Ms Clare Sweeney outlines how to recognise and act on the early signs of burnout
The Medical Council’s latest Medical Workforce Intelligence Report was candid about the effect that doctor shortages are having on professional wellbeing and the risk this represents to patient safety.
The report highlighted a 13 per cent annual rise in the number of voluntary withdrawals from the register (982 in 2021), with some citing workplace issues including resourcing, lack of appreciation, excessive work hours and lack of support. The Council warned that acute shortages of hospital doctors posed a risk to patient safety because it meant insufficient supervision and training for trainees and juniors, as well as the kind of excessive working hours that are associated with stress and burnout.
While the Covid-19 pandemic is likely to have exacerbated the situation, the issue of doctor fatigue and burnout is a long-standing one. In 2019, for example, a national study of workplace wellbeing in Ireland, published in BMJ Open, found 82 per cent of the 1,749 doctors who responded had experienced workplace stress and burnout was evident in 29.7 per cent.
There is now a wealth of research on the impact of working conditions, chronic stress and fatigue on doctors’ health and wellbeing and on their performance. Of the doctors who responded to a Medical Defence Union (MDU) member survey in 2022, over a third told us they feel sleep deprived on at least a weekly basis. They reported that tiredness resulted in poor concentration (64 per cent ), decision-making difficulties (40 per cent), mood swings (37 per cent), and mental health problems (30 per cent). Over a quarter said tiredness had affected their ability to safely care for patients, with 15 per cent of these doctors having been involved in a near miss and 3 per cent reporting that a patient was harmed.
Occupational stress, burnout and fatigue are listed as one of the most common occupational hazards for healthcare workers by the World Health Organisation (WHO). According to the WHO, “time pressure, lack of control over work tasks, long working hours, shift work, lack of support and moral injury are important risk factors.” The Organisation listed a range of preventative measures, including organising safe staffing levels, training and maximising staff autonomy.
The Medical Council has recommended the establishment of a national planning and advisory group to consider workforce strategy, but clearly there is no quick or simple fix. It is incumbent on those in positions of power to address the risk factors for exhaustion and burnout poses and ensure that those who are struggling receive timely and effective support.
There are also steps we can all contribute to help recognise and act on the early signs of wellbeing issues in ourselves and colleagues.
Recognise and act on the warning signs
Red flags for burnout include: Emotional and physical exhaustion; poor concentration; feeling detached or disconnected from your environment and those around you; negative thoughts; being uncharacteristically short-tempered with colleagues and patients.
If you notice these symptoms in yourself or someone draws them to your attention, it is important not to ignore them. Paragraph 58 of the Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Professionals says:
“If you have an illness which could be a risk to patients or which could seriously impair your judgement, you must consult an appropriately-qualified professional and follow their advice. This professional will have a dual role: To help and counsel you, and to make sure you do not pose a risk to patients and others. If such a risk exists, you must inform the Medical Council as soon as possible.”
Look out for colleagues
Similarly, it is important to keep an eye on colleagues and check they are ok if their demeanour or behaviour causes concern or if you see they are having a tough day.
You might be the first person that they are willing to open up to and help them access the help they need, such as their GP or the occupational health department. While you cannot force someone to confide in you, remember you have a responsibility to raise concerns if you believe a colleague poses a risk to patients. The ethical guide states (paragraph 59):
“If there is a risk to patient safety, you must inform the relevant authority of your concerns without delay. If there is no current risk, you should support your colleague by advising them to seek expert professional help or to consider referral to the Medical Council’s health committee.”
Avoid unhealthy coping mechanisms
Many doctors can continue to function by resorting to unhelpful coping mechanisms, such as alcohol, or other types of self-medicating, such as sleeping pills or illegal drugs. However, these will affect performance and could have serious consequences.
Seek immediate professional help if you find yourself medicating to help you cope or feel better.
Confide in someone
Sharing problems with colleagues can help you keep things in perspective and provide an early warning sign if you are showing signs of burnout. Families and friends are another invaluable source of support. Work stresses can often spill over into your home life, so it is best to share concerns, provided you respect patient confidentiality.
Register with a GP
As a profession, we are not always very good at recognising when to seek medical help ourselves. But it is important to have a low threshold for talking about the pressures your under.
Your GP can give you objective advice and refer you for further support if needed. Arranging an occupational health assessment could also allow reasonable adjustments to be made at work.
Ask for help
There is no need to face mental health challenges alone and the sooner help is sought, the greater the likelihood of making a full recovery.
It is common for doctors dealing with a medico-legal incident such as a complaint, Medical Council investigation, inquest or disciplinary matter to feel under additional stress. If that’s the case, it is important to speak to your medical defence organisation who can reassure you about the process and also recommend where you can seek further help if needed.
There are a number of organisations dedicated to supporting doctors and other healthcare professionals, including: The HSE’s Employee Assistance Programme which provides confidential counselling services for hospital staff; the RCPI’s mentoring initiative for trainees; and the Practitioner Health Matters Programme.
There are also organisations dedicated to helping people with mental health concerns or addiction, such as the Samaritans and AA.
Remember MDU membership is open to consultants and hospital doctors not currently in training posts who work in public hospitals.
To find out more see themdu.com/ireland or follow us on Twitter @the_mdu.
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