contact details.

The guide aims to get students thinking and talking about their own health and wellbeing and brings together advice from a wide range of experts in the field, on topics including stress management, mental resilience and financial planning. It aims to actively break down stigma associated with poor wellbeing, as well as provide practical resources to help YOU in times of stress.

Whether you’re a 1st year straight out of O-Camp, or a final-year chomping at the intern bit, we hope that you will take something from this guide that helps you to navigate your way, body and mind intact, through the rest of your studies and career.

Visit the AMSA website to download now

New GPRA resource to assist registrars in negotiations

For many registrars, negotiating an employment contract can be a challenging process. There are many things to consider when making the transition from the hospital system, with its standardised terms and conditions, to the more flexible world of private general practice.

While private GP clinics provide a community service, they are also businesses so there is scope to negotiate the terms and conditions of your employment contract based on the value you bring to the practice.

This GPRA guide is designed to help make contract negotiation easier for you throughout your training and post-fellowship. The scope of the guide concentrates on negotiation for GPT1 and GPT2 registrars, but many of the guidelines apply to registrars and GPs at any career stage.

Download your copy of More than Money: A Negotiation Guide for GP Registrars

The 3rd Annual Art of Good Health and Wellbeing International Arts and Health Conference is taking place at the National Gallery of Australia, Canberra, 14 to 18 November 2011.

• The Art of Good Health and Wellbeing, Canberra 2011
  • Program at a Glance
  • Arts and Health Australia Awards for Excellence 2011

Doctors are largely on their own to devise rules on how to maintain appropriate boundaries with patients on social media, and how to ensure that what they post online does not reflect badly on themselves, or the profession.

AMA Council of Doctors in Training has addressed this issue head-on, in a new initiative in conjunction with the the New Zealand Medical Association Doctors-in-Training Council, the New Zealand Medical Students’ Association and the Australian Medical Students’ Association.

Social Media and the Medical Profession & Psychologists – a guide to online professionalism for medical practitioners and medical students, provide practical guidelines to assist doctors and medical students to continue to enjoy the online world, while maintaining professional standards.

Click here to download the resource.

An ageing population, population growth, technological advances and increasing expectations of the health system will continue to sharpen the focus on a system that delivers value for money. This report has evaluated the cost-effectiveness of 150 preventive health interventions, addressing areas such as mental health, diabetes, tobacco use, alcohol use, nutrition, body weight, physical activity, blood pressure, blood cholesterol and bone mineral density.

As doctors, it challenges us to learn more from intervention experiences in tobacco control and sun safety, which have demonstrated enormous benefit in the past from well-targeted and sustained activity. It suggests that similar success could be possible in areas such as alcohol use and obesity.

Click here to download the report.

I CAN still fondly recall the first diagnosis I ever made. As with many others that followed, it was spectacularly incorrect, but it still holds a special place in my heart.

In my defence, I was just a mere boy at the time, wet behind the ears and only a few weeks into my first term at medical school.

I was sitting in the local Kentucky Fried Chicken and spotted a man slumped unconscious in his plastic seat.

A wave of excitement flooded over me. This was what it was all about! This was my vocation! With the limitless enthusiasm of youth and inexperience, I bounded over to undoubtedly save his life with my new-found wealth of medical knowledge.

It didn’t take me long to conclude that this gent had suffered from a spontaneous pneumothorax.

This was not based on clinical signs and symptoms, but more, that this was the condition we had learnt about that morning in a tutorial, and so was the first and only diagnosis that sprung to mind.

With an air of self-importance, I explained to the KFC manager my diagnosis and instructed him to call urgently for an ambulance.

Looking thoroughly unimpressed, he wandered out from behind the counter and roughly manhandled the unconscious man from his seat and threw him out of his restaurant.

My first-ever patient spectacularly regained consciousness, uttered a few obscenities addressed to no one in particular and staggered off down the street.

The KFC manager, in his far superior wisdom had, in fact, made the correct diagnosis of ‘drunk and asleep’ and prescribed him a swift exit from his premises.

I can see why the professor chose to teach us innocent medical students about a spontaneous pneumothorax that morning. It is, in fact, a wonderful feel-good condition for doctors.

