If you take ice, avoid our emergency departments

Greetings all,

I write today about a topic I have become familiar with, after working as a locum psychiatrist in Far North Queensland. In no way do I think FNQ has problems that aren’t seen elsewhere, far from it, but it was my chance to see first hand what the drug ‘ice’ was doing to our society.

I work as a psychiatrist and hence within the public mental health system which to say is under resourced is old news. We are way past under resourced now and as clinicians move from crisis to crisis providing band aid solutions to complex psychiatric solutions all the time. I accept that fact and like many of us, aim to do my best with what I have. But I will not abide by the recent influx of demand that has occurred as a result of the increasing use of ice. I do this to support my colleagues as as well as patients being cared for in the mental health system.

Ice is one of the most powerful, addictive and dangerous substances that our society has known. A ‘bad trip’ on ice is not the same as an experience with heroin or other psychostimulants. Because methamphetamines, including ice, affect levels of dopamine in the brain, they will cause patients to become psychotic merely because of their ingestion. In other words, if you take ice, you have a very high chance of becoming paranoid, misinterpreting things around you, including within your own body (commonly feeling there are objects or insects under your skin) and you may very likely become more violent than ever imagined as a result.

Someone who is acutely intoxicated because they have used ice is not the same as somebody who is experiencing symptoms of severe mental illness that requires immediate treatment in an authorised mental health service. Patients who are intoxicated on ice will often be fine once the substance leaves their system. They don’t need to be labelled with a diagnosis of a severe mental illness, and as such take up hospital beds and terrify other patients who are in the wards for other reasons.

Yes, we do know that there is an overlap between the use of illicit drugs and psychosis with the use of drugs precipitating a psychotic episode in a person who is genetically vulnerable. But what we are seeing in many cases is acute intoxication of a substance that we know causes psychosis and these patients are being labelled as having a severe mental illness simply because we need them out of our emergency departments due to bed targets within a period of time. In a system where medical and nursing teams are expected to triage, assess and admit every patient in an emergency department within a designated time period, we have lost the ability to use time as a healer.

When I was a psychiatry registrar I was routinely asked to assess patients who were intoxicated with alcohol and expressing thoughts of suicide. I knew that for clinical, ethical and medico legal reasons, I could not assess the patient until they were sober. In the cold light of day, and once alcohol is excreted from the system, a patient may no longer pose the same level of risk. It is the same for ice. During my recent locum post I was disappointed and shocked to hear that psychiatry registrars were routinely called to the emergency departments to see patients who were ice users, intoxicated and violent as a result. When ice dried up in town, the request was to see people who had obtained the medication ‘Ritalin’, crushed up the tablets and injected that instead. When ice dried up, users would collect at the community clinics threatening staff and demanding prescriptions for Ritalin.

I know that some ice users do have an underlying psychosis and as such deserve a different model of care. It is a tragedy that patients with severe mental illness now have access to ice with disastrous consequences on the prognosis and course of their illness. But I don’t feel we should assess which camp the person belongs in before they ‘come down’, and we shouldn’t sedate them with heavy doses of antipsychotic medication which may cause breathing difficulties and lengthen the time in hospital.

I don’t feel we should admit ice users to a psychiatric ward, with other vulnerable patients and staff, without a very valid reason. Because I know that if given time to come down, many would not require any treatment at all.

In FNQ there exists diversionary centres, created as an alternative place for those intoxicated with alcohol that is not part of the forensic or medical system. Diversionary centres are seen as safe places to withdraw from alcohol, avoiding custody. Now that we are at crisis levels with the numbers of ice users increasing beyond our level of understanding or capacity to respond, a similar model could be employed. Such a model would provide a safe place for users to withdraw, away from clinical staff and other patients, and then a comprehensive mental health assessment could occur when the risk of violence had dissipated. We need to curb the tidal wave of admissions to psychiatric units by ice users, for the sake of our profession, our patients and our colleagues.

Coaching and training in preparation for the RANZCP M-OCIs

It has been a busy time helping IMG candidates with their exam preparation ahead of the next 2 weeks! As their current training pathway comes to an end (October 2015) I know many are keen to do everything they can to prepare for the long case exams.

As a trainer, I often see the same thing happening with candidates, and as such I thought I would jot down some key points as well as provide you with some written material about how best to approach the exam. I am available for individualised coaching, and booking up ahead of the July and October 2015 RANZCP clinical examinations.

