Issue 2: Awareness

By Dr Michelle Adams For most of us, our professional reputation is incredibly important. It’s not just how we think our patients and colleagues see us, but also our own internal barometer of how competent we think we are that matters. Our perception of our competence is derived from the kinds of thoughts we have about ourselves and our practice. What influences the content of these thoughts? Much of it comes from external feedback: a positive response from a patient, the regard of a valued colleague, a positive report from a supervisor. Sometimes we receive feedback that is less than positive: perhaps we missed something important, or failed to respond empathically to a patient in need. How we make sense of these day to day set-backs and incorporate them into our larger internalised concept of ourselves as practitioners affects how well we bounce back, or in other words, our resilience. But what affects the way we make sense of, or internalise, the things that happen to us? In a nutshell it’s a product of the interaction between our temperament and our environment. Why is this so important now? Because we are all operating in a time of generally heightened anxiety in the community, and especially within the context of health care provision. We are uncertain. We don’t know what will happen. Many of us have been cut off from our usual sources of support and self-care. Many of us are caring for children at home, and many families are also trying to teach children whilst working from home. We are existing in a milieu characterised by anxiety and uncertainty. The messages we internalise about ourselves, our self-worth and our competence cannot help but be affected by this. For these reasons, it’s possible that you could find yourself feeling more vulnerable to stress at work and at home than you usually are. Or maybe you don’t notice that. Maybe for you it will be being unable to let go and move on from a mistake that you normally would. Feeling the need to check and double check your work, decreasing your efficiency. Or maybe it will be none of these things. Maybe things at work are alright, but you are feeling suffocated and frustrated by the extra time at home cut off from your usual social supports. My point is that the psychological consequences of COVID-19 are varied and won’t be the same for everyone. Not everyone will experience a readily identifiable sense of anxiety, accompanied by clear worries about the virus. It can be really helpful to check in with yourself and have a look at how you are coping in this difficult time. If you notice that your internal dialogue is less positive than usual, that you are feeling less patient with your family, that your sleep is poor or your alcohol use has increased, then some psychological support might make a real difference. Some doctors miss out on the support they need because of the fear of triggering a mandatory report to AHPRA. You may not be aware of the changes that have recently been made to the mandatory reporting legislation. In March 2020 the mandatory reporting notification for all states other than WA (they have no mandatory reporting obligation for health professionals) changed in relation to impairments. Under the amended legislation, simply having a mental health condition or some psychiatric symptoms, does not warrant a mandatory notification. To warrant a mandatory report, the assessing clinician must be satisfied that there is a substantial risk of harm to the public. This usually implies that a practitioner both has a serious mental health condition and has made no effort to modify their practice or engage in treatment. Even if a practitioner is affected to the point that they are unable to practice, so long as a plan is made for treatment and time off work is organised, this in itself need not trigger a mandatory report. I hope that this reassures anyone who may have avoided seeking help due to the fear of being reported. Dr Michelle Adams is a registrar currently working in Tasmania. In addition to Mentate, the following may be useful sources of information for you: Your state Doctors’ Health Advisory Service – they are able to offer confidential advice on Doctors’ health matters and help you figure out what you would like to do. – a service to help you find a GP who has been trained in looking after other doctors. For urgent advice where you are imminently worried about your risk or someone else’s – your local emergency department or mental health help line. "Between stimulus and response there is a space. In that space is the power to choose our response. In our response lies our growth and our freedom."  Viktor E. Frankl