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Opening up the Conversation about Mental Health

Updated on: 19 Jan 2021   First published on 13 Jan 2021

Being a doctor is a tough job. Facing every day the occupational challenges and caring for patients can result in your own wellbeing feeling like your last priority. It’s vital to remember that a high level of wellbeing is not only important for your sake, but for your patients’ sake too.

The size of the problem is worrying. A recent independent report by the GMC into the wellbeing of UK doctors and medical students revealed over a third of doctors in secondary care said they’d been unwell as a result of work-related stress in the previous year. It also found that nearly 1 in 4 doctors in training and 1 in 5 trainers in the UK felt burnt out to a high or very high degree because of their work.

Unfortunately, doctors are reluctant to seek help fearing stigma, guilt, and job loss, wanting to stay strong for those who need them, as well as denial and sometimes not recognising there’s a problem in the first place. Sadly, this not only fails to address the issue but can exacerbate it, leading to increased feelings of worthlessness and low self-esteem. The armour of invulnerability required for the job can be a double-edged sword; it helps you care for patients in the most tragic of circumstances, but it can leave you neglecting your own red flags.

It’s important to recognise early warning signs before they lead to a bigger issue. Our article on stress management outlines signs to look out for which you may find useful. Key contributing factors include:

Work factors Individual factors
Excessive workload and long working hours Self-critical
Working at home after hours Unhealthy coping mechanisms
Loss of autonomy at work and control over work environment Sleep deprivation
Inefficient use of time due to admin Over-commitment
Loss of support from colleagues Perfectionism
Poor leadership Work-life imbalance
Inadequate rewards Inadequate support system at home
Limited social collaboration and advancement opportunities

(adapted from modmed.com)

A study by Carol Burke, MD, presented at the World Congress of Gastroenterology during ACG 2017, found the below factors specifically contribute to Gastroenterologist burnout:

  • User-unfriendly EMR system
  • Lots of hours spent on domestic chores and childcare
  • Neutral or dissatisfying spousal/partner relationship
  • Carrying out patient-related tasks at home
  • Being single
  • Having an unemployed spouse/partner
  • Having a spouse/partner working long hours
  • Considering early retirement or leaving current practice within two years
  • Eating breakfast and lunch on less than half of workdays

Starting conversations about mental wellbeing with your colleagues can be difficult, as “How are you?” is typically met with “I’m fine”. Take the time to catch up in a more private environment or suggest a walk, maybe bring up a behaviour change you’ve noticed and express concern to help open the conversation. Regularly instigating such discussions helps normalise them, and getting to know your colleagues improves your ability to detect out-of-character behaviour that suggests someone’s struggling. It also works both ways, if you open up it could help encourage others to do the same.

It’s vital we open up the conversation of doctors and their mental health, and break down the barriers the stigma carries. The pressures of the job won’t go away, but the struggles we dangerously view as part and parcel of the profession can be overcome by acknowledging the harm and hostility they can instil. The culture of overwhelming stress and workload needs to be challenged and not accepted as the norm. This will help work towards a more positive and healthy work environment and wellbeing that benefits healthcare workers and patients alike.

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