Doctors will proudly and willingly dedicate thousands of hours of their lives to caring for and treating the sick.
Yet the immense burdens posed by staffing shortages, under-resourcing and patient demand mean that much of the care that doctors give is increasingly coming at the expense of their own health.
‘Doctors are often the last to recognise that they are ill, they don’t take sick leave and they soldier on regardless,’ Kent-based consultant anaesthetist John MacKinnon explained to those gathered at the BMA annual representative meeting in Bournemouth.
‘Once they recognise that they are stressed and unwell they are often reluctant to seek help,’ he added.
Much like everything else in the health service, doctors are finding themselves increasingly overstretched; working overtime and without adequate rest in order to meet the needs of patients.
North East England specialty trainee 1 in general practice Zoe Greaves said that she had recently returned to frontline medicine following a spell working in public health. She said that what she had seen and experienced in terms of pressure and stress had left her shocked.
She said: ‘We are being stretched – at times far beyond our capacity. Someone once asked me why, if it was reaching the point where it was unsafe, we didn’t simply say no? Such a simple word, yet with a patient standing in front of you in need of care it’s not so simple at all.
‘I cannot arrive on the ward in the morning, realise that we are two doctors down and [then] leave the final bay of inpatients to fend for themselves, and so we stretch ourselves.
‘We do more than we know we should, we skip lunch we stay late and we still finish feeling the care that we have offered is sub-optimal.’
Salisbury-based foundation doctor 1 Cristina Costache said that stress, burnout and fatigue were ever-present burdens which followed doctors across the wards and clinics like shadows.
‘We push ourselves every day and why? Because more often [than not] there’s no-one else and because we love our job, love our patients and we love our nurses.
‘We reach our limit and then we keep pushing that limit further and further. The more we push our limit the more this shadow is turning into mental illness, and the way back from that is more difficult.
Personal accounts of workplace pressure are sadly all too often backed up by wider numbers.
A survey of almost 2,000 doctors across the UK carried out last year by Cardiff University found that 60 per cent had experienced issues with mental health, with this figure rising to 82 per cent among doctors in England.
The growing tide of workplace-related stress has prompted a number of discussions and responses on the part of the medical profession.
One such initiative is the DocHealth programme.
Launched on 9 June last year and based at BMA House in London, the service is a two-year pilot scheme and joint initiative of the BMA and Royal Medical Benevolent Fund.
Doctors who find themselves struggling to cope are able to refer themselves to the service, which takes the form of six initial sessions conducted either face to face or, for those doctors living far from London, via Skype.
Some have questioned whether addressing the symptoms of workplace stress risks detracting from tackling the root causes of this stress.
Speaking at the ARM, Shrewsbury GP Mary McCarthy said while services such as DocHealth were laudable, providing support to doctors suffering from stress, without identifying and addressing the systemic causes of this, was like applying treatments for burns while the fire was still raging.
‘We should be putting out the fire, not just treating the victims,’ she cautioned.
Providing support is, however, only part of the conversation at this year’s ARM.
A study of 8,000 doctors published in the BMJ in 2015 found that those referred to the GMC were at the greatest risk of suffering from mental ill health, with 26 per cent suffering depression and 22 per cent anxiety.
Dr Greaves said that doctors forced to work beyond their capabilities within a resource-starved NHS not only meant increased stress for staff, but that errors in patient care would become inevitable.
To this end she said it was time that the GMC amended its guidance to distinguish between those mistakes resulting from unsustainable working environments and individual error, a move backed by this year’s conference.
She said: ‘The choice we can find ourselves facing is to offer no care at all to some patients or to offer a more stretched, less thorough and more stressed form of care to many.’
‘It is in climates such as these that mistakes happen … but when this happens whose fault is it?’
As well as endorsing the work of DocHealth, this year's ARM also saw doctors endorse calls for of a comprehensive policy on preventing alcohol and substance misuse, as well as the restoration of occupational health services for all NHS staff.
Though only halfway through its pilot-period, DocHealth has already been well received with the newly appointed chair of its board Ian Wilson crediting it as a unique service of doctors providing support to one another.
He said: ‘What’s really worrying in this is the number of doctors … particularly junior doctors … who are coming forward terrified by the amount of pressure they are coming under to stretch the boundaries of their own capacity and capability, and act beyond their competencies.
‘Quite a lot of what DocHealth does is act to support them in raising those concerns and deal with the underlying problem – far from putting a sticking plaster on and sending them back into the flames. It is actually helping them to find ways of surviving and putting out the flames.’
This is so true
Fantastic article and something on everyone's minds. We can't work at breaking point for much longer until something terrible happens. Let's promote positive mental health throughout all our workplaces and encourage people to speak up when something isn't right. #happymindsfordoctors
Why ? Yes there are more patients but more treatments more help computers etc is it the lack of the team 5 members of a team working together with the same patients supporting each other
The idea of the gmc distinguishing between unsustainable working environments and individual error is hugely important. I hope this happens asap, as doctors should not be paying attention he price for being overstretched in a service that is understaffed. Gill modern