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Doctors’ Health: Inspirations using Complexity Theory

Doctors’ Health: Inspirations using Complexity Theory. Dr. Margaret Kay MBBS(Hons),FRACGP, Dip.RACOG The University of Queensland. History. 1869 – Paget intemperance of 6% medical students 1886 – Ogle increased rate of physician suicide 1966 – Ironside – Otago, NZ

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Doctors’ Health: Inspirations using Complexity Theory

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  1. Doctors’ Health:Inspirations using Complexity Theory Dr. Margaret Kay MBBS(Hons),FRACGP, Dip.RACOG The University of Queensland

  2. History • 1869 – Paget • intemperance of 6% medical students • 1886 – Ogle • increased rate of physician suicide • 1966 – Ironside – Otago, NZ • High prevalence of stress in medical students • 1968 – Davies – Australia • High prevalence of stress in medical students • 1969 – Cramond – Australia • High prevalence of stress in physicians

  3. Literature • Physical health • mortality, low SMR (non-smokers) • Longitudinal cohort studies • Surveys – lots of studies • stress, mental health issues, workplace issues • Doctors are healthy • Healthy doctors = healthy patients

  4. Literature Gaps • Health access – limited data • Qualitative research– paucity, seriously ill • Illness Narratives • Interventions • Impaired physicians • Medical School • Minimal follow up • We all know that …

  5. Theoretical Perspective • Reductive Biomedical Perspective

  6. Complexity Science • Chaos Theory • Weather – Lorenz • Non-linear relationships • Patterned, not predictable – can be understood • Emergent • Self-organisation • Feedback

  7. Complexity Science Non-linear Systems Resilient Major change – minimal response Small changes – Major response Butterfly effect Bifurcation

  8. Complexity of doctors’ health Multiple intersecting issues Med student, junior doctor, senior doctor Mental health, physical health, workplace health Health access, health systems, Impairment, regulatory issues Community expectations Cultural issues

  9. Complexity of doctors’ health • Patterned behaviours • Non-linear interactions • Emergent processes • Self-organisation • individual, mentors, carers, culture • Sensitive to initial conditions • Responsive to external environment

  10. Doctors’ health access • Many components • Connected Profession T-D D-P Practice Legal Dynamic Community

  11. Doctors’ health access Profession T-D D-P Practice Legal Community No single component controls the system

  12. Doctors’ health access No single component controls the system Profession T-D D-P Practice Legal Community

  13. Doctors’ health access Legal • Self-prescribing • All students must… • All doctors must… • Mandatory reporting Resilient non-linear system major change – minimal response

  14. Doctors’ health access Mandatory reporting Small changes – major response in system Major response – bifurcation complete change in the patterned behaviours Unintended consequences

  15. Moving forward • Multi-dimensional • Holistic • Collaborative • Creative • Responsive / Iterative • Emergent – ground up, practical • Mentoring • Harness the resilience • Feedback - monitor

  16. Thank you

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