Burnout doc: ‘I lost compassion’
Long before Covid, doctors told us they were struggling. Now, they say their goodwill has run out. Rachel Thomas talks to one who’s changing the system from within.
It was insidious and looked like resentment at first, then a patient died. It’s now more than five years since Auckland anaesthetist Dr Jo Sinclair experienced burnout, but that day still plays on her mind.
The patient was elderly and the operation was major and high risk, Sinclair says. They survived the operation, but died two days later in intensive care.
‘‘I blamed and second-guessed myself... There wasn’t anything anyone could have done to change the outcome, but because I was already in a vulnerable place it knocked me for six.’’
At the time, she’d worked as a doctor for more than a decade, plus about five years as a consultant anaesthetist.
But this came at a time when going to work meant long hours away from her husband and school-aged children. She resented the job and patients, and when another knock happens in that place, there’s no bouncing back. ‘‘I lost all my confidence. My internal narrative was that I was a thoroughly useless doctor. I had already identified I’d lost compassion and now I was demonstrating I wasn’t competent either. To have lost that compassion felt like losing the essence of what it is to be a doctor. I hit rock bottom.’’
Sinclair now co-chairs a wellbeing group run by the College of Anaesthetists (ANZCA) and speaks in that capacity, but still works at Middlemore Hospital as an anaesthetist and clinical wellbeing lead.
While working at the coalface, Sinclair has helped to roll out an evidence-based programme called Stress First Aid, originally developed in the US for military workers with post-traumatic stress disorder.
‘‘It recognises what we’ve seen in some Covid-related wellbeing research, that shows under all the stressful situations healthcare workers have been in, they still would much rather have a social debrief after something going wrong, rather than all the things organisations tend to recommend when they know people are stressed,’’ Sinclair says.
Programmes like employee assistance (EAP) or making psychologist appointments are not the ‘‘preferred route’’ for doctors who needed to ko¯ rero if they are in a mental hole, she says.
‘‘It’s not a prescriptive thing, but it’s like a toolbox people can dip into, so they know what to say, they can recognise red flags... and it’s about destigmatising those conversations too.’’
Melbourne-based psychologist Dr Sharee Johnson helps medical staff identify signs of burnout. In her new book, The Thriving Doctor, she aims to arm doctors with the skills to look after their own wellbeing and identifies five stages along a spectrum: flourishing, coping, surviving, languishing and burned out.
She says the chain of command in hospitals and high-achieving nature of medical staff makes it difficult for doctors to show limitations.
‘‘(Doctors) have been taught from an early age that, as doctors, their patients come before anything else – even their families and themselves,’’ Johnson says.
‘‘We definitely need systemic change but for that to happen people have to be able to articulate what the problem is and what would be better.’’
As Australia comes out of the Omicron wave, she says doctors are feeling ‘‘sustained chronic fatigue’’, but that came with a silver lining that they were more open to therapy.
‘‘There’s a big, global systemic conversation happening now around those things. Whether we maintain that progress remains to be seen but right now it’s on the agenda much more.’’
More than half New Zealand’s senior doctors are burnt out, according to a 2020 survey by the Association of Salaried Medical Specialists, which more than 2000 doctors responded to. There had been no improvement in the past five years and burnout was now an entrenched feature of the medical workforce, stated the report, released last year.
‘‘Burnout has significant associations with sleep deprivation and is in turn related to the likelihood of making clinically significant medical errors.’’
Burnout has a direct impact on the quality of care patients receive, Sinclair says. ‘‘The best chance we have of getting our patients engaged in looking after themselves and those preventative healthcare things, looking after diabetes, is if we can get rapport with the patient, they trust us, and we care about their health. But when you’re sitting in that place of burnout and you just don’t have that compassion and the effort to put energy in, patients will sense that and be less likely to buy into the course of treatment you’re providing.’’
The reason for this, ASMS executive director Sarah Dalton says, is: ‘‘our current hospital system has made a virtue of slight understaffing, to put it kindly’’.
Missing staff meant the extra ongoing work burden and pressure to carry the load ‘‘is literally on our members’ shoulders’’.
‘‘There are massive amounts of goodwill that have been put in by our members over the years and that’s largely gone now. (Hospitals are) totally run on goodwill, completely.
‘‘Pay people appropriately, staff appropriately, and many of those symptoms of burnout will disappear because doctors aren’t being
‘‘Our hospital system has made a virtue of slight understaffing, to put it kindly... Hospitals are totally run on goodwill.’’ Sarah Dalton, right Association of Salaried Medical Specialists executive director
made to work outside their scope.’’
Sinclair says there is a ‘‘dissonance between the reality of working in our hospitals and the messaging from Government that everything is fine’’.
Health minister Andrew Little says it’s fundamental New Zealand’s health workforce has safe working conditions and well funded services. ‘‘We have to be very careful that we are not running a health system expecting or relying on our health professionals to exploit themselves. We have started from quite a way behind... we’re making good progress, but we’ve still got a long way to go in terms of those gaps with staffing.’’
A Nursing Safe Staffing Review report, released last week, found a quarter of all hospital shifts remain understaffed, despite a scheme established more than a decade ago to address that. Just seven of the 20 DHBs had rolled it out.
‘‘We’ve got to fix that and it’s not just nurses, it’s senior medical officers and so on too. Right now, that’s the focus of my work, what are we doing, not just to fill the gaps right now but in the long term we are building that constant channel of new health workers coming on board.’’
The new Crown entity, Health NZ – set to replace all 20 DHBs on July 1 – will have responsibility for workforce planning, which Little says will help tackle staff shortages. ‘‘It will be one employer that can bring some real heft to all those processes, dealing with training institutions, recruiting offshore, and we can streamline that.’’
Margie Apa, new Health NZ chief executive was also approached for comment. She declined to be interviewed but the Health Reform Transition Unit provided a statement to say Health NZ would mean health workforce would exist at a national level, avoiding duplication of effort or competition between DHBs. ‘‘One of our top priorities in the health reform is to ease the pressure on health workers and ensure the right skills and capacity exists within the health system.’’
An interim NZ Health Plan will outline immediate ways to tackle workforce shortages – including making better use of education and training pathways and models of care to match supply and demand pressures, it said.