An otherwise healthy person collapses with a deflated lung and then the clever doctor diagnoses it with his stethoscope and sticks a needle between their ribs. With a triumphant hissing sound, the lung inflates and the patient feels much better.

The professor was trying to help explain the normal functioning of the lung and what could go wrong. He was also trying to encourage us to embrace the wonderful healing abilities we could have as doctors.

Back during those early days of medical school, I believed most of medicine would be that straightforward. Someone would be unwell, I would do something fabulous, and then they would get better.

Funnily enough, despite a spontaneous pneumothorax being the first medical condition I ever learnt about at medical school, I have, in fact, never actually seen one since.

Looking back, I wonder if actually a far more useful and accurate introduction to being a frontline National Health Service doctor would have been a tutorial on how to remove a semiconscious drunk bloke from a waiting room.

First day

I can still remember my first day as a doctor very clearly. It is something that I had been looking forward to since I first chose my A-level subjects eight years earlier.

Now the actual day had finally come, I was absolutely shitting myself and wondering if I wanted to be there at all.

We spent most of the first day having induction-type talks. These consisted of a fire-safety talk and an introduction from a medical lawyer on how best not to get sued — not particularly confidence boosting.

As the induction day drew to a close, most of the other new doctors went to the pub.

Not me though.

I was doing my first ‘on call’ on my first-ever night as a doctor.

This may have been the short straw for some, but, although frightened, I was excited and keen to get my first on call over with.

‘This night would be themaking of me,’ I thought to myself. By this time tomorrow, I would be feeling like an old pro and be regaling heroic stories of my lifesaving antics to my admiring colleagues in the pub. It was going to be like losing my virginity all over again.

Just as I was beginning to gain a little confidence, my pager made a frightening sound.

Instead of the normal slow, steady bleep, there was a stream of quick staccato bleeps followed by the words ‘Cardiac arrest Willow ward. Cardiac arrest Willow ward.’

To my horror, that was the ward that my consultant covered. That meant that I should really be there.

I started running. The adrenaline was pumping, my white coat was sailing behind me as I zipped past people in the corridor.

I was important. It felt great!

Suddenly, as I got closer to Willow ward, a terrifying thought dawned on me, ‘Oh my god. What if I’m the first doctor there!

‘I’ve only ever resuscitated a rubber dummy in training exercises. I’ve never had to do the real thing.’

To my left was the gents’ toilet. Doubts began to race through my head. ‘Perhaps I could just nip in there and hide for a bit. I can reappear in a few minutes once the cavalry has arrived.’ It was tempting, but I bravely decided to keep on running and meet my fate.

Lying in a bed was a frail old lady with her pyjamas ripped open and her torso exposed. She was grey and lifeless and I can remember her ribs protruding out of her chest wall.

A couple of nurses were frantically running around looking for oxygen and the patient’s notes, while another nurse was doing chest compressions.

To my relief, a remarkably relaxed-looking medical registrar was standing at the head of the bed and calmly taking charge.

A monitor was set up and it was clear, even to me, the wiggly lines on the screen meant the patient needed to be shocked.

A few other doctors soon turned up and I was pretty much a spectator as they expertly performed a few rounds of CPR followed by a set of shocks.

It was all very dramatic, but the woman didn’t seem to be making any signs of a revival.

Thinking that I had managed to escape my first cardiac arrest as an onlooker only, I began to consider sneaking away, aware of how many mundane jobs were waiting for me to be done on other wards.

Unfortunately, the relaxed looking registrar spotted me and called me forward: “This one’s not coming back. Shall we let the house officer have a go with the defibrillator?”

I had just done my CPR training and it was all still clear in my mind. This was my big moment. For some reason, I had it in my head that if it was me who shocked her, she would suddenly come round. “What a great

story that would be,” I thought as I stepped up to the bed.

The one thing the instructors had really emphasised in the resuscitation training was the importance of safety.

I had to make sure all the doctors, nurses and oxygen masks were clear of the bed before shocking the patient.