  • Being ‘nice’ rather than asking direct questions or drilling down into the information you need. I see this time and time again. Being nice does not equate to missing out on key information, that if known would help the patient in the end. If a patient appears guarded and defensive it is probably a useful clinical sign to notice, rather than taking it personally.
  • Focusing on the formulation and running out of time to prepare an action plan. The action plan is marked in a separate domain, formulation isn’t, and many candidates fail as their plan is not well considered or specific as they have left it to the last few minutes to prepare. Remember to weave the demographic details into the action plan to make it specific.
  • Pay attention to cues, and ask patients to tell their story so you can observe their narrative and non verbal communication that goes with it. By doing this we are truly dong what good psychiatrists do, synthesising all the information available to us, and allowing the patient to be truly heard.

Here are some other tips, please share!

How to spot a bully in medicine and what to do about it

Greetings all,

Over the past weeks it has been reassuring to see so much lively debate about the concept of bullying in medicine. Despite the sensationalism, there has been a groundswell of those within and without medicine who simply cannot understand why professions such as medicine can’t adopt the attitudes of most child care centres and kindergartens. The way we encourage 3 year old children to name the behaviour, hold up their hand and say:

‘ Stop it, I don’t like it’.

After completing this first step, 3 year old children are really good at performing the next task. That is,

tell a grown up.

The grown up responds at the time, not days later, sits both down and helps them find a resolution. If discipline is needed that is explained too. Everybody learns and keeps going. Children feel heard, children learn what is unacceptable, and also that grown ups are around when they feel out of  their depth, often for a cuddle and reassurance they are OK.

This consistent measured response that infants can understand and take on as they grow up is crucial as a preventative measure for bullying behaviour. Simplistic, kind, immediate actions that leads to long term resilience.

The behavior we see in our profession is the antithesis of this.

So what happens somewhere between leaving the sand pit and entering the operating room? (I say operating room as apparently that’s where the media feel real doctors hang out so it’s always the background scene)

What happens is complex, multi factorial and beyond exposure in a 1 hour documentary. In this blog I am going to explore a bit more about how bullies get to be where they are, the absolute devastation they can cause at the expense of keeping their ivory tower polished and pristine, and why I can’t think of a single organisation that can be the ‘grown up’ in this issue.

Often the ‘grown up’ is the bully.

My definition of bullying is a culmination of my clinical knowledge, my own lived experiences, and where I see the state of play in medicine. It is written entirely as a mark of respect for those of my colleagues and peers who may not have believed they could get through bullying experiences and chose to die instead. Just as in the world of cyber-bullying, suicide is a tragic and common outcome. I am a victim of bullying, and I have had times where I found myself believing their criticism of me, their comments that I should ‘shut up’ and not answer questions for fear of making others look stupid rather than embrace and foster that I was keen and willing to learn.

For no other reason, bullying is dangerous because it takes our minds off our patients, derails us from contributing to medicine and causes us no end of distress and hardship.

A bully is anybody who does something either verbally, physically, or emotionally, with no other reason but to make themselves feel awesome and you to feel dreadful.

I am going to use this blog to profile one of the biggest bullies I had the displeasure to meet through my medical training and beyond. This person still works as a doctor and holds a number of high profile office bearer positions. I am doing this to showcase what is bullying behaviour, how it takes years to develop and to question why it simply continues when everybody knows. Those relevant to my profession will know who I am writing about. Everything I write can be substantiated by others. If I don’t lead by example, I see myself as someone who is colluding with bullying behaviour, allowing the next generation to experience what we did. Those people just like me that couldn’t find a grown up, or instead of getting that reassurance, were treated with disdain, told to shut up and cop it just like everybody else. After all, we are told

being a victim to a bully makes us stronger.

In my scenario, the perpetrator is a male. I preface by stating this is not a gender specific issue, and I have met women who were quite good at bullying as well.

Let’s paint the scene,

A bunch of keen medical students sitting in a large tutorial room of a major teaching hospital waiting for the “Prof”. Waiting as we did at the same time every week for a spray and perhaps a glimpse of something worthwhile learning.

Prof enters the room when he feels like it. He is after all, extremely busy, and often began tutorials by naming which prestigious media person he had just been speaking to on the phone.

We sit in silence. After all, he is the Prof, and we have all heard really scary things about him….

Prof begins the session by reaching into his wallet and pulling out a fistful of business cards, which he then proceeds to flick across the table like some random card game at a casino.

His first question for the audience;

Do you know who I am?

