Why stressed GPs are a prescription for disaster

“I lie awake at night dreading the next day. Can’t relax in evening because of
paperwork not done . . .”

“Enjoy seeing patients but overloaded with work from secondary care and
endless form-filling”

“I have irritable bowel syndrome and chronic back pain and headache, all of which are purely stress related”

“My psychological health is very

fragile due to stress”

These are just some of the responses from a recent survey of stress among Irish general practitioners. The survey of 100 doctors, who are part of an online academic group, makes for uncomfortable reading.

The implication of the findings is clear: the severity of the problem is such as to threaten the quality of care many family doctors are able to offer their patients.

In response to the question: “Do you feel that being stressed has an adverse effect on the quality of care you provide to your patients?” some 78 per cent of those surveyed said yes.

Respondents were equally divided between male and female GPs, with three- quarters working in group practice.

Some 45 per cent work in excess of 60 hours per week; seven in 10 say they are either “often” or “mostly” stressed. And they rate workload, rising patient expectations and financial concerns as the main stressors in their professional lives.

How has it come to this? General practice, for years the only stable and consistently functioning part of the Irish health system, is now on its knees.

Despite a decade-long political mantra of moving care away from hospitals and into the community, since the beginning of the economic recession the resources to achieve this have been systematically removed from the sector.

Funding cuts
As a result of wave after wave of funding cuts, practices have had to make nurses, doctors and administrators redundant and cut back the working hours of those who remain.

Many have had to cease providing structured care for patients with chronic diseases such as diabetes which, despite not being specifically paid to do, was implemented as “best practice” pending the implementation of a revised contract for medical card patients.

With some 92 per cent of daily patient contacts in the Irish health system taking place in general practice at a cost of just 2 per cent of the Health Service Executive’s budget, the value for money in primary care should be unquestioned.

But despite this the troika, with the acquiescence of Government, has labelled the sector as uncompetitive and in need of severe budgetary pruning.

Portrayed as salary cuts for doctors, the cuts have been applied equally to payments for essential equipment, premises and nursing grants.

By cutting indiscriminately, however, it means there is now no money to invest in new technology.

For example, the gold standard for the diagnosis and management of high blood pressure has recently been upgraded to 24-hour monitoring – but with no money for the machines or for the nurses to perform them, general practitioners risk providing sub-standard and possibly unsafe care for their patients.

However, the levels of stress reported in this and other surveys represents a much broader threat to patient care.

A 2011 study of British GPs found high levels of burnout (personal distress) with 46 per cent of doctors reporting “emotional exhaustion”.

Major medical error
In a 2009 study of hospital doctors published in the Journal of the American Medical Association, researchers found 39 per cent of the doctors reported making at least one major medical error.

Self-reported errors were associated not only with sleepiness and fatigue but also with burnout and associated symptoms of depression.

The authors concluded that “further research and interventions are needed to prevent, identify and treat distress among physicians and that ‘burnout’ must be considered as a health and safety issue from the patient’s perspective”.

And a recent Israeli study has shown that increased workload and burnout lead to more referrals for tests and to hospitals which translates to increased costs to the healthcare system.

They state: “Physicians should be aware that burnout and associated negative mood may significantly affect one’s behaviour, decision making and work performance.

“This means that the quality of patient care may also be affected by burnout.”

With plans in place to extend the medical card system to all children under six, (confirmed as a “take it or leave it deal” by a Cabinet decision last week), the question must be asked: how safe will the care of these young children be in a fractured system run by severely stressed doctors?”

Would you be happy for your child to be looked after by a GP here who recently told researchers, “I have been diagnosed with breast cancer recently. Could take only two days off each time I had surgery. Dread to think how I’ll manage for radiotherapy?”