Under Pressure MDs Work Harder, Buckle More

By Donalee Moulton

The Medical Post

November 25, 2003

HALIFAX - As more pressure is exerted on an already overburdened health-care system, doctors respond by doing more of what they do best: working hard. The result is greater burnout and increased stress, according to an expert in physician stress who lead a recent discussion co-ordinated by Capital Health, the largest district health authority in Nova Scotia.

"Most physicians were on the threshold, just coping. Now, there are fewer resources. There are also more things that can be done now for patients," Dr. Mamta Gautam, an Ottawa-based psychiatrist and chairwoman of the expert advisory group at the CMA Centre of Physician Health and Well-being, said in an interview. The result is a growing number of doctors who need a hand coping with the demands being placed on them. The first step, said Dr. Gautam, is to admit the problem.

"We're caregivers, not caretakers. (Asking for help) is seen as a sign of weakness." Doctors, she added, assume everyone else is coping well. "We need permission not to be tough all the time."

Some of that permission is coming from hospitals trying to address unhealthy problems among their own doctors. At the Capital Health district, the vision is "Healthy People, Healthy Communities," and that includes hospital staff.

"We're in the preliminary stages of trying to call attention to issues of physician health," said Dr. Robert Miller, who is coordinating efforts to enhance physician health at the Queen Elizabeth IT Health Sciences Centre and other area facilities. As a first step, the health authority conducted a survey of physicians to identify stressors. Loss of control is the number one stressor, said Dr. Miller. That's not unusual, he added.

"Our survey says we're just like everyone else. We still like seeing patients, but the demands are heavy." In an effort to reduce those demands, the newly created Physician Health Committee has met with Capital Health's executive to address what can be done to improve working conditions. Top of the list is streamlining communication with doctors. "We're trying to (reduce) the number of e mails and make communication more relevant," said Dr. Miller. "We're trying to make the executive aware of what the health demands of some of their decisions will be."

There are steps physicians can take to reduce stress, said Dr. Gautam, whose practice is devoted exclusively to physicians. "We need to understand what gets us into this situation and how to increase our comfort level with seeking help." Physicians can enhance their health by exercising regularly, sleeping eight hours a night and going home each day for dinner.

“This is not rocket science,” said Dr. Gautam. "It's stuff we would tell our own patients."

Physicians also have an important role to play in helping other physicians cope, she added. Physicians need to look for signs of difficulty in their colleagues and then determine how to raise the issue of stress and assistance with them.