Doctors are experiencing unprecedented levels of anxiety, depression and burnout as an under-resourced healthcare system struggles to contend with the demands of a growing population, widespread mental health issues and the ongoing COVID-19 pandemic.
“Doctors are very hardened up to what they see, they’re dealing with a lot of grief, trauma and sadness all day in their work,” said Sharee Johnson, a Sale-based psychologist and executive coach to the medical profession.
But she says, in a profession where stoicism is valued and there is a stigma to seeking help, many fatigued doctors are at breaking point.
“The truth is that about 50 per cent of them are burnt out, they have very high rates of depression, anxiety and more suicide ideation than the general public, so the fact that they are even showing up is a huge achievement a lot of the time.”
Ms Johnson, who was a guest speaker at last month’s virtual Physician Burnout Global Summit in New York, has been researching the causes of doctor burnout for her forthcoming book The Thriving Doctor.
She notes that the worldwide doctor burnout problem is underpinned by some common themes including a shortage of doctors, unsustainable working hours, bureaucratic protocols and under-resourced healthcare systems.
“Burnout is not a mental illness. Burnout happens because workplace conditions are not managed properly,” Ms Johnson said.
“All of these systemic and structural things need to be addressed from a leadership point of view, no individual doctor can really fix all of that.”
Similar concerns have been raised by the Victorian Doctors Health Program, a confidential service for medicos needing help for mental or physical health problems, that has seen calls double in recent months.
A need for systemic change
Ms Johnson has observed a growing hostility towards general practitioners and emergency department doctors, who, she says, the public views as “superhuman robots” with little understanding of the personal challenges they face.
“They cop an incredible amount of abuse and challenge that other people simply don’t have in their organisational working life,” she said.
“The idea that they’ve got a six-week waiting list, and every second patient that comes in to their room tells them how long they’ve waited for them, is not their idea of best medicine; it’s not their best plan, it’s not how they want to practise,” Ms Johnson said.
Rural Doctors Association of Victoria president Rob Phair agrees the medical system needs a rethink.
“Doctor workforce management, workforce strategies and industrial arrangements have to be carefully reviewed to help solve the problem,” Dr Phair said.
“This will require significant commitment and support from both state and federal governments — not just the local health services themselves.”
Searching for answers with Dr Google
Ms Johnson said having repeat conversations about the safety of COVID-19 vaccines had increased the pressure on doctors.
“There is the experience of the patient that has done their own due diligence on Google and then wants to challenge the doctor’s expertise, when the doctor might have spent anywhere from 10 years to 50 years understanding the science and anatomy of how our bodies respond,” Ms Johnson said.
“Many patients are now questioning and challenging the medical expertise of doctors in regards to COVID-19 vaccine safety, which has resulted in doctors finding themselves having to constantly justify and explain their expertise throughout the day,” Ms Johnson said.
She believes the community needs to be more sceptical of online information.
The life-threatening consequences of burnout
Whether it be pivoting between trauma cases every 15 minutes in an emergency room or working through a waiting room of impatient patients, the “patient-first” protocol often means that doctors put themselves second.
Although there is no comparable data on the rate of medical error per population in Australia, according to research conducted by John Hopkins Medicine in the US, about 250,000 in-hospital patients die each year from medical mistakes, making it the third biggest killer after heart disease and cancer.
However, an article published in the Australian Medical Journal in September 2020 estimated about 140,000 cases of diagnostic error occurred in Australia every year.
About 21,000 cases of misdiagnosis resulted in serious harm to a patient, resulting in 2,000-4,000 deaths.
“We’re asking our doctors to work these long hours, [to] be fatigued, and then we’re expecting them to make really good decisions about people’s lives,” Ms Johnson said.
Ms Johnson said she would like to see practitioner safety on par with other professions, and the safety of doctors and patients acknowledged as a fundamental requirement before a consultation.
“Truck drivers, airline pilots, people out on the gas platforms here are all heavily regulated in terms of the hours they’re allowed to work.
A lot of travelling salespeople have rules on how they can drive before they have to stop, and have a rest or sleep over, and we just don’t have a lot of that around our doctors’ work.”
Addressing the rural doctor shortage
With more people moving to rural and regional areas, pre-existing pressures on the medical workforce outside metropolitan areas have only increased in the COVID-19 era.
“We still find [that] rural GPs struggle to find successors to take over their practices,” Dr Phair said.
The Rural Doctors Association of Victoria has been addressing issues such as streamlined accreditation and career development in devising a Rural Medical Workforce Plan to train, teach, attract and retain more country doctors.
“The culture of medicine has become increasingly sub-specialised and metro-centric over recent decades. Many training colleges require trainees to spend most of their training time in big city hospitals,” Dr Phair said.
“Generalist doctors have been undervalued. We’re trying to turn some of these trends around.”
Technology and the future of healthcare
Ms Johnson predicts COVID-19 will result in a post-pandemic wave of frontline healthcare workers leaving the profession, as more and more burnout and PTSD (post-traumatic stress disorder) cases emerge over the next few years.
She said the emergence of telehealth conferencing technology, DIY monitoring devices and artificial intelligence (AI) in the medical space could mean even less face-to-face contact with doctors.
“You could once only go and see a psychologist in your local area; now you can go on telehealth and see a psychologist anywhere in the world,” she said.
But in a world of contactless consultation, Ms Johnson said doctors and patients would have to work even harder at showing kindness, compassion and empathy to each other to build trust.
“The AI is going to mean more robots, not less, and we are going to want our health professionals to bring more of that humanness because the machines are going to do a lot of what they do now such as taking blood pressure.”
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