Member Wellbeing

Emergency medicine is a rewarding yet challenging career. This page offers a range of resources which aims to enhance the enjoyment of emergency medicine and support you and your family throughout your career.

About
Managing Stress
Keeping Well
Where can I get help?
FAQs
Contacts

Welcome to the Member Wellbeing section. As a member organisation, ACEM exists to support you as an emergency medicine physician. Our committees and services play an important role in providing assistance to Fellows and trainees. 

The following tabs include useful resources to assist you in being a mentally and physically healthy doctor.

We welcome suggestions of any resources to include in the Member Wellbeing page. You can suggest a resource using the following short online form:

 Suggest a Resource  



Emergency medicine specialists work in a high pressure environment.

The ability to recognise and adequately handle stress in yourself and others is an important skill and one that may need revisiting from time to time.

This relates to the curriculum domains Leadership and Management and Professionalism.


The resources here have been divided into five categories:

Burnout and Stress at Work


The Happy MD

Dr Dike Drummond, USA, free (registration required)

A series of 5 (short) videos provides a brief introduction to the topic of physician stress / burnout. The presentation is clear, concise and uncluttered and provides an introductory framework for recognising the symptoms of stress, understanding its causes and provides a range of useful ideas for how to prevent and approach management of the problem.

→ Best of Web EM Resource
 

Stress Management Techniques


Mind Tools
Website, UK, free

A collection of strategies on reducing and managing stress including: coping strategies, relaxation and sleep, anger management and burnout. 
 

Challenging Situations and Transitions


Crisis Resource Management 
Stony Brook Simulation Centre via YouTube, USA, free

A snappy 10 minute video demonstrating the 5 key concepts of crisis resource management in the form of a simulated scenario. This is a practical and useful technique, and this resource is specifically from an Emergency Department perspective. Very accessible to those new to the approach.

→ Best of Web EM Resource
 
PACE
Harris CPD, UK, free

PACE is an approach to managing human factor errors utilising the idea of graded assertiveness, and it is explained simply in this 20 minute podcast discussion and brief video. A range of examples are given, and the technique is well suited to high stress situations encountered in Emergency Medicine.

→ Best of Web EM Resource

Working the night shift: preparation, survival and recovery. A guide for junior doctors
Royal College of Physicians, Nicholas Horrocks and Roy Pounder, UK, PDF, free

How to survive night shift is a valuable resource to all practitioners who encounter shift work. Definitely worthwhile reading.

→ Best of Web EM Resource
 


Order Out of Chaos
ER Cast, Dr Thom Mayer and Rob Orman, USA, free, 28 mins

Rob Orman discusses the daily stressors of em with great honesty and optimism with Thom Mayer, outlining different ways to deal with the myth of multitasking on the shop floor.

Best of Web EM Resource

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Coping with Mistakes and Unexpected Events


Brian Goldman: Doctor’s make mistakes. Can we talk about that?
Ted Talks via YouTube, Canada, free-

It is with great honesty and humility that Brian Goldman talks about making mistakes. He draws reassuring links to emergency medicine and baseball. This short talk will help all of us who struggle with the burden of life and death in our every day job. Do you remember ... ?

→ Best of Web EM Resources



Medical Error
EM RAP, USA, subscription required (high cost)

45 minute lecture covering issues relating to medical error. Broad discussion around error including that in emergency departments and system influences.

→ Best of Web EM Resource

Miscommunication and Handover in the ED
St Emelyn’s, Natalie May, UK, free

A well written blog on the perils of handover in the ED. Allows a brief explanation of a better way to handover patient care in the ED. Good for a refresher.

→ Best of Web EM Resource
 

Outside Work 


Australian Centre for Grief and Bereavement
Website, Australia, free 

Information about grief, supporting grieving children, adolescents and adults. 


Help is at Hand
NHS, UK, free

A PDF guide which explores issues around experiencing bereavement, bereaved people with particular needs and how friends and colleague can help. The guide also provides sources of support. 
 
Relationships Australia
Website, Australia, free

Information about relationship breakdown and dealing with personal conflict.
 

