Doctor Wellbeing Guide

If you have concerns about your health or the health of a doctor you know, please consider the following options:

• Discuss with your family doctor.
• Discuss with an Occupational Health Physician.
• Make contact with the Practitioner Health Matters Programme.
• Contact the Medical Council Health Committee.

These supports provide a confidential and independent service to doctors that may be going through a difficult and stressful time. We encourage doctors to access these supports.

• To ensure you are at your best mental and physical health, it is essential that you have your own GP, who is not a member of your family.
• As outlined in our Guide to Professional Conduct and Ethics for Registered Medical Practitioners (9th Edition), you should not treat, prescribe, or issue sick certificates or reports except in emergencies.
• You must not prescribe controlled substances except in emergencies.
• Your employer or the Irish College of General Practitioners website can assist you in finding a local GP.

• Do take regular work breaks throughout the day. A full lunch break and organised short breaks throughout the day will leave you in a stronger position when meeting patients’ needs.
• Use some of your lunch break for a short walk outside – this will assist in clearing your mind and feeling refreshed on your return.
• Do seek assistance from work colleagues if you feel overwhelmed to ensure the work load is evenly spread.
• A regular and consistent sleep pattern will assist your body and mind in being ready for the next day.
• Seek professional help for mental health issues such as anxiety or depression.
• Do take annual leave and have holidays booked in advance so you can be away from work with friends or family.

• While working, develop a regular eating pattern and avoid snacking in place of regular meals.
• Do not depend on alcohol to relieve stress and avoid drinking alcohol during the working week which can also reduce quality of sleep and impact mental well-being.
• Drink water regularly throughout the day to ensure your body is adequately hydrated.
• Opt for larger quantities of fruit and vegetables when preparing meals.
• Don’t skip meals or breaks or opt for fast food on the go during busy working days.
• If you are struggling to ensure you meet your nutritional needs during busy work days, it may be helpful to cook large quantities of food on your days off and freeze them in easy access portion sizes that you can quickly defrost and heat up during busy days.

• Ensure 30 minutes of exercise per day such as brisk walking. This could be done by walking in part or cycling to work or walking on your lunch break.
• Practise simple exercises in the morning before work to help feel energised and fresh.
• Use fitness apps on your smartphone to record and set daily targets for walking or steps.
• Simple measures like taking the stairs instead of the lift can really boost your activity level as well as offering a means of getting a quick break away from others if you feel overwhelmed.
• Ensure walking occurs throughout the day in your workplace or on your break.
• If you usually jog or walk daily during normal circumstances it is especially important to continue to do so during stressful periods to maintain good mental health.

The Medical Council recognises the importance of a positive working environment and collegiality in the workplace. Instances of bullying can have a detrimental impact on doctors, their ability to treat patients and to serve Ireland’s health service.

• The Medical Council will not tolerate any instances of bullying.
• All instances of bullying should be reported and dealt with appropriately by employers.
• Doctors should be aware that bullying can occur in their workplace among other staff and report such circumstances if they occur.
• All medical practitioners should show respect and offer support to each other to ensure strong collegiality.

The Medical Council’s Health Committee monitors and advises Council about the health of individual doctors who have relevant medical disabilities. Most doctors who suffer illness will recognise that they have an illness, will attend their general practitioner, consultant or occupational health physician and comply with the appropriate treatments and recommendations.. This may include taking time off work or indeed changing the nature of their work, either temporarily or permanently.

The majority of doctors with health problems will therefore have no need to have any involvement with the Medical Council or its Health Committee. Unfortunately, some with illness will not have such insights, may be in denial, or delay seeking treatment for some other reason. In such cases, their illness may impair their practice and indeed harm patients. It is this latter group of doctors who may be reported or referred to the Medical Council’s Health Committee.

The Practitioner Health Matters Programme offers a strictly confidential service to doctors, dentists and pharmacists. They have a confidential telephone line and email contact point for an expert clinical advice service and welcome contact from any individual whether you are the person in need of help, a family member, a colleague or a friend.

Practitioners can go through difficult periods in their lives and may experience stress, burnout, depression, anxiety or other conditions such as alcohol or drug misuse. Seeking confidential medical help is the most appropriate way to deal with these conditions.

Adverse incidents or complaints can also be very stressful for practitioners. They can impact negatively on mental health with feelings of incompetence, isolation, and guilt to name but a few. In some instances the practitioner can become the second victim and can feel isolated and alone. Often these are temporary feelings but talking with a professional in a confidential setting can help with processing these understandably distressing emotions.

This Programme provides appropriate care and support for health professionals in Ireland who may have mental health issues such as stress, anxiety or burnout or who may have a substance misuse problem. It is fully independent and separate from the regulatory bodies and employers. It has been endorsed by Memorandum of Understanding by the relevant professional councils and is supported by representative organisations and training bodies.

To make an enquiry or seek support please visit
www.practitionerhealth.ie, email on
confidential@practitionerhealth.ie or call (01) 278 9369.

