10 The pressure point


MPS has launched a worldwide counselling service for members, to provide support in times of work-related stress. Gareth Gillespie and Sara Williams look at the possible causes of stress and the potential consequences for doctors and patients


M


odern society is becoming increasingly frantic. If we are not rushing to get somewhere,


we are reading headline news or replying to text messages, in between preparing our next tweet and Facebook post, while planning how we can afford an iPad, get fit, feed the family, advance our careers and see our friends; we could go on. Stress has become an acceptable cliché, ignored by most and discarded as normal by many. In this all-action world, patience is


not often regarded as a virtue; it is a hindrance. This modern attitude is becoming increasingly evident in medicine, where the business of running a successful and profitable hospital or surgery increasingly becomes the focus. Doctors are under increasing pressure, with increasing demands on their time. Doctors are no strangers to stress,


but these attitudes certainly do not make their jobs easier: stress needs to be tackled effectively or it will lead to burn-out. Not only can stress eat away at a doctor’s physical and emotional health, also adding strain to relatives or colleagues close by, but the impact on patient safety is potentially severe. The association between stress levels and clinical negligence claims has been demonstrated in studies in the US, while the intervention of stress prevention programmes has also been shown to reduce the likelihood of errors and ensuing clinical negligence claims.1,2


Prevalence In the United Kingdom, studies have determined that the proportion of medical professionals demonstrating above-threshold levels of stress is around 28%, compared to around 18% in the general working population.3


The


British Medical Association (BMA) has estimated that one doctor in 15 could develop a dependency on alcohol or drugs at some point in their career.4 The most disturbing statistics,


however, come from the Working Group on the Health of Health Professionals, who prepared a report in 2010 for the UK Department of Health – these statistics showed that rates of suicidal thoughts and suicides, and those of substance misuse, are considerably higher among health professionals than in any other group of workers.5 Similarly, in New Zealand, studies


of stress among doctors in 2000 and 2001 revealed that 30% of doctors had significant psychological symptoms, and around 10% of GPs, physicians and surgeons had symptoms of significant psychological distress.6,7


In


Hong Kong, stress in doctors is such a prevailing issue that the Hospital Authority set up Oasis in 2002, a “Centre for Personal Growth and Crisis Intervention”, which, among other services, provides treatment by clinical psychologists for healthcare workers in situations including the occurrence of a medical error.8,9


Cause and effect There are many causes of stress in doctors, and not all of them are work-related. A study of the usage of the MPS counselling service in New Zealand – which is jointly- funded by the Medical Assurance Society and has been in existence since 2006 – revealed that many doctors had “home-based” issues related to their spouse or alcohol use, or problems adapting to new cultures.10


For the workplace, the New Zealand study highlighted


the following causes of stress: ■■ Perceptions of inadequacy and not performing to potential


■■ Staff shortages and working conditions


■■ Difficult dynamics within workplace relationships


■■ Bullying ■■ Poor management support ■■ Idiosyncratic reactions to patient deaths.


In the UK, the BMA runs a support service called Doctors for Doctors. The service takes more than 2,000 calls a year and lists career issues and being the subject of a complaint to the General Medical Council (GMC) as the two most common sources of problems affecting callers. A complaint that causes stress may go on to cause another adverse event, which will bring about either another complaint or a claim – a vicious circle that might be broken if a doctor is willing to be open about their stress. Depression, bullying and clinical competence are the other most common problems discussed with Doctors for Doctors.


Not only can stress eat away at a doctor’s physical and emotional health, but the impact on patient safety is potentially severe


Firth-Cozens identified compelling


evidence that high levels of stress impair a doctor’s performance, by affecting memory, concentration and attention, and decision-making ability.11


Firth-Cozens’ view was


that individual and organisational factors are involved in the potential compromising of patient care, which can create a vicious circle. Evidence of this process exists in


a review carried out in the US of a large number of claims reported to a leading malpractice insurer.12


These


claims were analysed to ascertain the period between the notification date of a first claim and the incident date of a second claim against the same doctor. The results showed that in any given quarter, a doctor’s average risk of being named in a clinical negligence claim was 5% – but during the three months following notification of a first


SPECIAL FEATURE


ASIA CASEBOOK | VOLUME 19 | ISSUE 3 | SEPTEMBER 2011 www.medicalprotection.org


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