5. Protect mental safety
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Reducing psychosocial hazards
Workplace harm isn’t just bad luck—it’s preventable. Employers must tackle common issues like stress, bias, conflict, and burnout head-on. Mental harm at work isn’t inevitable—it’s a failure of systems which predispose doctors to being targeted by patient complaints and involved in clinical incidents.
Your employer is responsible for putting in place systems, procedures and policies to prevent, reduce and manage the impact of psychological hazards that predispose to work related mental injury including:
1. Psychosocial hazards
2. Intense stress
3. Managing conflict
4. Bias
5. Other negative behaviours
6. Patient complaints and medico legal action
7. Clinical incidents
Medicine is demanding, and doctors can always do more to support each other through regular debriefing and interventions to reduce excessive stress.
Employers are legally responsible for addressing psychosocial hazards such as excessive job demands, poor organisational justice, exposure to traumatic events or material, and remote or isolated work.
The Work Health and Safety (Managing Psychosocial Hazards at Work) Code of Practice was registered on the Federal Register of Legislation at the end of 2024. Managing the risks associated with psychosocial hazards not only protects workers’ health and safety, it reduces staff turnover and absenteeism, and increases performance and productivity.
We all need to do better than a token 'Are you OK?' Real support sounds like: 'What do you need, and how can I support?'
1. Psychosocial hazards
Your employer is responsible for addressing the following psychosocial hazards under the Model Code of Practice :
A. excessive job demands
B. low job control
C. poor support
D. lack of role clarity
E. poor organisational change management
F. inadequate reward and recognition
G. poor organisational justice
H. exposure to traumatic events or material
I. remote or isolated work
J. poor physical environment
K. conflict or poor workplace relationships and interactions
Excessive job demands involve sustained physical, mental, or emotional effort and become hazardous when excessive or prolonged. Risks include long hours, heavy workloads, complex tasks without training, or exposure to aggression. Managing demands involves better planning, breaks, training, emotional support, and adequate staffing.
Low job control occurs when workers lack autonomy, becoming harmful when frequent or severe. Examples include rigid schedules or needing permission for simple tasks. Control can be improved by offering flexibility, faster approvals, control over task timing, and involving workers in planning.
Poor support arises from lack of help or resources, and becomes hazardous if ongoing. It includes missing tools, poor communication, unavailable supervisors, or a toxic culture. Solutions involve providing resources, improving communication, supervisor training, and encouraging teamwork.
Lack of role clarity happens when workers are unsure of duties or expectations. This includes unclear reporting lines or shifting tasks. It can be managed through clear job descriptions, reporting structures, task explanations, and improved instructions.
Inadequate reward and recognition becomes hazardous when efforts go unacknowledged. Signs include unfair feedback, lack of praise, limited development, or micromanagement. Control measures include timely recognition, meaningful feedback, fair evaluations, and training managers.
Poor organisational justice relates to unfair decisions, lack of transparency, or mistreatment. Issues include inconsistent policies, mishandled information, or unfair blame. Risk is managed through fair procedures, clear communication, respectful treatment, and privacy safeguards.
Exposure to traumatic events/materials is hazardous when severe or frequent. Examples include witnessing trauma or handling distressing content. Risk control includes limiting exposure where possible, rotating roles, breaks, and trauma response training and support.
Poor physical environments affect wellbeing and focus. Risks include unsafe tasks, ill fitting PPE, or poor accommodation. Managing this involves compliance with safety laws and referring to Safe Work Australia's hazard library.
More information can be found at Safe Work Australia: Model Code of Practice – Psychosocial Hazards
2. Intense Stress
Doctors face intense stress due to the demanding, high-stakes nature of our work - making constant decisions, managing crises, and being exposed to trauma, grief, and complex illnesses. These pressures are compounded by the community's high expectations for doctors to always be competent, caring, and dependable.
Stress can also come from personal life events—career changes, relationships, parenting, grief, or even holidays. These accumulate and amplify overall strain.
To manage stress, doctors are encouraged to:
- Confront concerns – Write down all worries, acknowledge emotions, and avoid suppression.
- Accept life’s challenges – Recognise your limits and focus on what you can influence.
- Observe thoughts from a distance – Use downtime to mentally disconnect and recover.
- Let time heal – Be patient with yourself, seek support, and practice self-compassion.
If work thoughts linger during time off, ask reflective questions to challenge unhelpful thinking and reframe the situation such as:
What is the evidence for this way of thinking about the problem?
Is there another explanation for what you are feeling or what is happening?
What is the worst that could happen?
What is the best that could happen out of this?
What is the most realistic outcome?
What would you advise a colleague if he or she were facing the same situation?
Effective strategies include:
- Cognitive behavioural techniques to reframe negative thoughts.
- Positive psychology to build gratitude, kindness, and optimism.
- Mindfulness and relaxation for mental resilience.
Sleep issues are common under stress, especially with irregular work hours. While generic sleep hygiene advice helps some, it’s not always enough for doctors. Non-drug solutions, like Dr. Giselle Withers’ Mindful Way to Healthy Sleep program (www.amindfulway.com.au), offer specialised tools to manage insomnia and reduce daytime stress naturally.
