Wearing the mask of invincibility has been the doctor’s lot for generations but the super-human role is unfair and grossly inaccurate according to doctors’ health expert, Dr Andrée Rochfort. “Many doctors are suffering with burnout and aren’t even aware of it. Sometimes it takes an event like completing a stress survey, or a period of sick leave for an unrelated illness, or an approach by a concerned colleague for them to realise that they symptoms of stress, depression or burnout.
“Unfortunately, we don’t have a representative national study on burnout but when you look at other studies in North America, Europe, the UK, Croatia etc. the lowest prevalence among GPs is 20 per cent, while the highest is 50 per cent. So the prevalence in general practice is 20-50 per cent; even at the lowest level that is one in five GPs. If you were to take 20 per cent of GPs out of the workplace in Ireland to address their burnout, it would create chaos.
“Look at Ireland’s working population generally, on the radio recently the public were saying they were stressed by work; bus drivers, gardaí, nurses, etc. Why would it be unusual that doctors should be stressed by work too? It’s time to start looking at doctors as part of the general population. If you look at the European Working Conditions Survey, on average 18 per cent of workers are stressed and when you look at stress statistics, on average 40-60 per cent of doctors report they are stressed. So, within the general population, doctors claim a significantly higher level of stress. Dr Rochfort acknowledged that stress isn’t always necessarily a negative, as it can increase alertness and improve professional performance. However, she feels that stress has the potential to become distress, and be harmful, if left unaddressed.
“Stress can lead to burnout which could become depression if it is not managed correctly. We are affected by it too because we’re human. If one in four people in the public get depressed then that includes doctors too. Going to university and doing a medical degree does not protect doctors from stress, anxiety or burnout.
She explained that there is an expectation that doctors should be impervious to the pressures of daily life, calling for a nationwide survey on burnout to legitimise the issues she and others have raised and enable doctors to recognise and feel comfortable speaking about their problems, this will enable them to take actions to prevent burnout or to manage it effectively if it already exists.
“Part of the reason doctors hide things is because they believe they’re expected to be superhuman. More data would not only make the general public more aware of doctors humanity but it would also make people within the medical profession, doctors, educators, managers, more aware and more supportive. There has been a national study done on stress in hospital doctors which was published recently. Dr Bláthnaid Hayes presented the data on stress in hospital doctors and doctors want to hear more about this topic because they know something must be done to help them and to help future doctors.
“Medical diagnostics and treatment options have changed in recent years, so has the role of doctors. Conducting a national survey can help to bring about discussion on the cultural change in the doctor’s role in the 21st century. The public expect doctors to be perfect, to know everything all the time and never to be over-burdened, or stressed by all the problems being presented to them by people and, what’s more, doctors have bought into that expectation. They see exhaustion as a weakness and failure. “My motto in medical education is that our medical training does not make us immune to illness of any sort, so we can get the same things our patients bring us. We can be shocked by the significance of our own symptoms; we’re not immune to disease, we’re not immune to distress, disappointment, financial pressures, grief and loss; we have feelings too.
“Whether you’re talking about a young intern or an experienced consultant or GP, it isn’t possible to meet the continuous demands of patients and their families who want numerous issues dealt with in a small amount of time. Looking at any quality surveys that have asked patients what would improve the quality of their healthcare, they have said that they would like more time with their doctor, which is really difficult due to current time pressures. Doctors often work without adequate breaks for food and water, or taking the time to pace themselves, this can be dangerous. Giving some patients extra time for a complex issue means that other patients may have to be rushed and that may cause something to be missed. We simply haven’t got the manpower to allow us to spend more time with patients and keeping their medical records up to date and safe. That brings us back to central issues of manpower and recruitment and retention.
“It would appear that younger GPs are leaving the country not simply because of salary but because of work conditions for doctors. We have to ask them what is attracting them elsewhere and what would deter them f
rom coming back, and would encourage them to return. We even have some older well-established GPs leaving the country to help pay their bills, so the work environment needs to be addressed. “If I had a wish list, I’d wish for a detailed national burnout survey, including following GPs right through from their trainee years. In fact, it’s the younger doctors who have the highest instance of burnout. So, covering newly emerging GPs to retired GPs would provide an amazing source of information. ies, taking regular work breaks and even something as basic as meeting other supportive people in the workplace
“There should be a two-pronged approach to burnout in Irish healthcare; one being the systems approach, like organisational issues, workload hours including safe administration hours. The other approach is the individual doctor taking responsibility for caring for themselves. That consists of a lot of different levels, one being a healthy attitude to work; a doctor would operate within normal physical limitations and recognise that they cannot be perfect and can make mistakes. Taking an active role in maintaining job satisfaction, recognising when a change must be made and remembering why they went into medicine in the first place is crucial as well. In addition, they could work on prioritising demands; setting boundaries.
“In a workshop on stress management that I deliver on the ICGP practice management diploma course something that frequently comes up is that importance of staying connected in the workplace. It’s very easy not to see the other people working in your practice from one end of the day to the other, you might send messages over the computer to improve efficiency but you might not get the opportunity for a personal conversation. Sometimes we don’t even have time for a bathroom break, which is crazy! Doctors are running themselves into the ground and that’s not going to do the patient any good; doctors’ health matters not only to themselves but also to their patients. “Reducing isolation, both professional and personal, is vital, particularly if you’re a single-handed or two-GP practice. Sometimes, you could have a practice on one road and another on the other side of the road who never see each other, except maybe at educational meetings once or twice a month.
Dr Rochfort noted that practising medicine defensively could be adding to the stress of Ireland’s doctors. “A complaint of any sort causes stress. We need local resolution of a local problem, practice based systems; if people have an issue, discuss it rather than allowing it to escalate, that’s about clear communication. There’s a blame culture and it is assumed that if something doesn’t go right in health then it must be the doctor’s fault. Dealing with the uncertainty of knowing whether a patient’s expectations are met or not is difficult to do in a ten-minute consultation. “I’m hoping that young doctors will be trained in open disclosure, and to empower patients to adapt to their role and responsibilities of being partners in their treatment and management, including making positive lifestyle changes.
“ICGP has been providing optional mental health supports to their members for quite some time; we have a popular full-day workshop on cognitive behaviour training, called GPs Take Care. In the past we’ve run mindfulness workshops and there is interest in rejuvenating Balint groups, which is where doctors can come together to talk about their roles as healers, the impact of the patients and the incidents that have happened since their last meeting. We also have telephone and online support in place but there’s always scope for improvement. The Doctor’s Health in Practice Programme is open to ideas and suggestions for what the GP needs in 2017. Contact administrator Carol White firstname.lastname@example.org, or text or call Andrée Rochfort 0877519307 email@example.com