Grave anatomy: burnout pushing doctors over the edge
Overwork and exposure to trauma is causing many to make potentially deadly mistakes, say researchers
Doctors around the world are exhausted, making them more prone to mistakes that could put patients’ lives at risk.
Burnout among doctors is so widespread that researchers who examined 182 studies involving 109,628 physicians in 45 countries are calling for the development of diagnostic criteria for the condition.
They say burnout, which has been associated with medical errors and lapses in professionalism, should be referred to and managed as a form of depression instead of as a “distinct entity”.
Overall burnout prevalence ranged from zero to 80.5%, and on average 73% of doctors reported emotional exhaustion, depersonalisation (a disorder in which people feel disconnected or detached from themselves) and low personal accomplishment.
The prevalence of emotional exhaustion ranged from 9% to 63%, depersonalisation from 4% to 52%, and low personal accomplishment from 4% to 73%.
Alongside the study, which appeared in the Journal of the American Medical Association, another showed that almost half of young American doctors are suffering from burnout.
The study suggested that doctors on the “front line” (in emergency units, general surgery, urology and general medicine) are likely to experience more symptoms of burnout than counterparts in other disciplines. Career-choice regret was reported by 14% of physicians.
Resorting to substance abuse
SA doctors say the situation is similar here, particularly in the public sector owing to doctor shortages and the burgeoning quadruple burden of HIV/Aids and TB; violence; lifestyle diseases; and child and maternal mortality.
SA Medical Association chairperson Dr Mzukisi Grootboom said burnout is so severe, particularly among young doctors, that there are growing reports of individuals resorting to substance abuse to “escape” work-related stress and exhaustion.
Doctors who worked in trauma units, which he described as war zones, were more likely to experience burnout. “Not only are they overwhelmed with intense work volumes but the intensity of trauma that they are exposed to leaves one stressed and exhausted ... mentally and emotionally.
“Most patients that doctors see in these centres are under the influence of alcohol and they can get very abusive towards doctors and make ridiculous demands ... adding stress for those treating them,” he said.
Grootboom said exhaustion led to errors such as wrong diagnoses or prescribing incorrect medication. Young doctors were more likely to be burnt out since they worked up to 300 hours a month.
One of the incidents that highlighted the exhaustion of doctors was the death in 2016 of a young Paarl Hospital intern, Ilne Markwat, who crashed her car into a barrier before rolling and colliding with two other vehicles. She is thought to have fallen asleep behind the wheel after a marathon shift.
Markwat worked in the obstetrics unit, where the previous year interns had complained to the Junior Doctors’ Association of SA about their working hours.
Cape Town doctor Jadrian Bothma, who was an intern at a tertiary hospital two years ago, vividly remembers being required to work between 64 and 80 hours of overtime a month.
He said young doctors were bullied by senior medical staff who believed they needed to be toughened up.
“There were moments I felt like quitting the profession because I would be so tired at the end of the day. Because of the long hours my life was all about work and my social life was so limited it was almost non-existent,” he said.