It is an undeniable fact that physicians’ well-being influence patient health. Doctors who work in a better environment make lesser mistakes. Having an attribute such as empathy is essential to clinical competence and decreased empathy has proven to be associated with increased risks of self-perceived medical errors in the future (West et al., 2006). Recent studies suggested that doctors are susceptible to mental problem such as anxiety, depression, dysfunctional relationships and burnout (Racp.edu.au, 2019). Stress and burnout are really common among doctors and becoming more serious recently. In Ireland, one in three doctors suffered burnout (Hayes et al., 2017). A report shows that 44 percent doctors have burned out, 11 percent doctors suffered mild depression and 4 percent were clinically depressed (Kane, 2019). In short, burnout is defined as a combination of extreme tiredness and perceived inefficacy which caused by long-term work stress. It was first reported by an American clinical psychologist in 1974, who observed emotional detachment and accompanying by psychological symptoms among medical professionals (Reith, 2018). Burnout has developed into a serious problem plaguing 21st century worldwide. Doctors who work at certain departments such as Urology, Neurology and Internal Medicine, are amongst those experiencing the highest levels of burnout (Figure 1) (Kane, 2019). In Ireland, doctors working in emergency medicine (44 percent) are most likely to experience burnout (Figure 2). 3 main risk factors have been emphasised to be relevant in resulting physicians to experience burnout: work factors, personal characteristics and organisational factors.
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If not addressed or when doctors’ wellbeing is not being taken seriously by health care systems and organisations, strikes by doctors are likely to take place (Metcalfe, Chowdhury & Salim, 2015). Doctor strike is a global phenomenon which already happened in many countries and commonly with the goal to oppose policies that are perceived to threaten their career. In 2015 alone, strikes were reported in India, Nigeria, Australia, America and Ghana. Unfortunately, doctor strikes have proven to cause serious harm to the patients (Chima, 2013). For instance, a report shows increased mortality by 67 percent was associated with doctor strike in South Africa in 2010 (Bhuiyan & Machowski, 2012).
Is there any healthcare support provided for medical professions?
Until recently, there is growing acknowledgement that addressing wellbeing problems in the early stages may have a positive impact, hence increasing amount of facilities have been provided to address this problem. A study shows that organisation-directed interventions have proven to be very effective and more likely to cause reduction of burnout (Panagioti et al., 2017). Two studies have shown that most physicians who are treated for mental health problem were able to return to work (Bosch, 2000) (Miller, 2009). In Ireland, many medical care supports are made available for doctors who need help in restoring their wellbeing.
Doctors who experience harassment or bullying are encouraged to seek support from human resources (HR) professional, which is available in all hospitals. Finding the right General Practitioner (GP) can be very useful in dealing psychological problem. Research shows that 57% of GP Trainees had unofficially consulted a colleague about their health problems and 35% went directly to a consultant for the same needs (Hayes et al., 2017). However, it is important that the GP is neither your family nor your friend to ensure all decision-making will be managed within professional boundaries. Doctors also can seek help from Occupational Health Services, which are made available for all public hospital staff. Occupational Health works by making sure a balance between work-life and health is achieved. These services are managed by a specialised team of nurses and staff which are clinically led by a consultant occupational physician/specialist. In addition, doctors can receive free confidential counselling and referral services through Employee Assistance Programme (EAP). Some EAP offer a 24-hour helpline. Doctors who have a concern about their wellbeing can get help from experts at the Practitioner Health Matters Programme. Doctors who have been involved in clinical errors can be devastated and should receive support from Medically Induced Trauma Support Services. Self-help books for therapeutic purposes, also known as bibliotherapy are recommended for doctors experiencing psychological distress. National Institute for Health and Clinical Excellence (NICE) UK recommended bibliotherapy as a first-line intervention in treating common mental health problems which include anxiety, depression and panic attack.
Clearly there are more than enough services and physicians’ wellness programmes that are available to support physician wellbeing throughout doctors’ working lives. The increase in rates of mental problems among doctors suggests that these services are not being used effectively as they should be. A survey which was conducted in America shows that majority of physicians who suffer psychological problems do not seek sought professional care (Figure 3) (Kane, 2019). The three common reasons of them not seeking any help; 50 percent of them think that the symptoms are not severe enough, 47 percent think that they can handle their problems on their own and 39 percent of them said that they were too busy to seek help (Figure 4) (Kane, 2019). Medical students also have low rates of reaching for help (Givens & Tjia, 2002). For this reason, increasing the amount of services will not make any difference as doctors do not make the full use of them appropriately.