I stepped up and took the paddles. Lifting them out of the machine, I carefully placed them on the woman’s chest. Looking all around me, I started the drill:

“Oxygen away, head clear, feet clear, charging to 360, shocking at 360.”

BANG.

My adrenaline had been pumping, but I hadn’t expected that. I had stayed on my feet, but had been thrown backwards with a jolt.

That never happened with the dummies. I must have been looking slightly dazed and the registrar glanced over at me with faint amusement: “You’ve electrocuted yourself, you prat.”

Unfortunately, he was right. I had checked closely to make sure the bed was clear of bystanders before I gave the electric shock, but I hadn’t realised that on running to the ward, I had shoved my stethoscope into the pocket of my white coat and as I was leaning over

the patient, the nicely conductive metal tubes had been lying on the patient’s left hand.

As if to rub salt in the wound, my first pathetic effort at resuscitation led the woman to go straight into asystole and the registrar called it a day.

The correct thing to have done would have been to report my electrocution as a critical incident and give me a bit of a check-over, but instead, the registrar just disappeared off the ward chuckling to himself.

I had made his night and he called me “Sparky” for the rest of my six-month spell at the hospital.

The ‘pat dog’

My last hospital job before I became a GP was in psychiatry. I already knew I wanted to be a GP by this stage and, given the large amount of psychiatry in general practice, I thought it wouldn’t be a bad idea to spend six months learning a bit more about mental health. The job I had was actually in forensic psychiatry.

I was on a locked ward with patients who were supposedly ‘criminally insane’.

I loved going to parties and telling people I was a forensic psychiatrist. It sounds good, doesn’t it?

It gave people the impression I was akin to the Robbie Coltrane figure in Cracker, solving crimes and bringing insane criminals to their knees with my brilliant questioning and diagnoses.

The reality, of course, was very different.

I wasn’t really a forensic psychiatrist, I was the junior doctor attached to the forensic psychiatry team.

I wandered around the ward doing the odd blood test and checking blood pressures. Occasionally, I would write a letter to the home office asking whether a patient would be allowed to go to his sister’s wedding as long as he promised not to drink too much or murder anyone.

The patients themselves were a mixed bunch. They had all committed crimes of some sort while mentally unwell, but many of them didn’t really need to be locked away.

One of the lads had set fire to a homeless hostel when he was having scary delusions and hallucinations because of schizophrenia.

There was no malice involved in his crime. In his psychotic state, he had simply been trying to save the other residents by smoking out the evil spirits.

His symptoms were well controlled now by medication and he wouldn’t have hurt a fly. However, arson is taken seriously so he was locked up on our ward.

Another patient became quite paranoid when smoking weed. He got into an argument at a party and stabbed someone.

I’m not sure if it was the paranoia to blame or simply the stupidity that lots of young blokes have when a bit drunk and stoned.

That was 10 years earlier, but he remained on our ward because he was still apparently a danger to society.

Our oddest patient was called Tommy. I’m not quite sure what his diagnosis was, but he was on the ward because of his sexual disinhibition. He had never raped or sexually assaulted anyone, but he used to expose himself a lot and masturbate in public.

Tommy was fairly quiet on the ward and the other patients had learnt to tolerate his odd behaviours. They would quite happily sit in the TV room trying to guess the Countdown conundrum while Tommy would be sitting quietly in the corner wanking himself off over Carol Vorderman.

Tommy’s behaviours seemed to be getting better with some help from the psychologist, and we thought things were going well until the incident with the docile old ‘pat dog’, kept around to make people feel a little better for a bit.

Everyone loves a big cuddly docile dog that likes being stroked. Trigger was just this type of dog.

He was a 10-year-old labrador who just adored being given attention. His owner was retired and enjoyed bringing him round to the hospital.

While Trigger was being petted by the patients, Ted, his owner, would have a cup of tea and a chat with the nurses.

It was a Wednesday afternoon and I was sitting in the nurses’ office writing up some notes. Trigger was in the lounge with the patients and Ted was in the office with us talking about his impending hernia operation.

Suddenly, we heard barking. “That’s odd,” said Ted, “Trigger never barks.”

We all rushed into the lounge to see a very upset-looking Trigger being chased around the room by a naked Tommy and his erect member.

