Why I WRaP EM – Dr Alex Markwell

This blog piece has been a long time coming. In fact, I think I may be one of the last of the WRaP EM founders to put finger to keyboard. It certainly isn’t a lack of passion about wellbeing that has delayed me.

I have been interested in doctors’ health and wellbeing since I was Chair of the AMA Council of Doctors in Training (2007-09). Our committee undertook a nation-wide survey on junior doctor health and wellbeing and the results were pretty confronting.¹ This was in the parallel context of what appeared to be a spate of doctor deaths which were reported in the media. Some of these tragic deaths were due to suicide, some due to medical conditions or accidents precipitated by fatigue from long working hours. All of them felt preventable.

Since then I have lobbied and advocated for safe working hours, work-life flexibility and tried to maintain momentum with the wellbeing agenda. This continued once I finished my training and became a FACEM. Wellness conversations were often met with skepticism- both by individuals and facilities. It just wasn’t “how medicine is.” Just as we are now finally starting to call out (erosive?) medical culture and behaviour with some confidence, so too are we finally able to legitimately discuss wellbeing in medicine.

I feel very fortunate to have trained and now work at my department. I was well-supported during my training and had wonderful mentors. At a very practical level, our department facilitates access to leave, part-time appointments and flexible rostering for all staff. We schedule regular wellbeing and career planning sessions as part of formal registrar education program. Our tertiary department continues to comprise of a high proportion of part-time staff (including residents, registrars and consultants), and at times the number of part-timers outnumbers the full timers. This poses its own challenges, but ones we are happy to overcome if it means our staff are better supported.

Wellbeing in emergency medicine is really gaining momentum – not just locally in South-East Queensland (where most of the WRaP EM team are based) but nationally and internationally. Having this passionate group of collaborators to help promote and advance wellness in emergency medicine is amazing, and to be able to link these opportunities and resources online is brilliant.

Why, then, has it taken so long to write this post? The honest answer is that I have been fighting an overwhelming sense of hypocrisy. We all hope to role model the good behaviours we espouse, and there can be even more pressure on those promoting wellbeing to have it all figured out. I know I fail this test miserably.

Take work-life balance for example. I have an ideal part-time appointment at my hospital, but I do other stuff on my “days off”. Lots of stuff – stuff that I love and find challenging and rewarding and keeps me sane. But I also have two young children, a household to organise (with support from my husband and lots of outsourcing), and elderly family members who need assistance from time to time. I don’t always get the balance right, in fact I often feel a sense of panic trying to keep all the balls up in the air. But I also know that I couldn’t do “just clinical medicine”, so I hope in the long term that it will all balance out.

Despite what feel like epic personal failings I will continue to champion wellness. By sharing our struggles and vulnerabilities and celebrating our successes, we can foster (good) medical culture where it is safe to falter. Let’s face it – life (like emergency medicine) is gritty and overwhelmingly hard at times, but ultimately immensely fulfilling. And that is why I WRaP EM.

Reference

1. Markwell A, Wainer Z. The health and wellbeing of junior doctors: insights from a national survey. Medical Journal of Australia, 2009: 191(8); 441-444. For the AMA Council of Doctors in Training