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Recognising Distress

Recognising Distress

Keep Calm & Recognise Distress (Part 2)

(Read Part 1: Keep Calm & Carry On)

How do you recognise distress? It might sound ridiculous. Of course doctors can recognise distress. After all, doctors are trained to recognise symptoms, diagnose and treat, right?  The number of Australians seeking help from GPs for mental health issues is higher than ever with over 16 million GP appointments for mental health-related issues during the 2013-14 financial year. That accounts for 12.3% of all GP encounters. Clearly doctors are trusted when it comes to managing other people’s distress4

But being adept at recognising symptoms of distress in others doesn’t necessarily mean it’s easy to recognise them in yourself. In clinical situations, objectivity allows medical professionals to observe distressed behaviour in their patients and elicit information to develop health care plans, refer for counselling and manage ongoing treatment.  It is much harder to observe this behaviour in yourself, especially when you are the professional on whom so many of your patients depend. For doctors and medical students, barriers to seeking professional help for mental health issues include;1

  • Fear of a lack of confidentiality or privacy within their profession
  • Embarrassment or shame
  • Concern about the impact on registration and right to practice
  • Preference to rely on self rather than seek help
  • Lack of time
  • Concerns about career development or progress

Consider this case, from an article in the Medical Journal of Australia, presenting a typical example of the barriers many doctors experience in the face of untenable stress.

‘Over the last 6 months you’ve noticed that you have become increasingly anxious. You find yourself constantly worrying about everyday events that never used to bother you. You are having difficulty sleeping and often wake up during the night. Having a few drinks seems to help you relax. Although your general health is quite good you are experiencing a lot of muscle tension and headaches. You’re also confident in managing this condition with your patients and feel that you could manage it for yourself. You know a competent doctor you could see whom you’re comfortable would be understanding of you, but you are unsure whether you can trust them to maintain your confidentiality. Your practice is so busy it would be hard to find the time.’2

Does this sound familiar? Here, workload, time constraints and confidentiality are concerns and the tendency might be to avoid broaching the subject with another doctor and hope the problem just goes away.

Resilience

As a doctor, you know that avoidance is not a workable option. Your mental health is just as important as everyone else’s and you have the right to access help without your reputation being at stake. You need to care for yourself before you can adequately care for others. And here’s some good news in the midst of all this distress. According to the 2013 beyondblue survey, doctors appear to have a greater degree of resilience to the negative impacts of poor mental health.1 But getting a baseline on your stress levels is important so you can assess how well you are managing at work and at home.

Assess your stress

Try taking this quick Professional Quality of Life survey to see how you’re tracking with stress at work. The PQoL assesses the satisfaction you derive from your work, your tendency to burnout and your response to extreme or stressful events. It’s an interesting exercise even if you’re feeling you have little or no stress at work.  You might be surprised with the results.

 

Of course, getting a baseline is just the first step. Professional help and advice are within easy reach, much easier now that work-related stress levels have been identified as an issue across most professions and workplaces in Australia.3 The Australasian Doctor’s Health Network is a great place to start. You can get immediate help, via state-based call centres, with issues around work stress, burnout and anxiety as well as bullying and harassment.  We recommend you seek help from a medical professional if you are feeling burnt out, distressed, overwhelmed, anxious or depressed. It’s OK. You can keep calm and carry on, you might just need some help.

