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Resources for Anaesthetists

Welfare of Anaesthetists Resource Documents

The following 'Welfare of Anaesthetists Resource Documents' can be freely downloaded at the Australian and New Zealand College of Anaesthetists website: http://www.anzca.edu.au/fellows/special-interest-groups/welfare-of-anaesthetists/introduction.html

These documents provide brief comment, give references, and identify strategies for use in dealing with the more common professional and personal stresses:

RD 1. Personal Health Issues and Strategies
RD 2. Financial Issues
RD 3. Recognising Depression and Anxiety (in yourself or a colleague)
RD 4. Late Career Options and Retirement
RD 6. Advice to Trainees, Training and Examinations
RD 7. Sexual Misconduct (NSW Medical Board)
RD 8. Mentoring and Peer Support Programs
RD 9. Why don't you have your own GP?
RD 10. Breaking Bad News
RD 11. After a Major Mishap
RD 12. Suspected or Proven Substance Abuse
RD 13. Impairment in a Colleague
RD 14. Medico-legal issues
RD 15. Training and Family Responsibilities
RD 16. Welfare Issues for the Anaesthetic Department
RD 17. Infectious Diseases
RD 18. Latex Allergy
RD 19. Manual Handling Injuries


RD 1. Personal Health Issues and Strategies

Problems

Anaesthesia is a demanding specialty, physically as well as mentally.

Occupational hazards include:

  • long hours with frequent and irregular overtime
  • alternating low level activity with extremely demanding, precise, procedural duties
  • potential for unexpected and rare crisis situations
  • perceived lack of recognition by peers
  • irregular meal and leisure breaks
  • “uncontrolled" work environment

Solutions

  • Have your own general practitioner and see him/her regularly (at least annually).(Resource Document 09). Choose a GP who is used to dealing with doctors as patients. Allow yourself to be a patient, and ensure your doctor treats you as one. How would you shape up as an anaesthetic risk? Dental and ophthalmic care are necessary too.
  • Do not self-diagnose or self-medicate (especially with sedatives). Corridor consultations are to be avoided.
  • Reassess your diet, alcohol and tobacco intake regularly.
  • Have breakfast every day.Take a lunch break outside the operating theatre.
  • Do not be manipulated into undertaking a whole day solo list without any breaks.
  • Remember the benefits of regular exercise. Re-discover the joys of music, books, art, conversation and relationships.
  • Recognise yourself as an expert on a par with any of your colleagues.
  • Take sick leave when it is necessary.Take all leave due to you. Do not be manipulated into feeling a break is impossible.
  • Take stock of your life once a year: Am I happy? Do I like my lists/surgeons? Who/what is stressing me? What can I do about it?
  • TAKE ACTION and remain in control

References

  • Pullen D et al. Medical Care of Doctors. 1995 MJA 162 (9):481-4
  • Vincent. Symposium: The physicians own well-being.Annals RCPSC 1986 19:131-5
  • Kelner & Rosenthal Postgraduate Medical Training, Stress & Marriage. Can J Psych. 1986;31:22-24
  • Sutherland &Cooper Identifying distress among general practitioners 1993 Soc Sci Med, 37 (5): 575-581
  • Higgs R. Doctors in Crisis: creating a strategy for mental health in health care work.
  • J Roy Coll Phys London 1994 28 (6): 538-40
  • Gabbard & Menninger (eds)Medical Marriages. American Psych. Press 1988
  • Australian Medical Association AMA Position statement. Health of Medical Practitioners. 2001
  • Nyssen AS et al Occupational Stress and Burnout in anaesthesia. BJA, 90 (3): 333-7. 2003
  • Ramirez AJ et al Mental Health of hospital consultants: the effects of stress and satisfaction at work. The Lancet vol 347 March 16 1996 724-728
  • ANZCA PS 49 Guidelines on the Health of Specialists and Trainees. 2003
  • Harrington JM The health of anaesthetists. Editorial. Anaesthesia; 1987 vol 42:131-132
  • ed O’Hagan & Richards In Sickness & in Health. Doctors’ Health Advisory Service, New Zealand

RD03. Recognising Depression and Anxiety

The Problem

  • Doctors tend to deny illness and be poor help-seekers
  • Denial is particularly prevalent in depression, as it is actually a symptom of the illness: "I'm just being stupid", "I shouldn't really be a doctor", "I'm a fraud".
  • Depression is often experienced subjectively as "stress", "burnout", with or without anxiety, or as a physical symptom eg: fatigue, headache, insomnia.
  • SUSPECT depression if there is diminished performance, pervasive changes in mood or behaviour, persisting moroseness, or withdrawal.
  • Depression may be the cause as well as the result of work problems, relationship difficulties, substance abuse and marriage problems.
  • Even when they seem to be understandable responses to a crisis, anxiety and depression may still need formal treatment.

