Stigma around medical burn-out is killing doctors, don't let it happen in your trust

Stigma is killing people, including NHS staff. This is a particularly bold statement but sadly supported by an ever-increasing list of people experiencing burn-out in our health system.

Stigma is preventing those affected getting the right help and staying safe. We need better systems in place to ensure doctors (and indeed all staff) are working with manageable workloads and do not suffer in silence. 

Burn-out (as defined by WHO) is defined as follows:

“Burn-out is a syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions:

• feelings of energy depletion or exhaustion;

• increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and

• reduced professional efficacy.

Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life which is an occupational phenomenon.” 

What this means that is that the institution you are part of is a cause of burn-out amongst staff. 

I write this short piece to urge leaders in the NHS to take seriously the value of staff wellbeing and the associated cultures in the health system. By looking after your teams, your organisation will be more effective, and patients will be better looked after.

My brother (a consultant cardiologist) burnt-out and died by suicide in November 2018 trying to do just that. 

Stress and subsequent inadequate access to effective support is the root cause of burn-out. Without any form of support or a reduction in stress levels burn-out is inevitable.

Doctors may be at a higher risk of burn-out due to their backgrounds and training methods. They find difficulty in asking for help or being seen to be unable to cope as they are engrained to be 100 per cent perfect all the time.

We cannot easily affect the number of patients in the short term; long-term prevention of disease is a key component of that, amongst others. Nor can we change the level of wider resources quickly, that needs its own political agenda

Most doctors carry this perfectionism trait and their work ethic means that they work hard, strive to achieve more, give more to patients but usually neglect their own needs in the process.  

They are trying to be perfect in an imperfect system, no one can deny the health system is under pressure. As I see it, there are simply not enough effective resources for the number of patients in need. Rather than regularly measuring the problem there needs to be action to deal with the issue. 

The immediate resolution? – either change the number of patients or improve the level of effective resources. 

I know we cannot easily affect the number of patients in the short term; long-term prevention of disease is a key component of that, amongst others. Nor can we change the level of wider resources quickly, that needs its own political agenda.

What we can all influence in the meantime is to foster a better work culture where doctors and other NHS staff can raise issues about workload and stress safely without the fear of judgement or reproach.  

I would urge the leaders within our health system to consider these simple steps:

1. Accept the fact that there are people within your organisation who are carrying burdens beyond their capability and ability to maintain in the long term. Proactively seek them out and help them. Don’t wait until they crumble to then do something about it. 

2. Don’t use words like mindfulness, wellbeing, resilience etc as excuses not to deal with issues, when misused these put the problem back on the individual when the issue is with the system and processes. This doesn’t help the person who is suffering. 

3. Ensure mechanisms exist that review and monitor staff who have key positions of responsibility and/or high levels of activity for high workloads. Then do something about it instead of having meetings about it. 

4. Ensure the demands of an excessive and dominant “management by the numbers” approach doesn’t become the primary ethos to delivering patient care and driver for doctors to work harder. 

5. Give doctors in leadership roles the appropriate training and skills to be leaders and develop their emotional intelligence. People do not acquire management skills by job title or age, those that do tend to lead by dictatorship, ego and intimidation of people. Not a great role model for a system that is supposed to be caring to society.

6. Ensure the culture in your institution strives for a “one team” mentality. Proactively eradicate stigma and blame cultures and reinforce the message to doctors that there is no shame in asking for help. When they do ask for help, recognise that they may need specialist support and possibly psychological/psychiatric intervention to keep them safe – not just a hand off to an underfunded and inadequate occupational health function. 

We must accelerate the rate of change within the NHS to make sure we have enough effective doctors within it to look after us and society. Stigma and fear of retribution killed my brother and his organisation was affected as a result of his death.

Don’t let this affect yours.