A top mental health expert has warned of the very real threat of doctor burnout in South Africa, with the chronic shortage of healthcare professionals putting strain on the already overloaded doctors and specialists in the country.
According to Professor Bernard Janse van Rensburg, physician burnout is a leading cause of medical error — a previous Health24 article reported that more than half of American doctors suffered from burnout.
Removing the stigma
Janse van Rensburg is the past president of the South African Society of Psychiatrists (SASOP) and current chair of the SAMA Academic Doctors Association (ADASA).
He emphasised the importance of removing the stigma from mental health conditions, in particular amongst medical professionals themselves – especially considering that doctors are 2.5 times more likely to commit suicide than the general population.
Prof Janse van Rensburg said awareness needs to start at student level, calling for medical education to “put more emphasis on doctors realising their limitations and recognising their humanity and fallibility”.
After Health24 explored whether mental health professionals themselves should be in therapy, Chantal Fowler, a clinical psychologist and South African College of Applied Psychology educator, said that mental health professionals need to take their own care very seriously in order to offer good quality care to others.
The problem is not unique to South Africa — studies in the USA, UK and Australia have all shown that doctors, specialists, nurses and other medical professionals are at higher risk of burnout and suicide, and they are also less likely to seek help.
The American Foundation for Suicide Prevention found that depression was an equally significant risk factor in the suicide deaths of both physicians and non-physicians, but that the physicians were far less likely to have been receiving mental health treatment.
Risk of drug and alcohol abuse
Janse van Rensburg said burnout was not a medical diagnosis in itself but was a combination of conditions such as stress, anxiety and depression, signalled by emotional exhaustion, detachment or lack of empathy with patients, and a reduced sense of job satisfaction or professional achievement.
“Burnout is a very real state that has a significant impact on sufferers and their productivity and performance at work as well as on their personal lives and relationships, heightening the risk of drug or alcohol abuse as a coping mechanism, and sufferers experiencing suicidal thoughts,” he said.
Burnout can lead to errors of judgment and it affects doctors’ prescribing habits, test ordering and overall professional behaviour. It is also a risk factor for injury and other mental and physical health conditions.
“Doctors and other medical professionals who are highly critical of others and themselves tend to blame themselves for their own illnesses, and are more at risk of major depression and other mental disorders that can lead to suicide.
“They tend to be reluctant to approach their professional colleagues for help and rather ‘self-medicate’ for symptoms such as anxiety or insomnia. They also slip into risky coping mechanisms such as alcohol and drugs, and isolate themselves from those who could support them — family, friends and their professional community,” Prof Janse van Rensburg said.
He said doctors needed to be self-aware and vigilant of their own vulnerabilities and possibly risky coping mechanisms, and not “suffer in silence”, referring to the self-administered Maslach Burnout Inventory questionnaire as a simple means for practitioners to check in on their own health.
Targeted interventions needed
“Those in the medical profession need to know that a mental health condition not dealt with is more likely in the long run to negatively affect their practice and professional performance, and that it’s best to rather ask for help early in their career,” he said.
Prof Janse van Rensburg said there was also a responsibility at an organisational level for management in the healthcare system to acknowledge the existence of the problem, to develop targeted interventions and to promote resilience and self-care.
“Leaders and managers of medical teams should also show that they are open to feedback, respect the opinions of others, including less-experienced colleagues, and to empower team members to do their work and advance in their careers,” he said.
Professional bodies including SASOP and the South African Medical Association (SAMA) have also turned their spotlight inwards, he said, raising awareness amongst medical practitioners to check in on their own mental health and self-care, and working to reduce the stigma that can delay seeking help.
“The SAMA and SASOP are also considering the best strategies to de-stigmatise mental illness in the health care profession, to assist healthcare professionals dealing with mental illness and occupational, professional and personal difficulties, and to create an environment conducive to professional exchange and debate, networking and support,” Prof Janse van Rensburg said.
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