Doctor stress, burnout and hospital rosters on agenda of key medical conference in Sydney

May 8, 2018

Stress, burnout, fatigue and the working hours of doctors and medical specialists in hospitals will feature at a key scientific meeting of local and international anaesthetists in Sydney this week.

According to visiting US Professor Karen Domino half of all US physicians in nearly 30 medical specialties claim to be “burned out” and 60 per cent are considering leaving their jobs because of it. Professor Domino is Vice Chair for Clinical Research at the University of Washington’s School of Medicine’s Department of Anaesthesiology and Pain Medicine.

In Australia, the medical profession has greater psychological distress and higher attempted suicide rates than other professionals and the general population according to findings from beyondblue’s landmark 2013 National Mental Health survey of 14,000 doctors and medical students.

Professor Domino has been invited to speak to trainee anaesthetists about burnout, its warning signs and how to prevent it by the Australian and New Zealand College of Anaesthetists (ANZCA) at its annual scientific meeting in Sydney from May 7 – 11.

In any given year there are about 1500 trainees undergoing accredited training by ANZCA which is one of Australia and New Zealand’s largest medical specialty colleges.

ANZCA’s president Professor David A Scott said the focus on fatigue and hospital rosters and their impact on the mental health and wellbeing of doctors and specialists was timely. The issues were now being discussed openly in the medical profession as a way of driving change in specialist training, mentoring and clinical practice.

“These are now global issues for the profession and the college is now working on reviewing its own guidelines on fatigue and fatigue management to ensure anaesthetists have adequate rest and effective rest breaks between their shifts,” Professor Scott said.

“This applies to consultant anaesthetists and to trainee specialists. Doctors aren’t bullet-proof. Working in a critical area like anaesthesia whilst fatigued is a risk for patients and bad for doctors’ health.”

Additional factors that have been found to contribute to burnout among doctors and specialists include too many bureaucratic tasks, spending too many hours at work where many admit to ‘’feeling like a cog in a wheel” and increased computerisation of practice.

Professor Domino believes the key to preventing burnout among doctors and medical specialists is not through mindfulness programs but recognising that the workplace culture of hospitals needs to change.

“While mindfulness training does have a place and may work for some it’s the whole hospital workplace culture that really needs to change. Many doctors in hospitals are under extreme stress, seeing patients every five minutes,” Professor Domino, an expert on patient safety, quality of care and patient/doctor communication, said.

“Hospitals and departments need to think about how they can prevent burnout for their staff and think about how they can change the hospital environment to make it less stressful.”

Professor Domino said the incidence of burnout was a concern for the medical profession as it not only affects the individual doctor or specialist but also affects patient care, patient safety and patient satisfaction. In extreme cases it leads to severe depression, substance abuse and doctor suicide.

“Disrespectful treatment and humiliation of students and residents is common in medicine and this can precipitate burnout and dissatisfaction in work,” she explained.

“Changes in health care have contributed to physician burnout by decreasing their autonomy, emphasising productivity over patient care and safety and excessive use of electronic health record systems and clerical tasks.”

“Burnout is a serious problem as it contributes to feelings of exhaustion, avoidance, irritability, frustration, sleep problems, reduced concentration and relationship issues. It affects patients as it can cause patient dissatisfaction and it also affects doctor-patient communication which can lead to medical malpractice cases,” Professor Domino said. 

“Unfortunately disrespectful behaviour is learned, tolerated and reinforced in the hierarchical hospital culture. ”
Professor Domino said trainees and younger doctors and specialists were speaking about the issue of burnout more openly and were not afraid to discuss it with their colleagues and families.

 “Creating a culture of respect in which all health care providers, including trainees, feel respected and safe from disrespectful behaviour is an essential component of creating a patient safety culture,” she said.

“Unfortunately old habits die slowly and many hospital settings place the blame of burnout on the individual physician, rather than creating changes in the workplace to improve joy in work.”

More than 2500 local and international anaesthetists, pain specialists and other medical practitioners have gathered for the ANZCA meeting at the International Convention Centre. The meeting features dozens of significant research papers, workshops and presentations on clinical and scientific advances.
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