Stigmatisation of physicians with mental illness
In order to know why it is unlikely for physicians with psychological issue to seek help, it is critical to understand public attitudes towards doctors. According to World Health Organisation (WHO), stigma is a complex and multifaceted construct, which is major cause of discrimination and exclusion which affects people’s self-esteem. Professionals such as doctors are perceived by the public to be living a happy life given their relative privilege and so our society thinks doctors do not need care for themselves. People expect doctors to care for them rather than them caring for the doctors. Such assumptions are unhelpful and inaccurate as doctors nowadays have surprisingly high suicide rates (Brooks, Gerada & Chalder, 2011). The process of stigmatisation often begins with identifying someone with mental health problems. Labelling someone with this problem may lead to forming negative stereotypes around them (Corrigan et al., 2003). For example, it is a common stereotype for people with mental illness think that they are responsible for their problem, hence this results to self-blame. A doctor who suffered manic depression for 30 years once said:
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If my colleagues knew that I was bipolar, I fear that I would never again be taken seriously, that I would be viewed as the ‘impaired physician’ who, at a display of passion or emotion, would be seen as having an ‘episode.’ My hard-earned credibility would be gone. My right to express even normal anger or irritability, happiness or my effervescent sense of humour would be suspected as pathological. I would lose the right to just have a bad day.
Her words have become a good example to show how stigma can affect physicians with mental illness. Generally, our society determines doctors’ medical competence through their health, thus putting doctors in a lot of pressure to appear both physically and mentally healthy even when they are not (Thompson et al., 2001). Physicians are afraid to be viewed as having a weakness or being labelled as the ‘impaired physician’. As a result of the medical socialisation and stigmatisation among doctors, it is immensely difficult for them to acknowledge their own mental illness. Because of this, a small number of doctors reported to seek help from mental health services in secret who some even used a different name (Kane, 2019).
Health care systems and organisations have high expectations for doctors. As a result, they tend to react on mentally ill physicians with disciplinary responses as they are more focused on patients’ health and less likely on doctors’ wellbeing (Taub et al., 2006). Although many support services are available for ill physicians, legal sanctions and threat of disciplinary action can be major factors which prevent them disclosing their issues and seeking proper help. A study by Miller of 116 doctors seeking help displayed that many doctors had to endure many consequences such as losing medical career, suffering anxiety and feeling demoralised, as a result of their action (Miller, 2009).
It is imperative to be sympathetic to mentally ill doctors. A study (King et al., 1992) of 133 doctors who complained of having history of emotional problem, a total of 40 percent of them reported that their colleagues showed sympathy and 11 percent reported to being offered help by their colleagues. This indicates while some physicians may condemn their colleagues suffering from mental problems, others may be very supportive show compassion.
What needs to change?
Although mental illness among physicians are common, they are reversible and preventable. Lately, many initiatives were designed to fight stigma against mental illness among doctors. In order to form an efficient anti-stigma programme, it is important to focus on working with the systems and individuals as well as those involved in changing the stereotypes and prejudiced behaviours (Heijnders and Van Der Meij, 2006). Wallace proposed three key areas to resolve this problem: raising awareness and education about psychological problems among doctors, providing confidential services for those who need them and establishing a way to assess and recognise mental illness among doctors (Wallace, 2012). Health care organisations and medical schools who are responsible for practicing doctors and doctors in training respectively, need to teach to identify signs of psychological distress in themselves so that they will be able to seek help when needed (Pitt et al., 2004).
‘Dare to Care’ campaign which was found in Canada by the Physician and Family Support Program, was designed to teach doctors about the substance use problem with care and concern (Dianne, 2006). This is a good example of promoting support among medical professionals especially for those who are at risk of substance abuse. This campaign provides initiative to raise awareness of substance abuse among doctors and gives information on how to find help for themselves when having this issue.
In my judgement, early intervention by medical schools is required. They must take a more proactive approach to raise awareness and educate medical students with the aim of creating a healthy help-seeking culture, by focusing on creating a safe and open space for them to seek proper services when required (Miller, 2009).
