3  Wellbeing and Support

3.1 You matter

“We come unbidden into this life, and if we are lucky we find a purpose beyond starvation, misery, and early death which, lest we forget, is the common lot. I grew up and I found my purpose and it was to become a physician. My intent wasn’t to save the world as much as to heal myself. Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our roundedness. And it can. But it can also deepen the wound.”

Abraham Verghese, author and Professor of Medicine, Stanford University

This part of the booklet — the words you are reading right now — used to come at the end of it all, right before the appendix. You had to work your way through the bits on how to admit patients, how to organise respiratory function tests and how to fill in forms in a way that makes everyone happy with overall form and functionality. In a way, it was sitting there like an afterthought in a conversation about something different altogether but, hey, while we’re at it we might as well throw in a bit of an extra line. Cheers, and have a good afternoon!

The fact that this section — where we address our own vulnerability, the way we are coping or no longer coping with stressors in our work and private life — has now moved to the very beginning of this text may give you some hope that things are changing, that your colleagues here at Monash Children’s really do care about how you are doing. Coping with the stress of looking after sick children, acting on a stack of nursing calls while worrying about the upcoming FRACP exam and whether you are really, truly cut out to get through all of this.

Practising medicine can be an all engulfing job. In fact, the somewhat dated term “occupation” more accurately describes what it is we do. We occupy ourselves with what we do. Just think about where the term “resident” is derived from.

We get involved in people’s lives on a deeply intimate level, often in times of severe crisis. We see the best in humans standing by each other. And sometimes we get a glimpse of the worst.

Parents who have so far made every decision to keep their child safe can now seemingly do very little to influence his well-being. In addition, they need to provide reassurance to other family members about things that they may not be so sure about themselves. We often tell parents how stressful their situation is to allow them to reflect on their own situation and take important time to look after themselves.

We see the amount of stress families are experiencing. In fact, it’s not too hard for us to spot. It can be much harder to see our own emotional turmoil.

Accepting to be vulnerable

“When we were children, we used to think that when we were grown-up we would no longer be vulnerable. But to grow up is to accept vulnerability... To be alive is to be vulnerable.”

Madeleine L’Engle

When you started medical school you may have had a picture in your mind of the doctor you wanted to become. Maybe you imagined yourself as very decisive. Someone who could make good decisions rapidly even under severe mental stress. Chaos to the left, hopeless incompetence to the right and general undecisiveness in the centre — until you arrived to calm those stormy waters, bring order to chaos, fluid to the dehydrated and return hope to half-broken staff who had lost all faith.[^1] Because that’s how you’ve always been. Back when you were class captain and also, later, when you made it to school captain. Pride of the family. Hell, let’s not hold back — pride of the nation. Up there, making the hard calls as easily as chosing which colour Skittle to next pop into your mouth.

Or you may have envisioned yourself more during those calmer moments, quietly involved in the emotional turmoils of patients, famlies and maybe even the treating team. Just sitting with someone when there’s not a lot left to say.

But through all this did you know what working in a hospital would really be like. Outside of Grey’s Anatomy, Chicago Hope or House M.D? Ok, so you’ve prepared diligently by watching all seasons of Scrubs and even made it through the train wreck that was Season 9.[^2] But did you have any idea of how it’d really be like?

You had probably heard about long hours, about sick patients. You may also have heard about budget cuts and overworked health care workers, seen the odd report on dwindling satisfaction levels in junior doctors. And then for Covid to come and blow every problem we thought we might have had straight out of the water. Nothing like a pandemic to sort out one’s perspective on things.

In between all of this you may have heard one of your lecturers talk about the clash experienced by many high achievers between very high self-expectations and the feeling of just not getting there — no matter how hard you try. They weren’t talking about you, of course. Because you are just fine. Always have been. Always will be.

Things can get overwhelming in medicine. No, scrap that. Things do get overwhelming in medicine. For any of us. Being stressed, overworked, feeling pounded by the emotional impact of tragedy that unfolds in front of our eyes despite all our efforts. The current pandemic did not start any of this — can’t blame Covid for everything, can you — but it certainly compounded the pressures particularly junior medical staff are experiencing on a daily basis.

Tick some boxes

When you begin your new rotation you may find it helpful to put into place a few things to help you along your time in the unit.

3.2 Schedule regular meetings with your supervisor.

“If you don’t know where you’re going, you might not get there.”
Yogi Berra

Meetings with your supervisor are not at all designed to gear criticism towards you. Rather, think of them like a pit-stop where we have dedicated, protected time to check with each other that everything is in order. That things are going - or may no longer be going - in the right direction and re-adjust accordingly. Touch on what may currently make it difficult for you to perform your job and how this could be improved. What are the more difficult parts of the job, which ones are the most rewarding? What are areas where you feel you could use some more support?

These meetings are there to support you: for you to feed back on pros and cons, difficulties and joys, communication issues with certain teams or members of staff. To gain some perspective with the help of someone who may be seeing things from a different viewpoint.

3.3 Claim your overtime.

The JMS roster at MCH contains overlapping shifts designed to cover the clinical needs of our patients. There will be times when the clinical load is low and you and your colleagues may not be very busy, giving you time to catch up on your backlog, study or even get in a breather.

There are frequently times though when the clinical workload seems to exceed what the rostered teams can cope with - particularly when the afternoon shift takes over and the daytime teams are supposed to hand over their work and go home. This does not always work, when there are still many children waiting to be admitted, complex patients to sort out and many loops to close with staff and families.

If you find yourself in the situation to do required overtime make sure you put in your overtime request on your timesheet and have it signed by the Department director.

