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Stressed doctors are more likely to binge drink and have sleep problems, finds study

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2245 (Published 16 May 2019) Cite this as: BMJ 2019;365:l2245

Re: Stressed doctors are more likely to binge drink and have sleep problems, finds study

I would like to thank Ms Mahase for her very interesting piece on the impact of stress on doctors in the UK. Her article sheds greater light on an issue which becomes more and more important each year with the greater stresses on the NHS[1].

Such stress and burnout- and their associated coping mechanisms- have only risen over the years, while doctors’ job satisfaction has seen significant declines. This has been attributed to a plethora of reasons- rising workloads, cultures of blame and interference of work into personal life[2]. All-in-all a worrying image of modern working environments in the NHS, and potentially of even worse ones to come.

And when needs are at their greatest yet, support services for doctors are being shut to them[1]. It is of no surprise at all then that doctors are turning more and more to substance use to provide the crutch they need, which was previously supplied by professional establishments. This itself poses even further harm to doctors, let alone in its risk of generating even further psychiatric problems and strain[2]. Furthermore, as the article reports, this harm is not just limited to the doctors, but impacts significantly on patient care and safety.

Yet negative coping mechanisms such as these can already be seen at early stages in medical training- within medical students. High alcohol intake, as well as illicit drug use, has been well documented within cohorts of medical students, linked to efforts to combat the stress of university study[3,4]. And while more is being implemented to address issues like these- such as Mental Health Awareness Week and university welfare weeks such as Imperial College London’s “Healthy Living Week”- more still can be done to improve students’ coping mechanisms[5][6]. After all, the negative coping mechanisms described in doctors by Ms Mahase’s article could potentially be a continuation of previous negative coping mechanisms established during medical training, or the establishment of new ones in the absence of effective preparation or guidance in the past.

If so, this poses a great opportunity to target these issues in doctors within a safe environment- that of medical students at university, free of fear of the impact on doctors’ jobs, or risks of harm befalling patients. Indeed, targeted interventions in students have already been shown to lead to better stress management, reduced psychological distress and depression, and decreased substance abuse amongst multiple other beneficial effects[7,8]. Whilst efforts to combat stress and negative coping mechanisms in doctors should be increased, more interventions simultaneously targeting these same problems in medical students should also be strongly encouraged- at the very least to reduce their prevalence in future cohorts of doctors. After all- prevention is the best form of cure.

1. Wilkinson E. UK NHS staff: stressed, exhausted, burnt out. The Lancet. Elsevier; 2015;385(9971): 841–842. Available from: https://doi.org/10.1016/S0140-6736(15)60470-6
2. Vijendren A, Yung M, Sanchez J. Occupational health issues amongst UK doctors: a literature review. Occupational Medicine. 2015;65(7): 519–528. Available from: https://doi.org/10.1093/occmed/kqv088
3. El Ansari W, Stock C, John J, Deeny P, Phillips C, Snelgrove S, et al. Health Promoting Behaviours and Lifestyle Characteristics of Students at Seven Universities in the UK. Central European Journal of Public Health. 2011;19(4): 197–204. Available from: https://cejph.szu.cz/artkey/cjp-201104-0003.php [Accessed: 20/05/2019]
4. Baldwin Jr DC, Hughes PH, Conard SE, Storr CL, Sheehan D V. Substance Use Among Senior Medical Students: A Survey of 23 Medical Schools. JAMA. 1991;265(16): 2074–2078. Available from: https://doi.org/10.1001/jama.1991.03460160052028
5. Mental Health Awareness Week, Mental Health Foundation, 2019, Available from: https://www.mentalhealth.org.uk/campaigns/mental-health-awareness-week, Accessed: [20/09/2019]
6. Healthy Living Week, Imperial College London, Available from: https://www.imperial.ac.uk/sport/be-active/events/healthy-living-week/, Accessed : [20/05/2019]
7. Shapiro SL, Schwartz GE, Bonner G. Effects of Mindfulness-Based Stress Reduction on Medical and Premedical Students. Journal of Behavioral Medicine. 1998;21(6): 581–599. Available from: https://doi.org/10.1023/A:1018700829825
8. Moshki M, Hassanzade T, Taymoori P. Effect of Life Skills Training on Drug Abuse Preventive Behaviors among University Students. International journal of preventive medicine. Medknow Publications & Media Pvt Ltd; 2014;5(5): 577–583. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24932389 [Accessed: 20/09/2019]

Competing interests: No competing interests

20 May 2019
Ludovic C J Musgrave
Medical Student
Imperial College London, South Kensington, London, SW7 2AZ