Well, yes, we do, but nobody has the guts to say. Then the following answer to his own question;

I am everything my business card says I am. I am the recipient of all these awards and merits. When I get on the phone to the media, my call goes straight through. I am one of the most influential people in my field.

This was the beginning, middle and end of the tutorial. We all left with a business card after watching a DVD made by a pharmaceutical company, featuring the Prof who had left the room by now.

Now, hopefully, most of the audience saw this  ‘tosser’ behaviour for what it was. But maybe some didn’t. Maybe some really started to believe from that moment on, this person was the one to impress if you wanted to get anywhere. Sadly, this was the case. You did have to be a golden child of the Prof to enter his kingdom.

Also, crucially, Prof was being very strategic and targeted with his ‘tom cat’ marking of his territory. He was making very sure that he was and would always be the smartest person in the room. Intolerant of criticism, and insightless to his behavior, not least of which was discouraging some fine future doctors from his area of specialty, the Prof legend continued to grow and the power imbalance became greater.

In later years, if you did decide to chose to enter the Prof’s turf, that is, choose the same specialty as him, and then become his registrar, you would be subjected to public humiliation on a weekly basis. The weekly ward round was your chance to present a case, in front of the patient you were speaking about, as well as the rest of the multidisciplinary team. All would watch in horror as the Prof took you down, bit by bit, in order to once again demonstrate he was still the most important and intelligent person in the room, and that humiliation was the best way to get you to think on your feet faster and suffer the rigors of being a real doctor.

This public humiliation went on for years, consistently, and without any attempts at intervention.

The complexity continues, as the needs of the Prof grow to maintain relevance over the years, to be seen to be furthering his career at every opportunity, getting onto boards, into professional organisations, marking his territory, and ensuring he remains

Untouchable

So faced with this, what do we do? How can we simply say with any hat that we have a zero tolerance to bullying, as if that will solve the problems without understanding where it all began? Shouldn’t we instead say to our peers, do not be defined by the criticism of bullies, but by those you trust and respect as they are everywhere too. Above all else, be defined by your own self worth which should be more than obtaining a fellowship to a college.

I don’t believe any organisation has the capability of removing bullies from medicine. The Australian Medical Association is a membership organisation that takes subs from bullies and victims. It also has a role in defending members who are wrongly accused of bullying. Colleges also cannot rid their hierarchy of bullies, and because of this, cannot offer assistance to members who receive threats from bullies.

In this whole argument, nobody is declaring they have a clear conflict of interest in dealing with bullies

As a doctor, a mother of a son who has been told how to manage bullies in the playground, and as a psychiatrist who sees patients that are suicidal as a result of bullying, I say the best way to manage this is;

1. Keep safe, get help and remember, you are so much more than what your supervisors write on your assessments. Bullies do in fact have much more to lose than you.

2. When you are ready, and if you so choose, name your bully’s behavior to protect others. If you can’t find a grown up to tell, be that grown up yourself and name it to your peers.

3. Take up the charge to rid bullies from the profession we are passionate about, understanding how much they will hang on, and appreciate how entrenched they are within the organisations that state they are trying to ‘out’ their bullies.

I have ‘named’ a bully. Now it’s your turn.

Sleep and psychiatry – time for a tweet chat!

Greetings all,

I have been involved in the area of sleep psychiatry and have been running medical education workshops, known as SleepSchool since 2008.

I have been running these in conjunction with Dr David Cunnington, director at Melbourne Sleep Disorders Centre, and creator of Sleep Hub.

We have run quite a number of workshops around Australia since 2008, but haven’t done so for a while. We used to have great support from pharma but for many reasons this is no longer the future of medical education.

Anyway, not to worry, as now that both David and myself are actively engaged on social media, and I am guesting at @WePublicHealth this week, we have decided to trial a tweet chat that highlights the intricate relationship between sleep and mental illness. This will occur on Friday 22nd May 2015 at 1430 AEST.

We will be using the hashtag #sleepschool although popular around mums and babes with sleep issues, it carries on our workshop name as it moves into the Twittersphere!

Find out more about #SleepSchool here

 

 

Ready to take on the wellness warriors?

Greetings all,

5 days to go until the early bird registration ends for MedicineSocial, and such a pertinent time to reflect on why doctors and other thought leaders in health must embrace social media for good.

We all have our degrees, expertise and experience in our particular crafts. We believe that because patients come to see us they take on board what we have to say as the truth. In many situations, this is the case. In my craft, psychiatry, this may not always be the case.

