[Authored by Louise Hall & Judith Johnson]

The NHS is rarely out of the headlines. Stories of growing waiting lists, breached targets and funding concerns abound. Some coverage has also considered the impact of these problems on NHS staff. Doctors have come forward to speak of the pressures of working long, antisocial hours in under-staffed, unsupportive environments. These articles have been met with scepticism by some – after all, aren’t doctors well-respected professionals working in modern healthcare facilities? And if things are tough for them, what has that got to do with us, their patients?

The real story

Truck drivers are forced to break every 4.5 hours for at least 45 minutes to prevent fatigue3, but doctors aren’t. In fact, doctors aren’t entitled to any break at all until they’ve worked for 6 hours, and then this break is only 20 minutes long. Despite the European Working Time Directive1 stating that the average number of hours a week must not exceed 48, this is actually spread across a 26 week time period, often resulting in doctors working in excess of 90 hours some weeks.

Although GPs hours may not be as long as those based in hospitals, their timetable is no less demanding. In addition to seeing as many as 40 patients a day, they make patient calls, house visits, and deal with all the paper work required to run a successful practice4. The average GP practice doesn’t have scheduled breaks, so staff are lucky if they have time for a proper lunch break or a rest from the intensity of continuously problem-solving patient cases.

The upshot

Research suggests that working such long hours, with such high levels of responsibility, takes its toll. A whopping 46% of GPs are classed as high risk for burnout5, and 30% of all healthcare staff have a minor psychiatric disorder, such as depression6-8. This is 11% higher than amongst the general population9.

So now let’s return to our second question: What has this got to do with us, their patients?

How doctor wellbeing affects patient care

  1. If your GP is unwell, you’re more likely to be referred, and your diagnosis delayed

Doctors that are suffering from burnout are more likely to refer you for additional tests. They realize they don’t necessarily have the mental resources to make a correct diagnosis, and may go overboard ensuring you’re checked for everything. Whilst this could be a sign of thoroughness, a doctor’s job is essentially weighing up risk and decision-making, and when they are functioning well they are able to make decisions on exactly which tests are essential. When these thought processes are impaired through poor wellbeing however, the additional tests you’re sent for will cost you time, requiring multiple visits back to the hospital/doctors surgery. These tests also inflict unnecessary costs on the health service, requiring resources that could be better used elsewhere10.

  1. Your experience of care will be poor

Burnt-out doctors are less likely to engage in patient-centered communication, which alongside making your appointments less enlightening is also associated with increased referral rates11. Additionally, a study found that patients of doctors who are burnt-out were less satisfied with their care than patients of doctors who had lower levels of burnout12.

  1. There’s more likely to be a mistake on your prescription 

The PRACtISe study in 2012 examined over 6,000 prescriptions within Primary Care and found that 1 in 20 prescriptions contained an error. That equated to 1 in 8 patients! Take a guess what one of the contributing causes to these mistakes was found to be…. Yep, you guessed it, the wellbeing of the GP. Anxiety, tiredness and physical wellbeing were all factors quoted by the GPs as causes for these mistakes. These factors are manifestations of heavy workloads, competing demands and time pressures that they are faced with daily13.

  1. If your doctor is unwell, they’re more likely to make a major medical error

“Medical errors” include things like wrong or missed diagnosis and wrong site surgery. Depressed, stressed, burnt-out, and anxious doctors are all significantly more likely to make errors than those who are psychologically healthy14-17. Which makes sense – if you’re not feeling well, it’s harder to concentrate. In fact it has been found that depression, for example, reduces cognitive functioning, which is important for our reasoning, memory, and attention systems18.

  1. Sick doctors cost you money

Doctors taking sick leave costs the NHS an average of £1.7billion each year19! But who foots this bill? We all do, in our taxes. And there’s no prize for guessing what one of the biggest contributors to sick leave in the NHS is: psychological wellbeing. Stress, depression, and anxiety account for more than a quarter of all sick leave. Worryingly, the level of stress seems to be only on the rise, with GPs reporting the highest levels of stress in Spring 2015 since the beginning of an ongoing survey that started in 199820.

