Doctors’ Health: Inspirations using Complexity Theory Dr. Margaret Kay MBBS(Hons),FRACGP, Dip.RACOG The University of Queensland

History 1869 – Paget o intemperance of 6% medical students 1886 – Ogle o increased rate of physician suicide 1966 – Ironside – Otago, NZ o High prevalence of stress in medical students 1968 – Davies – Australia o High prevalence of stress in medical students 1969 – Cramond – Australia o High prevalence of stress in physicians

Literature Physical health o mortality, low SMR (non-smokers) Longitudinal cohort studies Surveys – lots of studies stress, mental health issues, workplace issues Doctors are healthy Healthy doctors = healthy patients

Literature Health access – limited data Qualitative research – paucity, seriously ill Illness Narratives Interventions o Impaired physicians o Medical School Minimal follow up We all know that … G a p s

Theoretical Perspective Reductive Biomedical Perspective

Complexity Science Chaos Theory Weather – Lorenz Non-linear relationships Patterned, not predictable – can be understood Emergent Self-organisation Feedback

Complexity Science Non-linear Systems o Resilient Major change – minimal response Small changes – Major response o Butterfly effect o Bifurcation

Complexity of doctors’ health Multiple intersecting issues o Med student, junior doctor, senior doctor o Mental health, physical health, workplace health o Health access, health systems, o Impairment, regulatory issues o Community expectations o Cultural issues

Complexity of doctors’ health Patterned behaviours Non-linear interactions Emergent processes Self-organisation o individual, mentors, carers, culture Sensitive to initial conditions Responsive to external environment

Doctors’ health access Many components Connected D-P T-D Community Profession Practice Legal Dynamic

Doctors’ health access No single component controls the system D-P T-D Community Profession Practice Legal

Doctors’ health access No single component controls the system D-P T-D Community Profession Practice Legal

Doctors’ health access Legal Self-prescribing All students must… All doctors must… Mandatory reporting Resilient non-linear system major change – minimal response

Doctors’ health access Mandatory reporting Small changes – major response in system Major response – bifurcation complete change in the patterned behaviours Unintended consequences

Moving forward Multi-dimensional Holistic Collaborative Creative Responsive / Iterative Emergent – ground up, practical Mentoring Harness the resilience Feedback - monitor

Thank you