Promoting well being involves a shift in attitude toward health - moving from a disease model to focusing on positive functioning.

Studies of stress in the work place have focused almost exclusively on impairment, and as a result we know much about disease and despair, substance misuse, burnout, and dysfunctional relationships. But we know very little about what keeps us feeling well.
Though this may simply reflect the tendency for psychological research to focus on pathology rather than health, it nevertheless leaves us with little information to guide us in living positive and healthy lives.We need some healthy alternatives to our damaging ways of living and working. We have the ability to influence our own happiness through personal values and choices.

Five main areas to nurture are:

- spending time with family and friends

- religious or spiritual activity

- self care

- finding meaning in work and setting limits around it

- adopting a healthy philosophical outlook, such as being positive or focusing on success

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These areas are consistent with the predictors of happiness that have been identified through "positive psychology," the discipline that seeks to "measure, understand, and then build human strengths and civic virtues."' Myers recently reviewed these predictors and found that they included social support, close relationships, and religion. We would do well to remember that yuppie values -seeking a high income and occupational prestige -are strongly associated with misery. Internal psychological factors associated with wellbeing include setting and pursuing goals, attempting to realise one's potential, and possessing positive self regard."

Drawing on these lessons from positive psychology, we can therefore foster our own wellbeing by re-examining our personal lives and values. This might include changing our relationship to money; devoting more time to intimate relationships; or adopting a regular self care practice such as meditation, which is effective in reducing anxiety.' We can increase our awareness of our emotional lives through personal awareness groups.' Research is needed on the effectiveness of such groups in fostering wellbeing, though the limited data suggest that they are valuable.' We might also practice cognitive or behavioral techniques that can challenge our self critical thoughts and help to foster optimism and self worth."

Our ability of doctors to influence our work environment is highlighted by a survey of 608 physicians working for a health maintenance organisation in the Western USA." The survey aimed to identify factors that predict psychological wellbeing, satisfaction, and professional commitment, all measured using validated scales. The single most important predictor for all three outcomes was a sense of control over the practice environment. This included the opportunity to participate in decision making, to work autonomously, and to dictate the work schedule.
Therefore if healthcare organisations want healthy, happy doctors they need to engage them in the design and delivery of care. This will be empowering for patients and organisations, not just doctors, since physician satisfaction affects quality of care, patient satisfaction, and the effective use of healthcare resources."'

Acknowledging the need for doctors to influence their working environment, the Canadian Medical Association has adopted an impressive national policy on physician wellbeing." This demands an occupational environment with clearly defined limits to doctors' duties, training for medical students and graduates in maintaining wellbeing, and specialised health promotion services for doctors. Another north American innovation is the establishment of regional centres for physician wellbeing, offering courses for physicians and consultation services to healthcare organisations." Their impact has yet to be formally evaluated, but at least they raise awareness of the importance of healthy doctors to a community and allow medical schools, practice settings, and health insurers to join together in promoting wellbeing.
Organisations must also recognise that certain groups -women; those from visible and invisible minority groups; and those in rural, remote, or underserved areas-face a unique constellation of stressors. Their wellbeing requires sustainable and supportive work environments, free from discrimination, and sensitive to their needs.

Perhaps we could all acknowledge our duty to help each other stay well. To do so requires us to take personal responsibility and organisations to create nurturing environments.

Dr Sarah Temple
20 02 01

In summary from January Issue of The Journal of Western Medicine (www.ejwm.com)

See also: Happiness