It shouldn’t have been funny, but it really was. We never saw Trigger or Ted again.

Small talk

Drew, one of my patients in general practice, was a very good-looking guy. He was in his early twenties with big muscles, perfectly chiselled features, blonde hair, blue eyes and a probably fake, but nonetheless healthy-looking tan. “I’ve got a painful testicle, doctor. Wondered if you’d have a look at it.”

I was the only male doctor to have worked at this practice for over a year, and my first few days were spent seeing a queue of relieved men worried about their genitalia. Some had been worried about their ‘bits’ for months, but had been too embarrassed to expose themselves to one of the female doctors.

So there I was, gently rolling Drew’s testes between my fingers, looking for lumps. It can be a slightly uncomfortable situation for the patient in every sense of the word, so I decided to try to make a bit of small talk to put him at ease.

“So Drew, what do you do for a living?”

“I’m a film actor.”

“I thought you looked familiar. Have you been in anything I might have seen?”

“That depends, Dr Daniels, I only really do gay porn.”

“Ah, probably not then, no. You … erm … must have one of those familiar-looking faces, I guess. Definitely wouldn’t have seen you in a film. Nothing against porn or anything, except the degradation of women and all that … well, not many women in your films, I should imagine.”

There was now only one person in the room who was uncomfortable and it wasn’t Drew.

I really should remember to limit my small talk topics to the weather and city centre parking problems.

Extract from Confessions of a GP, Dr Benjamin Daniels, HarperCollins Publishers, 2011

As a global community, it seems to me that we value the ‘lofty’ virtues, courage, generosity, bravery, justice, self control, altruism, fortitude, morality, loyalty and so the list goes on. We see this reflected in mainstream media where, if we take courage for example, it can mean anything from a person risking their life to save a pet from a burning house, to a footballer running on an injured leg and kicking the winning goal in a grand final. Sure, these things may well be courageous, but if we allow our wisdom and morality to be dictated by the five o’clock news, we run the risk of undervaluing the gentler virtues. Those virtues that aren’t newsworthy enough to hit the headlines, and kindness, in my view, is top of the list.

Why did I start thinking about this? Well, I spend so much of my time talking, listening and interacting with people from different professions, from different cultures and people working and living in a diverse range of environments and yet I constantly feel a level of disconnect from people that made me wonder about all of this. Recently a friend of mine was talking about her workplace and how all they care about is ‘the bottom line’. The same day at a workshop a nurse told me she didn’t have time to talk to patients, “cause she had too much work to do!” Of course, this was like the proverbial “red rag to a bull” and I asked her to tell me about the ‘work’ that took precedence over talking to her patients. Sadly, it was the age old story of demands on her time that made her feel pressured and anxious. Fearful that a patient would want more of her time than she was able to give, she gave no time at all…she avoided communicating with her patients, just in case she couldn’t meet their expectations.

This is not an unusual occurrence. You only need to spend as much time as I do talking to nurses, doctors and other health professionals to understand why patients think that hospitals are soulless, uncaring places. No one has adequate time to spend so rather than disappoint their patients; they avoid them all together and put all of their energy into tasks rather than into “people”. But this practice isn’t confined to healthcare.

Have you tried to get served in a shop lately? Or what about the hairdressers? Years ago an appointment at the hairdresser wasn’t so much about the haircut, but about the relationship you had with the person cutting your hair. They were your counsellor, your cheer squad, your Australian Women’s Weekly gossip columnist. They were with you for the length of your appointment, fussing, talking, listening, cutting, dyeing, washing and MASSAGING your head. Now, you’re lucky if they stand behind your chair for five minutes before racing off to put in someone else’s foils or to wash off someone else’s perming solution or to answer the phone. And you know what? If you talk to them, they feel just as frustrated, just as pressured and have just as little job satisfaction as their contemporaries who work in health or in call centres or for the government or in any other environment you can think of. And when people are constantly under this sort of pressure, whether real or imagined, they lose their humanity, little by little. It stops being a job and becomes a battle for survival. Once this all pervading culture invades a workplace, it gains more and more momentum as the stress levels of the staff rise. Over time, people forget to be polite, they forget to be thoughtful and they forget to be kind, it’s all they can do to maintain the struggle to keep their heads above water. This HAS to change!

