Margaret Kay: Physician health starts with all of us

We mustn’t forget the power of empathy and kindness in our interactions with colleagues

Enhancing physician health is often presented as a Sisyphean task within the medical literature. It’s not an endeavour to be embarked upon lightly and is consistently positioned as being well outside the reach of the “average” physician. The lofty ideal of achieving cultural change can seem especially daunting, leaving individual physicians perplexed and the status quo untouched. But at the recent Third International Meeting on Wellbeing and Performance in Clinical Practice (WELLMED 3) in Greece, we took up this challenge.

The conference provided a refreshing perspective on physician health, offering practical strategies for addressing this phenomenon. The 120 or so attendees came from across Europe, the US, Canada, and Australia. As researchers and clinicians delivering care to physicians, the attendees were deeply invested in physician wellbeing and how to enable it.

Acknowledging the growing reports of high burnout rates within healthcare professions, Christina Maslach opened the conversation by revisiting the construct of burnout. She suggested that burnout is located at the interface where the individual physician and the health organisation connect. Understanding the complexity of this space, where the individual and organisation meet and must “fit” together, helps to explain why support and training interventions that just focus on individual physicians cannot effectively address burnout.

The problem is that the idea of developing systemic interventions can overwhelm the profession. While Maslach and Leiter have outlined six organisational issues associated with burnout: workload, control (autonomy), reward, community, fairness, and values, the difficult questions remain. Where to start? Who starts? But focusing on the “fit,” rather than either “individual” or “organisation,” provides a new lens for considering (and hopefully improving) physician health.  

All physicians can play a part as an enabler (or not) of a positive “individual-organisational fit.” Each of us contributes to the dynamics of the system itself, and can change a workplace culture, which may be cultivating burnout, by demonstrating compassion for our peers and proactively challenging the bravado that encourages, or even rewards, doctors working when ill.

There are other ways in which the individual physician and the health system touch, such as through education and with regulation.We can hone our educational techniques, so that our training organisations inspire excellence in healthcare without denigrating the learner. And since professional self-regulation is intimately connected with physician health, better collaboration between regulatory bodies and physicians can ensure a robust system that supports wellness in both physicians and their patients. Fundació Galatea in the Catalan region of Spain has demonstrated how an organisation can work closely with a regulatory agency to ensure patient safety, while still helping health professionals access confidential healthcare—even for complex mental health issues.

The sessions on narrative medicine were especially exciting. While I was already familiar with narrative medicine, including the writings of Rita Charon, these presentations demonstrated how narrative medicine could be applied to promote physician wellness in our day to day work. These sessions explored our use of narrative when physicians engage with their colleagues, and suggested that unlocking the personal narratives of our journey in medicine can provide powerful opportunities for teaching, team building, and care giving. By giving teams more opportunities for reflection, participants could better identify “invisible” institutional values, articulate dissonance with personal values, and proactively recognise institutional levers for enabling change—all of which would help to enhance “individual-organisational fit.”

The conference offered other practical strategies for developing a positive wellness culture within organisations. Mindfulness, gratitude meditations, poetry, drama, and Balint groups are often positioned as simply being personal wellness strategies. Yet incorporating these strategies within the health organisation enables connectedness between individual and organisation.

For example, improvisation with actors can enhance team development and interprofessional learning in emergency departments. Dr Louise Nash’s presentation of “Grace Under Pressure” demonstrated how drama techniques can be incorporated into medical education courses to enhance self-reflection. The sharing of narratives in Schwartz rounds enhances the compassionate quality of care, as well as staff wellbeing. And Balint groups can be incorporated as a positive peer review process within hospitals, enhancing communication across specialties when there is diversity within the membership of the group. These innovations can foster physician health at a systems level and benefit individuals, but more importantly they address the “individual-organisational fit.”  

To conclude the conference, Ronald Epstein wove the many threads of our learning together, highlighting the importance of compassion as we communicate with our colleagues. Compassion has already been recognised as an essential element of safe patient care, but we mustn’t forget the power of empathy and kindness in our interactions with colleagues, which can foster those individual-organisational connections.

Physician health starts with each of us. It is not simply about our personal endeavours to enhance our personal physical and mental health. In each connection with our colleagues, as we talk about patients, when we meet in busy corridors, as we lead, as we teach, as we work in a team—it is at these moments that we have a part to play in enabling the health of physicians. Where to start? Who starts? Enabling the flourishing starts here and starts with us. The myth that enabling physician health is a Sisyphean feat needs to be dispelled.

Margaret Kay is the medical director of the Queensland Doctors’ Health Programme and a part time GP. She completed her PhD in physician health with the University of Queensland where she currently holds an academic title of senior lecturer.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following:

  • Medical director of the Queensland Doctors’ Health Programme, which is an independent service supported through funding from the Medical Board of Australia. (Paid employee)
  • Chair, Expert Advisory Council, Doctors’ Health Pty Ltd (a subsidiary company of the Australian Medical Association.) This is unpaid, though attendance at face to face meetings is supported with travel and accommodation costs reimbursed