How can doctors cope with work-related stress?

One of the most concerning issues facing healthcare professionals today is our huge and probably unprecedented work pressure.

We are all acutely aware of the problems that healthcare professionals encounter on a daily basis and I appreciate the intensity of these problems will vary between colleagues, geography, and specialty. But often this overwhelming volume of work, packed into insufficient standard working time, is compounded by a lack of support, reduced workforce, low morale and for some people. insufficient pay and a large number of complaints from patients.

The contracting workforce is a large problem for many segments of the healthcare sector. For example, GP numbers have decreased every year since 2015 despite political promises to grow the workforce by 5,000 people from that date, according to a recent article.

I could list more and more problems, but I think you get the point. I want to explore this area further but because of the variety of healthcare professionals and their varied interests, it is easier to concentrate on one group. For the purposes of this article and reflecting personal experience, I will concentrate on doctors and how they cope or can cope with this ever-rising work-related stress and its attendant personal and professional problems.

The issue is complicated by the fact that we have a strong duty of care to our patients

Almost at every medical specialty and at every level of experience and grade, a large majority of doctors are likely to be experiencing significant work-related stress which can easily spill into our personal lives. The issue is complicated by the fact that we have a strong duty of care to our patients as well as our employers and though it is relatively easier to have a poor relationship with an employing authority; we cannot have the same poor relationship with our patients.

We must put patients at the centre of our activity, and we all want to do our best for our patients. Ideally, the vast majority of us will try to go the extra mile for our patients. Not uncommonly we will have to put patient’s welfare before our own.

Work pressures versus providing optimal patient care

However, as we get squeezed by the various job pressures, it is easy to say we can’t stop doing the best for our patients and as a result the pressure grows on us as individuals and it is possible that this pressure can overwhelm us. It is easy to get demoralised as doctors are crushed between the opposing forces of work pressures versus providing optimal patient care. So how do we cope?

Well, it is important to realise that we are ‘only’ human and can only work efficiently for so long and we need breaks. At some point during the working period, we need time out and it is easy to give up that downtime to do administration or see to a patient or their relatives. However, we all need some protected time to either do the basics such as eat or go to the toilet or have a coffee and a chat with colleagues. It is up to us to create that time.

Even if it is short, try to make it protected. A 10-15-minute break is better than no break. Also find time for regular exercise and it does not have to be a gym, a simple, quick and relaxing walk to clear the mind can work wonders during the working time.

It is critical that we discuss difficult or tricky situations, of which there are plenty in everyday practice, with colleagues and peers. You may think you know the answer but it is useful to seek a range of answers. This can be done face to face or in electronic forums. However, be careful that if you post in an internet forum such as a doctor only Facebook group or a tweet then be sure that there are no patient or colleague identifying factors and be factual, avoid derogatory comments and be polite and professional.

A good safety precaution is ask yourself, if this post comes into the public domain, would you be ashamed of it? If so then seriously and strongly consider not posting.

Some people might find guidance from the General Medical Council (GMC) helpful. A problem shared (it can also be with a non-medical partner or trusted friend) is a problem lessened and a clearer more sensible decision can be made which can help reduce stress. As well as being educational, this can help reduce anxiety and worry about a complex issue.

Don’t forget there are mental health helplines run by professional organisations which can also be supportive. The British Medical Association (BMA) offer a helpline for all medics irrespective if you have BMA membership.

Or if you are concerned about a colleague, the BMA has advice available about that. There is also a helpline from the Sick Doctor’s Trust and its website contains useful and helpful information.

Also make time for leisure in your spare time such as reading, walking or immerse yourself in a hobby that you enjoy, as well as spending quality time with family and friends. Talking about the incredible problems that a doctor faces with close family and friends is therapeutic and it is surprising how many people are sympathetic (medical and non-medical) to the current severe workplace issues that doctors face.

It is reassuring to discover that you are not alone about having some negative feelings associated with working as a doctor and that this kind of support can be very good for the soul. If you think you need formal medical advice, don’t ask colleagues and peers go and speak to your GP. If you don’t have a GP register with one now.

Also be prepared to acknowledge your own of feelings of stress such as becoming argumentative, not sleeping, increased anxiety, and drinking too much alcohol. If any of these issues arise, then they need to be tackled and not ignored.

Even if you are not in the mood during a clinical setting then try and display kindness, compassion and understanding. It is amazing the effect of you radiating a positive and kind demeanor (even if you are not in the mood for it) will have on your outlook but it is also quite possible that you will get good feedback for your positive approach. Hopefully that may sometimes even settle your mood.

Reduction in frontline GPs in next five years

Sometimes you have to think the unthinkable and contemplate reducing working hours and creating more ‘downtime’ or even consider the nuclear option which is to quit your post. This does not seem as extreme as you may initially think. A recent University of Manchester survey published in April 2022 stated that about a third of GPs will no longer have a front line care role within the next five years, due to leaving their post.

Of course, there are financial implications of changing hours or leaving your current post but there are ways of mitigating the financial loss. However financial considerations are considerable when changing hours, a post or quitting altogether and always seek expert advice.

One posting I found on Twitter recently was about a person who found a Barista in a coffee bar who was previously a GP registrar. If you read the thread of this tweet, this type of story does not seem unique.

Some doctors may be near retirement and may take their pension earlier than planned and simply quit. Other doctors nearing retirement may reduce their hours and either have more leisure time or find a post that requires a medical qualification but not necessarily being a front-line healthcare post or contain a mixture of clinical and non clinical activity.

It is not just a doctor’s problem; it is everyone’s problem

There is little doubt that doctors today are under unprecedented and unacceptable levels of pressure from an excessive workload and it is easy to forget about your own health at the expense of improving that of our patient’s health. Sure, we have to do the best for our patients but we have to look after ourselves with time out, proper leisure time, staying mentally and physically fit. We should all have a mechanism for coping but sometimes we have to accept we can’t cope and seek help.

It is an awful state of affairs but think about it, doctors are well paid and yet we have a workforce crisis. Something is clearly wrong and doctors have to protect themselves but just as importantly, our political leaders have a duty to sort this massive problem. It is not just a doctor’s problem; it is everyone’s problem and very specifically a big issue for the people in power.

Dr Harry Brown is a retired GP, Leeds and medical editor of GM Journal