Understanding peer support for doctors

Categories: Research project completed

Nyhetsartikkel publisert 05/02/24

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A qualitative study examining peer support for doctors in Norway. The study investigates both peer support services provided to Norwegian doctors, namely Villa Sana and Støttekollegaordningen. The peer support services at Villa Sana Modum Bad is also investigated thorough a longitudinal qualitative approach. The aim is to gain a better understanding of how peer support for doctors works.

Ingrid Marie Taxt Horne, Ph.D.

Medical Doctor, Psychiatrist

Ingrid Marie Taxt Horne is a medical doctor specialized in psychiatry working as a peer counsellor at the peer support services Villa Sana, Modum Bad. Ingrid’s areas of interest include the work life of doctors, their health, and the professional medical culture as well as qualitative research.

About the Project

The project is a qualitative study that examines why doctors seek peer support, how the services can contribute to change in a short term and long-term perspective as well as which conditions are important for the doctors to benefit from the services. The study utilizes data collected through 3 sets of semi-structured interviews; 13 doctors were interviewed within 10 days after they had made use of the peer support services at Villa Sana, Modum Bad (2018). 12 of these doctors were re-interviewed a year (+/- 30 days) later (2019). 12 doctors who had made use of the peer support services Støttekollegaordningen were interviewed a year (+/- 30 days) later (2020). The project uses a qualitative analytical approach developed by Malterud.

Objectives

The project’s objectives are to acquire knowledge of why doctors seek peer support and how change may occur after attendance to a peer support service. This knowledge can be used to tailor peer support services and should be of use to medical associations. Considering the recent campaign #DoctorsMustLive, health policymakers may also make use of the study’s results.

Results

The study has the following main findings:

The first paper addresses the reasons doctors seek peer support. The doctors reported a broad spectrum of reasons for seeking support, spanning from concerns and seeking advice, feeling unable to cope any longer, to having been on sick leave and now looking for a way back to work or a way out. They described both work- and privately related reasons for seeking support. Expectations of the help they would receive varied from dialogue and advice to career guidance to treatment. The confidential setting and the no record-keeping policy of the service were thought of as being important in lowering the threshold for help-seeking.

The second paper addresses whether the use of peer support influences change processes through investigation of what the doctors attributed to the received support a year later. This was done through comparison of interviews with the same doctors in 2018 and 2019. The results were interpreted in light of theory of organizational culture and the hidden curriculum in medicine. A common theme in the first interviews (2018) was the difficulty of accepting the individual situation because of beliefs and values concerning what a doctor ought to be. A doctor should be strong, healthy, and always put the patient´s needs first. But the private challenges did not match these expectations. A year later (2019), the interviewees seemed to have adjusted their expectations of what it means to be a doctor to also embrace and accept more human aspects, such as illness, limitations, and self-worth beyond work performance. The doctors reported having made changes both in relation to work and in their private relationships. Some had attended therapy and treatment. It thus seems that peer support can facilitate awareness of and promote changes in professional cultural values that help the doctors to self-care.

The third paper addresses how various elements in the peer support services’ design impact whether and how the doctors can benefit from it. The results were discussed in light of theories on organizational culture. The doctors wanted peer support to have a different quality from that of a regular doctor/patient interaction. They expressed that they needed and found psychological safety and an open conversation in a flexible and informal setting. Some of these qualities are related to the formal structure of the service, whereas others are based on the way the service is practiced. Peer support can enable reflection about, and questioning of, basic assumptions in professional medical culture. For some, the reflections help them to see new opportunities regarding how to handle difficult situations and may also lead them to question the professional culture that can hinder self-care.

The study shows an increased awareness in the interviewees about the expectations related to the so-called hidden curriculum in medicine, expecting doctors to work more than stipulated hours, sickness presenteeism, and dealing with both time and emotional pressure by working harder. Peer support for doctors seems to offer a unique possibility to re-examine values and beliefs concerning medical culture that can hinder self-care, and thus to broaden the scope of appropriate actions to handle difficult situations. A year after peer support, the participants have reconsidered and adjusted these expectations towards acceptance of their own mental and physical issues. Such acceptance seems to enable the doctors to initiate changes both at the workplace and in the private situations, helping them to see and attend to their own needs.

The results in this study underpin the theoretical perspectives presented. They demonstrate that values and underlying basic assumptions in the medical culture, as described in the hidden curriculum, seem to hinder self-care. They also show that providing a psychologically safe space can enable discovery of and reflection around basic assumptions in the professional medical culture.

The PhD-project constitutes a contribution to the discourse on doctor health in general, and on the specific issue of collegial support services. It emphasizes the importance of having appropriate support mechanisms that can provide doctors with a space for reflection, which in turn can lead to change. Furthermore, the study highlights the significance of raising awareness among the medical community regarding professional norms that may hinder self-care, and the importance of reflecting on how to address this issue in daily work.

Background

The health condition and health-related behavior of doctors are important preconditions for optimal treatment of patients, as well as of importance to the doctors themselves. Doctors are less absent due to illness than other professions and seek treatment more rarely. Based on this, many countries have developed peer support services for doctors as a measure of lowering the threshold to seek help.

The project is a doctoral research project that began in 2018. The project uses interview data collected from doctors who have sought peer support in one of the two services offered to Norwegian doctors.