 

References

  1. National Mental Health Survey of Doctors and Medical Students October 2013 https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1132-report—nmhdmss-full-report_web
  2. Davidson SK, Schattner PL. Doctors’ health-seeking behaviour: a questionnaire survey. Med J Aust 2003;179(6):302-5. https://www.mja.com.au/journal/2003/179/6/doctors-health-seeking-behaviour-questionnaire-survey
  3. Commomwealth of Australia. Working Well: An organisational approach to psychological injury. http://www.comcare.gov.au/__data/assets/pdf_file/0005/41369/PUB_47_Working_well.pdf
  4. Australian Institute of Health and Welfare 2014. Mental Health Services: in brief 2014.

http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129549620

  1. https://www.mja.com.au/journal/2003/179/6/doctors-health-seeking-behaviour-questionnaire-survey

 

 

 

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Keep Calm & Carry On

Keep Calm & Carry On

Keep Calm & Carry On

How’s your clinic day mapping out? Feeling calm and measured - managing your appointments on time? Keeping up to date with paperwork or taking work home? How’s your home life? Getting enough exercise? Eating well, drinking in moderation and getting to bed early?

Full marks to those who answered ‘Yes’. Carry on. You must have a handle on the demands of working in the medical profession.

If you answered ‘No’, you’re not alone. A beyondblue survey from 2013 showed that doctors are at higher risk of mental ill-health than the general population.1 Key findings from the survey showed that doctors reported substantially higher rates of psychological distress compared to both the Australian population and other Australian professionals.1 Notably, levels of high psychological distress were reported in doctors aged 30 years and under, in particular young female doctors who reported greater work stress in relation to career and family/carer responsibilities.1

So how are health professionals countering the tendency to high stress and vulnerability to poor mental health? It’s apparent that doctors are not taking their own advice about work-life balance. In fact, studies have shown that doctors who experience ill health tend to disregard the advice they give to their patients.2

Thriving on stress

The very nature of medical practice means it is inevitable that you will experience a certain level of stress. The key is recognising when normal stress or ‘eustress’ becomes ‘distress’ and having strategies in place to deal with it.

Stress is a generic term we use on a daily basis to describe the feelings we might have in response to pressures we face in our lives. Stress itself is not a disease or injury and ‘feeling stressed’ at work is common however, the way we deal with stress is key to coping with daily life.

Eustress is good stress. Even though it’s challenging, eustress produces positive effects, such as maximising output and creativity. In fact many professionals tend to perform best when faced with a certain level of stress. Distress may become evident, however, when we are subjected to demands and expectations that are out of keeping with our needs, abilities, skills and coping strategies. We feel distress when the resources demanded of us outstrip the resources we have. Distress is likely to result in a loss of productivity and a decline in overall levels of well-being.3

If you’d like to know more about recognising distress read Part 2 of Keep Calm and Carry On: Recognising Distress

 

Follow @beyondblue on Twitter

 

References

  1. National Mental Health Survey of Doctors and Medical Students October 2013 https://www.beyondblue.org.au/docs/default-source/research-project-files/bl1132-report—nmhdmss-full-report_web
  2. Davidson SK, Schattner PL. Doctors’ health-seeking behaviour: a questionnaire survey. Med J Aust 2003;179(6):302-5. https://www.mja.com.au/journal/2003/179/6/doctors-health-seeking-behaviour-questionnaire-survey
  3. Commomwealth of Australia. Working Well: An organisational approach to psychological injury. http://www.comcare.gov.au/__data/assets/pdf_file/0005/41369/PUB_47_Working_well.pdf
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5 Tips to a Great Reference

5 Tips to a Great Reference

5 Tips to a Great Reference

Whether you’re recently graduated or planning a career move, the people you choose as your referees could make or break your job-seeking prospects. If you want a glowing reference of your skills, experience and teamwork, you need to prepare so we’ve put together our 5 top tips to a great reference.

  1. Keep it Professional

When choosing a professional reference, be strategic. Consider a person who knows your work and who is aware of your unique skill set. Ask yourself: who teamed up on your final research project? Who has worked alongside you in a crisis situation? What about your medical supervisor? Think of a broad range of professional or academic colleagues who understand you and your work ethic.

  1. Ask First

Once you have a few referees in mind, ask their permission first. This is best done over the phone or via email. Healthcare professionals are busy people. Be polite and ask them if there is a good time to call so you can discuss the position you’re applying for. You could also provide any prospective employers the details of your referees’ preferred contact times to everyone’s lives easier.

