A targeted approach to improving our wellbeing and a thoughtful approach to managing the demands upon us can turn our work from a source of stress to a source of further wellbeing. Mental health statistics for Australian doctors are sobering with high rates of psychological distress, as well as depressive and anxiety disorders. Work stress is often cited as a contributory factor and yet our unique work as doctors has the potential to contribute enormously to our mental wellbeing.
So, what’s going wrong and how can we change our experience of work from stressful to wonderful?
Stress is experienced when we perceive that the demands on us exceed our capacity to withstand them. We can therefore reduce our experience of stress by increasing our resilience and/or reducing the demands upon us. We increase our resilience by improving our wellbeing.
Fortunately, we don’t need to speculate on how to improve our wellbeing. Decades of research has identified the key components that contribute to wellbeing and they are succinctly summarised by Seligman and his PERMA+ acronym.
Positive emotion
Engagement – in activities that promote ‘flow’ and the ability to be present in the moment
Relationships
Meaning, purpose, a sense of being part of something bigger than ourselves
Achievements – working towards goals as much as achieving them + exercise, nutrition, sleep and optimism.
By enacting on this evidence base outside of our work, we can build resilience. Furthermore, being a doctor provides incredible opportunities to find PERMA+ within our work itself. At work we can achieve flow to build relationships,
to find meaning and to work towards achieving goals.
The notion of deliberately reducing the demands upon us may seem quaint and impossible to many doctors at first glance. However, I would argue that not only is it possible, but it is also actually our responsibility as doctors to regulate the demands upon us. Optimal patient care requires us to be mentally healthy ourselves.
Beyond altruism, there are many forces driving us to work longer and faster. It is up to us to understand these and to regulate them – not just for our sake, but for the sake of our patients. Let’s examine a few of these.
1) Health system pressures
A system that is perpetually under resourced will always ask more of its doctors. It is up to us to understand this and to accept the limits of our individual capacity to meet these apparently endless needs. By acknowledging our limits within a large, complex system, we are more able to enjoy our work within it.
2) Cultural, parental and family pressures
These (often unconscious and unspoken) influences are powerful forces that relate to the attainment of status and prestige. They have influenced us all since childhood and may have played a role in us selecting a career in medicine in the first place. By consciously examining the role these influences may have played, we are empowered to choose our own path.
A ‘people pleaser’ will often find it difficult to say no to patient requests and referrals. This personality trait, so common in doctors, can be an important contributor to burnout when not carefully managed.
3) Financial pressures (large debt, expensive lifestyle)
Financial incentives relate to status and security. By asking ourselves “how much income and wealth do I really need”, we can find the balance that enables our work to contribute to our wellbeing, not reduce it. Research into the association between income, wealth and wellbeing is inconclusive, with many studies failing to find a correlation, let alone causation.
By carefully reflecting on how these invisible forces impact us as individuals, we can be better placed to manage the demands upon us. Actively managing our workload, and improving our resilience via the PERMA + approach, our unique work can be a source of wellbeing, not stress.
Key messages
- Doctors experience high rates of psychological distress
- The PERMA+ acronym outlines components for mental health
- Doctors can turn their work into a source of wellbeing.
Author competing interests – nil