How to Promote Wellbeing. Rachel K. Thomas

      Preface

      This book provides a concise resource for addressing many mental health and wellbeing challenges that we, as clinicians, may be confronted with. These are summarised in an evidence‐based toolkit to help us in several ways. Initially, to decrease the risk and impact of potentially debilitating conditions such as burnout on ourselves, and consequently, to impact more positively on our patients’ outcomes.

      Working in healthcare means that we are at the helm of an unsteady ship, a system focussed on providing optimal care for patients. We have to be ready to act when required – be this at 2am on a night shift, on a long weekend day shift with skeleton staff, or in the middle of a day when we can feel our blood sugar dropping to our boots as the imaginary idea of lunch hour sails by. Unfortunately, keeping an even keel is often at the sacrifice of those of us working within this system.

      Emergencies are unpredictable. Patients can suddenly deteriorate. Someone who seems on the mend one moment, can be seriously ill the next, for example with infections or complications. Coupled with immune systems that are already under pressure, the results can swiftly become catastrophic. And when the unthinkable happens and a pandemic sweeps the globe, the cases of emergencies and deteriorations start to occur at an exponential rate. Healthcare systems are expanded to cope in as best a way as they can, stretching all of their components, including clinicians working within them, to breaking point and beyond.

      The idea that clinicians suffer from ‘injury’, such as burnout, due to an over‐stretched healthcare system is increasingly becoming apparent. The COVID‐19 crisis has highlighted how our healthcare systems need to protect not only the patients, but also the clinicians and other healthcare practitioners working within the system.

      While positive steps towards improving mental health and wellbeing for the general population are being taken, such as increased conversation and decreased stigma around mental health and wellbeing, this progress has arguably not translated to clinicians. Research reveals that mental health conditions are increasing in this group, and that these conditions may be exacerbated by perceived reluctance or delay in seeking additional help and support. Conditions such as burnout and injury may not be due to failures in the individual clinician, but rather more due to factors such as excessive workloads, workplace culture, or overall work environment.

The importance of the wellbeing of clinicians is being increasingly recognised. However, although well‐intentioned advice to support us may be given, this may seem impractical at the times when it is needed most. Some of this advice may seem tone‐deaf to the real‐world practicalities of when we are ‘on the job’. This is not to say that the role of people in different fields in helping to protect and preserve our mental health and wellbeing is unhelpful. Quite the contrary. We need people who have a more objective view of what a work–life balance is, to help many of us in healthcare roles who have long‐forgotten the concept, albeit through no fault of our own. This slow erosion of our work–life balance often starts early in our training. The sheer quantity of knowledge we are required to digest and retain, the stress of exams, and the very nature of the areas we are training to become proficient in, can leave us with a different perspective of what work is, what life is, and how, exactly are we to balance the two.

      A hospital I once worked in had a brightly coloured poster informing us of ways to decrease our stress. The poster had 10 small sketches, with information added in artistic calligraphy. Each suggestion was sensible, and indeed even likely to be very useful in many occupations. However, healthcare often isn’t just any regular profession. At times, suggestions to leave work on time, and to make sure we take our lunch breaks, are practically impossible. If a hand‐over is needed, we cannot leave until this is done, no matter whose birthday dinner we are missing – even if it is our own.

      It is recognised that, as clinicians, we have conflicting pressures at times. Historically, delivering high quality patient care along with maintaining our own personal health and wellbeing were often perceived as being at odds with each other – that pausing for ourselves meant neglecting patients. However, it is time for us to challenge these historical views in light of evidence showing we need to, as the airline safety videos so succintly phrase it, ‘put on our own oxygen mask first’, in order to continue to deliver and perform optimally throughout our career. This has never been more acutely highlighted than during the COVID‐19 pandemic, where, due to forces beyond our control, our inability to always put on our own mask first – literally – led to sacrifices not only of wellbeing, but of life.

      While highlighting many of the benefits, and our sense of pride, in the healthcare system’s responsiveness as a whole, the COVID‐19 pandemic has also highlighted areas for improvement, and stimulated discussion on how this could be achieved.

      Research increasingly supports evidence of the significant links between mental and physical health. Evidence suggests that patients with mental health issues are more likely to have physical health issues, leading to poorer health outcomes. For instance, it has been shown that patients with cardiovascular disease are also more likely to have depression, when compared to the rest of the general population.¹ Conversely, there is also evidence that people with depression are more likely to develop cardiovascular disease, when compared to those who are not depressed.¹ So it is important to take a patient’s mental health into consideration when evaluating their physical health, as this may lead to a better outcome overall. Additionally, in turn, better outcomes for the patient may link to better outcomes for us, their healthcare practitioners.

      The information in this book is relevant to clinicians and other healthcare practitioners – doctors, nurses, dentists, physiotherapists, counsellors, therapists, and other associated team members. Reading it may count towards our continuing professional development points. Combining the suggested strategies with elements of reflection will assist us in promoting and strengthening our own mental health and wellbeing – in turn, in helping us to deliver optimal outcomes for our patients.

      During the COVID‐19 pandemic, we worked in a healthcare system that responded flexibly to the demands placed upon it. We were called to work in different areas and in different ways, while the infrastructure around us also changed. New hospitals were built and staffed within days in the UK and USA, highlighting the flexibility for a rapid response within the system. However, it also highlighted a period of potential need for increased support for healthcare practitioners. Embracing this newly‐found flexibility, we can now consider creating a more balanced set‐point for how our healthcare system works, with an increased focus on the mental health and wellbeing of the clinicians who work within it.