Rather than stigmatising those with mental illness, doctors need to be supported especially by their colleagues when they acknowledge they require help. Having a supportive work environment as well as supportive colleagues are crucial in restoring and treating a doctor’s wellbeing (Taub et al., 2006). A study by Miller found that certain working atmospheres such as having supportive staffs and short working hours, were essential in helping doctors to return to work (Miller, 2009).
It should be noted that a plentiful amount of mental health facilities has been provided for medical professionals, which some even offer 24-hour helpline. However, these services are underutilised due to many factors; primarily stigmatisation of mental illness as discussed. To tackle this problem, actions with the aim of breaking stigma in the house of medicine must be made and this can be a huge challenge, thus a strategy must be properly formulated. In doing so, by creating a systematic anti-stigma programme, it has proven that doctors are more inclined to recognise and deal psychological problems in themselves. On top of that, there is a need to further investigate the consequences of associative stigma, aside from the perspective of medical professionals who experience stigma but also the effect that it may have on patients and the society. The health care systems and organisations also play a huge role in this matter as they need to eliminate any form of discriminatory reactions associated with psychological problems among doctors despite making sure mental health facilities are enough. It is also essential to foster a culture that helps in improving doctors wellbeing as healthy doctors are better in solving complex problems and make better decisions.
- West, C., Huschka, M., Novotny, P., Sloan, J., Kolars, J., Habermann, T., & Shanafelt, T. (2006). Association of Perceived Medical Errors with Resident Distress and Empathy. JAMA, 296(9), 1071. doi: 10.1001/jama.296.9.1071
- Racp.edu.au. (2019). [online] Available at: https://www.racp.edu.au/docs/default-source/advocacy-library/pa-pos-health-of-doctors-2013.pdf [Accessed 21 Sep. 2019].
- Hayes, B., Prihodova, L., Walsh, G., Doyle, F. and Doherty, S. (2017). What’s up doc? A national cross-sectional study of psychological wellbeing of hospital doctors in Ireland. BMJ Open, 7(10), p.e018023.
- Kane, L. (2019). Medscape National Physician Burnout, Depression & Suicide Report 2019. Retrieved 20 September 2019, from https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056
- Reith, T. (2018). Burnout in United States Healthcare Professionals: A Narrative Review. Cureus. doi: 10.7759/cureus.3681
- Metcalfe, D., Chowdhury, R., & Salim, A. (2015). What are the consequences when doctors strike? BMJ, h6231. doi: 10.1136/bmj.h6231
- Chima, S. (2013). Global medicine: Is it ethical or morally justifiable for doctors and other healthcare workers to go on strike? BMC Medical Ethics, 14(S1). doi: 10.1186/1472-6939-14-s1-s5
- Bhuiyan, M., & Machowski, A. (2012). Impact of 20-day strike in Polokwane Hospital (18 August – 6 September 2010). South African Medical Journal, 102(9), 755. doi: 10.7196/samj.6045
- Panagioti, M., Panagopoulou, E., Bower, P., Lewith, G., Kontopantelis, E., & Chew-Graham, C. et al. (2017). Controlled Interventions to Reduce Burnout in Physicians. JAMA Internal Medicine, 177(2), 195. doi: 10.1001/jamainternmed.2016.7674
- Bosch, X. (2000). First Impaired Physicians Therapy Program Appears to Be Successful in Spain. JAMA, 283(24), 3186. doi: 10.1001/jama.283.24.3186-jmn0628-2-1
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- Corrigan, P., Markowitz, F., Watson, A., Rowan, D. and Kubiak, M. (2003). An Attribution Model of Public Discrimination Towards Persons with Mental Illness. Journal of Health and Social Behavior, 44(2), p.162.
- Taub, S., Morin, K., Goldrich, M., Ray, P. and Benjamin, R. (2006). Physician health and wellness. Occupational Medicine, 56(2), pp.77-82.
- Heijnders, M. and Van Der Meij, S. (2006). The fight against stigma: An overview of stigma-reduction strategies and interventions. Psychology, Health & Medicine, 11(3), pp.353-363.
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- Pitt, E., Rosenthal, M., Gay, T. and Lewton, E. (2004). Mental Health Services for Residents: More Important Than Ever. Academic Medicine, 79(9), pp.840-844.
- Maier, D (2006) Hail to Physician: Dare to Care. Alberta Doctors’ Digest September/October: 22-23.
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