5. Protect mental safety

Workplace harm is not bad luck. It is predictable and preventable.

Mental harm at work is not inevitable - it reflects system failures that expose doctors to unmanaged psychosocial hazards, increasing the risk of patient complaints, clinical incidents and work-related mental injury.

Your employer has a legal duty to put in place systems, procedures and policies to prevent, reduce and manage the impact of psychosocial hazards that predispose doctors to mental injury, including:

1. Psychosocial hazards
2. Intense stress
3. Conflict
4. Bias
5. Other negative behaviours
6. Patient complaints and medicolegal action
7. Clinical incidents

Medicine is demanding. Doctors can - and do - support each other through debriefing and peer support. But individual resilience cannot compensate for unsafe systems.

Employers are legally responsible for addressing psychosocial hazards such as excessive job demands, poor organisational justice, exposure to trauma, 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 in late 2024. Managing psychosocial hazards protects health and safety, reduces turnover and absenteeism, and improves performance and retention.

We all need to do better than a token “Are you OK?”
Real support sounds like:
“What do you need - and how can I help?”

1. Psychosocial hazards

Under the Model Code of Practice, employers must identify, assess and control the following psychosocial hazards:

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

Excessive job demands involve sustained physical, mental or emotional effort and become hazardous when prolonged. Risks include long hours, heavy workloads, complex tasks without training, and exposure to aggression. Controls include realistic staffing, protected breaks, training, emotional support and workload planning.

Low job control occurs when autonomy is restricted, such as rigid rosters or unnecessary approvals. Risk is reduced by flexibility, shared planning, and control over task timing and priorities.

Poor support includes lack of resources, poor communication, unavailable supervisors or toxic cultures. Control measures include resourcing, supervisor training, clear escalation pathways and teamwork.

Lack of role clarity arises from unclear expectations, shifting duties or ambiguous reporting lines. Risk is reduced through clear role descriptions, instructions and accountability structures.

Inadequate reward and recognition become hazardous when effort is persistently unacknowledged. Controls include meaningful feedback, fair evaluation, development opportunities and respectful management.

Poor organisational justice reflects unfair processes, inconsistent decision-making, lack of transparency or blame cultures. Risk is managed through fairness, privacy, consistency and respectful communication.

Exposure to trauma becomes hazardous when frequent or severe. Controls include limiting exposure, role rotation, protected recovery time, debriefing and trauma-informed responses.

Poor physical environments affect safety and concentration. Risks include unsafe tasks, poor equipment, ill-fitting PPE and inadequate facilities. These must be addressed in line with WHS standards.

More information:
Safe Work Australia – Model Code of Practice: Managing Psychosocial Hazards at Work
https://www.safeworkaustralia.gov.au/sites/default/files/2022-08/model_code_of_practice_-_managing_psychosocial_hazards_at_work_25082022_0.pdf
https://www.safeworkaustralia.gov.au/safety-topic/managing-health-and-safety/mental-health/psychosocial-hazards

2. Intense stress

Doctors work in high-stakes environments - making rapid decisions, managing crises, and being exposed to trauma, grief and uncertainty. These pressures are amplified by community expectations that doctors are always competent, caring and available.

Stress also accumulates from personal life events - career transitions, relationships, parenting, illness or loss. Together, these pressures compound overall strain.

Helpful strategies may include:

• Confront concerns: write worries down; acknowledge emotions
• Accept limits: focus on what you can influence
• Create mental distance: try to disconnect during breaks
• Allow recovery: seek support and practise self-compassion

If ruminating about work persists, try to ask:

• What is the evidence for this belief?
• Is there another explanation?
• What is the worst, best and most realistic outcome?
• What would I advise a colleague?

Evidence-based tools include Cognitive Behavioural Therapy techniques, positive psychology, mindfulness and relaxation.

Sleep disruption is common in doctors, particularly with shift work. Generic sleep hygiene may be insufficient. Non-pharmacological programs such as The Mindful Way to Healthy Sleep (www.amindfulway.com.au) offer tailored approaches for clinicians.

3. Conflict

Respectful disagreement is essential for learning and patient safety. Conflict becomes harmful when unmanaged or personalised.

When conflict arises:
A. Set ego aside and view it as a chance to strengthen relationships
B. Stay calm and assertive
C. Start positively (“I value your standards…”)
D. Clarify facts to avoid misinterpretation
E. Listen actively and seek examples
F. Acknowledge perspectives
G. Generate and evaluate solutions together
H. Review outcomes later

If emotions escalate, use “I” statements, address behaviour not character, and consider mediation if needed.

Reflect on past conflicts: did authority, tone or past experiences influence your response? Experiment with remaining professional, calm and persistent in future interactions.

4. Bias

Explicit bias involves conscious discrimination.

Implicit bias is unconscious, automatic and widespread - and no one is immune.

Bias harms individuals, teams and patient care. Ongoing training and reflection are essential. Doctors must practise cultural curiosity, humility and a commitment to inclusion.

Practical steps:

• Value all voices
• Challenge stereotypes
• Focus on competence, not appearance
• Call out disrespectful language
• Recognise cumulative harm from “small” comments

5. Negative behaviours

Healthcare is under-resourced and complex. Legitimate feedback and performance review are not bullying. Bullying involves repeated, unreasonable behaviour that risks health and safety.

Poorly handled processes for managing negative behaviours can worsen harm - particularly when victims and perpetrators are forced into inappropriate mediation. Early, confidential escalation to a trusted senior person can prompt change and protect others.

Culture matters. A strong speak-up culture, visible leadership and anonymous reporting reduce harm and improve retention.

6. Patient complaints and medicolegal action

In strained systems, patient complaints are inevitable. Early, compassionate responses reduce escalation:

A. Meet promptly and listen fully
B. Validate patient distress
C. Establish facts and contributing factors
D. Clarify expectations and apologise if appropriate
E. Document carefully
F. Address billing issues appropriately
G. Provide options for ongoing care

Contact your MDO early.

Front-desk interactions matter. Customer service training is critical in anxious environments.

Vexatious complaints

Some complaints are unreasonable, persistent or malicious. The management of vexatious complaints differs from justified complaints. Doctors targeted by vexatious complainants need experienced collegial, organisational and psychological support.

7. Clinical incidents

Clinical incidents occur despite best practice. Open, timely and compassionate communication reduces harm.

Always contact your MDO before open disclosure or apology. Expressions of sympathy are not admissions of liability.

Systems matter. Long hours, poor supervision and unsafe processes increase error risk. Root cause analysis, audits and governance processes are essential for prevention.

Doctors are often harsh on themselves after incidents. Without support, this can lead to defensive practice, unnecessary investigations, early exit from practice, depression or anxiety.

Seek debriefing early - from trusted colleagues, your GP, psychologist and your MDO.

Sometimes the most powerful support is hearing:
“I’ve made mistakes too - and I recovered. You will as well”

For further support, refer to Topic 9.

For further information, the 2nd edition of the book Every Doctor: healthier doctors = healthier patients co-authored by Dr Leanne Rowe and published by Taylor and Francis is available via Booktopia. See Topic 12.