Nearly three quarters (72%) of doctors surveyed in the UK say they will always come into work, even when they are too unwell, fatigued or stressed to be productive according to a leading medical protection organisation.
In its report – ‘Breaking the burnout cycle’ – the Medical Protection Society (MPS) says doctors turning up to work wanting to give their best when too unwell is unsurprising considering the chronic workload and time pressures doctors face. However, it says the behaviour also stems from a stigma deeply entrenched in the medical profession’s culture that doctors do not raise their own health concerns, take time off sick, and must always present as a picture of health and strength to the community. This perpetuates an almost superhuman belief system, known as the ‘Superdoctor Syndrome’.
MPS, which supports more than 300,000 healthcare professionals around the world, says trying to live up to the ‘Superdoctor’ expectation can lead to burnout, mental health issues, longer term sickness and increased medicolegal risk, as doctors who continue to work while unfit to do so are more likely to make mistakes. In the MPS survey, more than 25% suspect that emotional exhaustion has contributed to an irreversible clinical error, with 67% of them saying this was due to a lack of concentration.
It calls on health organisations and practice managers to aid a shift to a culture which frames legitimate sick leave by doctors as responsible and healthy behaviour - and ensure their policies and procedures do not create a barrier to doctors taking time off.
Professor Dame Jane Dacre, MPS President said: “Doctors are notoriously reluctant to take time off when they are sick, even though they would regularly advise patients to stay off work under the same circumstances. It is hardly surprising that doctors behave in this way – the working environment is challenging and relentless and doctors want to do their best for their patients - this is evident from our survey as 46% agree or strongly agree that they feel guilty when taking time off.
“Medical training has also historically resulted in many doctors measuring themselves against a superhuman benchmark, resulting in the ‘Superdoctor Syndrome’ where doctors expect the unachievable of themselves. Those who find themselves in this situation have an increased risk of burnout, mental health issues, making errors that could lead to an adverse patient outcome and taking long-term sickness absence.
“At MPS we believe everyone in healthcare – from large organisations through to practice managers - has a role to play in actively challenging the unhealthy ‘Superdoctor’ culture in medicine and considering whether their policies inadvertently encourage it. For example, are there procedures to cope with workload in the event of a doctor’s unplanned absence? Are there policies to enforce absence when necessary, and what is the threshold?
“There is rarely a panacea for something so deeply embedded in the profession’s culture that it has become the norm. But that doesn’t mean we shouldn’t take collective steps to counteract it. Clearly doing nothing comes at a cost.”
Full list of MPS recommendations:
- All healthcare organisations should have clear policies and procedures in place to ensure healthcare professionals feel able to take breaks and to take time off when ill.
- NHS organisations in England should fully commit to the implementation of Wellbeing Guardians. This is a recommendation made by the NHS Staff and Learners’ Mental Wellbeing Commission which was set up by Health Education England (HEE). We believe GPs should not be overlooked and should also have a dedicated person who makes their health and wellbeing a core priority and is trained to recognise and support GPs when they are experiencing difficulties. We think this could be achieved by 2022, and would support similar actions in Scotland, Wales and Northern Ireland.
- Private sector healthcare should mirror the recommendations for NHS employers, and commit to the implementation of and access to Wellbeing Guardians, preferably one guardian per group or cluster of clinics/practices.
- Government should offer additional support through financial and other resources to provide confidential counselling service for all healthcare professionals across England, Wales, Scotland and the HSC in Northern Ireland.
- The CQC should assess the extent to which healthcare providers look after the wellbeing of their doctors and other healthcare professionals. Whilst this is already a publicly reported criterion as part of the ‘well led’ domain, it could be made more specific and should also be made a key line of enquiry.