So, next time that you think the welfare of our doctors isn’t your problem, think again. The healthier and happier the NHS staff are, the healthier and happier we all will be.

References

  1. http://www.bma.org.uk/support-at-work/ewtd
  2. http://www.heraldscotland.com/news/13126162.Revealed__junior_doctors_working_90_hours_a_week/
  3. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/208091/rules-on-drivers-hours-and-tachographs-goods-vehicles-in-gb-and-europe.pdf)
  4. https://www.healthcareers.nhs.uk/explore-roles/general-practice-gp/working-life
  5. Orton, P., Orton, C., & Gray, D. P. (2012). Depersonalised doctors: a cross-sectional study of 564 doctors, 760 consultations and 1876 patient reports in UK general practice. BMJ open, 2(1), e000274.
  6. Calnan, M., Wainwright, D., Forsythe, M., Wall, B., & Almond, S. (2001). Mental health and stress in the workplace: the case of general practice in the UK. Social science & medicine, 52(4), 499-507.
  7. Myers, H. L., & Myers, L. B. (2004). ‘It’s difficult being a dentist’: stress and health in the general dental practitioner. British dental journal, 197(2), 89-93.
  8. Wall, T. D., Bolden, R. I., Borrill, C. S., Carter, A. J., Golya, D. A., Hardy, G. E., … & West, M. A. (1997). Minor psychiatric disorder in NHS trust staff: occupational and gender differences. The British Journal of Psychiatry,171(6), 519-523.
  9. http://www.ons.gov.uk/ons/dcp171766_310300.pdf
  10. Kushnir, T., Greenberg, D., Madjar, N., Hadari, I., Yermiahu, Y., & Bachner, Y. G. (2014). Is burnout associated with referral rates among primary care physicians in community clinics?. Family practice, 31(1), 44-50.)
  11. Stewart M, et al. The impact of patient-centered care on outcomes. J Fam Pract 2000; 49: 796–804
  12. Anagnostopoulos, F., Liolios, E., Persefonis, G., Slater, J., Kafetsios, K., & Niakas, D. (2012). Physician burnout and patient satisfaction with consultation in primary health care settings: evidence of relationships from a one-with-many design. Journal of clinical psychology in medical settings, 19(4), 401-410.
  13. Avery, T., Barber, N., Ghaleb, M., Franklin, B. D., Armstrong, S., Crowe, S., … & Serumaga, M. B. (2012). Investigating the prevalence and causes of prescribing errors in general practice. London: The General Medical Council: PRACtICe Study.
  14. Dyrbye LN, Satele D, Sloan J, Shanafelt TD. Utility of a brief screening tool to identify physicians in distress. Journal of general internal medicine. 2013;28(3):421-7.
  15. de Oliveira Jr GS, Chang R, Fitzgerald PC, Almeida MD, Castro-Alves LS, Ahmad S, et al. The prevalence of burnout and depression and their association with adherence to safety and practice standards: a survey of United States anesthesiology trainees. Anesthesia & Analgesia. 2013;117(1):182-93.
  16. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. Jama. 2009;302(12):1294-300.
  17. Niven K, Ciborowska N. The hidden dangers of attending work while unwell: A survey study of presenteeism among pharmacists. International Journal of Stress Management. 2015;22(2):207.
  18. Linden DVD, Keijsers GP, Eling P, Schaijk RV. Work stress and attentional difficulties: An initial study on burnout and cognitive failures. Work & Stress. 2005;19(1):23-36.
  19. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_108910.pdf
  20. http://www.population-health.manchester.ac.uk/healtheconomics/research/Reports/EighthNationalGPWorklifeSurveyreport/EighthNationalGPWorklifeSurveyreport.pdf

A previous version of this article was originally published on 5th February 2016 on healthprofessionalofinfluence.com (now an inactive website).