How many of you ask your patients what they think might be wrong with them or if they have researched their symptoms, or even you on sites such as Google before attending the appointment? Increasingly. the answer is yes. And that is OK if it means patients are trying to learn as much as they can about how to manage their illness, or believe they may not have one.

But the opposite may be true. For example, despite global campaigns and public health messages about vaccination, the majority of information on social media may actually attract parents to anti-vaccination lobbyists.  Known as keyboard warriors, these people despite different motivations spend a great deal of their day uploading content that is ill-founded but plays upon the vulnerabilities of new parents. Sometimes they can play dirty. Often they use motivations such as fear and shame to endorse their message. What they are good at is knowing how to drown out a debate regardless of truth by saturating common search engines and staying on message.

And then there are those with the ‘quick fixes’. Once again a varied bunch who may actually believe they are onto the right thing. At least 2 or 3 times a week, I am asked by patients if I have heard of a recent cure for schizophrenia or anxiety. Not because they don’t believe in their care, they simply hope that there could be something more benign than the potent medications we prescribe with sub-optimal efficacy. Recently, I told a patient that if I believed high doses of folinic acid cured anxiety I would be the first to promote it. I don’t like prescribing medications with intolerable side effects but I also don’t like seeing patients suffer from severe mental illness.

What enrages us all is those who don’t have any training in health, who deceive the public for overt secondary gain (financial) and delay others from getting help until it’s too late. Recent ‘wellness warriors’ have been vilified for this, and at times been excused for having a mental illness. In particular, these warriors are said to have Munchausen’s syndrome.

Now, Munchausen’s syndrome is extremely rare and involves the development of the sick role to foster care, nurturing and attention. That is the secondary gain. We see this in extremely traumatised individuals who perhaps have not been cared for in childhood years, or even abused. Their behaviour is conscious but the gain is to keep people close.

What I fear is those who do not have Munchausen’s syndrome may be seen to have it without a clear understanding of the true definition. Again, the behaviour is conscious but the secondary gain is fame and financial. This is called fraud or malingering.

Why do patients then fall for these claims and not listen to health professionals? Because the perpetrators of the claims are very good at manipulating basic human behaviour. For example, if you were faced with a blizzard and had to go the to supermarket, would you walk or drive? You would weigh up the quickest, most appealing option, and if the correct amount of spin was placed on this option you would take it.

What doctors and health professionals don’t understand is that we no longer live in a world where many accept medical advice with a degree of scepticism and inquiry. That’s understandable when information is so readily available. But what we have to do is be as savvy as the wellness warriors and campaigners, deliver our messages unique to our craft and fight fair. Because if we are left behind, patients will work with what they have and our crucial evidenced based public health messages will be diluted by the snake oil merchants.

Dr Helen Schultz is a consultant psychiatrist and blogger in Melbourne, Australia. She has organised Medicine Social to educate and inform doctors and health professionals about the importance of being a leader in social media and medicine. 

DiT Forum at AMA house on Thursday 5th March 2015.

Greetings all,

In light of recent deaths amongst our Victorian DiTs, a small working party has formed, and a decision has been made to hold a forum on Thursday 5th March 2015 at 7pm at AMA House, Parkville.

This is short notice but it was decided that it would be prudent to hold the meeting sooner rather than later as we are aware of impending examination timetables.

I am involved because I was a DiT not long ago, used to be a president of the AMA(Vic) DiT subdivison and around when there were some suicides amongst our friends about 10 years ago. What came of similar forums was the establishment of the AMA peer support service.

I have never shied away from being outspoken and an advocate for all DiTs including medical students. DiTs are a large, invaluable, resourceful and caring group of the medical profession.

DiT’s also get very bogged down in making to the ‘ticket’. They work hard and endure a lot to get good reports and pass exams.

Despite being a large group of the medical workforce DiTs can feel alone.

I have been vocal recently about what I do know. 4 DiT’s including 3 psychiatry registrars are no longer with us. There is and probably will always be conjecture and a lack of understanding about why they are no longer with us. These deaths may be unrelated or there may be a factor that ties more than one.

We don’t know unless we start talking. 

And even if we do not know, we may be able to use this tragedy, and it is a tragedy, to regroup so trainees can tell those that want to listen exactly how it is to be a DiT nowadays.

We may uncover that other DiTs working in the 4 sites where they lost colleagues are not coping with the news. They may be struggling too. There may be systemic or their may be local issues.This is not about blame, it’s about guiding future discussions that hopefully will implement real change.

