THE NHS is facing a “growing disaster” due to doctors suffering stress and exhaustion, putting patients at risk from mistakes being made in their care, medics have warned.
The British Medical Association (BMA) conference in Edinburgh heard that in the worst cases, stressed-out doctors were turning to alcohol or even suicide as they struggled to cope with the pressures of their work.
Doctors in Scotland said they could not imagine working under the same stresses until they retired and the intensity of their jobs was not sustainable long-term.
Yesterday’s debate on doctor “burn-out” – a combination of stress, anxiety and exhaustion which can mean doctors have to be signed off sick – heard growing concerns about the impact on patient care.
Dr Jamie Green, from the BMA’s Junior Members Forum, said burnout among doctors could often be severe.
“There are safeguards in place for pilots and lorry drivers to prevent them causing loss of life with their large, dangerous machines,” he said.
“But how much more dangerous do you want to get than a scalpel or a prescription pad? Stress and burn-out in doctors can be catastrophic, putting our patients at risk while ruining the careers of students and doctors at all levels.”
Dr Green said part of the problem was that stress had become a normal part of doctors’ lives and they were made to feel they were ethically obliged to carry on whatever happened.
“As such, doctors may be reluctant to come forward for help and this is compounded for medical students and doctors in training with exams, portfolios and log books,” he said.
He called on the BMA to investigate the causes of stress and burn-out as well as the root causes, and provide guidance and support for those affected.
“This meeting has identified the growing disaster which is stress and burnout in the health service,” Dr Green said. “It is time to act now and act decisively.”
Dr Sangeetha Sornalingam, also from the BMA’s Junior Doctors Forum, said burn-out was leading to doctors leaving the profession and seeking work abroad.
“It is linked to alcoholism and, tragically, suicide,” she said. “This is an issue that needs to be taken seriously. Recent changes to healthcare structure and delivery have led to increasing concerns of burn-out, particularly of GPs, who are known to be a high-risk group.” Dr Sornalingam said a review of stress among hospital doctors had been conducted by the BMA in the late 1990s.
“At that time, working hours, pressure and shortages of beds and increased acute medical admissions were the issues,” she said.
“From my recent experience, little has changed.”
Dr Nikki Thompson, a consultant anaesthetist and chairman elect of the BMA’s Scottish Consultants Committee, said a lot had changed in the NHS during her career.
“The constant pressure of the intense workload makes me feel that while still worthwhile and useful, my work is not anything like as enjoyable as it used to be. I personally feel under pressure and I can see that the system is under a huge amount of pressure.”
A BMA survey has revealed that eight in ten (80.6 per cent) of doctors feel that their current level of pressure at work is very high or high.
Dr Brian Keighley, chairman of the BMA in Scotland, said: “Doctors report that they are facing relentless pressure in their day-to-day work just to keep up with the pace of demand and meet targets whilst maintaining the quality of care they believe their patients deserve.
“This increased intensity of work, unless managed, will lead to rising levels of stress and burn-out among doctors.”
A Scottish Government spokesperson said: “All staff, including doctors, are covered by the working time regulation, which includes controls on working hours and ensures minimum daily and weekly rest requirements for all staff..
“We have also negotiated our GP contract to reduce the workload associated with bureaucracy.”
The GP: Pace of job damaged patient care
GP AMY Small found working long hours in her practice “incredibly stressful”.
“I dreaded going into work. I felt like I was constantly treading water and keeping my head afloat,” she said. “The more stressed I got the more detached I became from my patients.
“I started to cut them off while they were talking, trying desperately to ignore little cues they dropped indicating they had things they really needed to talk about. I would deal with the matter in hand but perish the thought they wanted to talk about other things.”
Dr Small, who works in Prestonpans, said she would become frustrated with patients who arrived with a list of problem and would be “ratty” and tell them off.
She said after working for so long at this pace she stopped sleeping well at nights.
“I often woke in the night and remembered things that I’d forgotten to do. I also felt incredibly guilty.
“I wasn’t the doctor I wanted or aspired to be. I wasn’t the compassionate, empathetic person that I used to be.”
After talking with her colleagues and husband, Dr Small decided to go part-time and work three days a week.
“Before I cut down I made the realisation that, at the age of 32, I had more years left working than I’d lived on the planet,” she said. This filled me with horror and I realised there was no way I could continue working at this pace for the next two years, let alone the next 35.”
The junior doctor: Sleep debt caused by long shifts fails both doctors and patients
Dr TOM Berry, a trainee surgeon, said junior doctors could face long shifts with heavy workloads which often left them exhausted.
“Too many long runs of successive long days or nights build up a sleep debt and fatigue that can be of no benefit to doctor or patient,” he said.
“You cannot train, you cannot learn, you cannot be at your best if you are too tired to remember your own name…Simply we are failing ourselves and our patients.”
Dr Berry, who works in the west of Scotland, said he could experience stress both in and out of the workplace due to the pressures he faced in his job.
“As a general rule I have a relatively placid temperament, but I have lost my temper quite spectacularly at work.
“I have argued and ended personal relationships where work has undoubtedly played a part. I have suffered insomnia.
“I don’t believe I’m unique. I don’t believe that the problems are unique to doctors. I do believe that things will only get worse and the situation is unacceptable.”
Dr Berry said he wanted to be well rested and well trained so he could do his best for the patients in his care.
“I want to be awake and able to concentrate when my patients are telling me their concerns. I want to be able to promise my patients I’ll be well rested when operating.
“I want the stories of the doctors who’ve left the profession, taken to drink, grown ill or left the country due to the stresses and demands of working in our NHS, to be stories of a past generation of doctors.”
The anaesthetist: More patients means more pressure
Consultant anaesthetist Dr Nikki Thompson graduated in 1989 and has worked in the NHS for over 20 years.
She said the system had changed a lot during her career. “Patients can now expect to receive higher standards of care. New technologies and advances in medicine mean that we can treat patients who, ten years ago, wouldn’t have had any options.
“And in the last four to five years I’ve noticed a big difference in how quickly patients are being treated.
“However the downside of this is that work is much more pressurised.”
The doctor, who works in Dundee, said she found being on emergency on-call duty she could spend long hours on her feet.
“I find this work increasingly tiring and at my age, especially after a particularly busy night or weekend, it can take me a week to ten days to feel ‘normal’ again,” she said.
The medic said changes to the pension age meant that she would probably have to work another 20 years at the same pace.
“I can’t see the health service getting any easier, especially as we see more and more older patients with complex medical problems, but this will make things more and more stressful,” she said.
“Certainly the out-of-hours work will be more difficult to deal with as I get older and I become more tired.”