Your most important patient

Teaching registrars to look after themselves is essential

• Work-life balance now higher priority for Gen Y Registrars
• Self care now embedded in Registrar training
• Despite this, self-diagnosis and self-treatment still common

OLDER GPs are often berated for putting their patients’ needs ahead of their own.

But, along with their laptops, soy lattes and flexible working hours, today’s young doctors are heralding a new approach in personal health.

Statistics have shown that 53% of GPs have considered quitting because of work stress, and one in eight city GPs has had a severe psych­iatric disturbance.

It is figures like these, from the 2004 literature review The Conspiracy of Silence – Emotional Health Among Medical Practitioners, that have prompted those responsible for GP training to put self-care on the agenda.

SIGHTS SET ON SELF CARE

The RACGP now includes self-care in its GP training curriculum, runs a Professional Peer Support Program and ensures its Keeping the Doctor Alive resource is available to all GPs and registrars.

ACRRM stipulates in its curriculum that registrars must learn some self-care. And now, the vast majority of reg­ional training provider (RTP) teaches registrars self-care.

“It is, unfortunately, common for doctors to put others’ needs before their own,” says Dr Winston Lo, a medical educator for Sydney RTP GP Synergy.

“Consequently they may put themselves in a position where they self-diagnose, self-treat and self-manage their illnesses.”

In 2007, in a bid to determine what self-care education was being carried out by RTPs, Dr Lo conducted a study. He found 20 out of the then 21 RTPs delivered some training on self-care during the past 12 months.

They covered a variety of topics, such as:

• achieving a satisfactory work/life balance
• potential dangers of self-diagnosis and self-treatment
• benefits of having an independent doctor
• identifying danger signs of inappropriate behaviour (e.g. sense of a loss of control, and mood changes such as anger and irritability).

Introducing registrars to the merits of self-care early is vital, Dr Lo says, because they face many stressful situations during their training.

Exams and transitioning from public to private practice, especially during the basic term, are some of the peak stressors registrars face, Dr Lo’s research identified.

A NEED FOR BALANCE

Associate Professor Simon Willcock, General Practice Education & Training (GPET) chair, says young doctors increasingly understand the need for “balance and boundaries” between their professional and personal lives.

“The oft-made criticism of Generation Y that they ‘won’t commit’ should be reinterpreted that they’re just as committed as their predecessors, but that they won’t continue to work in situations that do not promote balance or conform with their moral and ethical principles,” he says.

“Doctors provide high levels of emotional support to patients, [and] if they don’t replenish their own emotional reserves, they become burnt out.”

This in turn can lead to poor health, including anxiety, depression and substance abuse, Professor Willcock says.

As a registrar, Melbourne GPDr Evan Grambas took care to stay on top of his own health needs and encourages others to do the same.

“Self-care was brought up in the Victorian Metropolitan Alliance [an RTP] training sessions and it seems to be the culture of medical educators now to constantly reinforce the importance of self-care,” he says.

Another RTP that has taken giant steps to drive the self-care message home to its registrars is the Adelaide to Outback GP Training Program (A2O).

When it implemented its GP self-management program into the curriculum in 2004, it was just trying to support its own registrars.

The RTP's unique self-care model uses consultant psychologists to educate registrars throughout their hospital, basic and final years in methods of building emotional resilience.

“It’s using psychological principles in terms of how they approach the way in which they’re interpreting what’s going on and making decisions about how to better moderate their lifestyle,” says A2O CEO Linda Black.

SELF CARE TIPS FROM THE EXPERTS

• Avoid corridor consultations. Engage an independent GP for your healthcare
• Maintain a healthy work/life balance
• Follow a healthy diet and get regular exercise
• Have regular check-ups
• Accept that general practice is full of uncertainty and not everything is known
• Take time off when you’re sick
• Ask lots of questions – and often.

This article has been updated from the original, which appeared online 04/10/2007.