New Doctor’s mental health workshop – tackling crucial conversations

It is fantastic to be running a workshop for RANZCOG addressing doctor’s mental health in one week’s time. I have been advocating in this space since 2003, when armed with the important role of AMA(Vic) President, Doctor-in-Training Subdivision. At the time we were rocked by the news of suicides among our registrar population. In 2003, some of the responses made by consultants included;

Maybe they weren’t cut out for medicine

Maybe they just weren’t ready to face the pressure

Maybe they shouldn’t have sat the exams

Maybe they chose the wrong career

What are the current factors impacting on doctor’s health and wellness?

In 2017, 14 years later, I hear the same thing. I hear that somehow when a tragedy such as suicide occurs, it must be something to do with the doctor’s weakness or vulnerability. Few real conversations have focused on the external factors that push doctors to the edge. Seldom do discussions focus on how doctors reach out for help, are spoken to in the workplace, or suffer when they speak out against intolerable conditions or heartbreaking situations.

Some shifts doctors endure contain enough graphic content that if a movie would attract a R 18+ rating. Doctors are inherently resilient because they turn up again the next day for more. So the conversation we need to have isn’t about resilience or self care. It’s about true advocates standing up for others so we can have safe, compassionate workplaces and rewarding careers.

So, after spending so much time in this space, participating in many committees and panels, speaking at conferences and treating so many doctors and medical students, I am using this opportunity to go straight to the heart of the matter. How to have a crucial conversation. What can happen when conversations go well and what can happen when they don’t. How breaking bad news can lead to suicide or a positive outcome. How third party regulators such as AHPRA and our colleges have conversations with us, whether we are prepared to hear them or not. Knowing when to put our hands up and ask for help and when to keep our opinions to ourselves and go elsewhere for what we need.

Communication is the key.

So, most  of the agenda for the RANZCOG doctor’s health workshop will play out via role plays using the brilliant acting skills of Mr Glen Hancox, professional actor and director of ACTReal. Glen has worked with me for 7 years, and together we have run through hundreds of scenarios to display rather than preach valuable learning. We have coached and trained many doctors in key specialty areas, worked in the corporate world and now developing conversations around doctor’s mental health.

So what sort of conversations will we be examining in depth?

The clinical scenarios I have written to be included in the workshop are based on conversations and interactions I have either witnessed or have been involved with. They will encapsulate the following;

  • doctor’s help seeking behaviour
  • the need for every doctor to have their own GP
  • managing performance rather than being labelled a bully 
  • how to relate to junior colleagues to be the mentor you truly want to be.

 

All are raw and controversial, designed to be so that we can have real conversations to evoke change. They are also completely fictional (including names).

Keen to read more? Here are the teasers:

  1. That corridor conversation. After a multidisciplinary team meeting,  Dr Anne Salter, a psychiatry registrar working in consultation-liaison psychiatry (wanting to be a perinatal psychiatrist) is approached by Dr Alex Scott, an O&G registrar. Alex is being paged but wants to have a ‘few minutes’ with Anne to ask her opinion about something….
  2. Doctors treating doctors. Dr Alex Scott consults with Dr Simone Davige, a GP in a busy family medical centre. Alex is nervous but after talking to his wife, and trusting in Anne, he decides to open up and be honest about how he is struggling…..
  3. The supervisor asking “So,  how’s it going?”. Dr Ian Anderson is a senior consultant in the gynaecology department. He is well meaning, but quite detached from the issues facing junior doctors. His idea of mentoring a junior doctor is to share his own experiences that he thinks are valuable to hear about rather than listening….
  4. The consultant delivering negative feedback. Dr Peter Richard is a consultant and supervisor. He has had feedback from the college and other peers that his registrar Dr Sophie Donald is ‘not up to scratch’ He hates conflict but knows he has to tell her some hard truths….

By working through these scenarios, and with the guided expertise of Dr Mukesh Haikerwal, and Ms Mayada Dib, we hope to uncover what is at the heart of the matter for doctors who have mental ill-health and need our help. They are, after all, valuable, meaningful people who have devoted their lives to helping others. We owe it to work out how to help them, or not put them in a situation where they are distressed.

And all kudos to RANZCOG who are holding their regional scientific meeting in Albury NSW after they lost a fellow to suicide in Albury in 2016. They have opened the event up to all health professionals regardless of specialty.

If you would like to contribute to the discussion to help our colleagues please register here

See you in Albury,

Best wishes,

Helen

 

Throwing the branding baby out with the bathwater

I wasn’t expecting such a heated debate on Twitter when I woke yesterday, regarding the upcoming state RANZCOG congress, and now known as “Mirenagate”.  But I shouldn’t have been surprised because that’s exactly what happens on Twitter. The reason I love being a doctor on Twitter, and why I know social media has the power to change.

Some amazing doctors that I admire so much on social media, including Dr Nikki  Stamp and Dr Eric Levi has put forward their points of view regarding what could have been an absolute branding nightmare for the RANZCOG on 2nd January 2016. The Australian newspaper revealed that a branch of the RANZCOG was proposing a debate on whether female registrars should be given contraception to avoid breaks in training. It happened outside business hours, as these things often do,  and that is exactly why all organisations regardless of industry and craft need a strict social media policy that can firstly identify and secondly handle anything.