The links on Finding Support and the Keeping Well tabs, may also be of assistance. Please remember, when you are in a crisis, always seek professional help. 


It is important to ensure that we all have methods of keeping healthy for ourselves and our work before we get to breaking point.

For example, the Beyond Blue survey (below) demonstrated high levels of depression, anxiety and stress among healthcare professionals.

We are all at risk. Prevention is better than cure!



The resources on this page have been divided into three categories:  

Mental Health


 
Beyond Blue National Mental Health Survey of Doctors and Medical Students
Beyond Blue, Australia, PDF, October 2013, free
 
This document reports on our own professions state of Wellbeing. It is quite eye opening and will help you look after yourself and others you work with.
 

Black Dog Institute 
Website, Australia, free
 
This website is specific to depression. There are good resources for professionals to use for educating and supporting patients.
 

Ecouch
Australian National University, e-Learning, Australia, free (registration required)
 
A self-help interactive program with modules for depression, generalised anxiety & worry, social anxiety, relationship breakdown, and loss & grief.


Mental Health Online
National eTherapy Centre at Swinburne University of Technology, Australia, eLearning resource, free
 
An online self-help or therapist-assisted treatment attached to a university psychology department.
 
Area of concern
Users must create an account to access resource. If user is determined to be moderate to high risk of mental health difficulties as a result of the online assessment, costs will apply for ongoing treatment.


Centre for Clinical Interventions 
Western Australia, Department of Health, Website

A website run by the public mental health service in WA, there are a number of freely available self-guided modules aimed at assisting those with issues including depression, perfectionism, disordered eating and panic attacks. There are also some WA specific treatment programmes and resources available.


Mental Health Foundation 
Website, New Zealand, free

A New Zealand website which focuses on positive mental health and wellbeing. Including a practical guide titled Five Ways to Wellbeing
 

Keeping Well


 
CALM- Computer Assisted Learning for the Mind
The University of Auckland, NZ, eLearning resource, free
 
This website provides some specific exercises to increase mindfulness. There is also advice on how to improve coping with various life stressors.


Mood Gym
E-learning, Australia, free

An online self-help course for anxiety and depressive disorders which uses CBT. Developed by the Centre for Mental health research at Australian National University. Also provides self assessment quizzes on anxiety, depression etc.


Mentoring at ACEM
ACEM, webpage with links to resources, free

Mentoring is a powerful professional development tool for emergency medicine physicians which supports people to grow and develop both personally and professionally. The ACEM Mentoring Framework outlines the four phases of a mentoring relationship and provides resources for use by mentoring pairs and Mentor Program Coordinators.


OnTrack
Website, Australia, free (registration required)
 
Offers a number of screening tools for alcohol, mental health diagnoses and diabetes. You need to register to access wellbeing information.  
 

Wellness Book for Emergency Physicians 
PDF, ACEP, USA, free 

A USA publication on burnout, incidents at work, harassment and managing stress that are relevant to an emergency medicine physician. 

 

Meditation and Mindfulness 



Headspace
App to assist meditation, offices in the USA and UK  

Smiling Mind
Web and app based program to assist meditation 
 

 If you would like to suggest a resource for inclusion on this page, please use the link below:

Suggest a Resource  



There are many services and support groups available locally, nationally and Australasian wide that you can connect with dependent on your situation.

ACEM has identified resources that may be of assistance.





The resources on this page have been divided into the following categories:

Specific Interest Groups

The Australian Indigenous Doctors Association (AIDA) is a not-for-profit, non-government organisation dedicated to the pursuit of leadership, partnership & scholarship in Aboriginal and Torres Strait Islander health, education and workforce. AIDA advocates for improvements in Indigenous health in Australia and encourages Aboriginal and Torres Strait Islander people to work in medicine by supporting Indigenous students and doctors.

Social and Emotional Wellbeing and Mental Health Services in Aboriginal Australia *NEW
A website designed for those seeking to learn about ways of meeting the social and emotional wellbeing and mental needs of Aboriginal and Torres Strait Islander people and communities.  

