Burnout in the hospital system

By Dr Claudine Cerda-Pavia, FGP Ambassador WA
Doctors (particularly those in the tertiary healthcare systems) are notoriously bad at self-care. The nature of doctors is one that is highly driven, competitive and perfectionist, and when coupled with the nature of hospital medicine itself, self-care can take a backseat for many doctors.

Hospital medicine is very prone to burnout. This is clear to the junior doctors who are working in the field where they may be surrounded by cynical, fatigued or depressed senior doctors.

It is not uncommon to work on a team where the majority of registrars are under immense training pressures and showing signs of depression and burnout: they have ceased doing activities they enjoy, they don’t sleep, they are irritable, they gain significant amounts of weight or lose significant amounts of weight and are genuinely unhappy.

Consultants are burdened by administrative issues: long hours, fewer clinic times, shorter lengths of stays, and alternative ways to care for sick patients that do not include an admission to an already over-catered hospital.

These are in addition to the inherent pressures of being a consultant and maintaining patient continuity of care. Many maintain a brave face but their fatigue and burnout is tangible.

Many doctors defend the status quo

The culture of poor self-care is so ingrained amongst hospital doctors that it is the norm. When a junior doctor expresses a need for self-care, it is not uncommonly met with an element of derision. Even those well-meaning doctors who have genuine intent and compassion to care for junior doctors struggle to put aside the culture of medicine they have become used to in order to help.

Some may say ‘Well that is medicine’, others may say we have taken ‘the calling’, we must now sacrifice. Some will say you must lead a monastic life to be a physician/surgeon/other. Others, often well-intentioned, will tell you it was so much worse in their day and how things are so much better nowadays. Many will defend the status quo despite the grave consequences to their own well-being.

Medicine is changing

Medicine was traditionally filled with mostly men, straight from high school and university, who lived under the support of their family homes or in a college. They could dedicate all their spare time to study and to the practice of medicine throughout their training, later supported by their wives if they chose to marry.

Society has changed, women outnumber men in many training programs, and many medical students are post-graduates with multiple commitments. The system has struggled to adjust to the changing demographic of the medical graduate and how to cater to their needs.

As new doctors decline to live the ‘monastic lifestyle’ and attempt to balance life and medicine, there will be an increasing number who chose not to pursue hospital medicine in order to pursue life, health and balance.

Stories from the front line

One prominent surgeon shared her experiences with me recently regarding a late pregnancy fetal death she had some years ago, which happened to be around her final exams.

The college would not entertain any allowances, reschedules or flexible options; she was forced to undergo exams during what must have been an emotional, tiring and scarring time.

Another senior consultant shared his experience with me, and freely admits that he has never attended his children’s assemblies due to the burdens of his training and later consultant life.

At one time, he agreed that was the only way to be a doctor; now he feels that was not the right decision.

Numerous other consultants and senior registrars have told me that they have struggled to access any unpaid leave over their careers, often being encouraged to resign if they need time off (and indeed lose their entitlements as a result).

Trying to practise what I preach

It has been a rewarding yet hard and very busy few years during which I have married, had a child, lost pregnancies, moved houses and attempted to live a life as a full-time doctor and a full-time mother and a wife and a daughter and a friend – in other words, a normal life.

I have attempted to practise self-care consistently, by taking personal time / getting good sleep/exercising / meditating / spending time with friends.

Yet, I am tired and need some time before forging ahead in my journey as a doctor.

The reactions I have received to a request for unpaid leave are varied – almost at polar opposites. Those who work in tertiary care are not surprised regarding the cultural difficulties in accessing leave (and indeed resigned that it is that way), whilst doctors in primary health care are shocked and concerned that this archaic attitude is still ongoing inside the hospitals.

Although most colleges have some permissions to allow for part-time training or time away from work, they are difficult to access and often leave the trainee disadvantaged.

General practice is an attractive choice

Burnout is real and becoming increasingly more so at all stages of a doctor’s career. Many senior consultants dream of retiring, leaving the practice or changing paths – but are simply unsure how to forge an alternative career.

Perhaps it is no surprise that general practice is an increasingly attractive choice for many who wish to care for others whilst looking after themselves and their families.

For many who choose to be a GP, the drawcards of flexible working hours and a work-life balance are a highlight, and their own health and wellbeing a vital component of their career choice.

Flexible training options combined with the ability to broaden one’s scope with sub-specialisation, building a private practice, engaging in teaching or research makes GP a very attractive option for both junior and senior doctors alike.