Practise what you preach: health behaviours and stress among non-consultant hospital doctors

Abstract

JournalClinical medicine (London, England) ABSTRACT IntroductionDoctors may experience better physical health than the general population, but higher rates of mental illness, suicide, depression, compassion fatigue and substance misuse are widely described. 1,2 In addition, workplace stress can lead to high rates of doctor burnout. 2Although the need to address doctors' health has been recognised, 2-5 medical training internationally gives little emphasis to self-care.2 In Ireland, some support services are available for doctors, although these are limited. 6 A key difficulty is the issue of unconventional access to health services. Studies have shown that doctors often engage in selfprescribing, self-referral, 'corridor consultations', denial and symptom minimisation.2,3,7 Many work through illness which can impact negatively on the care of their patients. Non-consultant hospital doctors (NCHDs) experience particular stressors associated with working in hospital jobs and being at an early stage of their careers. 8 In Ireland, training requires NCHDs to frequently relocate. This, combined with health expenditure cutbacks, increased healthcare demand, non-compliance with the European Working Time Directive (EWTD) and increased public expectations, has led to difficult working conditions. 8 This study aimed to identify the factors driving NCHD health behaviours, assess the impact of workplace stress on NCHDs and evaluate initiatives which may improve the health behaviours of this new generation of doctors. It also assessed their standard of self-care and preferred sources of support.There have been few studies 1 , 9,10 worldwide focusing specifically on NCHD health behaviours and these were limited in terms of direct feedback from the doctors themselves. MethodologyA review of the literature revealed that there were no validated instruments that specifically addressed the study objectives. However, elements from previous studies 1,7,11,12 did contain similar components and these were adapted to facilitate comparisons. This resulted in the development of a 25-item survey, which aimed to assess current health behaviours, the impact of work-related stress and coping strategies, sources of support, training in self-care and stress management, and invited feedback in terms of possible solutions and interventions to improve NCHD wellbeing.

Doctor, how can we help you? Qualitative interview study to identify key interventions to target burnout in hospital doctors

“…The overwhelming emphasis on issues of staffing, cover and leave in our study is in line with other studies and not surprising, given the current doctor shortage and growing patient population in Ireland 34 38. The shortage of doctors is a global phenomenon predicted to reach crisis levels by 2030 39–42.…”

“…The preference of doctors in this study for primary-level, system-focused interventions over secondary-level, individual-focused training interventions is in line with preferences of doctors in Ireland uncovered in a recent study 34. It has also been shown that physicians expected to deal with their burnout individually feel less ‘resilient’ and take more personal ownership of their burnout than physicians who receive support from their hospital through system-level changes 35 36.…”

Work-related stress: volunteer and employee drivers/rescuers

“…Our research shows that, in the field "Demand", the two groups have a similar overall score, falling into the red area. We may consider that this result is linked to the heavy workload and the kind of tasks often not suited to their abilities, which could be a cause of dissatisfaction and, sometimes, lead to interruption of the working activity (5,6,12,14,31,32). Even though this situation can lead to take targeted strategies, the workers of both groups achieve a score higher than the 80 th percentile in two of the eight items of this area, as it emerges in our results denoting they are not subject to intense and very fast work.…”

Physician, heal thyself: a cross-sectional survey of doctors’ personal prescribing habits

“…Finding time to attend a doctor’s appointment, the cost of lost work time, and lack of encouragement by employers have been postulated to cause barriers to doctors accessing appropriate healthcare, therefore leading to a higher likelihood of self-diagnosis and self-treatment 10. The convenience of self-prescription and a sense that doctors 'should' be able to manage their health problems have also been described 11. Physician health services, catering to the regular health needs of doctors, have been trialled in Norway to improve health outcomes for doctors 3…”