3. Conflict
Objective peer review, constructive feedback, and debate are key to maintaining high patient care standards. While differences of opinion are essential for learning, egos can make conflict hard to manage. When conflict arises with colleagues, try to:
A. Leave your ego aside and view the conflict as a chance to strengthen relationships.
B. Stay calm and assertive, and encourage respectful differences of opinion.
C. Start the conversation positively with phrases like "I hope we can create a trusting relationship" or "I appreciate your high standards."
D. Clarify the facts to avoid misunderstandings, ensuring the conflict stems from communication issues or personal differences.
E. Listen actively, understand the other person’s intentions, and ask for examples to better grasp the issue.
F. Acknowledge the other person’s perspective, saying, “I see why you’d be concerned. I’ll consider that in the future.”
G. Brainstorm solutions together, evaluate them objectively, and choose the best one, being open to compromise.
H. Agree to review the solution later and assess if it’s working.
Ask later: ‘Is everything OK now? How can we work together to prevent any misunderstanding happening again?’
If the conflict becomes heated, address strong emotions, avoid personal attacks, and use “I” statements to express your feelings. If things escalate, professional mediation might be necessary to:
- Acknowledge any strong feelings on either side.
- If you are being interrupted, ask if you may finish your sentences.
- Refer back to the issue at hand if there is any personal attack.
- Take responsibility for your own feelings by using ‘I’ statements like ‘I feel hurt . . .’ and ‘I feel distressed . . .’, rather than ‘You make me . . .’
- Also try: ‘I do not agree with your assessment’, ‘It is unprofessional to attack me personally’, and ‘I’ll discuss this with you when you are ready to communicate calmly’.
Think about a recent difficult conversation and your reaction. Did you cut it short? Did you acquiesce when someone showed a display of authority, attacked your integrity or yelled? Did the encounter trigger something from your past? Did you back down?
Try experimenting with your next conflict by remaining professional, listening fully and stating your rationale without emotion. Persevere with your point of view even if others behave inappropriately. Try reviewing your response using the points above. What did you find helpful?
Reflect on past conflicts and reactions. Consider how you might remain professional, stay calm, and persevere with your point of view in future situations.
4. Bias
Conscious or explicit bias occurs when there is a deliberate attempt to discriminate against a person or a group of people based on certain differences.
Unconscious or implicit bias involves a lack of awareness of inadvertent prejudice, and although it may be unintended, it can harmful. It is an automatic form of cognitive processing, which draws on our attitudes, to shape our pre-conceived perceptions and assumptions about people. It is extremely dangerous to assume that we, no matter how open-minded and educated, are immune to unconscious bias, and needn’t be constantly working on recognising and challenging it.
For these reasons, training is recommended to help all doctors become more aware of the dangers of stereotyping certain groups of people and to commit to treating everyone with understanding and respect. Doctors cannot be experts in all the intersecting cultures they encounter in their professional lives, but we must display an ongoing cultural curiosity, sensitivity and humility, as well as an ongoing commitment to learning about diversity and inclusion.
Practical tips for responding to unconscious bias:
- Value all voices.
- Challenge outdated role stereotypes and labelling.
- Focus on capability and competence not superficial appearance.
- Call out disrespectful language and jokes.
- Be aware that seemingly harmless comments may trigger painful feelings in people who have been subjected to chronic low-grade bias.
5. Negative behaviours
Health care is increasingly complex and under-resourced, making it important to distinguish between poor behaviour and legitimate feedback. Routine performance reviews, justified criticism, or occasional irritability are not bullying. Bullying involves repeated, unreasonable actions that pose a risk to someone’s health and safety, such as verbal abuse, unjustified criticism, intimidation, exclusion, impossible demands, or spreading false rumours.
Ideally, negative behaviours would be addressed quickly by clinical teams and HR to prevent bullying, but in reality, processes can be flawed. Sometimes, victims and perpetrators are inappropriately brought together for mediation, which can worsen the situation in the future. Perpetrators may deny wrongdoing and retaliate in subtle ways, often going unchallenged if others fear career repercussions.
To respond early, one should confidentially raise concerns with a senior, trusted individual—someone with influence—without necessarily making a formal complaint. Stay objective and anticipate dismissive reactions, calmly reinforcing that the behaviour is unacceptable and harmful to others. Speaking up can prompt change and protect other colleagues and patients from ongoing harm.
Workplace culture plays a key role in either enabling or preventing negative behaviours. A speak up culture that prioritises psychological safety, open communication, and mutual respect can act as a protective factor, reducing the likelihood of poor behaviour taking root.
Leadership plays a key role in modelling respectful behaviour and setting clear expectations. Regular training on professional conduct and conflict resolution, as well as anonymous reporting mechanisms, can empower people to speak up without fear of retaliation. Building a culture of accountability and support improves team morale, patient care, and clinician retention.
6. Patient complaints and medico legal action
In the complex world of medicine where access blocks are common and under resourcing is compromising quality of care, patient complaints are inevitable.
