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Occupational health support for doctors & health professionals
1. ‘The Doctor in Difficulty’
28th March 2014,
Dr Peter Noone
MPH(Glas),LLM(Sal),FFOM(I),MFOM(UK),FFTM
Consultant in Occupational Medicine,
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2. Why is it important?
Doctors are not immune from becoming unwell!
Rates of work-related mental illness amongst doctors
are x 15 times higher than the national average
(UK Health and Safety Executive 2005)
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9. “Patients are complaining all the time
because expectations are being
raised despite less and less
resources. There is [sic] more
complaints to deal with and less time
for clinical work!! “
“The quasi-legal systems the NHS has adopted
that cast a reductionist veneer on issues that are
more systemic and difficult to resolve.
For patient or relative with an issue they want to
redress, targeting an individual doctor can seem
like the 'only' way to deal with wider systemic
issues.
Doctors are just one part of the system, certainly
not the key movers and shakers, and The NHS
'knows' this, but has 'due process' in place to
obfuscate the underlying problems within the
system”.
11. The Doctor’s Leadership Paradox
A physician does not really need a boss at all
If there should happen to be a boss anyhow, it must be
another physician
“Bosses” only do un-important, administrative things
Colleagues who become “bosses” are no longer real
physicians
However, all physicians want to be bosses and have a highly
developed sense of hierarchy….
Source: Chief Physician Carola Lemne MD
Hospital Manager of Danderyds University Hospital Karolinska
Institutet, Stockholm
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13. The Staff Governance Standard
well informed;
appropriately trained and developed;
involved in decisions;
treated fairly and consistently, with dignity and respect, in
an environment where diversity is valued;
provided with a continuously improving and safe working
environment, promoting the health and wellbeing of staff,
patients and the wider community.
http://www.staffgovernance.scot.nhs.uk/what-is-staff-governance/staff-governance-standard/
18. Effects of Work on Health
Effects of Health on Work
“Managed Employee Wellbeing”
&
Organisational Health Management
What is Occupational Health?
Safeguarding and enhancing employee health
21. Work Stress
"Physical and mental strain resulting from the
mismatch between an individual and their
environment", resulting from demands on a person,
their ability to cope with those demands.
Stress is most likely to occur in situations where:
demands are high; the amount of control an
individual has is low; and, there is limited support or
help available for the individual.
Bynoe G. “Stress in women doctors”. Br J Hosp Med 1994; 51(6): 267-8
23. HSE UK Management Standards
Demands: workload, work patterns, and the work
environment
Control: How much say the person has in the way they do
their work
Support: encouragement, sponsorship and resources provided
by the organisation, line management and colleagues
Relationships: promoting positive working to avoid conflict
and dealing with unacceptable behaviour
Role: Whether people understand their role within the
organisation and whether the organisation ensures that they
do not have conflicting roles
Change: How organisational change (large or small) is
managed and communicated in the organisation.
24. Conceptualising Work Stress
Job strain (Demand-Control) model
Effort-Reward Imbalance model
Organisational Justice model (fair treatment)
Major work stress models (questionnaire based measures)
25. Organisational-level impact studies;
Donald et al., (2005) – 23% of
variance in employee productivity
(n= 16,000 UK employees) is
explained by
- Psychological well-being
- Perceived commitment of
organisation to employee
- Resources and communications
Cropanzano and Wright (1999)
Five year longitudinal study of
psychological well-being and
performance. Strong correlation
between well-being and work
performance
Harter, Schmidt and Keyes
(2003) Nearly 8,000 separate
business units in 36 companies
engagement/well-being
correlated with business unit
performance
(sickness-absence, customer
satisfaction,
productivity, employee turnover,
etc…)
Boorman review NHS (2009)
Health & well-being related to:
MRSA, Patient satisfaction, NHS
spend.
27. Case Law
Johnstone v Bloomsbury Health Authority 1992
Junior hospital doctor brought a claim for work stress
suffered because of long working hours
31. EARLY WARNING SIGNS
The disappearing act
Rigidity in thinking
Very slow
Inappropriate emotional outbursts
Failing to gain the trust of others
Colleagues don’t want to call on them
Lack of insight
Problems with probity
Paice & Orton (2004) .