The Māori Medical Practitioners Association, Te Ohu Rata o Aotearoa (Te ORA) aims to advance Māori health by increasing the Māori medical workforce and providing a supportive network for Te ORA members.  Te Ora's vision is to provide Māori medical leadership to the health sector to effect Māori health development. Te ORA supports all efforts by its members to improve the health of Māori.

The National LGBTI Health Alliance is the national peak health organisation in Australia for organisations and individuals that provide health-related programs, services and research focused on lesbian, gay, bisexual, transgender, and intersex people and other sexuality and gender diverse (LGBTI) people and communities.
 
Australian IMG an online community of International Medical Graduates in Australia.

First Shift in the ED Orientation for Overseas Trained Doctors a free ELearning program designed for both International Medical Graduates (IMGs) and Overseas Trained Specialists (OTSs) who are either currently working in an Australian emergency department or living in another country and wanting to work in Australia.

New Specific Interest Group
If you know of any other specific interest groups that would be applicable to wellbeing, please email curriculum@acem.org.au   
 

Crisis Helpline 

Beyond Blue
Website, Australia, free

Butterfly Foundation
Website, Australia, free
 
Counseling Online
Free drug and alcohol counseling 24/7
Website and counseling service, Australia, free

Depression.org.nz
Website and helpline (0800 111 757), New Zealand, free   
 
Lifeline
Website, Australia, free

Lifeline Aotearoa 
Website and helpline (0800 543 354), New Zealand, free  

Lived Experience Forum 
An anonymous forum for people living with mental illness or experiencing mental health issues
 
Man Therapy
Website, Australia, free
 
MensLine
Website, Australia, free

MindSpot 
An easily accessible website providing free support both online and via phone for those troubled by symptoms of depression and anxiety. They provide information and mental health screening assessments via online questionnaires or phone, and direct towards sources of support including treatment courses.

SANE Forums and Helpline
The SANE organisation provides both online and phone anonymous helpline support for those needing assistance with mental health issues. The SANE forums are anonymous and moderated, with a safe space for those with mental health concerns to support one another and exchange stories, information and tips. A separate forum for family and friends allows those providing support allows carers to also discuss resources and share stories. Other resources include fact sheets, podcasts and videos providing information on a broad variety of mental health topics.
 
Suicide Call Back Service
Website, Australia, free

Suicide Crisis Helpline NZ
Helpline (0508 828 865), New Zealand, free 
 

Drugs and Alcohol 

Alcoholics Anonymous (Australia)
Website, Australia, free

Alcoholics Anonymous (New Zealand)
Website, New Zealand, free

Alcohol Drug Helpline NZ 
Website and helpline (0800 787 797) 
 
Narcotics Anonymous
Website, Australia, free

Narcotics Anonymous 
Website, Australia, free
 

Regional Services


ACT

Colleague of First Contact, Doctors’ Health Advisory Service (ACT)
24 hour helpline 0407 265414
Office 02 6270 5410
 

New South Wales

Doctors Health Advisory Service (NSW)
Website and 24 hour helpline (02 9437 6552) for advice, usually based around stress and mental illness, substance abuse problems, financial and personal problems. 
 
Medical Benevolent Association of NSW
Independent organisation funded through donations website and helpline ( 02 9987 0504). Assistance available to all medical practitioners based in NSW and ACT. 
 
EAP (employee assistance line) for NSW Health
Provide a range of services from massage days in the workplace, OH&S advice through to counseling assistance. EAP do not report back to HR or your superiors. They are found through the NSW Health intranet page.
 

Northern Territory 

NSW Doctors’ Health Advisory Service (NT)
Helpline: 02 9437 6552

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Queensland 

Doctors’ Health Advisory Service (Queensland)
Website and 24 hour helpline 07 3833 4352
Office 07 3872 2222
 

South Australia

Doctors’ Health Advisory Service SA
Confidential support, information and appropriate advice for distressed medical practitioner. Resources for finding a medical professional friendly GP with clinic hours that may be more suited for doctors rosters, there are links on the website for assistance.
24 hour phone line 08 8366 0250
Office 08 8232 1250
 
Medical Benevolent Association of South Australia
Provides assistance to SA medical practitioners and families with financial hardship.
Phone 08 8267 4355.
 
