South Africa is burnt out … corporate SA is especially burnout – and a segment of our population whose mental and physical health is often not considered, despite them being at the forefront of providing healthcare, our doctors, are showing increasing numbers of burnout too.
Burnout is a psychological condition that arises from chronic stress, usually in the workplace. It is associated with depression, anxiety, exhaustion, poor physical health, deteriorating personal relationships, premature resignations, and negative attitudes towards those one works with or for.
Ahead of World Health Day which will be commemorated on Sunday, The South African Society of Anaesthesiologists (SASA) held a round-table discussion today in Joburg to take the pulse of South Africa’s clinicians – specifically those working in the demanding field of anaesthesia – and to ask the seldom asked question, who will care for the care-givers?
According to Professor Johan Coetzee of the University of Stellenbosch, psychologists look at three dimensions when dealing with burnout, namely: emotional exhaustion, cynicism and a sense of no personal accomplishment.
“So with emotional exhaustion, these people are chronically burnt out or chronically fatigued and experience loss of energy and enthusiasm. Cynicism is manifested by feelings of detachment from your job and negative attitudes towards your clients or patients and they feel they have lost some of their idealism and they tend to become withdrawn and with reduced personal accomplishment, these people tend to become withdrawn and have a sense of reduced productivity,” he explained.
Coetzee and his research team did a study on burnout among SASA members last year, using the Maslach Burnout Inventory (the leading measure for burnout), garnering 498 replies from members which equalled a 27% response rate.
“We found through our survey that 22% of practitioners in the private sector and 48% in the public sector experienced emotional exhaustion.
And 28% of practitioners in the private sector had feelings of low accomplishment in their jobs, while 41% of practitioners in the public sector had the same feelings,” he said.
Studies that had been done overseas also showed high numbers of anaesthetists experiencing one or more of the dimensions of burnout. In France, 16% of anaesthetists and 31% in the US suffered from high degrees of emotional exhaustion. At least 18% of the practitioners in France, 11% in the US, and 20% in Australia had feelings of low accomplishment.
In certain European countries such as Sweden, a diagnosis of burnout makes one eligible for sick leave and government support. In the Netherlands it is regarded as a disease and employers are required by law to pay 70% of a person’s salary for 104 weeks. In the United States it is accepted as a billable condition. In SA however, it isn’t accepted as a condition that justifies sick leave.
Explaining the role of the anaesthetist and why it was such a high pressured job that led to many professionals experiencing burnout, Coetzee said, “An anaesthetist is a specialist’s specialist… the surgeon places their patient under the care of the anaesthetist and we take on the patient to evaluate the problem for which they are being operated on but also other health problems they may have, like heart problems. Anaesthetists take over that patient’s bodily functioning completely. It’s not just about putting a patient asleep but also taking care of all the bodily functions,” he explained.
Coetzee continued: “It’s routine for instance to give a patient a drug that paralyses the patient in order for the surgeon to access that bodily are, so we have to take over their breathing. But things happen during surgery, they get reflux responses and you have to be monitoring this all the time and be prepared to act if there’s crisis. So you have to be aware of what is happening to your patient from minute to minute, if a cardiac arrest happens you have to be on your feet, thinking clearly, its high pressure.”
Dr Caroline Lee, an anaesthetist in private practice and convenor of the SASA Wellness Support Group said that if burnout among medical professionals was not taken seriously and tackled urgently, quality patient care could become unsustainable in future.
“To achieve systemic change in the health sector and expand support to doctors, South Africa needs collaboration among administrators, regulators, hospital groups, policymakers and other bodies, as well as a culture change,” she said. “It’s time to recognise that the health of our healthcare providers is critical. Everyone must invest in creating and maintaining a healthy, sustainable healthcare workforce. Doctors must be involved in healthcare policymaking at every level in the public, private and academic sectors to achieve this.”