A detailed survey published online in the journal BMJ Open in January 2020 says that almost a third of doctors in the UK are under significant stress and burnt out. The ones most at risk are those who are posted in the emergency room and in general practice. These professionals complain of exhaustion, stress and “compassion fatigue”, or a lack of satisfaction or pleasure at having completed a job well and having helped others.
The survey is limited by the fact that not all doctors who received the survey form chose to respond to it, and therefore the sample contains only those who filled it out at that point. Even so, this is the largest survey to be published in this category, and it has included a diverse array of practitioners hailing from multiple specialties and service grades all over the UK.
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Doctors, by the nature of their profession, have a higher risk of being depressed, anxious, using substances to dull their pain or increase their alertness, and a higher suicide risk, compared to the general public. Their hours of work are not only long but filled with intense pressure. In the UK, doctors are usually overworked because of a relative lack of resources. And the job is all about doctor-patient relationships which includes a wide spectrum of taxing emotions. Added to these are factors like the high chance of facing a lawsuit brought by one or more patients, the need to comply with numerous and tight regulations on the job, and the lack of budgetary support. Put together, all these can have a heavy impact on mental health, especially with respect to burnout. The researchers define burnout as “exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration.”
One factor which helps people under stress to cope successfully is resilience, the emotional characteristic which helps the individual to rebound from trying or stressful situations. The survey was aimed at measuring the average resilience in this profession, and also how common stress and burnout was among doctors.
The researchers distributed the survey online to thousands of doctors through medical colleges and other professional societies, from October to November 2018, both included. Any doctor working in the UK was eligible to fill in the survey. The questions specifically asked questions relating to the evaluation of resilience, the quality of life with respect to their profession, covering burnout, stress and trauma related to the workplace, compassion fatigue and mechanisms of coping. Validated scales were used to measure these items.
About 1,600 physicians completed the form. When individual sections were looked at, resilience was measured in about 1,500, quality of professional life in about 1,400 and coping mechanisms in about 1,400.
The average score for resilience among the doctors who responded was about 65, which is lower when compared to the average measured score in other studies. Among specialties and grades, general practitioners (GPs) appeared to be less resilient than hospital physicians, while surgeons of all kinds were more resilient than non-surgical doctors. Resilience was, unsurprisingly, lower among the doctors with the least experience and the lowest grade. Thus, those who had just qualified, and those who were specialty or associate specialty grades scored lower compared to specialty trainee doctors and consultants.
Doctors in Northern Ireland had greater resilience than doctors in other parts of the UK.
Burnout and stress scores showed a major upswing, with about 32% being burned out and over 25% being highly stressed. About 31% had compassion fatigue. These figures indicate that the affected doctors are perhaps going through clinical depression, and require to be treated for it, to take some time off or to take up another job.
Both stress and burnout were much higher among emergency medicine doctors than other specialties. Compassion satisfaction was lost most consistently among GPs, who scored lowest, but highest among non-surgical practitioners. There was no significant difference between men or women doctors, nor between different grades or the degree of experience since graduation.
The ideal picture of a doctor, according to the researchers, is that of a person with a lot of compassion satisfaction and low burnout. This pattern was observed in a very low percentage (6%) of the responding doctors. The reverse, with high compassion fatigue and high stress or burnout, was found in abut a tenth of them.
Coping mechanisms varied, but the most common included self-distraction, or self-blame. Very few said they would think or work out a strategy to adapt to a given situation. This indicates maladaptive behavior, where people fail to change their behavior to cope with pressures.
However, religion-based coping with the adverse conditions was most common in Northern Ireland.
The researchers point out that the observational nature of the study precluded any attempt to draw conclusions from the data, and the self-chosen nature of the participants is also an issue. For instance, many more women than men took part. However, gender differences are not significantly shown in the scores.
With all its limitations, however, the study is large and the first to look for resilience and psychological traits. The researchers disagree with the common notion that encouraging emotional resilience will prevent burnout. They point out, “Doctors cannot be expected to recover from the emotional stress and adversity they encounter in their role as clinicians while managing a heavy workload in an under-funded, over-worked system. It is unlikely that emotional resilience is all that is required to cope with increasing regulation, litigation, and administration.” Instead, they promote a better organizational environment such as reducing working hours, providing more social support and reducing the extent of regulation at the workplace, among other things, to improve the wellbeing of the individual physician as well as of the healthcare system.
McKinley N, McCain RS, Convie L, et alResilience, burnout and coping mechanisms in UK doctors: a cross-sectional studyBMJ Open 2020;10:e031765. doi: 10.1136/bmjopen-2019-031765, https://bmjopen.bmj.com/content/10/1/e031765