Doctors’ wellbeing: learning from the past can help improve the futureBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4101 (Published 01 October 2018) Cite this as: BMJ 2018;363:k4101
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In response to the writer’s statement regarding doctors’ well-being being an increasingly recognized and critical factor in staff health and job satisfaction as well as the provision of safe and quality care to patients. I must also include nurses and other health care professionals who directly work with clients accessing or admitted to various health care delivery organizations. They too are at risk for burnout as health care professional burnout represents real suffering among people dedicated to preventing and relieving the suffering of others (Dyrbye, Shanafelt, Sinsky, Cipriano, Bhatt, J., Ommaya, A., … & Meyers, 2017).
We need to consider the burnout levels of all healthcare workers intimately involved in delivering care. According to literature the mean stress levels of hospital personnel have also been linked with the number of hospital malpractice cases, and burnout levels amongst hospital nurses are an independent predictor of health care related infection (Dyrbye, Shanafelt, Sinsky, Cipriano, Bhatt, J., Ommaya, A., … & Meyers, 2017).
Nurses working on understaffed units with minimal supplies available to give efficient is also a contributing factor to staff burn out. Additionally, doctors working in the specialties at the front lines of care (e.g., emergency medicine, family medicine, general internal medicine and neurology) are among the highest risk of burnout.
We need to be concerned about the healthcare professionals who are administering care to clients as well-being and burnout are associated with patient safety. High levels of burnout were found to be significantly associated with more self-reported errors (Hall, Johnson, Watt, Tsipa, & O’Connor, 2016).
Hospital administrators in their bid to provide an environment to give care to the public they serve needs to be intimately involved in providing interventions to meet the the well-being of their staff and improving the working conditions of the health care professionals which will reduce the risk of health care worker burn out resulting in quality patient care delivery which should be the ultimate priority.
Dyrbye, L. N., Shanafelt, T. D., Sinsky, C. A., Cipriano, P. F., Bhatt, J., Ommaya, A., ... & Meyers, D. (2017). Burnout among health care professionals: A call to explore and address this underrecognized threat to safe, high-quality care. NAM (National Academy of Medicine) Perspective.
Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PloS one, 11(7), e0159015.
Competing interests: No competing interests
Doctor wellbeing is an increasingly recognised and critical factor not only in staff health and job satisfaction but also in the provision of safe and quality care to patients. There is much written on support strategies at an individual level however without an integrated approach that addresses institutional issues of workload, roles, team support and expectations, effectiveness of such strategies is likely short term and subdued.
Junior doctors in particular, face numerous challenges at work with competing priorities and increasing workload combined with rapidly changing rosters and on call (1) that result in sleep disturbance. Even those with strong support networks and high performance can find themselves driven towards emotional stress and threatened wellbeing (2).
Not only are busy health systems fertile grounds for the development of burnout in junior doctors, the determination to rapidly define and secure a professional path and career progression can create significant additional stress. Junior doctors may feel patient complaint or medical error is an ever-present threat and this may impact on wellbeing. If such complaints subsequently materialise, there may be fear of far-reaching consequences, even if resolved in the favour of the clinician (3). This has been depicted historically with physician suicides.
We support Dr Arnold-Forster's comments on the undue focus on individual resilience. We must question again why we create vulnerabilities where only the hardiest clinicians will survive - and at what cost to future clinicians, leaders and our patients. As organisations we need to ensure that it is not only the mentally toughest that make it through but all those that have chosen this vocation for the right reasons of providing empathic, compassionate and patient centred care. Rather than emphasising individual resilience, institutions should prioritise workplace processes, including acceptable workload, supervision, support and rostering, which are more conducive to the ongoing wellbeing of clinical staff.
(1) Hoffman, R and Bonney, A. Junior doctors, burnout and wellbeing: Understanding the experience of burnout in general practice registrars and hospital equivalents. AJGP 2018; 47 (8). 571-575.
(2) Wadhwa V, Brookes J. We must support junior doctors working after hours. BMJ. 2018 Jan 22; 360:k241.
(3) Schattner, P, Davidson, S and Serry, N. Doctors’ health and wellbeing: taking up the challenge in Australia Med J Aust 2004; 181 (7): 348-349.
Competing interests: No competing interests