So What Now?.... How Do I Look After Myself??

1. So What Now?.... How Do I Look After Myself?? Dr Drew Moore Senior Lecturer in General Practice School of Medicine University of Queensland doctordrewmoore@gmail.com

5. The 3 P (primary, preventative, patient-centred) and 3 C (continuing, comprehensive, in the community) model of general practice, espoused by Monash University Department of Community Medicine (Victoria) seems to be substituted, when it comes to doctors’ own health with the 3 D (delusional, denial and delay) and 4 S approach (self-investigation, self-diagnosis, self-treatment and self-referral) Rogers 1998 In an extreme case with near disastrous consequences, Miller (1997) cites a case of a surgeon attempting to self-perform a haemorrhoidectomy!!

6. General Healthy Living as a Medical Student/Doctor • Sleep – adequate and restful, avoid fatigue and long work hours • Exercise – daily for at 30 minutes • Diet – regular meals including breakfast, low saturated fat, avoid junk and takeaway foods • Social contact with partner, family and friends (including non-medical friends) • Colleague support and opportunity for debriefing • Having your own GP (see following slides) • Avoid alcohol and drugs as coping mechanisms • Meditation practice (see following slides) • Relaxing and enjoyable activities or hobbies separate from medicine • No self diagnosis, self treatment or self prescribing • Holidays for recreation, study or conference leave, sick leave or “mental health days” • Spiritual wellbeing

7. But How Do I Find A GP?? • Existing GP • Colleague/Friend recommendation • Not a relative, a partner, a friend or a doctor in the same practice as you • Medicare Local or Local Division of General Practice

8. But I am Healthy - Why Do I Need to See a GP? • Complete history on a new patient • Past Med Hx, Surg Hx, Medications and Allergies • Family Hx eg any early bowel or breast cancer in the family? • Social Hx – partner, family and friends, support structure • Alcohol, smoking, recreational or prescribed drug misuse • Vaccines – HepA and B, DTPa, Influenza, ?MMR, ?Varicella • Sexual activity, sexuality and STI screening if appropriate • Pap smear, contraception, pre-conception advice, HPV vax • SNAP (smoking, nutrition, alcohol, physical activity) • Weight, height and BP • CVS risk assessment (if multiple risk factors) • Skin cancer exam if high risk • Depression screen and other affective disorders • Stress levels and management strategies employed • Blood borne virus status – HepB immunity (?seroconversion from vax), HepC and HIV (Medical Board of QLD has policy statement that yearly checks if doing invasive procedures and increased frequency if needle stick or personal risks) • To establish an ongoing relationship with an independent GP, learning to be a patient and have this relationship established before your intern year

9. Relaxation/Meditation Practice • Book “The Happiness Trap” by Dr Russ Harris CDs/MP3 “Mindfulness Meditation 1 & 2” by Dr Russ Harris www.thehappinesstrap.com www.actmindfully.com.au • Acceptance Commitment Therapy (ACT) – accept what is out of your personal control, while committing to whatever is in your personal control to improve your quality of life • Mindfulness Meditation is a mental state of awareness, focus and openness which allows you to engage fully in what you are doing at any moment

10. What worked for me as a Junior Doctor • Drink water and listen to your body’s needs • Carry snacks with you (eg dried fruit, nuts, protein bars, fresh fruit) • Take meal breaks and control your pager during these times • Limit hours of work and be vocal with hospital administration • List tasks (notebook) and prioritise, realising that there is endless work to be done • Use your sick leave and “mental health” leave and don’t feel guilty about doing it • Accept imperfection in your medical working life and uncertainty • Be supportive rather than competitive with colleagues • Have medical protection insurance • Have income protection insurance • Attend risk management and communication training with Cognitive Institute (often free via your hospital, college or medical defence organisation) www.cognitiveinstitute.org • Ask for help both professionally and personally and realise your limitations of safe practice • Find an area of medicine you love and find rewarding

11. What works for me now • Balance of work and mix of interests – clinically, teaching and surgical assisting • Working in great work environments with people I trust, respect and like • Knowing my limitations and lots of inter-colleague consulting on patients in clinical practice and teaching • ½ day off each week • No on call • No weekend work • At least 2 weeks holidays every 3 months • At least 6 weeks holiday in one block every year • Refine and plan my work mix for the next year after reviewing what is working for me and what is not this year • Not having huge debts, financial needs or having to live an extravagant lifestyle – realising that my happiness and satisfaction is related to my relationships with other people and not my material possessions • Learn and practice using the word “NO” and not feel guilty • Having my own GP, care and interest in my diet, what I eat and cooking, exercise, meditation, enjoyment and non-medical friends, asking for help, social involvement with family, friends and students and valuing my partner • Feeling genuine gratitude for how lucky I am in my life

12. References • “Guidelines for Preventative Activities in General Practice” (“The Red Book”) 8th edition, RACGP, 2013 www.racgp.org.au/your-practice/guidelines/redbook/ 2. “The Conspiracy of Silence among Medical Practitioners”, RACGP, 2004 www.racgp.org.au/Content/NavigationMenu/PracticeSupport/peersupport/20060106conspiracy_of_silence.pdf • “AMA Survey Report on Junior Doctor Health and Wellbeing”, AMA, 2008 www.ama.com.au/node/4217 • “Managing the Risks of Fatigue”, AMA, 2008 www.ama.com.au/node/4193 • “The Student and Junior Doctor in Distress – Our Duty of Care”, Medical Journal of Australia, Vol 177, 1st July 2002 www.mja.com.au/public/issues/177_01_010702/suppl_010702.html • “Self Care Strategies for Doctors” (series of 3 articles), Australian Family Physician, Vol 31, No.4 (April), No.5 (May) and No.6 (June) 2002 (via UQ Library search as AFP accessed via the RACGP only goes back to 2003)