  1. Provide Your CV

Even though your chosen referees may be well aware of your abilities, give them the opportunity to speak about these skills in the context of the position. Provide them with a copy of your CV and the position description. You may even want to highlight the specific skills and experience on your CV for easy access when they’re providing a reference over the phone. Each time you submit an application advise your referees of the timeframe during which they may expect a call from a prospective employer.

  1. Check out Referral Rewards

HealthcareLink recently launched an exciting new feature, where your colleagues can recommend you for a job via the HealthcareLink website. It’s a clever incentive for health professionals to increase their network, refer their colleagues and even recommend positions to their peers as they become available.

  1. Say Thanks

Whether you land the job or not, send your referees a note of thanks. Thanking your referees is not only polite, it’s sure to bode well for the next round of applications. Remember, a little gratitude goes a long way, especially when it comes to a good job reference.

 

Follow @HealthcareLink on Twitter

Find out more about the Peer-to-Peer Referral System on the HealthcareLink Blog 

 

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I’m Sorry, What Was That You Said?

I’m Sorry, What Was That You Said?

It’s Hearing Awareness Week 23-29 August, 2015 and there are events, screening clinics and information sessions across the country. Take a look at  www.healthawarenessweek.org.au here for local event info.

 

While exploring the canals of hearing loss, we found these two infographics about Noise and Evolution of the Hearing Aid and we’d like to share them.

 

HOW LOUD IS TOO LOUD?

How Loud is Too Loud? An infographic from Safety Culture

Embedded from Safety Culture

Like this infographic?-  Jump over to Evolution of the Hearing Aid 

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Clinical Supervison Integral to Nursing

Clinical Supervison Integral to Nursing

Compassion comes at a cost

Mental health nurses are at the frontline of any mental health engagement. So, it’s an odd kind of disconnect when counsellors, psychotherapists and psychologists engage in compulsory regular debriefing sessions during their training yet a similar model is yet to be mandated for mental health nurses - the very people who are expected to respond to the mental health needs of their patients from shift to shift.1

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e-GPS on a Mission

e-GPS on a Mission

Resilience. It’s a peculiar trait we humans have. Even when things get tough, we don’t give up. We may flounder momentarily, but to give up, chuck it in, give it the flick, wash our hands of it, drop it like a hot potato, buckle under or throw in the towel just isn’t part of the game plan. We may feel as if we’ve given up relinquished control, capitualted, rolled over and played dead. And that’s OK. They’re part of the human experience, these little deaths - in fact la petit mort is the French expression for orgasm - so bring those little deaths on!

Running a small business is reflective of life and growth. Excitement at an idea’s birth. Joy and hope for the future. First steps, falling down, getting back up. Falling down again. Letting go, moving forward, making connections. Working hard, slacking off. Getting the contract, getting knocked back. Gaining clients and losing them.

It takes resilience and fortitude to run a small business. It takes failure to reach goals. It takes blood, sweat and tears. But here we are. Still at it. Resilient and ready to relaunch.

So we decided to lay our business plan on the table and go through it with a fine tooth comb. We found weakness - loads of them. We decided what should stay and what should go. We pared right back while reflecting on our original vision of creative, innovative health promotion.  And now we’re back on track. We know our strengths and we understand what we need to work on. We have analysed the gaps in our skill levels and have taken steps to improve and strengthen what we can offer our clients.

If you haven’t picked apart your business model and developed a strong Mission Statement that reflects your values as a company, we strongly suggest you do. It’s an opportunity to drill down through the froth and bubble to the sludge at the bottom of your coffee cup. As we’ve found these last three years, the sludge is where you develop a greater understanding and where new concepts are born. Down times are reflective times. They provide clarity, a chance to experience a little death, then wake up and move on. They make life that much more precious.

e-GPS is all about ecoloGical Project Solutions and always has been.  For three and a half years, we’ve been on a mission to deliver health awareness messages in creative, inspiring ways that embrace the ecological health promotion model, it’s just that we had never articulated it before. So here it is. the e-GPS Mission Statement. And here’s to more life and death experiences in the challenging world of small business.