Time has a constant presence in conversations about workload, career development, organisational culture, job satisfaction and consumer or customer satisfaction. Talk to anyone who’s required a service lately or think about the last time you wanted to buy something in a shop. The ‘give away’ symptom of a disempowered, stressed and unsatisfied staff member is that they will not have eye contact with you. If they don’t see you, you can’t require anything of them and therefore they can finish the task at hand.

What happened the last time you went to the doctor’s surgery? If you’re like me and sometimes find yourself at one of the ‘McDoctor’s’, you won’t get eye contact from the receptionist when she calls your name, from the doctor (for the two minutes you’re sitting across the desk from him/her) you won’t even get eye contact after the whole process is finished and you pay your bill. Then you go home with a script for your infection and a ball of anger in your gut. You walk in the back door and realise that because you had to wait for an hour beyond your appointment time to spend that precious two minutes in the doctor’s office, you have now run out of time to cook dinner, so you have to order take away. And guess what? The lady on the phone says “Sorry there’ll be an hour wait for home delivery ’cause we’re really busy”.

Every person we come in contact with during the day ‘splatters’ us with their frustration and we become contaminated. It’s like a virus and it’s virulent. I call it the “I don’t have time” virus and we need to find a cure before we all become anxious, angry, despondent and unkind. From there it’s a fast downhill slide into chaos. Relationships cannot survive this virus. Organisations can’t survive it. Community groups definitely can’t survive it. AND yet…

Think about what has happened in the past months with the disasters in Queensland and Victoria. People have SOMEHOW been able to shake of the shackles of this virus, put aside their normal lives and go to the aid of areas devastated by flood. Lots of people have avoided the temptation to say “I don’t have time” and have proactively DONE something. They’ve donated money, advice, expertise, goods, clothes and TIME. But I’m not suggesting that we all “down tools” and head to disaster zones, in fact what I’m saying is that if we don’t do something soon we’ll all be living and working in emotional, social and spiritual disaster zones of our own creation.

So where do we begin?

My suggestion is to start small. Kindness doesn’t require as much concentrated thought and energy as empathy and compassion. It is the first step towards empathy and compassion. At the risk of embarking on a diatribe about ethics theory, my simple understanding is this. Empathy, requires us to ‘step into someone else’s shoes’, stay there for a bit, feel how it feels, think their thoughts and experience their experience, then step back out, better informed. Compassion requires us to take action.

Therefore my simple equation is that empathy + action = compassion.

It requires intention, heart and commitment. Compassion takes work and personal investment.

Kindness is a whole lot easier. We don’t HAVE to be able to empathise to be kind. Kindness is as simple as a touch, a thought, a gentle word, a smile. Kindness can be as simple as NOT bitching behind someone’s back or scowling at the girl behind the counter in the bakery, not matter how long she’s kept us waiting. Kindness can be as simple as doing something to save someone else having to do it. It can be cleaning up the cat poo on the kitchen floor, to save your partner having to do it or watching “Top Gear” because he enjoys it (even though you can’t stand Jeremy Clarkson). Kindness doesn’t take a huge effort, it requires little or no planning and you can wrap it into your day with a minimum of fuss.

Being unkind, in my mind, is not an act of commission, but merely an act of omission. You haven’t necessarily done something cruel or mean or hurtful to someone else, you just haven’t had the presence of mind or the wisdom to BE KIND. It’s up to you to want to change this.

Kindness probably won’t win you a Nobel Peace Prize, but it will make someone else’s day just a little bit better and you know what? It will make YOU feel better. Kindness is also contagious and I believe it’s the perfect cure to the “don’t have time” virus…..Why? Because it takes no time at all to be kind, it takes only a shift in your consciousness. It requires you to open your eyes, your ears and your hearts and the rest will follow. You’ll begin to notice what’s happening around you, in your home, in your workplace and in your community. You’ll incorporate a touch, a smile a gentle thought into your day and everyone will feel the benefit. People around you will model what you do and before you know it your organisational culture will start to change. People may even start to experience some joy in their work. Time will cease to be an artificial, linear construct and will evolve to be more about quality rather than quantity.