Here are some tips for helping patients with their complaints and reducing the risk of inappropriate or unnecessary medico-legal action:
A. Try to re-establish patient trust by having a prompt face-to-face meeting. Listen fully. Use a concerned, sincere tone, take your time during the meeting and offer to work with the patient to address the situation together.
B. Patients often experience justified anger in response to their experiences in the health care system particularly if their have been access blocks due to skeleton staffing levels due to poor resourcing. Allow your patient to express their anger and validate a patient’s anger by saying ‘It must be very frustrating for you’.
C. Establish the facts behind the complaint and the factors that led to the complaint, to deal with the patient’s concerns and identify any changes that can be implemented to prevent this happening to another person.
D. Establish what the patient expects to happen after the complaint. Apologise if this is appropriate.
E. Provide relevant clinical information and document the process of dealing with the complaint. Ask if there is anything else the patient needs to know about or if the patient requires any other support.
F. Discuss appropriate ways of dealing with the payment of accounts. For example, it may be appropriate to waive payment. Do not send accounts for incorrect treatment.
G. Provide options for ongoing medical care and consider referral to another doctor if required.
Contact your medical insurer (MDO) for advice sooner than later.
It is also worth taking time to observe what is really happening in our waiting rooms and on our front desk telephones. Staff training on customer service is especially important in a medical context where patients may feel sensitive and anxious. This is a common cause of patient dissatisfaction and may be another source of complaints.
Vexatious complaints
Doctors must also distinguish when a patient’s behaviour is sociopathic or vexatious because the management is very different from reasonable or justified patient anger.
Unreasonable complainant behaviours are demanding, persistent, uncooperative or aggressive through unreasonable anger, abuse, intimidation, threats or violence. Their communications are often relentless, out of proportion, voluminous but vague, and they often misconstrue communication from others. They seek reparation and retribution, but are rarely satisfied with offers of resolution. In these situations, it is particularly important for doctors to support each when personally targeted by a querulant or vexatious complainant.
Querulant (morbid) complainants are relentlessly driven by an out of proportion ‘perceived injustice’, and their complaints cascade over years, often devastating the lives of their victims and their own lives. Vexatious litigants often repeatedly institute a diverse range of legal proceedings without reasonable grounds.
Doctors who are targeted by unreasonable complainants require the support of their colleagues, workplaces and skilled mental health professionals to help them set firm boundaries and limits, and to debrief after encounters and attacks.
Helpful reference
7. Clinical incidents
The human body is not a machine, and clinical incidents and treatment complications happen. Open, honest, timely and caring communication with patients and their families is encouraged in this situation. Patients need to be reassured that any clinical incidents are being taken seriously and responded to by the doctor concerned.
Medicolegal action is more likely if a situation has been handled insensitively, or if there has been delayed or poor communication. To lower the risk of medicolegal action, we must contact our medical defence organisations (MDOs) immediately after a clinical incident, and before open disclosure or an apology is offered.
MDOs will usually advise against making any admission of liability or error of judgement, particularly before all the facts of the case are known. Expressions of sympathy do not constitute an admission of fault. We can say to our patients, ‘I am upset about this outcome’ without admitting negligence. We may express regret for what has happened by saying ‘I am very sorry this has happened’.
Many patients wish to be reassured that an error will not be repeated and may seek compensation if they believe this is the only way to raise awareness about a medical mistake. Others may take medicolegal action to punish the doctor or to raise money.
Whether a clinical incident involves a near miss, an adverse event or a sentinel event, we must also recognise the way the system in which we work might predispose us to making mistakes, by requiring us, for example, to work long hours or without adequate supervision and training. After any clinical incident, it is important for a hospital or practice team to undertake root cause analysis to determine the cause and contributing factors, in order to identify and manage systems issues and avoid repeat incidents.
Sometimes this involves identifying clinical training needs, performing clinical audits and examining the systems that have contributed to a failure such as processes for reviewing investigations, infection control procedures, and the management of confidentiality and privacy. While being involved in these investigations and peer reviews can be personally challenging, they are a routine process to maintain the highest standards of safety and quality in healthcare.
Doctors have become more aware of the importance of proactive clinical risk identification and the management of quality and safety in everyday practice. While it can be a time-consuming process to be involved in clinical governance, most doctors understand the importance of regular formal meetings with colleagues to continuously improve the quality and safety of patient care and to prevent future clinical incidents.
Because we care about high standards, we can be overly harsh with ourselves and other colleagues after a clinical incident. It is usually easy to see clearly in retrospect with a full analysis of the patient outcome what should or should not have happened in the past. This is much easier in the light of day, and much harder in the fog of a difficult presentation or during the dark of night.
Unless we receive support in these situations, we can be more likely to practice defensively and more likely to order unnecessary investigations, refer to other specialists for minor issues and consider leaving our practice or retiring early. Doctors can also suffer high levels of depression and anxiety following a significant clinical incident, even if there is no wrongdoing.
It is essential to seek supportive debriefing from trusted colleagues, treating GPs or psychologists (and MDO sooner than later).
Sometimes the best response to a colleague who is devastated by an error is ‘I have made mistakes and recovered and you will too’.