Self-care: Why it matters and what to do about it

The literature is replete with research on doctors’ wellbeing.^1–3 A simple PubMed search demonstrates the explosion seen in this field, from a handful of articles 40 years ago to hundreds published last year. This increased research attention has been accompanied by a growing focus on doctors’ wellbeing by regulatory bodies and the media. Yet, there is nothing recent about the underlying difficulties doctors face in managing their health. Indeed, an article from 1859 comments on how an eminent physician died prematurely from his poor lifestyle habits.⁴ In addition to being longstanding, poor self-care practices stem from a complex series of interacting factors, many of which are not within the control of the doctor. As such, there can be some resistance within the medical community against calls for doctors to engage in self-care.

In this article, I will outline several arguments demonstrating why self-care is an essential part of medical practice and, in conjunction with broader systemic reforms, vital to addressing the current doctors’ health crisis we are witnessing across the globe. I will also introduce a new toolkit from The Royal Australian College of General Practitioners (RACGP) to guide you in your self-care journey.

Wellbeing is inherently important

Imagine you are presenting to a kindergarten class as part of a careers showcase. When you explain to the group that you are a doctor, one child asks what that means, so you tell them you look after people’s health. They then ask you the epitome of all young children’s questions – why? Why do you look after people’s health?

Think about that question for a while – why do you look after people’s health and wellbeing? Why does medicine itself exist? Why does society spend so much of its resources on healthcare and medical research? The answer to this young child’s profound question is quite simple – because people’s health is important. This is something that we as a society take to be a self-evident truth: people’s wellbeing matters. It just does.

As a general practitioner (GP), you will strongly agree with this – that supporting people to live their best lives is something that is inherently important. After all, you have dedicated your career to this. You care for your patients, helping them navigate through health and life challenges. Outside of your work, you likely do the same, supporting your loved ones in whatever ways you can.

But what about yourself? What about your health and wellbeing? Oftentimes, doctors have a strong sense of self sacrifice, focusing on others’ needs potentially to the detriment of their own.⁵ This can be greatly reinforced by medical culture under the guise of altruism or service.⁶ Yet, are you not also a person just like anybody else? Does this not mean you also deserve to enjoy a high sense of wellbeing because it is inherently important? It therefore follows that you deserve to prioritise your own wellbeing and should be supported to do so. Your wellbeing matters for its own sake.

Self-care is a professional responsibility

Beyond the inherent importance of wellbeing, you also hold a professional responsibility to support and maintain your wellbeing. The RACGP identifies a core competency of a GP as being self-aware, which includes undertaking regular self-reflective practice and appraisal, and demonstrating a positive personal health and wellbeing outlook.⁷ Likewise, Section 11 of the Medical Board of Australia’s Good medical practice: A code of conduct for doctors in Australia acknowledges doctors’ obligations to supporting their own health, including seeking support when needed and recognising the impact of your wellbeing on your practice.⁸

The rationale for incorporating self-care as part of a GP’s professionalism arises from a simple fact we all intuitively know – those whose wellbeing is compromised will struggle to effectively perform their duties. This intuition is supported by considerable evidence demonstrating the hazards associated with poor health among doctors. Three large systematic reviews and meta-analyses examined the associations between burnout and quality of care, each pooling data from over 200,000 healthcare providers. These reviews concluded that healthcare providers experiencing burnout were at greater risk for providing poor quality of care, including inappropriate test ordering and making more medical errors (both self-reported and observed).^9–11 Negative consequences have also been found for issues beyond burnout. For example, one study found that as doctors’ self-reported depression and anxiety levels rose, so too did their odds of issuing potentially inappropriate antibiotic prescriptions for patients with respiratory tract infections.¹² These observations align with the views of GPs themselves, who have voiced concern that when they experience poor wellbeing, they have reduced decision-making capacity and so deliver a lower quality of care.¹³

The consequences of poor wellbeing extend beyond clinical skills to professionalism. Another systematic review, this one specifically among doctors, highlighted several concerning outcomes of doctors’ burnout. These included reduced empathy, less participation in their practice (ie doing the ‘bare minimum’) and higher intention to leave their practice or job.¹⁴ Likewise, a study of family medicine residents found that burnout was associated with significantly poorer professionalism ratings as part of their certification milestone assessments.¹⁵ The consequences of having reduced professionalism are clear – one study found that GPs who experienced burnout were at greater risk of their patients changing their GPs.¹⁶ These consequences of poor wellbeing highlight what a serious issue this is and why action must be taken.

Self-care is everybody’s responsibility

Given how important your wellbeing is, you have a responsibility to support your wellbeing. But this responsibility extends beyond just you. Organisations and systems also have a clear duty to support the wellbeing of their doctors. Indeed, the challenges facing doctors’ wellbeing span individual, organisational and system levels, meaning an integrated approach is required. A considerable volume of literature has been written about what practices, hospitals and regulatory bodies can and should do to support their doctors’ wellbeing.^17–20 For example, the Every Doctor, Every Setting framework developed in and for Australia outlines actions that can be taken at each of these levels.²¹ It is beyond the scope of this article to comment on these initiatives; however, the core message is that doctors’ wellbeing is a shared responsibility. Although you are ultimately responsible for your self-care and wellbeing, you deserve – and can expect – the systems around you to also actively support your efforts.

Turning the intention into reality

When problems emerge, they require a response; however, as a GP, a core part of your practice is preventive medicine. You likely practise opportunistically to support your patients in making positive changes that will enhance their wellbeing in the long term. You also know how much patients’ health benefits from prevention rather than treatment. The same applies to your own wellbeing and, consequently, self-care practices. When your wellbeing is strong, it can be easy to focus your attention elsewhere, but the risk with this is that your wellbeing can start to deteriorate. Before you know it, your wellbeing is suffering and more serious action is required. It therefore follows that you need to implement structures to support your wellbeing. Such structures need to incorporate both preventive and reactive strategies so you are fully equipped against challenges to your wellbeing.

To guide you in developing these structures, the RACGP has developed a new self-care package that is now available. This package has been designed specifically for GPs on the basis of research with GPs.²⁰ Additionally, it draws on acceptance and commitment therapy,²² a psychotherapy with a strong evidence base for a variety of presentations.^23–25 Importantly, it recognises the skills and experience you bring as a GP and allows you to harness that expertise as part of your self-care. The package comprises two tools: (1) a self-assessment; and (2) a framework for developing a personalised 12-month self-care plan. Completion of these activities represents an RACGP-recognised professional development activity that will count for 25 continuing professional development (CPD) hours, covering all program-level requirements for professionalism and ethics. Further, the tools can be completed by you confidentially, so you can rest assured that your wellbeing remains in your control.

Conclusion

Self-care is something that can easily fall down the priority list among many other competing demands. Cultural attitudes within medicine reinforce this self-sacrificial mentality. However, your wellbeing is inherently important. Further, you have a professional duty to monitor and support your wellbeing. This responsibility is a shared one, requiring ongoing attention from the organisations and systems surrounding you. You are well-placed to coordinate your self-care, bringing a great deal of clinical and personal expertise to this task. This expertise can be harnessed using the new toolkit offered by the RACGP. May this article offer you an opportunity to reflect on your own self-care practices, no matter the state of your current wellbeing, and be a prompt to take positive action.

Key points

• Doctors struggling to practise effective self-care is a longstanding issue.
• Just as for your patients, your wellbeing is inherently important.
• You hold a professional duty to monitor your wellbeing and practise effective self-care.
• Self-care is a shared responsibility, requiring input from the systems around you.
• The RACGP is offering a new toolkit to guide you in your self-care journey