Rural Doctors Workforce Agency: Dr Doc Program
Aims to support the health and wellbeing of SA Rural GPs and their families. Two key aims- Crisis intervention and Crisis Prevention.
Phone 08 8234 8277.
 

Tasmania

AMA Tasmania Peer Support Service
Helpline 1300 853 338- confidential and anonymous peer support for doctors by doctors
365 days per year 8am-11pm.

 

Victoria

Victorian Doctors' Health Program
Website and 24 hour helpline (03 9495 6011)
Confidential service, covers any health concerns including stress and substance abuse. The website provides information on clinical services, a rural outreach program and lists of GPs specifically happy and interested to treat other doctors.
 
Victorian Medical Benevolent Association
Assistance for medical practitioners and families affected by financial hardship.
Referral via the Victorian Doctors Health Program.
 
AMA Victoria Peer Support Service
Helpline (8am-11pm) 1300 853 338
Office 03 9280 8722
No charge, cost of a local call.

 

Western Australia

Colleague of First Contact, Doctors Health Advisory Service in WA
24 hour telephone service 08 9321 3098
Confidential service to deal with stress, depression, suicidal thoughts, substance abuse, illness.
Advice on appropriate referral services.
 
Rural Medical Family network
Telephone counsellor: 1800 218 176


 

New Zealand

Doctors Health Advisory Service
24 hour helpline 0800 471 2654

Resident Doctor’s Support Team (RDST) *NEW
A specific resource for those working at Canterbury District Health Board containing practical, work related information for doctors new to working in the area, along with helpful contacts for any questions or queries.

Communicating with Patients and their Relatives *NEW
A section of the Canterbury District Health Board website giving assistance regarding communication with patients, including Maori perspectives. Useful for junior doctors and those new to the region.

 
You can always contact the ACEM regional trainee representatives using the Contact tab. 

If you know of any support services that you think will be appropriate for the Member Wellbeing page, please email curriculum@acem.org.au 

 

Frequently Asked Questions

1. How do I look after myself after a critical incident?
2. I am having conflict with my colleagues. What strategies can I use to improve this?
3. I am worried that my friend is an impaired practitioner. What should I do?
4. I am drinking too much. How can I find help?
5. Am I depressed? 
6. I think I am being bullied, what should I do?

1. How do I look after myself after a critical incident?

In emergency medicine, there are likely to be times when we are all involved in situations that are stressful; a near-miss, an adverse incident, or particularly confronting cases such as paediatric arrests. It is not unusual to find yourself affected by these, so it is helpful to have some coping strategies.
 
You are not alone. There are times when we all feel hopelessly inadequate, and others around appear self-confident and assured. These outward appearances can be quite different from what other people really feel. So don’t feel isolated. Any of us working in this challenging environment feels like this some of the time, particularly after a critical incident. Talk to others about how you are feeling after any stressful event. You may well be surprised about how they have had similar experiences, and can often share concerns and their own failures and successes to help you maintain perspective. This might be with a colleague whom you respect, admire and like and can talk to. If you have a mentor, they may well be the best person to utilise at this time.
 
Try not to worry or ruminate too much. If you think you are becoming pre-occupied, stressed or depressed following a critical incident, do seek help. You should enjoy work, not just tolerate it, and certainly not dread it! Talk to someone. Sometimes it can be beneficial to consult your GP, a counsellor or clinical psychologist. Do not suffer in silence, or believe you are the only one who is going through this.
 
Debriefing after a high stress incident can be extremely helpful. Some departments and organisations have a formal structure in place for debriefs, including professional facilitators. If you know this occurs where you work, and you think it would be beneficial, ensure you know when they are occurring and can have the time from other duties to attend. Spending time reviewing what happened and hearing how others view and feel about it can be valuable in processing the event for yourself. If there is no regular culture of debriefing in your workplace, ask about whether this could be arranged. It is very likely that other people involved will find it helpful.
 