I call this a branding nightmare because I know as a coach and mentor of doctors in training, and past president of the AMA(Vic) Doctors in Training subdivision that the RANZCOG are leaders when it comes to providing flexible and supportive training for men and women. I speak as a total outsider, but hey they leave some other colleges for dead. I know that those within the RANZCOG have worked very hard to establish a brand, their college seal that when viewed by potential applicants, actually means something. To me it has meant that they mean business when it comes to workplace training and flexibility.

BRAND related text inside hand drawn jigsaw piece on chalkboard

This is why branding and mission statements are so crucial, and also why they are so vulnerable. Anybody of official status or anybody who represents the RANZCOG in a public forum needs to protect their brand and mission statement. This is especially at times of crisis, when negative comments hit the media, and should also reflect not just the content but the approach to training registrars. This includes choosing how to phrase topics on conference agendas.

I have spent the last three years learning the art and craft of branding and know a little bit about social media thanks to some wonderful friends I found in the Twittersphere. Oh and a brand accelerator program that cost a bomb. I am writing my article based on two viewpoints, but both on what branding means to me. Branding is powerful, so when messages are delivered that are inconsistent with a brand we feel we can trust, we feel let down. Speaking for myself, I felt hurt and disappointed to see such a progressive college take such a stance when choosing agenda topics, regardless of whether federal council knew about it, and also felt that eerie silence that follows when there is no official response, and the subsequent void which becomes swamped with outcry.

This article is an attempt to explain to those at RANZCOG why so many people were upset and shocked at the headline in the Australian magazine yesterday. I know the new owner of the @RANZCOG handle is an expert on branding and social media too, and I am not trying to tell him how to suck eggs. But maybe others within the college can listen to leaders like Dr Joseph Sgroi and take on what he knows about branding, consistency and social media.

I am also writing this as a mum who, like many who have spoken on social media, really copped a rough deal when pregnant. I wonder how many have suffered as they left parenthood until too late and now face infertility. Men and women that choose to share parenting roles (believe me I know that there a quite a few male registrars who are really looked upon as being totally selfish when choosing to go part time to share parenting).  So I couldn’t help but be shocked by the title for the debate at the RANZCOG congress. Even if it isn’t my college, once again I felt they were a college that were better than this, and it brought back what I put up with.

Here is my story, as a psychiatrist who only ever wanted to be a psychiatrist. At some stage I really wanted to specialise in child and adolescent psychiatry. I also wanted to have a baby. And soon because I went to medical school in my mid 20s, and time was ticking.

In 2006, I was working in an advanced training position in child and adolescent psychiatry, and passed my clinical exams when 15 weeks pregnant. I even blitzed the OSCE station based on a CPR scenario, with the mannequin placed at the feet of the examiners so I felt they could look down our tops as we did chest compressions. (The RANZCP did acknowledge this was a problem after quite a few complaints but female registrars were implicated and found to be at fault for not choosing correct work attire suitable for all work situations). Anyway I digress.

At 30 weeks gestation I developed gestational diabetes and hypertension.  At 34 weeks my beautiful son was born. The week before it was decided that I should step aside from my office bearer role within the AMA as it was a very important role and should be handed over to somebody that was not about to go on to maternity leave, rather than seeing out my term (at this stage I didn’t know what was to happen the following week, and trying to come to terms with BSL’s of 11 despite eating food resembling cardboard). The day I was to start insulin, I started being a mum.

I was meant to become a mum around early December 2006. My 12 month post with my teaching hospital would end in January, as all of us registers are only employed for 12 months, hence no accrual of any entitlements. There was no planning or offers of roles, or even a discussion about what my plans were with regards finishing my advanced training. Because I became a mum in October, I got a few extra weeks leave of maternity leave.  Maternity leave ended at the end of my 12 month contract, and in early February 2007, I was an unemployed mother of a premature baby with severe reflux. My post was given to somebody else, but not as a maternity leave role.

I know I was classified as unemployed, despite paying money to the RANZCP to apply for a ‘break in training’. Because outside of medicine, if you don’t have a job, you don’t have a job. None of this ‘just get back in touch and we’ll keep you in mind, we’ll see what we have when you are ready to return’. Westpac bank wouldn’t cop it. I was unable to refinance my mortgage as I was unemployed. That was only one of many examples.

So after coming up for air, and recognising the irony that I was working in a sub-specialty that is based on attachment, infancy and how easy it is to stuff it all up, I didn’t go back to child and adolescent training and I didn’t go back to that hospital. I focused on my beautiful son and made damn sure I didn’t mess up what I could manage when it came to attachment and bonding. I finished my training in general psychiatry and got out. Not only out of training but also the public mental health system.

I know that many of us get caught between the interface of our colleges and our workplaces, both blaming each other, and doing a lot of ’keepings off’.  That comes at a personal price to us. So yes when we see topics like what appeared in the Australian yesterday we will be hurt.  And when we believe in a brand that represents a college that we do look to as one of the better ones when it comes to caring for their trainees regardless of gender, we might take to Twitter and shout the sky down.