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Workplace stress takes a major toll on doctor health

Many doctors and medical students have contemplated suicide or are suffering severe psychological distress and burnout, a major investigation into mental health in the medical profession has found.

In a result with major implications for how workload, occupational demands and resources are managed, a study commissioned by the mental health organisation beyondblue found 20 per cent of medical students and 10 per cent of doctors had had suicidal thoughts in the preceding 12 months – rates much higher than the broader community – and a quarter of all doctors were likely to have a minor psychiatric disorder, such as mild depression or anxiety.

The study, one of the biggest of its kind ever undertaken, drew on responses from 14,000 doctors and medical students to show that they are far more likely than the general community to be suffering significant psychological distress, but are very reluctant to seek help because of stigma surrounding mental health problems.

AMA President Dr Steve Hambleton said the extent of distress reported by both doctors and medical students was “really disturbing”, and underlined the need to break down the stigma surrounding mental illness and improve workplace practices to reduce levels of stress and burnout.

Dr Hambleton told the Health Professionals’ Health Conference in Brisbane earlier this month that for a long time discussions about the health of doctors and other health professionals had been taboo but – driven by younger professionals entering the workforce – this was now changing.

“Attitudes are changing,” he said. “The AMA has now made the health and welfare of doctors a priority. As health professionals, we have a responsibility to ensure that programs exist to assist our colleagues to access quality health care when they need it.”

The beyondblue study found that the rate of depression among doctors was similar to that among the broader population, but suicidal thoughts were much more common (24.8 per cent compared with 13.3 per cent), as was the instance of very high psychological distress (3.4 per cent compared with 2.6 per cent).

In a finding that highlights the particularly intense pressure placed on those beginning in the medical profession, the beyondblue research found the incidence of very high psychological distress was greatest among doctors aged 30 years or younger.

Young doctors were far more likely to suffer emotional exhaustion, low professional efficacy and a high level of cynicism.

Women doctors also experienced higher levels of distress than their male counterparts. The study found that they were more likely to suffer a mental health disorders, and to have contemplated or attempted suicide.

Dr Hambleton said that although medicine was an extremely rewarding profession, it was also stressful and demanding, and almost invariably doctors paid less attention to their own health than to the wellbeing of others.

“This is a stressful job,” the AMA President told Brisbane radio station 4BC. “The work hours for young doctors are quite long, you are wondering about making the wrong decision, you are working with people’s lives.”

Dr Hambleton admitted there was a tendency among doctors to dismiss thoughts of their own health, and even to share in the stigma attached to mental health problems by the broader community.

“There is a stigma about mental illness, and in the medical profession it is probably even worse, because expectations are so high, and disclosing to a colleague that you are anxious or worried or depressed, you are not sleeping, you actually have a mental illness, is very, very difficult,” he said.

Dr Hambleton was critical of mandatory reporting regimes in some states, which he warned deterred people from seeking help.

“The impact of mandatory reporting has resulted in some states seeing dramatic decreases in access to these programs – in Queensland, for example,” he said.

“This is a retrograde step [and] the AMA has been vocal in calling for exemptions from mandatory notification requirements for doctors treating colleagues and medical students.”

The beyondblue researchers identified young doctors as particularly vulnerable to the stresses associated with practicing medicine, particularly long work hours, high demands and heavy responsibilities.

They highlighted the need for greatly increased support for those just embarking on their medical career.

“Levels of cynicism were substantially higher in young doctors in comparison to both pre-clinical and clinical medical students,” they said. “This suggests that the transition from study to working may be a particularly difficult time for newly trained doctors, and they may require additional support.”

The report found the most common source of stress was trying to balance work demands with personal responsibilities (27 per cent), followed by workload (25 per cent), work responsibilities (21 per cent), long work hours (19.5 per cent) and fear of making mistakes (19 per cent).

Dr Hambleton said the findings underlined the need to promote mental health awareness and support in the workplace.

“There is a common belief in the medical profession that ‘we don’t get sick, we treat sick people and, besides, we are too busy to go to a doctor’,” he said. “Thankfully, attitudes are changing and, driven by young doctors and doctors in training, we are seeing a greater focus among medical practitioners on their own health and the health of their colleagues.”

Dr Hambleton said the AMA had made the health and welfare of doctors a priority, and praised steps being taken by the Medical Board of Australia toward funding doctors’ health advisory services.

Doctors’ health advisory services are available in each State and Territory.

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Adrian Rollins

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