Thriving in Medicine

As medical practitioners of all specialties, we are a diverse, global group of women and men, bound by long traditions, deep insights into life and a common purpose to care for people and communities. Together, we work in complex, changing environments and we are witnessing transformational advances in medical, surgical and ehealth technologies, particularly in the last decade. In the next decade, further subspecialisation of medicine and disruption of our unsustainable health systems are inevitable. In the near future, some specialties currently regarded with high status, will no longer exist, which is both exciting and threatening.

There are immense challenges facing the 21st-century doctor – stress, burnout, mental illness, suicide, substance abuse, bullying, harassment, discrimination, patient-initiated anger and violence and medical litigation – all of which result from and often contribute to a negative medical culture, which can interfere with the quality of our patient care. There is a mountain of commercial wellness books on work/life balance, positive psychology, stress management, communication skills and sleep hygiene, but many doctors find generic self-help strategies do not work in medicine because of the excessive pressures in our daily lives. For example, the competitive nature of our training programs, exhaustion due to long working hours and broken sleep, chronic exposure to patient misery, trauma and death and threats of medico-legal action or deregistration, can all weigh heavily on even the most resilient doctor. Information about healthy nutrition, exercise, meditation and mindfulness is everywhere, but how do we find the time to prioritise self-care when just getting through each day can be a challenge in itself, particularly where there are health workforce shortages?

As doctors, we carry an enormous sense of obligation and commitment to our patients. For this reason, the medical profession has had a long and admirable, but often unhealthy, tradition of self-sacrifice and selflessness at work. The culture of the medical profession is such that the signs of burnout are often worn as badges of honour. It’s time to change the mindset that being a worn-out medical practitioner is the sign of a dedicated doctor. The tendency to strive to be perfectionist, self-critical and risk-averse are traits which can make us great doctors, but can also make it difficult to work and live with us. When we raise the bar too high, we can become worn-out by our impossible expectations. How many of us are surviving or enduring, rather than thriving and experiencing joy in life and medicine?

While our medical organisations advise us to seek professional support and balance between our work and life, our medical culture is rarely conducive to doing so. In reality, medical workplaces can be harsh, cold environments and there is very little understanding for doctors who are perceived to not be carrying their weight or ‘not up to it’. On the other hand, if you are one of the fortunate among us who thrive in medicine and have not yet experienced burnout first hand, this book is also for you. We would challenge you to be proactive in protecting yourself and others, and encourage you to open your eyes to the stigma preventing your colleagues from seeking your support. There are solutions to these complex problems.

Who is this book for? As audacious as it sounds, this book is for every doctor – doctors of all specialties at all career stages, including medical students, recent graduates, doctors in training, experienced doctors and those approaching or beyond retirement, because exemplary care of our patients, our peers, our profession, our community – and ourselves – is a life journey.

Why this book? Our starting point is excellence in patient care. Clearly, to provide consistent high-quality patient care, we must care for our own health and for the health of our colleagues.

What is this book about? This book is different from generic self-help and mental health books in that it discusses practical strategies that work in medicine, based both on the medical literature and the wisdom of experienced doctors. First, it is about treating ourselves well – finding our ‘mighty purpose’ and creating our legacy; discovering and rediscovering great joy and beauty in medicine; transcending common stressors in medicine; taking back control of our time while maintaining our duty of patient care; building stronger relationships with our colleagues; responding constructively to inevitable criticism, conflict and complaints; strengthening our personal resilience; caring for our own physical and mental health as priorities; dealing with extraordinary crises and trauma; and seeking support, regular debriefing and professional help from other practitioners.

It’s about collaborative medical leadership in every day practice through caring for our colleagues, strengthening our clinical teams and changing our medical culture. These are major challenges in themselves because the focus of our care is often on our individual patients in the solitude of our consulting rooms, rather than creating a healthy environment in which we can all flourish. To summarise, there are three themes underpinning this book, which we hope will begin a new conversation about our individual and collective fortitude and common humanity at a time of immense change and challenge. By collaborating, every doctor can rediscover joy in medicine by:

  • Improving our physical and mental health to provide patient care of the highest standard
  • Creating a healthier and happier medical culture
  • Leading and influencing positive changes in our workplaces every day

Most of all, we want feedback from every doctor about ways we can do things better and what works best for us in practice. We are all still learning.

Leanne Rowe and Michael Kidd

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