3.4 Protected personal time - afternoon off

The roster at MCH has slightly increased daily hours for JMS to help cover the clinical needs of the wards. To ensure you stay within your contracted weekly hours you have one rostered afternoon off per week. This is a time where you are not supposed or rostered to be working at MCH. It is our clear expectation that you take this afternoon off every week unless there are strong and urgent clinical care needs for you to forgo it.

We ask that the ATR and Resident coordinate their afternoons off so that at least one of you is available to cover the unit. However, please be prepared to have a valid and convincing explanation should we notice that you are not taking your regular rostered afternoon off.

Seek help. Absolutely nothing wrong with that

Almost all services in our hospital get very busy. At times things are so busy that it seems there is little time for anything else but sick children and families in need and chasing the commands your pages is throwing at you.

The thing about lack of time is that you need to make time for important things. If you are finding it hard to cope with the additional difficulties of work, if you come home exhausted only to lie awake for hours. If you dread coming to work. We want to know!

We want to know, because we have likely all been there and asked ourselves: “Am I cut out for this?”. Some of us may still ask ourselves this question, specialists in our field with the answer to about every conceivable question always at the ready.[^3] Come and talk to any team-member you feel comfortable talking to. Whether this is a nurse you get along with well, a consultant you have good rapport with or another colleague. Come find us in person, on the phone or via email.

Monash Health offer a number of services you may find useful. Find an overview on the Intranet at http://intranet.southernhealth.org.au/healthyopportunities/New_Folder/link%20pages/Mental%20Wellbeing.html

Here’s a selection of available services:

  • Victorian Doctors Health Program. Not for profit organisation that arose from the concern of a group of doctors about the difficulty for people of the medical profession - that’s you and me - to turn anywhere for help. VDHP is independent of other professional organisations (i.e. AHPRA) and has no ties to any employers. They provide assistance for issues relating to stress, anxiety, substance use problems, mental or physical health concerns as well as any other health issue affecting doctors.

    VDHP have 20 years experience in looking solely after doctors. Your information is confidential (within the limits of the Health Practitioner Regulation Act of 2009). Find out more about them at www.vdhp.org.au or call them on 03 9495 6011. There is a clinician on call 24/7 - a colleague you can talk to. After hours you leave a message on the answering service. If you are extremely concerned about anonymity either block your outgoing phone number or buy yourself a prepaid SIM card at the supermarket - it’ll cost you all of $2. You can also send VDHP an email at vdhp@vdhp.org.au.

  • There’s a good overview of services available to you on Monash’s internal Covid pages.

  • Employee Assistance Program
    Conducted for MonashHealth by Converge International. Call 1300 687 327 to initiate contact Mondays-Fridays 8am-8pm (weekend hours vary) or send them an email at customerservice@convergeintl.com.au. You will only need to state that you are an employee of MonashHealth and can otherwise remain anonymous. Services offered include counselling and debriefing. Converge will arrange for 4 counselling sessions, additional sessions may be available upon request. This service is free of charge to you.

    You can also log into their portal (use id/pw monashhealth) to access more information or request an appointment.

  • Lifeline
    Lifeline is an Australia-wide service supporting people in crisis. You’re not in a crisis, just want to talk to someone? Fine as well.

    While Lifeline don’t particularly specialise in doctors in need they are very experienced with humans in need (doctor or not: that includes you). You can contact them in a variety of ways. Their “chat one-on-one” service is particularly interesting as it has almost no threshold to overcome. Get on your browser and chat with the person on the other end. Feels right? Keep it on screen for a bit longer or maybe want to change over to the phone or even texting? Your call. Chat is available 7 days a week, 24h a day at https://www.lifeline.org.au/crisis-chat/.

    You can reach their direct line on 13 11 14.

  • AMA Peer Support
    Staffed every day from 8 am to 10 pm, your call goes straight to the mobile phone of a trained volunteer peer. This means you’re going to speak to a colleague who will know a bit about your professional background. Plus they’re trained in counselling. The volunteer can link you into services best suited to your current situation or just lend an ear. The service is anonymous, it is free and you do not need to be a member of the AMA to use it. Call 1 300 853 338.

  • **Victorian Doctors Health Program** Let’s have them introduce themselves:

    The Victorian Doctors Health Program (also providing services to practitioners in Tasmania) is a free, confidential service for all doctors and medical students who have concerns about their well being such as stress, mental health problems, substance use problems, or any other health issues.

    VDHP provides assistance to doctors and medical students who have any of the following concerns:

  • Stress and anxiety
    Substance use problems
    Mental or physical health concerns
    Any other health issue
    Help you find your own GP/Doctor

  • Advice is also provided to anyone who is concerned about a doctor or medical student. This includes family, friends, colleagues, university staff and clinical staff.

  • Since the commencement of VDHP, we have assisted doctors and medical students presenting with numerous issues ranging from those having a mild impact on quality of life to those threatening careers and lives. VDHP deals with each individual case on its merits and offers a range of interventions.

  • VDHP develops individual management plans and co-ordinates treatment, including arranging appropriate referrals to external treatment providers. We conduct our service with the utmost discretion. Confidentiality is of utmost priority to VDHP. However, like all health practitioners, we are required to remain in compliance with the Health Practitioner Regulation National Law Act 2009.[^4]

  • Sensitive to the needs of doctors and medical students, we are a non-judgmental service dedicated to improving the health and well being of those within the profession.

  • Bush Support Telephone Service
    This might not apply to you while you’re with us at MonashHealth but you might find this useful at a different time in your life. CRANA have build a support service specifically for health care workers in rural and remote areas. This is an anonymous and free service. Call them on 1 800 805 391. Their website has more information crana.org.au/support or a brochure you can download from https://crana.org.au/support/publications-our-survival-guides/.