Healthcare workers have been identified as a group at high risk of poor mental health mainly due to the nature of their profession. Previous research has identified several factors that could contribute to the risk of mental health problems in doctors. These include challenging work environments such as regular exposure to emotional pain, long working hours, dealing with a patient’s death, high-intensity work, etc.
Recently, the COVID-19 pandemic has exposed the faults in the healthcare systems all around the world. The pandemic has put healthcare professionals across the world in an unprecedented situation, having to make difficult or sometimes impossible decisions and work under extreme pressures. Such decisions may include how to allocate scant resources to equally needy patients, how to balance their own mental and physical healthcare needs with those of patients, how to provide care for severely ill patients with limited resources. This may cause some to experience mental health problems affecting their well-being.
It is widely recognized that healthcare professionals are at risk of psychological distress, but little is known about the current mental health and barriers to treatment-seeking behaviour. Whitecoats, a mobile and cloud-based online digital platform for doctors has surveyed in an attempt to understand the mental health and well-being of healthcare professionals.
Common sources/reasons for stress
When the healthcare professionals were asked about the common reasons for stress, 25% of doctors said that it is an excessive workload. This is especially true for countries like India where there is one doctor for every 1445 Indians as per the current population estimate of 135 crores. This is lower than the WHO’s prescribed norm of one doctor for 1000 people. However, interestingly when the same set of doctors were asked if they enjoy what they do at work every day, around 88% of doctors responded yes.
Methods used to cope under extreme stress
The doctors were asked about the methods used to cope if they ever felt depressed, anxious, or were under extreme stress. Around 35% stated that they often seek spiritual help or pray while 16% stated they never seek spiritual help. Around 57% of doctors sometimes prefer to take leaves. While 23% rarely do so and 15% never take time off. There is evidence suggesting anxiety and stress can trigger emotional eating. Some researchers even believe that binging may temporarily soothe feelings of anxiety. Around 28% of doctors sometimes and 6% of doctors often eat more than usual to cope with stress while 42% never do so. Around 32% of doctors sometimes avoided being with people. Around 3% of doctors sometimes and 2% of doctors often preferred to drink alcohol. Around 12% sometimes and 2% of doctors often take non-prescribed medication to cope.
The stigma of mental health disorders
Mental health has received variable attention across civilizations. There is a prevailing stigma of mental disorders. When the doctors were asked about the reasons for healthcare professionals not seeking professional help for their mental health. Around 33% responded to embarrassment as the main reason. The stigma related to mental health disorders was prominently noted when the doctors were asked if they would be comfortable working or hiring a healthcare professional who has a history of anxiety or depression. Around 43% of doctors responded that they are not comfortable and 35% responded that they may be uncomfortable.
What can be done?
Address the stressful and demanding nature of the work environment
Stress at work can be identified by various signs and symptoms such as fatigue, apathy, irritability, muscle tension, headaches, social withdrawal, loss of sex drive, etc. Promoting greater work-life balance and providing additional support to doctors may assist in reducing the stressful nature of work. Increasing the workforce to reduce the workload is a long term solution, but short term solutions are needed. Some short-term solutions to reduce the stress at the workplace can be reasonable hours of work shifts, taking breaks during the day to manage stress, promoting the spirit of cooperation and respect at work, incorporating programs and tools to help manage stress, providing a safe working environment, etc.
Burnout or a state of mental and physical exhaustion is common amongst doctors. Shift changes and night shifts are the most common reasons for burnout. Many programs have been designed to prevent burnout among physicians. A pilot program was carried out at Stanford University’s Department of Emergency Medicine. This program rewarded doctors for work they did outside e.g- mentoring or assisting colleagues with their shifts. They received credit towards personal services like house cleaning, prepared meals, etc. Another program hired medical scribes to reduce the administrative duties of physicians. These programs significantly reduced burnout and also improved teamwork and the ability to cope with conflict.
Monitor the mental health status of doctors
Monitoring of the mental health status of doctors could allow for the development of evidence-based guidelines and educational programs. Monitoring the mental health status could also help identify vulnerable subgroups of doctors (e.g. during the COVID-19 pandemic, the frontline doctors were more vulnerable to stress). This could help design more targeted educational and support programs.
Promote the importance of maintaining good mental health and wellbeing
Educating and promoting the importance of maintaining mental wellbeing and strategies to deal with negative mental health symptoms may promote improved mental health in the medical community. E.g. a social media marketing campaign could be developed to highlight the prevalence of mental health disorders amongst healthcare workers. Transforming healthcare institutions across the country to produce highly skilled professionals who optimize wellness, and find meaning in their work should be the goal. For young doctors and medical students, the provision of education and training in positive coping strategies and stress minimization as a part of the university curriculum could prove helpful. This could involve the development of pilot programs to test the methodologies and the effectiveness of such education programs within the university setting.
As doctors play a pivotal role in educating the community about important health issues, doctors’ attitude towards their mental health problems plays an important role in reducing the stigma of mental illness in the community. Open channels of communication and listening to voices at all levels of an organization help establish systems and initiatives in the most relevant, sustainable, and effective manner. This can help create an adaptable healthcare workforce that will ultimately enhance patient outcomes and promote wellbeing for everyone. Certain actions can be taken to reduce mental stress as mentioned above, but governments and hospitals should come up with programs to address the mental health issues of healthcare providers at large.
Survey conducted by Whitecoats-mobile and cloud-based online digital platform for doctors, 2020.
Greenberg Neil, Docherty Mary, Gnanapragasam Sam, Wessely Simon. Managing mental health challenges faced by healthcare workers during covid-19 pandemic BMJ 2020; 368 :m1211
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Global Health; Global Forum on Innovation in Health Professional Education; Forstag EH, Cuff PA, editors. A Design Thinking, Systems Approach to Well-Being Within Education and Practice: Proceedings of a Workshop. Washington (DC): National Academies Press (US); 2018 Oct 11. Appendix B, The Importance of Well-Being in the Health Care Workforce. Available from: https://www.ncbi.nlm.nih.gov/books/NBK540859/
Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic-A review. Asian J Psychiatr. 2020;51:102119. doi:10.1016/j.ajp.2020.102119
Wachter R, Goldsmith J. To combat physician burnout and improve care, fix the electronic health record. Harvard Business Review, March 30, 2018. 2018
The Washington Post. Time in the bank: A Stanford plan to save doctors from burnout.2015.https://www.washingtonpost.com/news/inspired-life/wp/2015/08/20/the-innovativestanford-program-thats-saving-emergency-room-doctors-from-burnout/?utm_term=.c1a4695e1eff