how hospital pressure harms doctors’ mental health

Even before Covid pandemicwhich has put significant pressure on healthcare workers, as Australian doctors have noted poor mental state to a greater extent than in the entire population.

The risk is particularly high for medical students, junior doctors and female doctors. Recent data review from 20 countries found that female doctors were 76% more likely to commit suicide compared to the general female population.

All this is a problem for doctors themselves, and often also for their relatives. But this is also a problem because we rely on physicians to provide high-quality health care to the public. If he is burnt out, experiencing anxiety, depression, or other mental health issues, it may impact his ability to care for us.

Our new study published today in BMJ Open examines how doctors’ workplace and working conditions affect their mental health.

What we did

We interviewed and then ‘worked’ with 14 doctors on shift in a public hospital in South Australia between June and October 2021. The doctors who took part came from a range of cultural backgrounds, genders, specialties and stages. treatment. careers (younger and older).

We asked doctors about their roles, the responsibilities they perform, training requirements, and hospital regulations and standards that influence their professional experiences.

We then observed the same doctors working at different times of the day and noticed:

• characteristics of their work environment (such as pace and demands)
• interpersonal relationships (team dynamics, mentoring, supervision, interactions with patients)
• the types of pressures they faced while providing clinical care (patient workload, administrative tasks).

During the observations, we worked with doctors to explore how workplaces could better support their mental health.

Administrative burdens on top of patient care

Among several challenges that participants reported in their daily work, a particularly sturdy theme was the burden associated with administrative processes (such as completing paperwork and obtaining consents required for referrals).

One physician stated that “hospital processes are more stressful than clinical scenarios.”

The administrative burden required in addition to clinical care made physicians feel disenfranchised and negatively impacted their satisfaction with service delivery. One said:

If [patient’s] the results are impoverished because they had a terrible accident or a terrible disease, I can rationalize that. However, if they performed poorly because we were unable to provide them with a good service, that would be much worse.

Staff and staff shortages

Physicians also described staffing shortages and fragmented teams, which often required them to cope with pressure to provide high-quality care. This, combined with shift work, led to exhaustion and took a toll on their mental health.

Still, physicians described feeling unable to refuse shifts or take time off for fear of losing professional credibility with peers or senior staff who might control future employment opportunities. One of the participants said:

We just take it, take it, take it […] until we can. And I think especially doctors who don’t want to be seen as causing trouble or disturbing the peace […] or perceived as delicate. You don’t want to be the one to admit that it’s actually impossible for one person.

Pressure combination

The physicians in our study were well trained, motivated, and adept at providing clinical care appropriate to their stage of career.

However, their medical practice took place in work environments characterized by high patient volumes, time constraints, geographic challenges (services scattered across locations), and administrative burdens. As one participant explained:

I think it just bubbles over the years and just causes this terrible sense of injustice. That’s why I think doctors are just feeling burnt out, tired and frustrated because they’re trying to do the right thing and be better and the system just doesn’t allow it.

A combination of competing pressures often clashed with the ambition to be a “good doctor.” As one of the younger doctors explained:

In addition to all the knowledge and actual competencies you must have, it is extremely vital to convey to others that you are a rational, balanced human being who is able to do your job effectively and appropriately. You just have to step into that role and fulfill all these different tasks and different expectations within this one job.

What’s next?

Our study was conducted only in public hospitals in South Australia, so our findings cannot be generalized to other hospitals or other health care settings where physicians may work.

However, to our knowledge, this is the first study of physician mental health in which, in addition to interviews, researchers entered participants’ workplaces to observe their working conditions. In doing so, it provides unique insight into the organizational and systemic factors that influence physicians at all stages of their careers.

Our findings indicate that doctors’ working conditions may have a direct impact on their mental health.

Physician mental health care often focuses on how to do this individual doctors they can build resilience and enhance their ability to cope with stress, for example through employee assistance programs.

While these approaches are vital, they place ultimate responsibility for mental health on the individual practitioner. This is not enough because doctors’ working conditions are largely beyond their control.

Programs are also not always accessible, for example due to stigma, work and professional culture, confidentiality concerns or perceived risks of registration.

Protecting physician mental health will require changes at the systemic level, including addressing workforce shortages and changing leave policies so that workers feel able to take time off. These changes are a key starting point for better care for our doctors so they can care for us.

If this article has raised concerns for you, or if you are worried about someone you know, please call Lifeline on 13 11 14.