While the latest funding is welcomed, our commitment to mental health needs to match the burden of disease, writes Dr Sarah Chalmers
While attending the Rural WONCA Conference, I had to use some of my resilience to deal with the fact that I was unable to attend a session on “Building resilience and preventing burnout in rural practice”.
There were international rural and remote practitioners spilling out the door of this session. I’m not sure if, like me, they were hoping for some hot tips for survival, but it was clear that the issue strikes a chord with many of my peers.
Resilience is understood as “the capacity to recover quickly from difficulties” or “the ability of a substance or object to spring back into shape”. Resilience in the medical profession has come under scrutiny of late, with the recent suicides of both junior and senior doctors prompting the federal government to inject funds into mental-health interventions for doctors.
But what does resilience mean to a doctor practising medicine in rural and remote communities?
Medicine requires the ability to discuss and manage almost anything a patient can hurl at you. In general practice we move from one patient to the next every 15 minutes, and this can include a request for a medical certificate, acute AMI or intense and imminent suicidal intent, all within the space of 45 minutes.
In rural and remote practice, the scarcity of specialist colleagues requires us to wholly manage these issues, as there is often no-one else to refer these patients to. Presumably, an ounce of resilience, and the ability to “spring back into shape”, means we can genuinely apologise for running 60 minutes behind, replace the wide-eyed horror with a winning smile and say to the next patient “And what can I do for you today?”
The problem, of course, is one of measurement: how long can we keep going? What makes people resilient? Can we teach it? Can we select for it with our students and registrars? What impacts on, and threatens, our resilience? Are some specialties in medicine more resilient than others?
If only I had resisted the urge to have another bad cup of coffee and a Danish at morning tea, I might have arrived in time to get a front row seat at the WONCA workshop, and may already have had some answers to these questions. The WONCA rural working party intends to release a list of recommendations which came out of the workshop – so all is not lost!
On a serious note, current, often-discussed threats to the resilience of GPs include the issues around professional respect, remuneration and growing expectations for increased outputs without extra resources. These extra outputs include the ever-growing red tape, administrative requirements and business management expected of general practitioners, and the increasing burden of chronic disease.
The issues of bulk billing, and so-called six-minute medicine, are a whole different discussion. Doctors find themselves being pulled in all directions, and having to make decisions under an increasing burden of demands. It is understandable that over time, something may give.
This brings up, again, a chronic disease that is one of the keys to resilience – mental health. I think we are starting to realise that we are not well prepared to manage the mental-health issues in our communities.
We don’t have adequate resources or training, and our inability to manage our patients’ mental health will have a significant impact on our own state of mind.
Dr Molly Shorthouse has made a name for herself in calling for a JCCA equivalent for mental-health skills for rural and remote generalists. She got a guernsey as a keynote speaker to describe her pathway into being one of Australia’s first Mental Health Rural Generalists. I’ve worked with Molly, and she was able to provide great support to me and my patients who were suffering from mental-health issues more complex than I had the time, skills or capacity to manage as effectively as I would have liked.
Having provided care for my own remote community over the last 12 years, some of the hardest and most heart-breaking of my healthcare interactions have been as a result of really complex mental-health issues which I have been unable to resolve. I strongly suspect that having invested more of my training in mental health, and less in intubation skills or trying to comprehend the anion gap on an ABG, may have saved more lives.
I have patients and colleagues, and friends and family of colleagues, who are suffering mental-health issues and their consequences. This is compounded by not having access, or the sense of being denied access, to mental-health services.
There are so many things we can do to help with this issue – allow doctors to admit to the limits of their resilience and get help, provide better resources for all mental-health services, including those doctors who are so generous enough to want to care for their own.
Governments, both state and federal need to take more responsibility in helping to find solutions for this increasing problem. The commitment to mental-health funding needs to match the burden of disease.
Any commitment made so far is welcome, but there also needs to be acknowledgement of the effect that the lack of resources has first on patients, and then on the primary-care sector drowning in the burden of disease demands. And that the commitment needs to be bigger and deeper.
The knock-on effect for the wellbeing, resilience and prevention of burnout among all general practitioners means our communities are counting on it.
Dr Sarah Chalmers, FACRRM, works as a GP at Endeavour Health Services in Nhulunbuy, NT