Now you might well read this and say, “What would she know? She doesn’t work in the dump I work in!” And you’d be right, I don’t know how it is for you, but I know the difference it made for me some years ago when I decided it was up to ME, to change how I felt about things in order to change what I experienced every day. All I can tell you is that kindness costs nothing, but you stand to gain a whole new perspective on life and you have the opportunity to experience joy you never thought was possible. I’m no Aristotle, no Socrates, I can only tell you what’s real for me, after that, it’s up to you. I just can’t help but think, if we all decided right here, right now to be kind, how different our world would be.

When we consider all the complex issues we juggle every day, sometimes it seems easier to try to ignore the frustration and just get on with the job. But chronic states of stress can catch up with us and if this happens, patient care will suffer. Most importantly, we need to challenge our medical culture, which tends to encourage us to wear our state of chronic stress like a badge of honour. For these reasons, all of us need to think about ways to maintain our resilience in the long term and how we care for our colleagues.

Looking after ourselves and building strong relationships are essential components of providing competent medical care to our patients. Here, we discuss eight principles for being a resilient doctor.

1. Make home a sanctuary

In any demanding career, it is essential to have a quiet sanctuary away from work. It is sometimes difficult to nurture personal relationships when working long hours or in different locations. It is tempting to withdraw from contact with family and friends on the weekends if we have been interacting with hundreds of people during the week. While making time for solitude is important for self-renewal, withdrawing socially from people regularly is a sign of burnout, which can lead to mental health problems.

Unfortunately doctors experience high levels of marital and sexual disharmony with partners, often due to the excessive demands of work. We can proactively choose partnerships and friendships that energise us and provide mutual love and support. As doctors, we often find ourselves adopting our carer role in our personal relationships as well as our professional lives. While this is inevitable, it is important to seek out people who will help sustain us.

Those of us with children need to be aware of the pitfalls of parenting and the challenges of balancing the responsibilities of being a parent with a busy professional life. We need to choose a parenting style that protects our children and allows them to grow into healthy, autonomous adults. By caring for our families and friends, we create a welcoming sanctuary at home — a place to relax and restore our loved ones and ourselves.

2. Value strong relationships

Strong doctors have strong relationships. As doctors we face excessive demands on a daily basis. To get the job done, many of us try to manage each day by unsuccessfully attempting to complete endless ‘tick lists’ at the expense of our professional and personal relationships.

We need to take time every day to nurture healthy relationships with ourselves, our family and friends, our patients, our colleagues and our physical environment. Anyone with the right training and experience can become an excellent medical technician. What sets excellent doctors apart are their strong, caring relationships with people.

3. Have annual preventive health assessments

As doctors, we each need our own doctor, someone whom we trust for our medical care and advice. If we are going to prevent major health problems, we must attend our doctor for regular, evidence-based preventive health assessments. This will allow early identification and management of the symptoms and signs of any physical or mental illness.

The early detection of serious illness saves lives and can prevent years of unnecessary suffering. As doctors, we deserve to have access to the same level of quality medical care that we provide to each of our patients. Our families also deserve this standard of care. Organise for a check-up today with a trusted colleague.

4. Control stress, not people

As doctors, we tend to have reputations for being overcontrolling. Whether this is true or not, many of us tend to develop driven personalities as an adaptation to the demands of our work. This personality can be a positive in the workplace, but can be damaging in our personal lives.

We need to accept that other people can’t be controlled and allow others to learn from the consequences of their actions. We need to learn to delegate and share care more effectively. Sometimes our patients, particularly those with special needs, benefit from a multidisciplinary team approach rather than the services of a single doctor working in isolation.

It is important to maintain feelings of control over our lives by managing the stresses we do have control over. Ignoring problems will not make them go away. Stress should not be worn like a badge of honour. We can take time to address the background stresses in our lives and to transcend difficulties by:

• Understanding our driven personalities and learning to take a break from these traits.
• Recognising and addressing signs and causes of chronic negative stress.
• Leveraging time and delegating tasks.
• Challenging our own negative thinking and beliefs.
• Aiming for wellbeing, rather than absence of stress.

