Health professionals and burnout

Sir, – Your publication of Prof Gaye Cunnane’s article “Even heroes are prone to burnout, particularly when their battles are ongoing, with little hope of resolution” (Health + Family, January 23rd) is timely.

Nearly a decade has passed since we undertook the National Study of Wellbeing of Hospital Doctors in Ireland. This confirmed what was long suspected: high levels of psychological distress, occupational stress and burnout as well as poor work-life balance in this group of workers.

The results have been widely promulgated both in the academic and mass media and more recently, systematic reviews (incorporating Irish data for the purpose of comparison with other studies) have confirmed that the levels of burnout and occupational stress in our hospital doctors is higher than in most other similarly developed economies. Importantly, our medical postgraduate training bodies are now championing the topic of wellbeing and encouraging the prioritisation of self-care. It is no longer a taboo subject for doctors.

There is a sense, however, that the working environment for doctors and their colleagues in hospitals is no better than it was then. The pandemic has highlighted not only the inadequacy of much of our public hospital infrastructure (including IT), from an infection control perspective, but has also drawn attention to concerning levels of post-traumatic stress disorder, suicidality and moral injury, as well as burnout, across our healthcare workforce. The link between these unhealthy places of work and the poor psychological health of many healthcare workers is irrefutable.

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In recent weeks, we have published the results of a large study on coping in hospital doctors.

Again confirming what we probably already knew, doctors generally cope well and typically choose adaptive rather than maladaptive coping strategies to tackle the multiple challenges they face in their working day. However, being an adaptive coper does not mitigate the effect of increased work hours, which themselves are associated with burnout and psychological distress, regardless of a doctor’s coping style.

Despite the implementation of the European working time directive in January 1998 and, arguably, a strong legal code underpinning workplace safety, doctors in our hospitals are still expected to work excessively long hours, not least because of gaps in recruitment of staff. So, an unattractive and often unsafe work environment, from which many are emigrating to more appreciative health systems, becomes ever less attractive and the cycle is self-perpetuating.

While self-care is a professional responsibility for doctors in Ireland, it is cynical to expect that it can absorb the demands of a workplace from which young doctors are fleeing. The burden of psychological distress in doctors cannot be mitigated meaningfully unless workplace factors are addressed. – Yours, etc,

Dr BLÁNAID HAYES,

Rathmines,

Dublin 6.