32. Key Pointers for Employers
Watch out for signs of stress
Report to someone senior
Once employer’s representative knows of the problem
employer will be liable for breach of duty
Safe systems of work are essential
Employers must adjust for people with disabilities
33. Why doctors health services? UK
Common mental disorder 28%
Depression (major) 10%
Newcastle junior doctors:
-60% exceed safe limits of alcohol intake
-36% males, 20% females use cannabis
-13% males, 10% females other illicit drugs
Estimated 1:15 doctors dependent on drugs.
34. Why doctors health services?
Australia
30% of GPs had mild psychiatric symptoms.
13% severe psychiatric symptoms.
Suicide rate for female doctors x 6 general female
population
35. Why Doctors’ Health Services?
Canada
“One in 10 physicians will become dependent on
psychoactive drugs or alcohol sufficient to impair their
practice at some time during their careers.”
“One in every 100 physicians will become a narcotics
addict at some time during their career”
Saskatchewan Physicians at Risk Committee, Canada
36. CMA 2003 Physician Resource
Questionnaire:
46% of respondents (n = 2,251) reported symptoms
suggesting advanced stages of burnout.
Canadian Physician Health Program
37. Physician Health Programmes in the United
States
About 10-12% of physicians in the US develop a
substance use disorder, BMJ2008;337:a2038
About three quarters of US physicians with substance
use disorders managed in this subset of physician
health programmes had favourable outcomes at five
years.
38. Why doctors’ health services?
-a unique group
Often don’t have a GP,
‘Corridor consultations’
Self prescribe
Denial
Access
Trust and confidentiality
Stigma, guilt, shame and remorse
BUT highly motivated to recover!
40. HEALTH & HOME
High workloads and time pressures lead to depression and
anxiety
Firth-Cozens (2003) found significant levels of stress among
junior doctors
– 28% above threshold levels of stress v 18% of the general population
Like anyone else, doctors experience ‘life events’ – family,
relationships, finance, etc.
41. PERSONALITY & BEHAVIOUR
Personality types and learning styles are associated with
different responses to working conditions , McManus et al.
(2004),
Personality strengths under pressure may become problematic,
e.g. enthusiastic – volatile , Hogan & Hogan (1997) ,
Isaksson Rø K -185 doctors at counselling centre in Norway ,
(doi:10.1136/bmj.a2004). “Burnout”, traits that make doctors
vulnerable to depression are those for a capacity for empathy.
42. ORGANISATIONAL ISSUES
Poor educational infrastructure,
e.g. poor induction,
rotation,
staffing/workload issues,
training and
support of supervisors
Bullying, harassment
Service reconfiguration
43. CLINICAL COMPETENCE
• Lack of specific practical skills
• or knowledge,
• attitudes
• Capability
• Limited experience in a specific clinical area
44. KEY Support Points
• Causes of poor performance usually multifactorial
• Poor performance often has early warning signs
• Educational supervisor makes informed judgements
about necessary steps once poor performance is
identified
• Thoughtful support will help most individuals to
improve performance
45. Issues
Several periods or extended sick leave
Isolated, worried about training and finances
Limited sick pay
Junior doctors have small savings and large debts
Difficult to be resourceful while unwell!
46. The Role of Medical Leadership
Strengthen line managers role, appropriate management
styles and skills,
Increase understanding of how management style and
practices help promote employee mental wellbeing and
keep stress to a minimum.
Ensure that managers can identify and respond to
employees’ emotional concerns, and symptoms of mental
health problems.
“We are particularly concerned at the high levels of psychological and mental health
problems that NHS staff suffer from, not least because … management attitudes and
practices may contribute to this”
NHS Health and Well-being Review, Interim Report, August 2009
47. Changes for Staff Support
Strong leadership ;
An evidence-based Health & Wellbeing Improvement Plan;
Build management capability & capacity at all levels;
Engage staff at all levels with health education,
encouragement & support;
HSE OHS that offers targeted, proactive & SEQOHS
accredited support systems for staff & organisations.
48. Jones, CP, Jones Cy, Perry GS, ‘the Cliff Analogy, Journal of Health Care for the Poor and Underserved 20 (2009): 1–12
49. What would you want?
‘Work should be comfortable when we are well
and accommodating when we are ill’
Nortin Hadler Professor Medicine,
University of NC (1997)