Is being a doctor bad for your health?BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1803 (Published 18 April 2017) Cite this as: BMJ 2017;357:j1803
Doctors and the organisations that they work for are beginning to recognise the importance of looking after a profession that is notoriously bad at caring for itself. Anne Gulland reports
While doctors are very good at caring for their patients, they aren’t always as good at looking after themselves. So, is being a doctor bad for your health? Unfortunately the evidence seems to suggest so. According to a Royal College of Physicians survey of trainees published last year junior doctors are tired, thirsty, stressed, and their mental health is suffering.1
The survey respondents said that, on average, they worked seven shifts a month without drinking enough water and four shifts a month without eating a meal. Four out of five of those surveyed regularly experienced excessive stress in their job and one in four juniors reported that their role had a serious impact on their mental health.
On top of this there is a whole slew of research looking at the effects of night shifts. Working nights has been linked to increased risk of breast and colorectal cancers,23 as well as diabetes.4 And night shifts can lead to poor decision making and impaired cognition, posing a risk on a long drive home.5
Take a break
The role of being a doctor, where individuals give more of themselves than they receive from others, will inevitably lead to stress and burnout, says Clare Gerada, medical director of the NHS Practitioner Health Programme. However, doctors need to take control, she says.
“Doctors can learn to say, ‘no, I’m not doing that extra shift except in a crisis.’ A crisis is not what’s happening in the health service every day. Doctors need to stop sacrificing their lives and take a break,” she says.
Caroline Reed-O’Connor, a psychiatric trainee at St George’s Hospital in south-west London, is one of the founders of the Tea and Empathy forum, a Facebook support group for NHS staff set up in response to the death of junior doctor Rose Polge last year. Reed-O’Connor was diagnosed with bipolar disorder in her early 20s and learnt about the importance of taking care of herself.
“My interest in doctors’ wellbeing came because of my bipolar disorder and my own experience as a doctor struggling. But this is ubiquitous—it’s not just about doctors with mental health problems, all doctors need to take care of themselves,” she says.
She says there are three ways that doctors must look after themselves. Firstly take care of your basic needs such as food, water, and sleep. Exercise is also important, as is taking any medication that you may be on. Secondly, give yourself permission to change your working practice by taking breaks and practise saying “no.” Be happy to be good enough and don’t feel like you have to finish everything. And thirdly, connect with other humans and take pleasure in life by meeting other people and spending time doing something you enjoy.
Reed-O’Connor believes there are traits common to doctors which can lead them to overwork. “We tend to be self critical, think we must do really well, and must perform at a high level. But at the same time we punish ourselves,” she says.
A culture shift
But while there are things doctors can do for themselves individually, there is only so much they can do to change an underfunded and pressured working environment. Employers and policy makers need to take note. Reed-O’Connor’s own trust has recently appointed a health and wellbeing lead and is considering making it mandatory for doctors to discuss their health in their appraisals.
One trust that prides itself on its care of staff is Guy’s and St Thomas’, which last month launched a campaign to encourage all staff to take their breaks. Spearheaded by Michael Farquhar, paediatric sleep consultant, and Eileen Sills, the chief nurse, the campaign aims to effect a culture shift.
Sills said she recently worked in a flu clinic where staff had been working for six hours without a break. “It’s not heroic to work through your break, it’s heroic to take one,” she says. “This isn’t about box ticking. We want people to realise they can take a break. They need something to eat and drink, and then to get back to work refreshed.”
“I think this will be a real issue for our junior medical staff, having the courage to take a break when others around them are not. But we want people to look out for each other,’” she says.
Farquhar, who is leading a mission to educate doctors about looking after themselves on night shifts,6 is delighted that the campaign is being promoted at executive level. “Guy’s and St Thomas’ is a big trust and it’s great that I’ve been able to persuade the trust executive how significant an issue this is. Rest breaks are crucial and self care is really important. If you’re stressed and under pressure you can’t work properly,” he says.
Melanie Jones, a retired anaesthetist and now a medical career consultant, says doctors can be their own worst enemies. “Doctors, culturally, don’t like to admit they’re not well. As a group, doctors are high achievers, but if things go wrong they feel they’re a failure,” she says.
She believes that the NHS may have lost some of the informal support networks that trainees used to have—the idea of “the firm” no longer exists; rotas mean doctors may rarely work with the same colleagues twice; and there are fewer opportunities to receive support from a consultant. The Royal College of Physicians’ survey called for hospitals to allocate common areas for doctors so they can get together as a group.
Reed-O’Connor believes that while a lot of the emphasis is on junior doctors’ self care, it is something that senior doctors must also be aware of —both for themselves and their staff.
“Senior members of staff need to model this behaviour. If senior staff talk openly about managing their difficulties and taking care of themselves, that will filter down,” she says.