Our Mission: To implement health awareness projects for diverse communities, and the people who live and work within them. To enable access to clear, consistent health information that is culturally appropriate, socially inclusive and environmentally driven.

 

 

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Becoming more Gay Friendly in your Practice

Becoming more Gay Friendly in your Practice

GPs and practice nurses seeking to become more ‘gay friendly’ in their practice now have the option to complete a short online learning module Becoming More Gay Friendly in your Practice. Developed by the STIs in Gay Men Action Group (STIGMA), the OLM guides GPs on the diverse health needs of gay and homosexually active men. In particular, sexual health screening, including sexually transmitted infections (STIs) and HIV testing, as well as psycho-social issues commonly experienced by gay men and men who have sex with men (MSM).

Dr Chris Bourne, Head, NSW STI Programs Unit and Senior Staff Specialist, Sydney SexualHealth Centre, said gay or homosexually active men in Australia are disproportionately affected by STIs, including HIV, and most diagnoses in Australia are made by GPs. “It is important for everyone to feel comfortable when visiting a GP. For gay or homosexuall yactive men, GPs play an important role in helping them assess their sexual health risk and providing opportunities to test for STIs and HIV,” he said. “The OLM aims to help GPs deliver care which is inclusive of gay or homosexually active men; where they feel safe and free from discrimination and can be offered current professional health advice.”

Dr David Baker, a GP at East Sydney Doctors, says the OLM training highlights the diverse health needs of gay and homosexually active men, which encompass primary health care,current trends in sexual health, understanding of gay culture and its diversity. “As a GP, it’s important to become confident in identifying common health issues faced by gay men and men who have sex with men, particularly when it comes to their sexual health,” Dr Baker said. “The STIGMA OLM is an excellent resource for GPs who want to know more about being ‘gay friendly’ in their clinical practice and how to address and work with health issues specific to this population. The knowledge gained from the OLM enables GPs to have a more informed perspective and to to open up a discussion about STI risk, STI testing, drug and alcohol use and mental health.’’

Becoming More Gay Friendly in your Practice was developed by STIGMA, following its development of a ‘Gay Friendly GP List’ for NSW, to support access to the primary health care of gay men and MSM. The OLM is structured in three interactive case-based modules. The modules include: towards a better understanding of gay men and men who have sex with men (MSM), discussing sexual history and testing for STIs, and common health issues facing gay men and MSM. The OLM can be completed over one hour or 20 minutes for each module.

GPs and practice nurses can access the OLM by going to the Australasian Society for HIV Medicine (ASHM) Learning Management System https://lms.ashm.org.au/ registering or logging on, then clicking on the Catalogue tab.

GPs who complete the OLM in full can accrue two Cat.2 RACGP QI&CPD points.

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HIV Shared Care for GPs

HIV Shared Care for GPs

The Australasian Society for HIV Medicine (ASHM) have developed a suite of resources to support GPs who provide care to HIV positive patients in their practice. Key to the HIV Shared Care for GPs model is the knowledge that improved treatment outcomes means that HIV is now considered a chronic condition. GPs, specialists, nurses, allied health and support services are involved in the management of people living with HIV and this management involves team-based interdisciplinary communication and planning.

GPMP for HIV

Central to HIV Shared Care for GPs is the GP Management Plan (GPMP) for HIV - a tool that encourages comprehensive disease management using an annual cycle of care for HIV based on current guidelines including the RACGP Red Book and STIGMA Guidelines for STI testing.

HIV GPMP Audit and Shared Care Training

To evaluate the GPMP for HIV, an Audit and training package have been developed by ASHM with endorsement by the RACGP.

