Back to School for Health

Like many hospitals, the University of Ottawa didn't get serious about physician health until after a suicide attempt. The physician - a top clinician, teacher and researcher wrote himself a prescription for a lethal overdose. Within a few years, the university had launched Canada's first physician wellness program at a university.

Founding director, Dr. Mamta Gautam, an Ottawa psychiatrist who specializes in physician health and wellness, says their first step was to document the need. "We needed numbers to kickstart change."

A 1999 survey of 5 medical departments (response rate 30%) found physicians were working about 59 hours a week and 48% reported low job satisfaction (compared with 58% for the general population). Half said they thought about leaving academic medicine every week; 30% thought of leaving medicine altogether. In the preceding 3 months a quarter were under high stress; 20% had poor emotional health; 12% thought of suicide and 7% - or about 10 physicians - had planned it. "This was an astounding number," said Gautam. "It left the faculty wondering what to do.”

Her proposal for a faculty of medicine wellness program fit the bill and within a year it was running. Its mandate is to provide maximum wellness for faculty members including education, prevention, research, resources and intervention for stress and burnout, anxiety, conflict, bereavement, relationship issues, financial and time management, support during litigation or complaint processes, etc.

Gautam offers the following tips for starting a successful university program:

· get numbers

· get buy-in from the Dean (or it won't happen)

· get Senate approval and a place on the org chart

· get a budget, terms of reference and a mandate

· ask the Dean to invite prospective committee members

· recruit committee members from all specialties and include junior faculty

· recruit a respected committee leader (not a psychiatrist) to destigmatize illness

At the University of Ottawa, Gautam devised an innovative structure to reach faculty at all 5 teaching hospitals. Through its Connector Program, each hospital has a contact person who has a list of specialists available on an urgent basis, including social workers, lawyers and psychiatrists. "The issue often is simply knowing where to go to find people with physician expertise," says Gautam. But expediency is essential: "By the time a physician comes for help they have already waited 6 to 8 months," says Gautam. "They are on the verge of crashing because they've waited so long."

The service is confidential and, if need be, anonymous. If a physician's ability is impaired they're only reported if they're noncompliant and "we've never had that happen," says Gautam. Most of the time when physicians are told they need to get well and can't practice, they feel huge relief that the responsibility has been taken away from them."

The Faculty Wellness Program also hosts workshops on everything from stress management to legal and emotional aspects of divorce, as well as other educational events.

Prevention activities centre on the idea of watching out for your neighbour. This is difficult because if your "neighbour" goes off on sick leave, you'll have more work to do. "This culture change isn't going to happen quickly," says Gautam. "We can't even guarantee that physicians will get time to eat and got to the bathroom. Even basic needs." But the Wellness Program is encouraging gradual change. One of its goals is to promote camaraderie among staff. Faculty are encouraging to post accolades on bulletin boards and in the Dean's newsletter. On birthdays, staff get a card loaded with personal comments: "A real treasure," says Gautam. "We're generating a spirit of colleagues rather than being competitive."

The program also provides a list of on-site exercise facilities, and help start a walking group, running clinic and bike club. It also started a book club, movie club and music appreciation group. Next spring it will hold it's first ever Humanities in Medicine Day to celebrate the non-scientific side of the profession.

The phone number for the wellness program and the contacts are widely circulated, and the program itself is promoted online, in newsletters and elsewhere.

Gautam also introduced Physician Appreciation Day. Officially proclaimed by the City of Ottawa as October 16. "Although we have a lot of privileges, we also need to be thanked," says Gautam.