Doctors suffering from burnout need compassion, not blame, researcher says

Doctors, nurses and other healthcare workers suffering from burnout should be treated with compassion and not blamed for their illness, a leading GP says.

Clare Gerada says employers often treat doctors like “naughty schoolchildren” when they fall ill or develop mental health problems. Professor Dame Gerada, former president of the Royal College of General Practitioners (RCGP), has called for more comprehensive guidelines that focus on “kindness” and “sensitivity”.

The doctor, who co-founded the mental health charity Doctors in Distress, discusses the need for sweeping reforms in a new book aimed at overhauling the care of doctors and nurses with mental illness.

The Handbook for Physicians’ Mental Health, highlights how suicide rates for doctors are up to four times higher than for other professions. General practitioners, psychiatrists and foreign-trained doctors are among the health professionals at particular risk.

This also applies to female clinicians who bear the burden of a ‘second shift’: caring for patients during the day and their families at night.

A global workplace crisis, fueled by increased workloads, bullying and racism, are among the many factors cited in the book as contributing to the onset of depression, anxiety and other mental health problems among clinicians.

Another major risk factor is what Professor Gerada calls “the industrialization of care,” which places too much emphasis on achieving strict targets at the expense of personalized healthcare for patients.

The Handbook for Physicians’ Mental Health refers to high-profile cases of physician suicide, including resident physician Rose Polge in 2016 and psychiatrist Daksha Emson who committed suicide in 2000, both of herself and her daughter.

Professor Gerada said: “General practice around the world is in crisis. The workload has increased significantly in recent years and has not been matched by growth in funding or staffing.

“Fear is at the heart of the factors that contribute to mental illness and suicide in physicians. Physicians fear losing their professional identity, being removed from medicine, becoming a patient, being abused and excluded, making mistakes, upsetting older people, and not meeting patient expectations.

“Healthcare professionals who are ill want to be treated with compassion, sensitivity, sympathy, empathy and without judgement. However, trainers, employers and supervisors often treat them like naughty schoolchildren or criminals because they cross the line between practitioner and patient.

“Many people in authority over physicians mistakenly confuse illness with a performance problem, as a disciplinary issue that needs to be addressed.”

This evidence-based handbook provides comprehensive insights into why doctors get sick, how to identify people at risk and the best approaches to support their recovery. It is based on knowledge from NHS Practitioner Health, a mental health service that supports around 6,500 health and care professionals each year.

Among the patient cases featured in the book is a first-hand account by Sarinda Wijetunge, a junior doctor who was admitted to a mental health unit. Dr Wijetunge says that doctors are “pushed to the limit by the demands of their job.”

The General Medical Council and the British Medical Association provide guidance on how doctors should behave if they are unwell or are consulting a sick colleague. But Professor Gerada says the advice is couched in “the language of blame, harm and avoiding problems – not compassionate”.

Patient complaints are a major factor in suicide among physicians who derive their self-worth from their work. The book explains that allegations of misconduct or unsatisfactory treatment can challenge health care workers’ self-perceptions, as unsocial hours, night shifts, and frequent relocation for career advancement expose physicians to the risk of loneliness and increase their likelihood of developing mental health problems.

The author says, “Physicians can feel surrounded by people and yet very alone.”

Professor Gerada also outlines the barriers that prevent healthcare providers from getting the help they need.

Fear of losing confidentiality, the public’s perception that doctors are immune to disease, and their training, which requires them to put the needs of their patients above their own, are some of the reasons why they hide their illness.