Junior doctors concerned for their safety

Transcript: AMA Queensland Committee of Doctors in Training Chair, Dr Elise Witter, ABC Radio Brisbane, Drive with Ellen Fanning, Friday 15 November 2024

Subject: Resident Hospital Health Check

ELLEN FANNING: When you arrive at work, do you ever worry about a customer or a client threatening you, hurting you? Imagine the stress of that happening to you on any given day while you're just trying to do your job. But that fear has become normal for junior doctors at our big training hospitals, with one in three reporting they feel unsafe at work and more than half of them are worried they’re so tired they'll eventually make a mistake that will harm a patient. The concerns have come out of the latest Australian Medical Association's check-up on junior doctors. Dr Elise Witter has lived experience of this. She's also the Chair of AMA Queensland's Committee of Doctors in Training. Dr Witter, thanks for joining us.

DR ELISE WITTER: Thank you for having me.

ELLEN FANNING: This is your experience, is it, feeling not only the exhaustion but that threat level at work?

DR ELISE WITTER: Oh, absolutely. And I think it's a common experience that I hear reported by my colleagues. Certainly working in the ED, I've had things thrown at me, patients punch holes in the walls, I've been slapped by a patient. It's not unusual for these events to happen at work. Obviously, that's the more extreme end. There's also verbal abuse from patients and other factors as well.

ELLEN FANNING: Was it always like this or is this something that has got worse over time?

DR ELISE WITTER: I think it is something that is getting worse over time.

ELLEN FANNING: Are there systems in place to deal with this?

DR ELISE WITTER: There are systems in place. However, I don't believe that those systems are adequate. We very rarely have structured debriefing available to people who experience incidents like this. And there's variable support or follow-up available. In terms of prevention, again, there’s variable strategies in place for prevention. There certainly needs to be more done in terms of security and building environments with things like CCTV and exit doors so that people can be safer at work.

ELLEN FANNING: This is an astonishing conversation for many of us in modern workplaces, where workplace health and safety is as embedded in white collar industries now as it is in mining or the building site across the road. I mean, it's in the DNA of those industries. How come the medical profession hasn't caught up? The public health system hasn't caught up?

DR ELISE WITTER: I think there's a challenge there that often the patients who are committing these offences or making people feel unsafe, they might be unwell, they might be drug-affected, they may be experiencing mental illness.

ELLEN FANNING: But that's a known danger, known vulnerability for staff every night.

DR ELISE WITTER: Absolutely.

ELLEN FANNING: Okay. So when do junior doctors feel most unsafe, would you say?

DR ELISE WITTER: Oh, I think it's difficult to say. Particularly in the emergency department is where we see a lot of aggression, patients who are affected by drugs. Another issue we found is in the ward call space. Junior doctors who are covering night shift, travelling between buildings that have poor lighting, poor security, and covering large areas of the hospital by themselves with very little support. They feel unsafe. One in five reported their safety as one out of five in that night shift context.

ELLEN FANNING: In that night shift context, because there isn't the lighting in place, there's not security guards in place, and you're wandering around big hospital precincts alone at night?

DR ELISE WITTER: Yes.

ELLEN FANNING: We're listening to Dr Elise Witter. She is the Chair of AMA Queensland's Committee of Doctors in Training, and she's talking to us about this latest data of the Australian Medical Association's check-up on junior doctors. Tell me about burnout.

DR ELISE WITTER: So, 50 per cent of doctors in training reported that they're currently burnt out. And to me, that's a terrifying statistic because I don't see how doctors can go to work and provide the care that patients deserve when they're feeling burnt out themselves. And I think this is a consequence of increased clinical demands. We're seeing more patients, we're seeing more complex patients, and we're also seeing junior doctors walking away from the healthcare system because they're burnt out. They can't access annual leave, they're fatigued. And it becomes a vicious cycle where doctors are leaving, there's fewer doctors doing the work and the burnout is just escalating.

ELLEN FANNING: And so these are people who have committed, and their parents and carers and communities have committed to getting them through this endless education you have to go through. And you're saying that they're walking away from that dream of being a physician?

DR ELISE WITTER: Yes. People are. And in fact, with the medical training survey last year found that one in five junior doctors are considering a career outside of medicine.

ELLEN FANNING: Have you ever thought about leaving?

DR ELISE WITTER: I've definitely thought about leaving, a couple of times, but I'm very fortunate to really enjoy my job and have a lot of support within my own training program.

ELLEN FANNING: Yeah, and that makes the difference. We'll talk about what support helps. This idea of being concerned about making a terrible mistake seems to hang over exhausted young doctors.

DR ELISE WITTER: Yeah, absolutely. And I think it's a reflection of rostering practices, people working extended overtime. I've spoken to junior doctors who've crashed their cars driving home from night shift because they're so fatigued. And to think that the same person is in charge of looking after sick patients is a real concern.

ELLEN FANNING: We've been hearing this - I'm 57, and I heard this from people your age when I was your age. To what extent is this a cultural problem within health services? “I went through it,” will say a more senior doctor. “I got through it. It was a test of fire and that's how we mint new doctors - put up with it. Teaspoon of cement.” Is that part of the problem?

DR ELISE WITTER: Yeah, there's definitely a huge cultural issue in terms of people not wanting to acknowledge that there's a problem, very limited political will to change the problem. And in fact, when we put out our survey, a number of large hospitals refused to allow us to visit to promote the survey or actively discouraged their doctors from doing it. Which just goes to show the services who refuse to even acknowledge there's a problem, let alone are ready to begin addressing it.

ELLEN FANNING: So what starts to make the difference? Because in the end we've got a new government, we've got a new Health Minister, Tim Nicholls. What makes a difference? Because this is a workplace and it sounds like an unsafe workplace.

DR ELISE WITTER: I think you know we're really hoping to work with the new government towards change in this space. And I think what will make the difference is investment and infrastructure to make hospitals safer workplaces, investment in incentives to retain junior doctors and to support them to access their leave, to stay in the workplace and just access to leave, access to additional supports for emotional wellbeing, just things like that.

ELLEN FANNING: It seems to me, listening to you, Elise, and thinking about what you're saying, that that's what's going to take. It's going to take a top-down change from the minister or heads of the public health sector to deal with this, because it can't be junior doctors among the most powerless people in the system speaking up and making change. They'll fill out your survey. But I imagine they're not going to raise their voices in the system.

DR ELISE WITTER: Absolutely. And one of our results was actually that 81 per cent of junior doctors wouldn't report bullying or harassment because they were worried that it would affect their career. And junior doctors are in a very vulnerable position where they're relying on references, experiences to progress. And so they can't report their supervisor who's bullying them or they don't want to whistleblow a safety issue. They're just trying to get through their rotation without being seen as a troublemaker.

ELLEN FANNING: Meanwhile they're fretting that the patients are the ones whom who might be injured as well in all of this.

DR ELISE WITTER: Absolutely.

ELLEN FANNING: Well, thank you for the research. We'd love to see you again. Maybe we'll get you in with the new Health Minister, Tim Nicholls, because it's the sort of conversation that I think we need to have more and more. There are certain issues that just come up over and over again, generation after generation, and stroking our chins and saying, “we really should do something about that,” it's just not good enough, is it?

DR ELISE WITTER: No. Absolutely not.

ELLEN FANNING: Dr Elise Witter, AMA Queensland Committee of Doctors in Training. Thank you so much.

DR ELISE WITTER: Thank you.

ELLEN FANNING: Doing double shift and doing the interview.

Contact: AMA Queensland Media: +61 419 735 641                  media@amaq.com.au