Doctor health, burnout and impairment (MEQ)

(i) Definitions. Burnout (Maslach): emotional exhaustion, depersonalisation/cynicism, and reduced personal accomplishment — a prolonged response to chronic job stressors; ICD-11 occupational phenomenon, not a DSM primary diagnosis. Major depression: pervasive low mood/anhedonia with cognitive and neurovegetative features that typically persist beyond work; high resident rates in meta-analysis. Impairment: health condition that adversely affects safe practice — may include substance use, severe mental illness, or cognitive decline; not synonymous with stress or burnout alone.[1][6][7]

(ii) Registrar assessment and safety. Private, non-shaming conversation; screen depression, anxiety, substance use, sleep, and suicide (ideation, plan, intent, means, protective factors). Assess fitness for remaining duties today. Near-miss and passive SI after complaint = high-risk context. Remove from independent high-risk duties if concentration/safety compromised; arrange cover; ensure not left alone if acute high risk; crisis pathway if needed; same-day treating GP/psychiatry access; means restriction advice; document facts; inform clinical lead as required for duty safety (need-to-know). Do not dismiss as “just burnout.”[6][7][4]

(iii) Interventions. Organisation-directed (often larger effects): roster redesign, reduce excessive hours/after-hours load, staffing, clerical burden reduction, leadership and psychological safety, fair complaint support. Individual-directed: peer support, mindfulness/small-group programmes, coaching, sleep recovery. Clinical treatment if depression/anxiety/SUD: standard evidence-based care. Evidence: West Lancet meta-analysis and Panagioti JAMA Intern Med meta-analysis support multi-level approaches with organisational emphasis.[2][3]

(iv) Impaired consultant. Patient safety first: if alcohol smell at work, do not allow clinical duties; arrange cover; private specific feedback if safe; escalate to medical director; offer physician-health support; follow local mandatory notification when public-risk thresholds are met. Document objective observations. Do not invent AHPRA section numbers; state jurisdiction-specific duties. Loyalty never outranks safety. Australian qualitative work highlights the tension treating doctors feel about mandatory reporting — still act on risk.[5][7]

(v) Literature anchors. Maslach job burnout review; West et al. intervention meta-analysis; Panagioti organisation-vs-individual meta-analysis; Schernhammer physician suicide meta-analysis; Mata resident depression meta-analysis; Brooks doctors’ mental health review; Bismark mandatory reporting study.[1][2][3][4][5][6][7]