• As stated in the Guide to Professional Conduct and Ethics for Registered Medical Practitioners (Amended)
• You have an ethical responsibility to look after your own health and well-being. You should not treat or prescribe for yourself. You should have your own general practitioner, who is not a member of your family, and you should be vaccinated against common communicable diseases.
• If you have an illness which could be a risk to patients or which could seriously impair your judgement, you must consult an appropriately-qualified professional and follow their advice. This professional will have a dual role: to help and counsel you, and to make sure you do not pose a risk to patients and others. If such a risk exists, you must inform the Medical Council as soon as possible.
• If you are concerned about a colleague’s health or professional competence due to the misuse of alcohol or drugs, a physical or psychological disorder or other factors, your primary duty is to protect patients. If there is a risk to patient safety, you must inform the relevant authority of your concerns without delay. If there is no current risk, you should support your colleague by advising them to seek expert professional help or to consider referral to the Medical Council’s Health Committee.
• You should not treat or prescribe for members of your family or others with whom you have a close personal relationship except in emergencies. You must not prescribe controlled substances for them or issue sick certificates or reports for them except in emergencies.

The Medical Council recognises the importance of supporting doctors’ physical and mental health, the following resources provide additional information on wellbeing supports that you may find useful.

HSE Resources

• HSE Employee Assistance: Programme Available to all HSE employees free of charge. Offers counselling on a range of issues including critical incident stress management.
• Occupational Health: A list of all providers is available here.
• Silver Cloud Health:Giving free access to all HSE staff to 3 self-directed online programmes dealing with stress, resilience and sleep. Dedicated phone line provided by the HSE to give information and advice to staff and managers: 1850 420 420.
• Broader supports (including family).

Postgraduate training body resources:

• Doctors Health Programme ICGP: Promotes physical, psychological and occupational health of GPs as well as general wellbeing.
• College of Psychiatrists of Ireland.
• RCSI: advice and resources for supporting clinical work and mental health in healthcare practitioners.
• RCPI: resources including videos, podcasts, tips, advice and access to psychological support in COVID-19. General wellbeing supports also available: Physician Wellbeing Programme.

Healthcare practitioner and allied health-led resources:

• The Practitioner Health Matters Programme supports doctors, dentists and pharmacists who have a concern about stress, burnout, mental health difficulties or who may have an alcohol or drug misuse problem.
• Royal Medical Benevolent Fund Society of Ireland: For doctors experiencing financial stress.
• Mind the Front Line: Set up by a group of Irish psychiatrists, offers advice to healthcare workers on a number of matters related to COVID-19.
• Psychological Society of Ireland: Psychologists fast-tracking access for healthcare practitioners here. Podcast: Chartered PSI Member Eva Doherty speaks about how frontline healthcare workers can manage their own mental health during the pandemic, under sustained stress and pressure.
• Trauma Response Network Ireland: Offering free support to healthcare workers using a voluntary panel of therapists who offer free 30 minute telephone support sessions. Email trnireland@gmail.comor phone 01 902 5020.
• Primary Care Psychotherapy: Free session available for front line workers.
• Therapy Hub: Free 30 minute first aid sessions for healthcare workers.

Indemnifier resources:

• Medical Protection Society Ireland: advice and guidance for members. Podcasts for member advice also available here.
• Medisec Ireland: Newsletter regarding COVID-19

International resources

World Health Organisation:

• Mental health considerations for the public and healthcare workers

Canada:

• Royal College of Physicians and Surgeons Canada: Wellness resources for health professionals.
• Alberta Medical Association: Physician health resources
• Canadian Medical Association: Physician advice on maintaining wellbeing.
• Doctors of British Columbia - Supports for physicians feeling stress or burnout – Physician Health Program (PHP): Clinical Counsellor supports for doctor’s concerns
• Saskatchewan Medical Association Physician Health Program. Provides access to Self-reflection tools and ePhysicianHealth.com (SMA members only).

Australia:

• Beyond Blue Mental wellbeing supports with a section dedicated to Healthcare Professionals.
• Drs for Drs: Each state in Australia has 24/7 helpline staffed by senior GPs and experienced counsellors trained in doctors’ health.
• Hand-N-Hand Peer support Facebook group for health workers.
• Mindfulness in medicine: Melbourne Centre for Mindfulness online tool for Doctors to learn more about mindfulness as ‘a tool for living in these difficult times’.
• The Victorian Medical Benevolent Association: Information on financial assistance for doctors in difficulty.

UK:

• Academy of Medical Royal Colleges advice for clinicians.
• British Psychological Society: Psychological needs of frontline healthcare staff as a result of the coronavirus pandemic.
• Intensive Care Society: Wellbeing resource library.
• Counselling and peer support for doctors and medical students in the UK.
• Poster offering advice on supporting colleagues.
• Covid-19: your wellbeing: General wellbeing tips. Managing sickness, looking after yourself and staying safe at work.
• The Joyful doctor: COVID-19 wellbeing webinars.
• Our NHS People: advice and guidance for NHS staff.
• University Hospitals Plymouth (UHP) Support Hub, which pulls together a range of Psychological, Practical, Physical and Professional supports.
• Newcastle and Birmingham NHS trust: Stress management tips.
• NHS Education for Scotland: Staff PowerPoint with tips for stress management, coping and resilience. Not available to the public.

New Zealand:

• Ministry of Health: Advice for healthcare workers
• New Zealand Mental Health Foundation: What is wellbeing

United States:

• American College of Surgeons: Assistance and wellbeing.