GPs with a caseload of five or more HIV positive patients have the opportunity to earn 40 RACGP QI&CPD Audit Points and 6 ASHM HIV Points when they participate in the Audit.

The Audit consists of three parts:

Part 1: A retrospective audit of five HIV positive patients for whom they have provided care in their practice. Each audit consists of 24 questions about the HIV management provided for that patient, and the level of communication between GP and HIV specialist or specialist service.

Part 2: Shared care training. The training consists of nine short videos from GPs, and specialist HIV services outlining how to develop a comprehensive GPMP for HIV and including the key issues in monitoring, management and best practice shared care between GPs and specialists.

Part 3: 6 months following the training component, the GP will be asked to complete a second retrospective audit of five HIV positive patients for whom they have provided care since the training.

The results will compare pre- and post- GPMP Shared Care training. GPs will receive a report that highlights their management of patients living with HIV, where their communication and monitoring needs improvement and encouraging GPs to reflect on their practice.

Participating in the Audit

The HIV GPMP Audit and Shared Care Training is available on the ASHM Learning Management System (LMS). Participants need to register for a username and password to access the LMS. Once registered GPs, and other health professionals, have access to an extensive library of online modules, training and webinars which accrue points towards their continuing professional development (CPD).

For more information, visit the ASHM Website
or contact ASHM via email hivsharedcare [at] ashm.org.au

 

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Who else should you test for HIV?

Who else should you test for HIV?

Who else should you test for HIV?

Groups that you know to test for HIV include; gay and other men who have sex with men, sex workers and people who inject drugs. There are however other groups that you should consider testing. In NSW during 2014, 14% of all HIV notifications were from heterosexual people1 and it is estimated there are currently 620 heterosexual people infected with HIV who are undiagnosed2. Heterosexual people who are:

  • sexual or injecting partners of people who live with HIV;
  • frequent or long term travellers, particularly those who have recently travelled to Africa or Asia;
  • people who inject drugs;
  • those who are chronically unwell, where no explanation can be found;
  • people whose sexual partners are from high prevalence countries or regions e.g. Africa or  Asia and;
  • heterosexual men having sex with men,

should also be tested for HIV, as they are at increased risk for infection.

Abby, 26, had trouble even getting a test from her doctor, with the doctor dismissing her concerns. ‘I had a new partner and just had a feeling…..When I asked  my doctor for a test she just said Abby you are young straight woman, living in Australia…why would you need a test?  She did test me and I was HIV positive. Of course it was a shock but finding out early was the best thing for my health.’

Associate Professor Catherine O’Connor, Director of the Sexual Health Service at Sydney Local Health District advises that GPs should be testing for HIV. ‘As GPs are the front line health services most accessed by the general community, it is important that GPs are aware of who is at risk of HIV infection. Sexual Health Services can provide support to GPs who are making HIV diagnoses,’

Pozhet is the Heterosexual HIV Service for NSW. We provide programs and services to improve the wellbeing of the diverse heterosexual community of people living with HIV, their partners, family and friends. For more information please visit the website: www.pozhet.org.au or call the Heterosexual HIV Information Line on 1800 812 404.

 

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Logo for PozHet Heterosexual HIV Service in dark blue showing 2 white and 2 lighter blue paper doll cutouts with arms raised

Information for GPs:

Making a New HIV Diagnosis  - Australsian Society of HIV Medicine (ASHM)

National HIV Testing Policy

 

 

 

References:

  1. NSW Ministry of Health (2014), NSW HIV Strategy 2012- 2015: A new era, 2nd Annual report on progress, snapshot, available from: http://www.health.nsw.gov.au/endinghiv/Documents/hiv-snapshot-november2014-2nd-annual-progress-report.PDF,  accessed 26 March 2015.
  2. Jansson J., Kerr C. C., Wilson D. P., (2014), Predicting the population impact of increasing HIV testing and treatment in Australia.
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