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First Do No Harm: Being a Resilient Doctor in the 21st Century

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Australian GPs Leanne Rowe and Michael Kidd detail the obligation of all doctors to their own well being, health and safety, which is vital for the competent care of their patients.

“We are advocating for a broader definition of ‘first, do no harm,’ to include not just ensuring the safety of our patients but also doing no harm to ourselves,” say Rowe and Kidd. “We can’t be effective doctors in the long term if we neglect our own health and wellbeing.”

Somehow, we’ve come to expect medical professionals to function like machines. The truth is our lives are in the hands of human beings with their own needs and weaknesses; people who are more likely to be overworked and overtired, and to contemplate suicide than most other professions. Often, doctors are themselves to blame, buying into a culture that sees baggy eyes and never-ending days as badges of honour instead of risks to their health, and to the health of the patients they treat.

Speaking with David Payne for a BMA podcast in November 2008, Dr Michael Peters of Doctors for Doctors said that although it appears that British doctors aren’t necessarily more prone to alcoholism than the general population, they present later – meaning they typically seek help much later and are therefore more prone to suffering graver outcomes from their illnesses. “Doctors tend to deny their own illnesses […] There’s a culture within the profession that makes it difficult for doctors to come forward.”

Furthermore, Rowe and Kidd say that there is such a stigma surrounding doctors seeking help (you’d be surprised how many don’t have their own doctors!) that little research has been conducted to determine the extent of the problems that medical professionals face. But by reversing this harmful lack of self-reflection, practitioners can expect invaluable long term benefits, including better relationships with family, friends, and patients, and the mental and physical capacity to practice medicine longer – and ultimately, heal or treat more people.

In FIRST DO NO HARM, Rowe and Kidd propose eight essential principles to promote doctors’ own health and resilience:

• Make home a sanctuary
• Value strong relationships
• Have an annual preventive health assessment
• Control stress, not people
• Recognise conflict as an opportunity
• Manage bullying and violence assertively
• Make our medical organisations work for us
• Create a legacy

“This book is about principles we now wish we had been taught about medical life and resilience before embarking on our medical careers,” the authors say in the introduction. “It’s all about discovering and then rediscovering each day the great joy of being a doctor.”

About the authors

Leanne Rowe AM is a GP and runs a medical practice for medical practitioners in Melbourne, Australia. She is Deputy Chancellor of Monash University and serves on the boards of beyondblue and Medibank Private. She worked for many years as a rural doctor and is a past Chair of the Royal Australian College of General Practitioners. She has been awarded the Rose Hunt Medal from the Royal Australian College of General Practitioners and the “Best Individual Contribution to Health Care in Australia” award from the Australian Medical Association, for her services to Australian medicine.

Michael Kidd AM is a GP and the Executive Dean of the Faculty of Health Sciences at Flinders University in Adelaide, Australia. He was President of the Royal Australian College of General Practitioners from 2002-2006 and was Professor of General Practice at The University of Sydney from 1995-2009. He is chair of the Australian Government’s Ministerial Advisory Committee on Blood Borne Viruses and Sexually Transmissible Infections, a member of the board of the World Organization of Family Doctors (WONCA), an adviser to the World Health Organization on primary care and mental health and chair of Doctors for the Environment Australia.

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