Be mindful that you are continuing to carry out everyday activities and don’t neglect the other aspects of your life. Maintain balance in physical, social, psychological and spiritual activities. Ensure you get some perspective by talking with friends and family. They will often spot when we are preoccupied, appear stressed or upset.
 
Think about whether you may want to focus on up-skilling in a particular area of practice to assist in building your confidence in potentially difficult areas. Maybe a crisis resource management course, or a trauma or life support course. Feeling more knowledgeable about these stressful situations will increase your resilience!
 
Constant exposure to other people’s suffering, heavy physical and emotional demands of work and the reluctance to talk about how we are doing and the impact of work on us all affect our wellbeing. Know how to recognise this, talk to someone and don’t feel alone.
 
Find further resources via the links on our Where can I get help? tab.

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2. I am having conflict with my colleagues. What strategies can I use to improve this?

Conflict is ubiquitous and a perennial challenge is to use conflict for good. There is no magic recipe that can strategise all circumstances. There is a growing body of social science that specifically covers this important Human Resources area. A good place to start is to make a genuine objective attempt to interrogate those parts of your own behaviours and attitudes that may be contributing to your current impasse. Continuously improving self-awareness is not only necessary but has been shown to pay dividends in terms of your ability to manage others. In fact if you can’t manage yourself, your chance of managing others will be compromised.

There are many excellent courses, programs or workshops available that provide both the theoretical concepts and practical skills training. This is a common and important issue that has led many specialities including emergency medicine to include management as a component within the curriculum.  

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3. I am worried that my friend is an impaired practitioner. What should I do?

Under the Health Practitioner Regulation National Law 2010 (Australia) there are precise definitions of impairment and voluntary and mandatory reporting requirements. In general it may be preferable in terms of consequences if a doctor voluntarily reports. If employed in a public sector organisation, that organisation will have process rules which govern this. This will normally mean that concerns should be escalated to a line manager, the Director Emergency Medicine Training (DEMT), the Director of Medical Services or the Director of Clinical Training. Providing that you do this in good faith, there are legal protections from civil and administrative liability. Conversely, there may be consequences if you do not disclose.

In New Zealand the situation is very similar. If you believe a doctor is unwell and may be unable to practice safely, you are required by law to notify the Medical Council. If you have a reasonable belief that a doctor may be unable to perform the functions required for the practice of medicine, the obligation to notify takes effect. If you haven’t notified the Council, this could be seen to be a breach of professional obligation and give rise to disciplinary proceedings. Supporting the obligation to notify, the Health Practitioners Competence Assurance Act 2003 provides protection for those notifying. It states that ‘no civil or disciplinary proceedings lie against any person in respect of a notice given under this section by that person, unless the person has acted in bad faith’.

Reference:

Information on the management of impaired practitioners www.medicalboard.gov.au
New Zealand Medical Council website under “Fitness to Practise” www.mcnz.org.nz

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4. I am drinking too much. How can I find help?

The National Health and Medical Research Council publishes Australian Guidelines to Reduce Health Risks from Drinking Alcohol which clearly explains what safe drinking levels are. These are easily accessed online and are a great place to start to reflect whether you are actually drinking too much. If you suspect that you may be developing an alcohol use disorder, the AUDIT Tool is a validated self-assessment questionnaire that provides another a quick answer to either authenticate or dismiss your suspicions.

Should both these objective tools prove to be in the affirmative, you are advised to seek help. This may be from your own trusted GP, an addiction medicine specialist or a doctor friendly Alcoholics Anonymous (AA) group. Alternately most university psychology departments administer interactive web-based counselling programs that can be accessed anonymously.

As lifetime prevalence studies indicate that one in ten people will develop alcohol strife, there is no need to feel shame should this be affecting you. Lifestyle changes such as replacing unhelpful alcohol consumption with alternate habits such as exercise, hobbies and satisfying social interactions have shown to assist. Fortunately, data shows that the prognosis for doctors who develop alcohol use disorder are favourable especially where the problem is recognised and managed early.  

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5. Am I depressed?

