(GP), friend, or family member is a helpful first step.
Why should we be concerned about our own wellbeing?
Healthcare is evidence‐based. We use evidence to decide the best treatments and courses of actions for our patients. Why should we not apply the same standard to look after our own wellbeing? Looking at the evidence – as we do in other areas of healthcare – there is plenty to support the fact that we are in the best position to look after our patients when we also look after our own wellbeing.
Grim statistics highlight what happens when we don’t.
In the UK, it is estimated that, per year, errors cost the NHS over 1 billion GBP in litigation, and 2 billion GBP due to bed delays.1 The human cost – grief, pain, and suffering by those at both ends of the error – is, of course, inestimable.
Even if we think we do not have time to care for our own wellbeing, or that it is ‘optional’, clinician codes of conduct make it clear that maintaining our own wellbeing is essentially a requirement.
Professional codes for different healthcare practitioners cover aspects of practice, and these can be interpreted to either explicitly or implicitly direct us to ensure our own health and wellbeing is adequate.
The General Medical Council (GMC) provides guidelines on ethical guidance and good medical practice.2 Patient care is the first concern under ‘Knowledge, Skills, and Performance’. Associated with ‘providing a good standard of practice and care’ is the recognition that we work within our own competence and its limitations.3
It even explicitly covers ‘risks posed by your health’.4 Knowing, or even suspecting, that our performance and/or our judgement could be impacted by a condition requires us to consult with a suitably qualified colleague. While at times we may not be fully aware of how our wellbeing is impacting on us, usually we have at least some degree of insight and self‐awareness which means we at least do ‘have a hunch’ that we may be in need of help.
Taking this a step further means that we should, in all likelihood, take as many steps as possible to protect our mental wellbeing.
The GMC’s guide for ‘Good Medical Practice’ emphasises that our first concern is the patient’s care, and that we should act promptly if we feel this may be compromised. We must monitor the quality of our work, and ensure that we work within the limitations of our competence (Figure 0.1).
Figure 0.1 Duties of a doctor registered with the GMC.3
The Nursing and Midwifery Council (NMC) outlines professional requirements and standards for nurses in the UK.5 Nurses joining this register are required to commit to uphold the standards it outlines. The register clearly states that ‘nurses, midwives, and nursing associates are expected to work within the limits of their competence’.5
The register also clearly states there is a requirement to:
‘pay special attention to promoting wellbeing, preventing ill health, and meeting the changing health and care needs of people during all life stages
be supportive of colleagues who are encountering health or performance problems. However, this support must never compromise or be at the expense of patient or public safety
take account of your own personal safety as well as the safety of people in your care
take all reasonable personal precautions necessary to avoid any potential health risks to colleagues, people receiving care, and the public
maintain the level of health you need to carry out your professional role
support any staff you may be responsible for to follow the Code at all times. They must have the knowledge, skills, and competence for safe practice; and understand how to raise any concerns linked to any circumstances where the Code has, or could be, broken.’5
It can clearly be seen that these, and additional, areas of the code highlight that there is a professional requirement to maintain our own wellbeing. It is not only doctors and nurses who are bound by these requirements. Other healthcare professionals may have similar codes, highlighting the need to ensure and maintain personal wellbeing.
The practice standards are clear for all Allied Health professionals, for example Speech and Language Pathologists, Occupational therapists, Physiotherapists, Physical Therapists, Chiropodists, Audiologists, Diagnostic Imaging Technologists, Specialist Diagnostic Imaging Technologists, Medical Laboratory Technicians, Emergency Medicine Technicians, Addiction Counsellors, and Dietitians.6
In the section on ‘Maintaining fitness to practice’, the standards instruct that an Allied Health professional is to ‘maintain his/her own health and wellbeing. A registered professional should restrict or accommodate practice if he/she cannot safely perform essential functions of his/her professional role due to mental or physical disabilities’,6 to ‘strive to maintain a healthy work‐life balance’,6 and that ‘registered health professionals should support the health and wellbeing of their colleagues. When doing so a registered professional should encourage colleagues who require care to seek appropriate help.’6 Thus, there are clear requirements to look after our own wellbeing, and to ensure we have a work–life balance that is healthy and sustainable.
Hence, it is essential for us to protect our own wellbeing, in order to be able to provide the highest quality of care to our patients. This, in itself, is sufficient motivation. Besides, if we are unwell, we, ourselves, may become a burden on the very healthcare system we are trying to uphold – and negatively impact on workloads, both our own and our colleagues. In any event, by signing up to as clinicians and other healthcare professionals, we have already agreed in principle to protect our own wellbeing through our relevant codes of conduct and ethics.
Why should we consider both problem factors and protective factors?
‘Mental health’ and ‘wellbeing’ appear, on the surface, to be influenced by somewhat nebulous factors. Without teasing these factors out, it is difficult to know how to start tackling them. We can give ourselves a ‘road map’ to follow by categorising the factors as either problem or protective. We then have indications of where and how we should direct our attention. There are some problem factors that will always be present, just as there are some protective factors which will never be adequate. With increased awareness, we can start tipping the scales into more balance than has historically been the case, resulting in overall improvement in our mental health and wellbeing (Figure 0.2).
Figure 0.2 Balancing problem and protective factors.
Being physically fit will not categorically prevent illness, and similarly, improving mental resilience and stress management will not categorically avoid burnout. The techniques
