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'How can it be,' said the fox, 'that you are able to cure others of their illnesses, but the signs of sickness can still be seen in your own face?'

Aesop’s fable of the frog and the fox echoes the proverb ‘physician, heal thyself’, and shares its moral of the need to attend to our own problems before those of others. It also makes a more literal point about the need for healthcare professionals to look after themselves.

Taking care of yourself does not simply set a positive example for your patients, or act as a sign of validity when you provide health advice. Health practitioners who are mentally and physically well may in fact provide better healthcare1,2.

Medical practitioners don’t need mountains of evidence to be persuaded that their jobs can have negative effects on their wellbeing. Their personal experience has probably already made that obvious, given the incidence of burnout in doctors is somewhere between 20% to over 50%3.

This existing poor state of doctors’ wellbeing is itself a health crisis3.

Many interventions, focussed on individuals or structural and organisational systems, appear effective for reducing burnout in doctors4. However, wellbeing is not simply an absence of the stresses that contribute to burnout of healthcare providers; rather, it “includes mental, physical, social, and spiritual [quality of life] in both… work and personal lives”, “and the presence of positive wellbeing, including vigour and thriving states and behaviours beyond mere job satisfaction.”3

The World Medical Association5, Medical Board of Australia6 and Australian College of Nursing7 all recognise the importance of practitioners’ wellbeing for the provision of optimal health care, and they encourage health care providers to look after themselves.

 

What is self-care?

The World Health Organisation defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health-care provider.” Self-care practices nurture awareness, balance, flexibility, physical health, social support, and spirituality8.

 

How to practice self-care

An important thing that health practitioners can do collectively to improve their wellbeing is to help each other. Many general practitioners do not have their own GP9, and the majority probably self-diagnose or self-medicate10. Just like for the general public, health professionals’ regular visits to a GP promote preventive healthcare9. Regular visits to primary care providers can reduce burnout and improve quality of life11.

There are useful resources to help you practice self-care, ranging from BeyondBlue’s Developing a workplace mental health strategy – A how-to guide for health services12, to RACGP’s Keeping the Doctor Alive: A Self-Care Guidebook for Medical Practitioners13. RACGP provide the following list of self-care strategies in their Self-care and mental health resources for general practitioners14:

  • Not taking work home, where possible
  • Scheduling regular breaks
  • Being realistic with time and avoiding overcommitting
  • Developing and maintaining healthy therapeutic boundaries
  • Debriefing with colleagues regularly
  • Demanding a good work-life balance (and not seeing this as a sign of weakness)
  • Maintaining a healthy, balanced diet
  • Scheduling regular physical activity
  • Practising good sleep habits
  • Practising mindfulness
  • Participating in activities that bring personal joy
  • Making your relationships a priority and enjoying time with family and friends
  • Maintaining connection with culture, country and community
  • Establishing a relationship with an independent GP to assist you to manage your own health.

The wellbeing of health practitioners has been linked to their capacity for empathy and compassion — characteristics of any good health professional — leading to the suggestion that “physician wellbeing is the foundation of professionalism.”2 In this context, health professionals would seem obligated to take care of themselves.

 

 

[1] Wallace et al., 2009. Physician wellness: a missing quality indicator. Lancet

[2] West & Shanafelt, 2007. Physician well-being and professionalism. Minnesota Medicine

[3] Brady et al., 2018. What Do We Mean by Physician Wellness? A Systematic Review of Its Definition and Measurement. Academic Psychiatry

[4] West et al., 2016. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet

[8] Posluns & Gall, 2020. Dear Mental Health Practitioners, Take Care of Yourselves: a Literature Review on Self-Care. International Journal for the Advancement of Counselling

[10] Kay et al., 2008. Doctors as patients: a systematic review of doctors' health access and the barriers they experience. British Journal of General Practice

[11] Shanafelt et al., 2012. Avoiding Burnout. Annals of Surgery

[13] Clode & Boldero, 2005. Keeping the Doctor Alive: A Self-Care Guidebook for Medical Practitioners. RACGP. https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Member%20services/Keeping-the-Doctor-Alive-Guidebook.pdf

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