Talking point: Why not measure "wellness" in doctors?

14 December 2009

By Jim Killgore, Summons editor, MDDUS 

Doctors make lousy patients – so the 'truism' goes. But more often the trick is getting a doctor to submit to being a patient in the first place.

It won’t be surprising to anyone to learn that research confirms that doctors are notoriously bad at looking after their own health problems – be that through excessive dedication or stubbornness (or perhaps both). Some tireless doctors might argue that at least they are only hurting themselves.

But a recent review in The Lancet makes the interesting observation that sick physicians can lead to a sick healthcare system.

The review written by a group of researchers from the University of Calgary states:

“Results of emerging research show that physicians’ stress, fatigue, burnout, depression, or general psychological distress negatively affects healthcare systems and patient care. Thus when physicians are unwell, the performance of the healthcare system can be sub-optimum. The corollary is that physician wellness might not only benefit the individual physician, but also be vital to the delivery of high quality healthcare.”

Stress and burnout

The review sets out some of the current research on stress among doctors which is most often framed in terms of burnout, emotional exhaustion or withdrawal, fatigue, depression, anxiety, suicide or substance abuse. One study found that 46 per cent of physicians surveyed reported medical practice to be very or extremely stressful and another found that 17 per cent of resident doctors rated their mental health as only fair or poor compared to double that number in the general population. The review found that 'burnout' affects an estimated 25–60 per cent of doctors with some studies reporting 75 per cent.

Even more worrying, suicide rates for physicians are estimated to be six times higher than among the general population and an estimated 8–12 per cent of practising physicians will develop a substance abuse problem at some point in their career.

Studies also support the common assumption that doctors are poor at seeking help for their problems. One study of Canadian physicians found that of the 18 per cent who were "identified as depressed, only 25 per cent considered getting help and only 2 per cent actually did". Another cited that only 42 per cent of Australian physicians had a GP and most had sometime self-prescribed drugs. Among young Irish physicians 30 per cent had not been to a general practitioner in the previous 5 years.

The report comments that doctors often rely on denial and avoidance as coping strategies which are ineffective, and the problem is "exacerbated by the medical profession’s poor record for giving mutual support and feedback". But findings also show that doctors who do get support from either colleagues or spouse are often more healthy.

Healthcare system heal thyself

But most surprising is the contention that sick doctors make for a sick healthcare system through reduced recruitment and retention of physicians, impaired workplace productivity and efficiency, and poor quality of patient care and patient safety. One study cited in the review found that 22 per cent of young physician residents said they would not pursue medicine if given the opportunity to relive their career. In terms of looking after patients another study found that 57 per cent of participants believed that tiredness, exhaustion, or sleep deprivation negatively affected patient care, and 50 per cent reported that work-related stress led to reduced standards with 9.4 per cent reporting serious mistakes and some resulting in patient deaths.

Among their conclusions the Calgary researchers propose that healthcare systems should not rely solely on patient-based indicators such as survival rates after major surgery to measure quality but should also focus on physician "wellness". It points to existing standardised measures that can assess this.

The report concludes: "Ultimately, individual physicians will personally benefit from taking better care of themselves. Such efforts would probably lead to increased job satisfaction and overall wellbeing, and reduced likelihood of physicians experiencing an overwhelming sense of stress and burnout. The organisations employing physicians will benefit by having more productive and efficient health-care providers in conjunction with reduced absenteeism, job turnover, and recruitment and retention issues. And perhaps the patients themselves will benefit by receiving better quality of care."

'Physician wellness' might seem a woolly concept but at least it acknowledges that a health service is truly the sum of its parts – individual healthcare workers and people, not performance units. It shifts the emphasis away from just curing ills to promoting health among staff and by extension the entire health service.

There again, 'wellness' does sounds awfully like 'well notes' – and no doubt is soon to be heard in a party manifesto near you.