Prioritising our wellbeing is not a luxury, but a necessity

Adequate mental wellbeing support is crucial to retaining our healthcare workforce, writes Dr Rachel Birch 

Many doctors are reluctant to put their health and wellbeing first, especially when patients are waiting to see them, or if taking leave to seek help or recuperate will put further strain on their colleagues.

At Medical Protection Society (MPS), we recently surveyed more than 500 doctors across Ireland about presenteeism in the medical workforce, particularly in relation to mental wellbeing.

The survey revealed that two-thirds (64 per cent) of doctors are experiencing exhaustion and symptoms of burnout, with 63 per cent confirming that they have continued to work when they were mentally not well enough to do so. These results are not distinct only to Ireland; this is something we see in other countries around the world where we have members.

What I found most concerning from the survey was that three-quarters (74 per cent) of doctors said they tend to self-assess their mental health instead of consulting a GP. 

There appear to be a variety of reasons why doctors may self-assess, including time and resource pressures. For example, one survey respondent commented that “the work will just build up”, with another explaining that “the pressure of trying to arrange cover is too much”.

It seems that many doctors feel that being out of the workplace, for even a short time to attend their own medical appointments, has too detrimental an influence and is difficult to arrange. Some doctors, such as locums, may have additional financial pressures, as seeking medical help may mean turning down work essential to their income.

‘Moral distress’

Furthermore, doctors tend to have a strong ethical motivation to look after others, but conversely this positive can have a negative impact when it comes to looking after themselves. One survey respondent highlighted that it caused them “moral distress”, being only too aware of the impact their taking time off has “on patients and their families”.

When asked why they continue to work when not mentally well enough, 42 per cent of respondents pointed out that patients rely on them and 31 per cent cited waiting list pressures.

Most survey respondents were also concerned about the impact or burden of any health-related absence on their colleagues, with 56 per cent feeling guilty adding to other colleagues’ workloads and 20 per cent pointing out that their colleagues may also be struggling with their own mental wellbeing.

  The survey has highlighted that there will likely continue to be potential barriers within some workplace cultures. One survey respondent commented that they feel “they would lose their job if they discussed mental health issues with colleagues and consultants”, whilst others described the “unspoken culture of judgment” and an “unsaid rule that you take minimal time off when sick”.

Our survey also revealed that three in five (60 per cent) of doctors believe the Government doesn’t do enough to ensure mental health services for doctors are properly funded.

The Government and HSE have a responsibility to doctors and they must play their part.

We hope the Government will work with both HSE and private healthcare providers to ensure healthcare professionals are in supportive environments with resources such as counselling, peer support networks, and specialist support available as standard. This would help to tackle issues early on, avert crises down the line, and ultimately enable healthcare professionals to continue to care for patients safely.

The Government should also ensure mental wellbeing services, such as the Practitioner Health Matters Programme, are properly funded and safeguarded so healthcare professionals are always able to access confidential, specialist help outside of their place of work, without fear of repercussions from their employers.

Medical Council guidance

In the Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners, paragraph 12 relates specifically to the health and wellbeing of all doctors in Ireland, and their obligation to keep healthy for their benefit and that of patients.

You should:

▶ 12.1 Look after your own health and wellbeing. This is in your own interest but also supports you to sustain safe and effective medical practice.

▶ Have your own general practitioner. This should not be a person with whom you have a close family or personal relationship.

▶ Be vaccinated against common communicable diseases.

▶ Not treat or prescribe for yourself, (subject to paragraph 12.2)

▶ 12.2 You must not prescribe controlled drugs for yourself.

▶ 12.3 Doctors are entitled to good care and support from colleagues and employers when they suffer ill-health.

▶ 12.4 If health and wellbeing risks arise for you from your work, you should raise these concerns with an appropriate person or authority such as your employer.

▶ 12.5 If you have concerns about your health, you should consider seeking guidance and support from colleagues and/or family and friends, or support services provided by a professional body or organisation.

▶ 12.6 If you have a condition 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 advise you and to make sure you do not pose a risk to yourself, patients, and others. If such a risk exists, you must inform the Medical Council as soon as you become aware of it.

It is crucial that all doctors follow the Medical Council’s guidance to ensure that they can provide the best care for their patients, remembering that in order to do they must prioritise their own wellbeing.

As we are reminded whenever we fly, we must put on our own oxygen masks before helping others

Managing your wellbeing

MPS sees firsthand how poor mental wellbeing affects doctors personally, and how it can impact on patient care. Without early support, mental wellbeing issues can also result in doctors needing extended time off work or leaving the healthcare profession altogether. Therefore, adequate mental wellbeing support is crucial to retaining our healthcare workforce.

In general terms, it can be helpful to consider five key areas contributing to wellbeing as follows:

Emotional wellbeing

▶ Being able to feel well and free from depression, anxiety, and other mental health conditions.

▶ Being able to reduce the level of stress to a reasonable, workable level.

Physical wellbeing

▶ Being able to keep your body in good physical and healthy shape.

▶ Having sufficient, good quality sleep.

Social wellbeing

▶ Being able to have healthy, meaningful relationships with others.

▶ Having a supportive network for when it is required.

Workplace wellbeing

▶ Being professionally enriched and able to pursue your interests, values, and life purpose.

Societal wellbeing

▶ Being able to participate actively and happily in community, culture, and environment.

There is no doubt that, within a busy work setting, there can be challenges. However, where possible and especially if in management roles, doctors may wish to encourage open discussion about mental wellbeing and presenteeism, supporting colleagues to seek help if they are experiencing difficulties with their mental wellbeing. Workplace culture is not something that necessarily changes overnight. However, recognising and raising awareness is a good first step.

The five areas of wellbeing tend to have some overlap. For example, keeping physically fit or having a social support network may positively influence a doctor’s wellbeing at work. Similarly, if doctors ensure that they seek support and treatment for their mental health, this is likely to improve both their social and workplace wellbeing.

As we are reminded whenever we fly, we must put on our own oxygen masks before helping others. Similarly, doctors can best and most safely treat patients when they are in a place of wellness. As such, prioritising our own wellbeing is not a luxury, but a necessity.

MPS counselling service

At MPS, we know that the pressures and demands healthcare professionals face are having a significant impact on their mental wellbeing. We would like to remind members that they have access to a counselling service as part of their membership, for work-related issues such as stress, burnout, anxiety, and conflict. Members can access telephone support 24 hours a day, seven days a week, and face-to-face counselling sessions can also be arranged. The service is completely confidential and independent of MPS.

More information can be found at www.medicalprotection.org/ireland/wellbeing