We all know that recognising disease in those we are close to can be more difficult than seeing the same features in a patient we are seeing at work. Our emotional involvement can rob us of some of our objectivity. This is just a quick list of things you may have noticed in yourself that would suggest that you might have clinical depression. All that makes us sad is not clinical depression - you may be burnt out, may be going through a stressful period in your life or suffered a recent loss. None of those things make us a different or worse person or doctor. Make sure you talk to someone about how you feel.

Behaviour:
  • Not going out anymore
  • Not getting things done at work/at home
  • Withdrawing from close family and friends
  • Relying on alcohol and sedatives
  • Not doing usual enjoyable activities
  • Unable to concentrate
Feelings
  • Overwhelmed
  • Guilty
  • Irritable
  • Frustrated
  • Lacking in confidence
  • Unhappy
  • Indecisive
  • Disappointed
  • Miserable
  • Sad
Thoughts
  • 'I’m a failure.'
  • 'It’s my fault.'
  • 'Nothing good ever happens to me.'
  • 'I’m worthless.'
  • 'Life’s not worth living.'
  • 'People would be better off without me.'
Physical
  • Tired all the time
  • Sick and run down
  • Headaches and muscle pains
  • Churning gut
  • Sleep problems
  • Loss or change of appetite
  • Significant weight loss or gain
If, after reading through this list, you think that some of these features fit your mood we encourage you to complete the BeyondBlue short checklist. It is important that you don’t try to manage your own depression - make sure you have a GP who can focus on caring for you while you focus on recovering. 

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6. I think I’m being bullied what should I do?

Several studies have shown that bullying is unfortunately commonplace in the medical profession.  Up to 50 percent of Australian junior doctors have experienced bullying in their workplace and a recent study from New Zealand found that 50 percent of doctors had experienced bullying in the last 3-6 months. Bullying can happen to anyone, from medical student to senior specialist.

The College defines bullying as:
 
“…Repeated, unreasonable behaviour directed towards a person or group that creates a risk to health and safety..”

Within this definition:

Unreasonable behavior means behaviour that a reasonable person, having regard to all the circumstances, would expect to victimise, humiliate, undermine or threaten.

Behaviour includes actions of individuals or a group, and may involve using a system of work as a means of victimising, humiliating, undermining or threatening.

Risk to health and safety includes risk to the mental or physical health of the person.

Bullying can be dealt with either informally or formally.  A formal complaint can be made under the ACEM bullying and harassment policy.

If you think you are being bullied the AMA advises:
  • Document threats or action taken by the bully
  • Discuss your concerns with your supervisor (or someone equivalent if your supervisor is the bully)
  • Consider making a complaint under your employer’s bullying and harassment policy. Most employers have grievance, occupational health and safety or equal opportunity officers who can assist in accessing the appropriate part of the complaints procedure. If your employer does not have a policy, consider using an informal/formal complaint procedure, and
  • Seek support from your peer network, colleagues, your local AMA and other organisations (e.g. the Australian Human Rights Commission), who can give you advice on your options and rights and some of which may act on your behalf.
If you feel unsafe you must seek help immediately.

ACEM considers bullying unacceptable behaviour that will not be tolerated under any circumstances.  
Below is a link to the college bullying and harassment policy and some other useful resources. You can also find further resources via the links on our Where can I get help? tab.

References

Australasian College of Emergency Medicine Policy on Bullying

Australian Medical Association Position Statement: Workplace Bullying and Harassment 

Askew DA, Schluter PJ, Dick ML, et al. Bullying in the Australian medical workforce: cross-sectional data from an Australian e-Cohort study. Aust Health Rev 2012;36:197–204

Rutherford A, Rissel C. A survey of workplace bullying in a health sector organisation. Aust Health Rev. 2005;28(1):65-72

Scott J, Blanshard C, Child,S. Workplace bullying of junior doctors: a cross sectional questionnaire survey. NZMJ Digest. 2008. Vol 121 No 1282: 13-15.

Paice E, Aitken M, Houghton A, Firth-Cozens J. 2004. Bullying among doctors in training: cross sectional questionnaire survey. BMJ Jul 15.

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If you are in crisis, please seek support through one of the resources provided on the Where can I get help? tab.