5. Recognise conflict as an opportunity

This is not about seeking or avoiding conflict. It’s about managing conflict maturely when it inevitably arises. In order to deal effectively with conflict, we can recognise it as an opportunity to build stronger relationships with people.

If we have ever had a calm debate with someone over an important issue that concludes in a negotiated solution, we will recognise that our relationship with that person has become stronger. If we have ever amicably agreed to disagree with someone over an issue, we will recognise that the ability to have an open debate, even without resolution, has strengthened our relationship with that person.

On the other hand, avoiding conflict, non-assertiveness, hypersensitivity to criticism, refusing to listen or angrily squashing another person’s point of view can be destructive to relationships. We can become as expert at managing challenging behaviours and strong personalities, conflict and anger as we are with managing other aspects of our professional work. We can learn how to deal with criticism constructively.

6. Manage bullying and violence assertively

Bullying and violence are not acceptable behaviours and must not be tolerated. As doctors, we must know our responsibilities as employers in addressing cases of bullying or violence in the workplace. We need to be aware of how our own behaviours are perceived and strive always to behave in an appropriate professional manner.

Medical practitioners must become skilled in ways of assertively managing patient-initiated violence, and violent behaviour must always be reported to the police. Failure to do this often results in the violence being deflected onto another colleague or the wider community.

It is well-known that people with mental illness suffer a great deal because of the stigma attached to their disorder and they are more likely to be the victims rather than the perpetrators of violence.

7. Make our medical organisations work for us

Our medical organisations are charged with the responsibility for advocating about many of the issues that affect our ability to deliver a high-quality service to our patients and our communities.

These issues may range from areas of clinical interest, inequity in access to healthcare, clinical independence, training needs or the impact of the environment on health.

By becoming involved in our membership organisations, even in a limited way, we can gain peer support, develop areas of special interest and learn how our organisations work and how they can provide us with ongoing support and advice.

Our medical organisations can also provide opportunities for leadership training to support our roles in advocating for our communities and our patients.

8. Create a legacy

We can be proud of our profession. Each of us has the potential to be a role model for future doctors and contribute our own lasting legacy through the examples we set in the way we live our lives and practise medicine. It may be worth considering how each of us would like to be remembered at the end of our medical careers and act accordingly now.

Each of us has a set of values and principles that determine how we behave as ethical medical practitioners. In creating our legacy we can also discover ways to transcend the adversity we encounter as part of our professional lives. It helps to focus on big-picture issues that make a difference by:

• Finding meaning and purpose in our everyday work and rediscovering the joy of being a doctor.
• Identifying the qualities we admire in our role models, mentors and colleagues.
• Upholding our integrity in everything we do.
• Developing goals for all aspects of our lives including our spiritual life, our physical and mental health, our careers and our relationships with other people, especially those who love and support us.
• Personally supporting our medical and other colleagues.

Conclusion

Through our experience as doctors we learn how to deal effectively with the many joys and challenges of medical life. We have also learned some principles about protecting ourselves from harm and developing resilience. Most importantly, our patients and our colleagues have taught us about the true meaning of healing.

While ‘first do no harm’ has long referred to protecting our patients, in the 21st century its meaning needs to be expanded to also include protecting our families, our colleagues, our environment and ourselves.

If we are going to be effective medical practitioners providing care to each of our patients and contributing to healthier and stronger communities, we must not only avoid inadvertently harming ourselves, but also be proactive in building our resilience.

We must learn about the true meaning of healing.

Adjunct Associate Professor Leanne Rowe AM is patron of the R-Cubed initiative. Sheis a GP and runs a medical practice that treats medical practitioners in Melbourne. She is deputy chancellor of Monash University.

Professor Michael Kidd is a GP and the executive dean of the faculty of health sciences at Flinders University, Adelaide.

This article was originally published in Australian Doctor on 15 February 2010.

Provided that bulky medical equipment etc is carried in the car, you can claim the costs of your trips between home and work.