1. Rahaïa Editorial October 2014:
Guest Editor Dr Damien Daniel
Physician – Heal Thyself (Luke 4:23)
October 5–12 was Mental Health Week.1
Such initiatives should encourage us
to stop and look at ourselves and those around us. We all know how prevalent
the rate of mental illness is in our patients, especially depression, and we take
care to observe, ask and instigate treatment if necessary. Not only do these
illnesses interfere with the rehabilitation program, they can be partly treated
with exercise and psychology, two essential elements of a rehabilitation
program. How often, however, do we take the time and care to turn the
microscope on ourselves? After all, the same illnesses in us can lead to poorer
care of our patients through impaired concentration, memory and substance
abuse.2
It has been shown that medical students and doctors suffer much higher rates
of stress, anxiety, depression and suicidal ideation than the general
population.2
More than a quarter of doctors are highly likely to have a minor
psychiatric disorder.3
However, perceived stigma about mental illness remains
rife in the field, with almost half of doctors believing that doctors with a
history of depression or anxiety are less likely to be awarded jobs and 40%
agreeing that many doctors think less of doctors who have experienced
depression or anxiety.3
Therefore, doctors are, on the whole, reluctant to seek
help or discuss their issues with others.
Risk factors include personality traits identified as common in medical
professionals (e.g. perfectionism, commitment, self-criticism and
obsessiveness), high workloads, conflicting time demands and heavy
professional responsibility.2
Another issue we are all familiar with is the need
to study while working.2
One less publicised, but just as important, factor that
has also been identified as a significant contributor is deficiencies in

2. interpersonal skills and communication training in medical education.2
This
impacts on doctors’ ability to communicate their own feelings and therefore
their ability to seek help.
Attempts have been made to address these deficiencies at various medical
universities in Australia in the past decade. In addition, the AFRM Fellowship
Clinical Examination (FCE) emphasises communication skills in its marking
scheme. The lack of these skills in AFRM trainees has been identified as
contributing significantly to poor passing rates in recent years. This trend has
been arrested in 2014, despite the exam continuing to be heavily weighted
toward communication in the OSCEs. The reason is likely to be multifactorial;
however, one significant contributor is almost certainly that the need for
strong communication skills has been identified, and finally understood, by
AFRM trainees. Trainees are now concentrating on building strong
communication skills in preparation for the FCE. This will be reflected in
examination results and also in clinical practice. Hopefully, it will also result in
greater emotional understanding and expression and in greater self-care. As
such, it needs to constitute a significant part of Rehabilitation Medicine
training for these multiple reasons.
The Royal Australasian College of Physicians has two interim Trainee in
Difficulty Pathways, separating the issue into difficulties with examinations
and work-based difficulties.4
One example listed in the work-based difficulties
pathway is personal/external issues.4
This is presumably where stress,
depression and anxiety come in, and it is a shame, but not surprising, that
issues with mental health are not given more emphasis, especially given their
greater prevalence in this population. Nonetheless, every trainee, supervisor
and Fellow needs to be aware of these documents and how to deal with these
issues, be it for themselves, their trainees or their colleagues.
The first step is identification. Mandatory reporting laws have muddied the
water in this regard, with some doctors arguing that it will further stigmatise
mental illness and lead to further reluctance in self-reporting. The Australian
Medical Association (AMA) has endeavoured to address these concerns, and it
remains paramount that doctors are afforded the same opportunities for
treatment as every other Australian.5
It can be argued that Rehabilitation Medicine requires better communication
skills and empathy than some other medical disciplines due to the models of
teamwork we encounter every day and the high level of patient contact over
extended periods of time. Managing individuals and teams takes
thoughtfulness, respect and understanding, as well as strong communication
skills. These are skills we must employ daily. An additional benefit from
enhanced interpersonal and communication skills is the ability to express our
own emotions. And with these skills we can develop a language of self-care.
Whilst we take great pride in identifying and managing the pain and

3. difficulties of others, be they physical, psychological or social, we often lack
the skills and/or the wherewithal to apply the same care to ourselves. We
should endeavour to cast our eyes and thoughts inwards, express what we
find and seek appropriate help. And we should look a little more carefully at
each other too. Not to do so could be viewed as being negligence, not only to
ourselves but to those we purport to care for.6
References
1 www.abc.net.au/mentalas/
2 Elliot L, Tan J, Norris S 2010. The mental health of doctors: a systematic
literature review. Executive summary. beyondblue: the national
depression initiative.
3 Harrison, D 2013. Doctors more likely to get depressed. The Sydney
Morning Herald, 7 October.
4 www.racp.edu.au/page/educational-and-professional-development/trainee-
support.
5 Sexton R, Morton B 2011. Mandatory notification. Australian Medicine, 21
March. https://ama.com.au/ausmed/node/1990.
6 www.beyondblue.org.au