AMA (Victoria) and its senior officebearers, including the current AMA(Victoria) president, Dr Tony Bartone, and past presidents have stepped up to hear about this from the time we all heard about the deaths of 4 DiT’s since January 2015.

AMA(Victoria) have kindly offered to host the meeting and provide facilitators to assist the discussion.

I will be there because I want to know as well.

It’s Ok to say if you are not coping, or if you can see others not coping.

Please attend, regardless of your involvement in the passing of 4 DiT’s and especially if you are affected by the news. You do not have to be an AMA member to attend.

RSVP here

Please see your GP, or contact the Victorian Doctors Health Program via AMA(Victoria) if you need more formal support.

See you Thursday,

Helen

Supervision versus mentorship What we don’t learn in medical school, but find out from the school of life.

I was a pretty outspoken registrar during my psychiatry training. That’s a comment that has been levelled at me many times. Along with the one about caring ‘too much’. Self-reflection revealed that this was a combination of being passionate, as well as trying to transition from a life where I worked as a pharmacist to one of a medical student. I was older than many of my peers and also some of my ‘seniors’ which proved very difficult for me. In addition, I had worked in very senior roles and did not quite fit the paternalistic mould of master and student. And I knew that although I knew a lot about pharmacy, I had a load to learn about medicine.

Because of these reasons, I recognised early that if I was going to succeed at being a doctor I would have to go out and find some like-minded individuals to get the support I needed.  I needed mentors to guide me to and beyond training years. I needed this as importantly as my professional training

And then I was accepted into psychiatry training. A large part of my training occurred on the job and in lecture theatres but also as part of what I would come to know as supervision. Peers training in other specialities regard psychiatrists to have a layer of support they might not have because of this formal component to psychiatry training known as supervision. This article reveals my impression regarding why this is often not the case, what can go well and not so well in supervision, and above all else, why one mustn’t confuse supervision with mentorship.

Supervision in psychiatry is as old as psychiatry itself. But it was never designed for support. Classical supervision would occur behind closed doors and be a vehicle for further exploration of what Freud described as the ‘transference’, that is, the dynamics of the interaction between patient and therapist. In these early times, supervision allowed another psychiatrist, aka the ‘supervisor’ to interpret and analyse the treating psychiatrists’ feelings about the case, and the dynamics at play between the treating psychiatrist and their patient. The supervisor was kind of like a fly on the wall in the therapy session yet a on a wall down the corridor and about 2 days later. Maybe a Venn diagram would help explain this dynamic as well. It’s tricky.

Yes, so much of early psychiatric diagnosis and even today is about interpretation of what is said and the way it is said by the patient. Having a supervisor in modern times is still based on these foundations. When you are primarily involved in the care of a patient, ie a consultant psychiatrist, you seek out a supervisor to discuss complex cases. Such as patients that don’t seem to be responding, challenge what else you can try, and explore why you feel a certain way about a patient and how they respond to you. (I am hoping Freud is looking down on me and ensuring I have this correct).

The reason I labour this is because supervision in the strictest sense is not about your stuff. It is not about how you are, what is annoying you this week, and how your own personal life interplays with professional duties. These more personal conversations occur between a person who just happens to be a psychiatrist and a mentor.

And then there is the role of a supervisor during psychiatry training, as set out by the training college for all registrars, the RANZCP. As part of training, registrars move sites and roles ever 3-6 months and are lucky (or unlucky as I will explain) to have the same role for a year. Each time they are rotated through, they get to meet their new supervisor who is invariably their consultant, ie, boss. Their direct report, the one who hopefully engages in meaningful bedside teaching, dispels some myths about psychiatry and shares anecdotes over coffee in the hospital cafeteria. These supervisors may be swamped by all the forms they need to fill out about your progress, which is given to the college of psychiatrists, and they may be good or not so good at giving feedback. They are often busy consultant psychiatrists who juggle public and private practice work, their own lives, hospital administration and whatever else. They may have all the time in the world for you, or they may encroach on your dedicated supervision session times (which should be protected) because they are consumed by the tasks of service provision. No matter what, however, by the time you work out what they are like, it will be time to move to the next rotation.

This is important to note because it is a trap for young players to presume the role of supervisor before getting feedback about how they see and perform their role. They may be somebody you see only once a week, they might be very hands on, or they might not have a lot of time to teach you. They may not be the best people to tell if you are struggling as they are also the ones that fill in your progress reports.