Solutions

  • Share your concern. Others may have made the same observations. Discuss with appropriate colleagues. Consult with a psychiatrist or Doctors’ Health Advisory Service if necessary.
  • Someone must take responsibility to make the approach.
  • Someone who has the capacity to affect the subject's career MAY not be the best person to make the approach (eg: the head of department, director of training).
  • Devise a plan and rehearse fall-back strategies in case the approach is rejected(eg: re-contact in 48 hours).
  • A sensitive and timely approach expressed clearly in terms of concern for the subject will usually be effective, even if it takes several attempts.
  • Assist the subject to see an appropriate professional (a psychiatrist); confirm attendance.
  • Review structural and systemic implications (workloads, support, etc).

References

  • Morrant C. Doctors, depression and physicians’ inner landscape of fear. Can Med Assoc 1992; 146 (6): 1050-1056
  • Haw C. Coming out. BMJ 1990; 330:547
  • Styron W. Darkness Visible. Random. New York 1990
  • Victoroff V. My dear colleague: are you considering suicide ? JAMA 1985; 254 (24): 3464-3466
  • Personal View Watch me struggle, watch me drown. BMJ 1993; 307:1431
  • DCSKhursandi Stars Disappear BMJ, 15th August 1998, Vol 317, p 480-481



RD13. Impairment in a Colleague

An impaired practitioner is one who is suffering from any physical or mental condition which affects or has the potential to affect, his or her capacity to practice medicine safely. It may be acute, episodic or chronic.

Impairment refers specifically to behaviour or performance which compromises patient safety.

Problems

  • Anaesthetists work in isolation.
  • Recognition of impairment is difficult, even when the colleague is well known to you.
  • Notification mechanisms are inadequate.

Recognition

  • Nursing or anaesthetic assistant staff may report behaviour or incidents of concern.
  • Other staff may complain about his/her work. Personality clashes must be distinguished from impairment.
  • Practice may be noted to deviate significantly from accepted standards.
  • Family members may report concern about his/her health.

Solutions

  • ‘Buddy’ and/or mentor systems in a department may be of use (see Resource Document 08). Peer review, QA and accreditation systems may help in the early identification of impairment.
  • Discuss concerns with a trusted colleague – two heads are better than one.
  • Use the sick doctor scheme if necessary (Doctors’ Health Advisory Service, DHAS)
  • The medical profession has a duty of care to the profession as well as patients – there is a duty to report an impaired colleague to the relevant medical board if patient safety is jeopardised. This is mandatory in some States/New Zealand. Most State Medical Boards and the Medical Council of New Zealand have Impaired Registrant panels which can advise on, and supervise treatment and rehabilitation of, doctors with performance issues in a structured, supportive, non-punitive manner.
  • In the case of drug dependency, see Resource Document 02 and the Auckland Hospital Substance Misuse Protocol.
  • If necessary, trusted colleagues or nursing staff should be specifically asked to monitor performance, in complete confidence. Potential medico-legal problems must be considered. Consult with your defence organisation. Privacy issues should also be considered. All concerns must be documented.
  • Discussion of the problems with the person concerned should be done with extreme care, The person should have a support person accompanying him/her if they wish. Insight should be assessed. Take time to listen.
  • Sick leave, retraining or retirement options must be considered. ANZCA can assist with competency assessment.
  • Anaesthetists should not self-diagnose or self-medicate. Corridor consultations should be discouraged. The importance of having one’s own general practitioner is again emphasised.

References

  • Medical Board of South Australia The Need for Care of the Medical Profession 2003
  • Atkinson RS The problem of the unsafe anaesthetist BJA 1994 73:29-30
  • O’Hagan J. The best of health to you, doctor. NZMJ 1996 109:280-2
  • Posen S. Doctors in Literature. The portrayal of the doctor in non-medical literature: the impaired doctor. MJA 1997 166:48-51
  • Schwartz et al. Four years’ experience of a hospital’s impaired physician committee. J Addictive Diseases, 1995 14(2):13-21


NB: The 3 Resource Documents listed above have been prepared in good faith and having regard to general circumstances and is intended for information only. It is entirely the responsibility of the practitioner as to the manner in which s/he follows these documents, having express regard to the circumstances of each case, and in the application of these documents in each case.

The information contained in these document is not intended to constitute specific medical or other professional advice. The College and Societies, their officers and employees, take no responsibility in relation to the application of use of these Resource Documents in any particular circumstance.

These Resource Documents have been prepared having regard to the information available at the time of their preparation. They are reviewed from time to time, and it is the responsibility of the practitioner to ensure that s/he has obtained the current version. The practitioner should therefore have regard to any information, research or material which may have been published or become available subsequently.

Whilst the Welfare of Anaesthetists Special Interest Group endeavours to ensure that Resource Documents are as current as possible at the time of their preparation, it takes no responsibility for matters arising from changed circumstances or information or material which may become available subsequently.