Anna Mitjans and Miquel Vilardell: Fostering healthy practice among physicians

Anna Mitjans and Miquel Vilardell describe the experience of the Barcelona Medical Council and Galatea Foundation in creating programmes that focus on caring for healthcare professionals and preventing ill health

The Barcelona Medical Council’s* Caring Programme for Sick Physicians (PAIMM (Programa d’Atenció Integral al Metge Malalt)), which has so far given assistance to nearly 3000 doctors, was formed in 1998. As we started to recognise how other health professionals would benefit from similar caring programmes, the idea for the Galatea Foundation arose. The foundation was created in 2001 with the support of the autonomous government of Catalonia with the aim of enhancing the health and wellbeing of all health professionals, including doctors, nurses, veterinarians, pharmacists, psychologists, dentists, social workers, and physiotherapists. 

Caring programmes for all these professionals are managed by the Galatea Foundation and led by their respective councils. We think that these programmes are an essential tool for patient safety, while also helping healthcare workers and promoting professional cohesion. However, the foundation wanted to go further than caring for professionals who are already unwell; we also wanted to work on preventing this ill health from developing in the first place. With this aim in mind, we created preventative and health promotion programmes that would carry out research into the attitudes and behaviours of healthcare professionals and develop training initiatives to improve them. 

Since 2006, we’ve gathered and analysed a vast amount of data about healthcare professionals’ health, lifestyles, and working conditions. Our data confirms that healthcare professionals have a greater risk of poor mental health than the general population. While the risk of poor mental health for the general population in the same socioeconomic group as doctors is 6.6% (using data from the 2014 Catalan Health Survey (ESCA)), doctors, psychologists, and dentists have around a 20% risk, and pharmacists, nurses, and medical students an even higher risk (all over 35%). 

A prospective study we carried out among residents who joined their training programme in 2013 also found that the risk of mental disorders increases from 15% as a baseline to 29% after their first year and to 38% at the end of their training period. Worryingly, these findings would seem to suggest that residents’ mental health worsens as time goes by, instead of them learning how to deal with and manage workplace stress, as might be expected.

When we analysed residents’ working conditions it was apparent that in their last year, most of them were working more than 60 hours a week due to on call duties. Most of those interviewed were largely accepting of this since it involves a much higher salary. We also asked residents in their final year to rank their workplace experience in terms of the support received from superiors and colleagues; the control they have over their work (in terms of autonomy and creativity); their participation in decision making in either their service, department, or hospital; and the psychological demands placed upon them. We found that residents who reported having a poor experience in these categories were more prone to becoming mentally unwell.

From our research, it seems that women are more at risk of poor mental health, including anxiety, stress, and depression. This was the case in all healthcare professions, although in the case of nurses and psychologists we didn’t have enough men in the samples to firmly make this conclusion. We know from the women surveyed that they still bear a greater part of the domestic workload, including childcare and looking after older parents, which is a contributing factor to becoming stressed and ill.

These results have been very useful in designing new training initiatives (such as workshops, e-learning, and clinical sessions) to raise awareness and promote self-care. If we want high quality healthcare systems, then health professionals should be taught to care for themselves. Indeed, self-care should be viewed as essential for being a good practitioner.

In the preventative programme we have for resident doctors we have invested a lot of energy in workshops to encourage a healthier practice both for resident doctors and their seniors. It is a coordinated effort with training staff from doctors’ hospitals, primary care centre, and the Galatea Foundation training team. These training sessions are an opportunity for the attendees to share and discuss the causes of stress in resident doctors and how to develop the skills and attitudes to manage it. They also learn to deal with difficult situations with the support of occupational health services and the Galatea Foundation’s caring programmes. Since starting this initiative, more than 350 resident doctors have been treated so far.

We also recognise that healthcare professionals’ workplaces have a responsibility in this matter too and that self-care is difficult (or even impossible) in an organisation that doesn’t support it. Consequently, we’ve recently been using the data available to design interventions to help healthcare teams work in a more compassionate manner and enhance the individual-team-organisation “fit.” These interventions focus not only on the individual, but also the interdisciplinary team where they work, and the organisation employing all of them. We expect to develop these interventions more in the years to come as we gather and assess more data. Once we have more evidence, we can recommend the effective components to be included in organisations’ management practices.

These initiatives are absolutely complementary to the caring programmes and centred around the principles of prevention, where possible, and early detection where it’s not. We want healthcare professionals to be able to easily find someone who can help them when they have mental health disorders but, moreover, we want professionals and the institutions they work for to learn how to manage risks to wellbeing and foster healthy practice.

*“Barcelona Medical Council” directly translates to “Collegi de Metges de Barcelona,” although it has both functions of medical council and association.

Anna Mitjans is the corporate projects manager in the Barcelona Medical Council and the preventative and health promotion programmes manager in the Galatea Foundation. She completed an MBA and has devoted her career to the health and social sector.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: None declared.


Miquel Vilardell is a specialist in internal medicine, president of the Galatea Foundation, and former president of the Barcelona Medical Council.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: None declared.



Related article: Gustavo Tolchinsky Wiesen and Jaume Padrós: Caring programmes for sick doctors are a crucial step to self-regulation