Stress has almost saturated the workforce of doctors, according to research, but will something decisive finally be done about it? Keith Cooper finds out
The human cost of stress, pressure and an unsustainable workload has been laid bare by a BMA survey, which has found eight out of 10 doctors are at a substantial risk of burnout.
More than a quarter of the 4,300 respondents to the survey said they had received previous, formal diagnoses of mental conditions, and four out of 10 said they were suffering from psychological or emotional distress, which affected their work, training or study.
Younger and junior doctors, medical students and those working longer hours are more likely to suffer from mental ill health, the survey found.
It also pinpoints a strong relationship between the use of alcohol, drugs and self-medications by doctors with current or previous mental health diagnoses – with 62 per cent using them as a coping mechanism. Alcohol, drug use and self-medication were more common in consultants, those working shorter weeks, doctors aged 64 and above, and men.
The survey uncovered worrying evidence of inadequate or no support for doctors when sought. Medical students were most likely to find help unacceptable while older, staff, associate specialist and specialty doctors, and overseas-qualified doctors were most likely to say support was not there when requested.
Deterred and depressed
The survey is part of a larger project led by BMA president Dinesh Bhugra to find ways to improve the mental health of the medical workforce and so improve patient care.
The second research phase of the project will look in more detail at the issues raised by the survey. The results are due to be published in the summer.
Professor Bhugra says that while stress is in the nature of medical practice it could affect doctors differently, depending on whether they are trainees, consultants, GPs, or SAS doctors.
‘Medical students are surprisingly stressed, which is a bad sign, as these are some of the most energetic, enthusiastic people who want to help people by going into medicine.
‘Informally, I’ve heard that some of these stresses come from financial problems and debt. They are also feeling that as they learn on simulators, on dolls and with actors that they do not develop the same empathy with patients.’
He is concerned about the lack of support in some medical schools, calling for more research to pinpoint any geographical differences in stress rates and support levels.
‘As the only organisation that looks after doctors in all specialties and across the UK, we should examine how terms and conditions in which people learn and practise could be improved. That’s my challenge to the BMA and I hope it takes this on board.’
He hopes that the BMA will repeat the survey of doctors’ mental health regularly. ‘The longer people struggle on without support, the more chronic their conditions become, the more difficult it is to treat.’
Also published this month are the findings of a separate study by Swansea University of junior doctors’ experience of mental illness, the stigma they face, their struggle for support and the effect it has on their professional lives.
‘It got to the point where I was almost catatonic in my room all the time,’ one doctor told researchers. ‘I was making it to work, just doing what was required, then coming back. But I wasn’t making any advancements.’
Another was told by a colleague, ‘if you’re crying this much you shouldn’t be a consultant’.
The Swansea study found the trainees were reluctant to disclose their illnesses for fear of the effects on their careers and struggled to access support, especially in rural areas. Some also found it difficult to return to work after time off sick.
‘I went back, nothing was said of it,’ one said. ‘I self-referred to occupational health. I basically got sort of a generic letter back, giving me an appointment in May. I was due back in February.’
The Swansea report recommends special provision for doctors in training with mental ill health and for employers to take steps to tackle the stigma of mental illness in the medical profession.
Professor Bhugra says more is needed to be done to address the stigma of mental health and to improve the support to doctors.
‘We must create spaces where all doctors, trainees, SAS, GPs, can go for support,’ he adds. ‘We invest a tremendous amount of money in training doctors to leave them to fall by the wayside. It just isn’t fair on them or society.’
Find out more about the survey
Read the survey
BMA wellbeing support services are open to all doctors and medical students. They’re confidential and free of charge. Call 0330 123 1245 and you will have the choice of speaking to a counsellor or taking the details of a doctor who you can contact for peer support
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