Don’t get me wrong. I have some outstanding colleagues and friends in my life whom I aspire to be like and would never have met if it wasn’t for the fact that fate sent me to a rotation where they would be waiting for me. But the key is, you need time to work out which ones these are. This takes time and experience. Just as Freud would sit back and observe, we also need to do the same with our supervisors. And then make considered decisions about what we disclose and what we leave for others.

In some cases, clashes can occur between supervisor and registrar and during these times it is very hard to identify a mediator. Often it’s about waiting out the rotation, hoping that the feedback isn’t too harsh and trying to move on. I have been on occasion quite vulnerable in some supervision sessions that have occurred behind closed doors. What made it worse was that I discovered I wasn’t the only registrar to feel that way with that particular supervisor. But sadly, nothing often changes and registrars do rely on the ‘get out’ clause of the weeks ticking by till the next move.

Supervisors also have a role to play in protecting the public and reporting up if they feel a registrar is impaired. This is an extremely difficult situation for everybody not least the supervisor who is concerned. Often systems are bad at handling these situations. Often the people most in need of support find it lacking. At the pointy end, some supervisors without adequate support themselves may fall into a role of trying to treat the registrar as if they were a patient, or somebody to rescue. These blurring of boundaries can lead to harm, they can happen insidiously and cause devastating outcomes.

So hence, my advice is to find mentors. Mentors can be absolutely anybody within and without medicine. In this era of social media I now have mentors I have never met in real life, who send me private messages and make me feel connected at times of vulnerability. Some mentors come and go, often to plant knowledge and wisdom within you that you will share with others over time.

My wonderful example of this was a lovely medical registrar who was working on night shift alongside me when I was a frightened resident, sleep deprived and about to throw my never ending buzzing pager at the wall. It was about 5.30am on the fifth night of night shift in a row and it felt like time had stood still. As often happens in the early hours of the morning, multiple patients experience cardiac and respiratory symptoms requiring urgent attention all at the same time. Unless you have experienced it, it is hard to comprehend how surreal the combination of sleep deprivation and terror really feels.

So as we were sorting out the latest complex case (well he was sorting out and I was doing what I was told), he looked over at me, must have recognised I was in that crazy sleep deprived/terrified/surreal state and said

“You know, they can hurt us but they can’t stop the clock”

In that moment I knew he got me. He got the sheer frustration of a system that makes you work in such difficult circumstances and he was reassuring me that it would end. Because I had forgotten that at some point I would go home to reality.

That person became my hero and my mentor for the rest of the nights I was on duty.

So in summary, when thinking about supervision and mentorship, perhaps have a think about the following:

  • Just because psychiatry registrars have supervision does not mean they have support, or are more resilient than other folks in medicine. In psychiatry, the concept of supervision is much more complex than this.
  • Nobody teaches you how to work out which supervisor you will tell what to, that’s up to you to discern. In the meantime, form your own opinion.
  • Sit back a lot and work out why you have chosen certain people in your career that you want to aspire to be like in medicine.
  • Tap those same people on the shoulder and ask if you can meet with them for a coffee sometime
  • Have the utmost respect for anybody who comes along after you that you may mentor, and needs help working out who they trust and respect as well. Work out which camp you are in. Declare your conflicts of interest up front so they can work out how to relate to you. If you are supervising and having a direct impact on their progress through training, perhaps you just aren’t the best person to be a mentor. But maybe, when that conflict has disappeared and the registrar has moved on, you can be.

Dr Helen Schultz is a consultant psychiatrist and mentor of doctors in training. She wrote about her experiences as a psychiatry registrar in her new book, How Shrinks Think. She was recently a part of Radio Nationals Background Briefing documentary regarding doctors in distress. Helen loves being a mentor but it has to involve good coffee.

Mandatory reporting and doctor’s health. Friend or foe. ABC Background briefing today.

I have taken part in a documentary on ABC RN Background Briefing today, and I will write more posts to follow. A compelling, confronting discussion about the constant concerns of doctor’s health, the factors at play, and raw accounts of the effects of completed suicides on partners, families, colleagues and patients. Particular reference was made to the impact of recent laws around mandatory reporting as set down by the national regulatory body, AHPRA.

Well done to Ann Arnold for an amazing documentary. She has put together a depth and breadth of opinion from key people either directly affected or in leadership roles within the medical community.

My hope is that this discussion continues out of respect for the recent tragic loss of 4 colleagues in Victoria, for those that we don’t know about or those that can be prevented if the correct help is provided in a caring, professional and confidential manner.

My next post will be about the role of supervision and mentorship, and why they can’t be seen as the same thing.

Helen