80% of doctors at very high – BMA report

BMA ‘Tired doctors make mistakes’ say junior doctors at Lewisham Hospital

BOTH junior doctors and seniors are facing serious burn out because of lack of staff, overwork and stress, and this has created a serious mental health crisis within the profession, a new BMA report has revealed.

The BMA said: ‘Doctors’ and medical students’ wellbeing is being placed at enormous risk.’

A survey of more than 4,300 doctors and medical students in the UK, which informed the report, revealed worrying levels of burnout, a high prevalence of psychological and emotional conditions, and a concerning number turning to alcohol, drugs or prescribed medication to cope with their condition.

The findings are alarming, with eight in ten respondents at high or very high risk of burnout, just over a quarter having been diagnosed with a mental health condition, and four in ten currently suffering from a broader range of psychological or emotional conditions.

Key findings from the survey include:

  • The majority of doctors (80%) were at high/very high risk of burnout with junior doctors most at risk;
  • More than a quarter (27%) of respondents reported being diagnosed with a mental health condition at some point, and 7% said they were diagnosed in the past year;
  • 40% of respondents reported currently suffering from a broader range of psychological and emotional conditions.

Doctors working the longest weekly hours (51 or more hours per week) were most likely to say they were currently suffering;

  • 90% of respondents stated that their current working, training, or studying environment had contributed to their condition either to a significant or partial extent;
  • In primary care, half of GPs said they or their practice had sought help or support for a condition affecting their work or training;
  • While the majority of respondents said they did not use alcohol, drugs, self-medication or prescribing as a way to cope with a mental health condition, one in three said they used it regularly or occasionally.

Men and older doctors were most likely to engage in regular use of alcohol/drugs/self-medication/prescribing to cope with their condition.

As well as the need to address the pressures which are negatively impacting medical students and doctors’ mental health, the BMA is calling for a fundamental shift in the current workplace culture with a view to building a supportive working environment, enhancing access to support services and ending the worrying stigma of doctors feeling unable to seek help.

Professor Dinesh Bhugra CBE, BMA president and Emeritus Professor of Mental Health & Cultural Diversity at Kings College, London, who launched the survey on medical students’ and doctors’ mental health and wellbeing, said: ‘This report shines an important light on the alarming mental health crisis currently burdening the medical workforce as the link between the current pressures on doctors and poor mental health can no longer be ignored.

‘The findings speak for themselves. With four in ten of the respondents surveyed currently suffering from depression, anxiety, burnout, stress, emotional distress or another mental health condition, and an overwhelming eight in ten of those surveyed at high risk of burnout, the enormous demands being placed on doctors have come at a worrying price.

‘While there is no denying that being a doctor is a challenging and demanding role, too often the line of what can be considered routine pressures of the job has most definitely been crossed and the consequence is a workforce that has been pushed to literal breaking point.

‘As the people who are entrusted with caring for the health of others, doctors often feel particularly vulnerable or unable to come forward and seek help for fear of judgement and or any perceived ramification a declaration of poor mental health may have on their prospective career.

‘As well as focusing on addressing the immediate pressures which are negatively impacting doctors, such as long working hours, unmanageable workloads and rota gaps, we need to see a wider cultural shift that addresses this stigma that currently inhibits doctors seeking help and ensures that support is publicised and readily available for those who do so.

‘A system that fails to support and protect the health of its own workforce will only flounder and this is as clear a call to action if ever there was one.’

Dr Thomas Kitchen, an anaesthetist specialist trainee, who works at Health Education and Improvement Wales, recounts how his own experience of working as a junior doctor impacted his mental health: ‘There have been many times in my career where I felt that my mental health has been at risk.

‘I can recall two specific incidents recently that have had a big effect on me.

‘The first was around the loss of a colleague and tutor to suicide.

‘The other was around the management of two difficult clinical cases involving the resuscitation of young patients which in retrospect caused me to experience an episode of depression.

‘I lost any sense of joy and I was left challenging my identity as a medic.

‘I know I am far from alone in these experiences.

As doctors, our daily interactions with patients and their families, who are often at the height of their own emotional distress, can take its toll.

‘We strive to do our best for our patients, whether that’s in training, in practicing medicine or delivering care but we are often underprepared for the everyday emotional experiences of the job, never mind when these experiences become exceptional.

‘Perhaps these are the things which affect us the most?

‘I feel that this is made worse by the broad stigma around disclosure of mental health disorders, suicide, substance misuse and vulnerability within our professional culture.

‘Given their backgrounds and exposure to certain education systems and culture, many doctors and medical students can often feel a deep aversion to “failing” and perhaps can’t even perceive what failure would really mean or look like.

‘Sadly, but inevitably in this job, particularly given the current pressures, not everything goes the way you would like or plan, even when you have done everything right.

‘How we manage ourselves in the face of our perceived failings can add a unique pressure on top of already challenging situations.

‘We need to be kinder to ourselves.’

To gain a more in-depth look at the particular challenges facing medical trainees and the impact on mental health, the BMA gave a research grant to Swansea University to produce a paper: ‘Personal stories of doctors in training with experience of mental illness’.

This compilation of narrative interviews gives a unique insight into what it is like to experience mental illness during a doctor’s trainee years.

The paper attempts to understand the factors, specific to their occupation, that may have contributed to their illness and explores the current barriers to getting help alongside the factors influencing recovery.

Drawing on these experiences, they have developed a series of recommendations designed to improve the support available to doctors experiencing mental illness.