encourage colleagues to seek help in difficult times.
7.Prepare in advance for the changes that punctuate a career in medicine.
8.Are aware that we are a role model to colleagues and the community.

COLLEAGUES
1. Are aware of and sensitive to the needs of colleagues’ lives – professional
and non-professional.
2. Are prepared to support each other in times of need.

MANAGERS AND LEADERS
1. Have an obligation to foster wellbeing.
2. Proactively discuss wellbeing at departmental or team meetings.
3. Ensure that there is a safe and supportive environment to confidentially discuss concerns with colleagues.
4. Have fluent processes to support and assist colleagues.

HOSPITALS AND JURISDICTONS
1. Have a role to support a work environment that is open, inclusive and accessible for all, including those with disabilities and chronic illness.
2. Have an obligation to provide a safe and healthy working environment including cover for sick leave, reasonable working hours and flexible work options.
3. Support doctors’ wellbeing by creating a culture of care and compassion.
4. Have doctors’ wellbeing at the core of healthcare strategy and leadership accountability, enabling compassionate leaders, measuring staff wellbeing regularly and confidentially, identifying and acting on risks including organisational factors, team factors and job design.
5. Provide practical and emotional support to teams and individuals.
6. Offer and promote targeted initiatives to enhance protective factors that affect
overall wellbeing.