Almost three-quarters of healthcare practitioners (72%) say they have continued to work despite not feeling mentally well enough to do so according to a new survey - with many citing increasing patient demand and feeling that taking time off for mental wellbeing issues is not deemed “acceptable” where they work.
The Medical Protection Society (MPS) survey of 802 doctors in South Africa revealed that almost half (49%) of respondents have continued to work despite not feeling mentally well enough because their patients relied on them, with 45% saying they felt pressured due to increasing patient workload. Two in five (40%) said taking time off because of mental wellbeing issues was not acceptable at their work.
Many respondents said continuing to work when not feeling mentally well enough had contributed to a lack of empathy with patients (61%), loss of concentration (58%), being more fearful of making mistakes (46%) and practising defensive medicine (38%). 55% also suspected that it may have contributed to a lower standard of patient care and a quarter (26%) suspected it may have led to a missed or incorrect diagnosis.
MPS – which protects the professional interests of over 300,000 healthcare professionals around the world, including more than 30,000 in South Africa – said more needs to be done to address the factors driving a culture of presenteeism, and ensure doctors working in both public hospitals and private clinics can access mental wellbeing support when they need it.
Dr Volker Hitzeroth, Medicolegal Consultant at MPS, said: “It is concerning that so many doctors say they continue to work even though they are not mentally well enough to do so. When mental wellbeing is poor, a practitioner should feel able and supported to take time off to recuperate or seek appropriate support. Not doing so could exacerbate the problem, result in them taking more time off in the longer term, or even leaving the healthcare profession altogether.
“Working despite not being mentally well enough to do so can also impact on patient care and our survey shows the variety of ways this can manifest - from lack of empathy with patients, right through to a missed or incorrect diagnosis.
“What is equally worrying are the factors driving this culture – in particular that two in five doctors state that taking time off due to mental wellbeing issues is not acceptable at their work. Nearly half say they continue to work because of the unrelenting workload and not wanting to let colleagues down, and two in five feel patients expect them to work even if they are unwell. Many doctors in private practice also say they simply cannot afford not to work, despite mental wellbeing issues.
“One member who engaged with our survey anonymously even said they attempted suicide, but had to go in to treat patients the next day as there were no other doctors.
“Much more needs to be done to enable and support all healthcare practitioners to take time off when they are too unwell to work. This includes considering a range of measures to increase capacity, to allow doctors to take time off when they need to. 89% of those who took part in our survey believed such measures would be helpful in reducing presenteeism.
“MPS would also like to see greater education about presenteeism and the risks associated with it - to both the doctor and the patient - and more local mental wellbeing resources established so that doctors whether working in public hospitals or private clinics can access support when they need it.
“Without action, the culture of presenteeism and the problems it leads to will only exacerbate.”
Doctors who participated in the MPS survey commented anonymously:
“There is still a negative stigma to admitting mental health issues. It is viewed as admitting weakness in a profession where being able to cope is everything. Even if one is feeling mentally vulnerable, anxious, disconnected, we are trained so well that we know we can still turn up and do the job. It is when medical practitioners continue in this vein that they eventually 'fall off the edge'. They burnout, quit the profession or attempt suicide.”
“With anxiety, it’s something that has become easy to cover up at work. So I just say I’m fine when asked how I am. In the meantime, I have insomnia, and I’m feeling anxious for not being able to get out to my family’s needs.”
“I fear doing harm or substandard service for my patients. I fear that they don’t get the compassion from me because I feel ‘numb’ to continuous exposure to extreme patient suffering.”
“I do not have the patience to listen and talk to my patients like I usually do. My empathy skills and counselling ability decline. I also get easily irritated and snappy - which is not fair on patients. It drops my quality of care.”
“My main concern is that if I continue to work while mentally unwell, I am not offering my patients the mental health care that they deserve. I feel that my preoccupation with my own mental health takes away from my ability to remain empathic and present with my patients.”
“I fear that a patient may pay for my burnout with their life.”
“The state sector is so reliant on doctors stepping up to fill the gap that we are very aware of the weight of the burden when one of us cannot come to work and the rest of the team needs to ‘pick up the slack’.”
“Due to the overburdened healthcare system, we all are acutely aware of how much work we do and thus the workload that will have to be taken on by our colleagues if we were to be absent - so a reason is guilt, as we don't want to be the cause of our colleagues overwork.”
“I continue to work even if I'm not feeling well enough to because this is what we do... We just get up, dress up and turn up and keep on going on, because that is our work ethos.”
ENDS
Key findings
- 72% of doctors said they have gone to work or continued to work despite not feeling mentally well enough to do so
- 61% said they feel guilty if they took time off due to mental wellbeing issues
- 52% said they regularly continue to work despite not feeling mentally well enough to do so
- 49% said they have gone to work, or continued to work, despite not feeling mentally well enough to do so because their patients rely on them
- 45% said they have gone to work, or continued to work, despite not feeling mentally well enough to do so due to the pressure of patient workloads
- 38% said they have gone to work, or continued to work, despite not feeling mentally well enough to do so due to financial reasons
- 61% said they would feel guilty if they took time off work due to mental wellbeing issues
- 40% said taking time off work for mental wellbeing issues was not acceptable at their work
- 78% said that working while feeling not mentally well enough to do so contributed to feelings of exhaustion and burn out
- 61% said working while not feeling mentally well enough to do so contributed to a lack of empathy with patients
- 58% said working while not feeling mentally well enough to do so contributed to a loss of concentration
- 46% said working while not feeling mentally well enough to do so contributed to them being more fearful of making mistakes
- 38% said working while not feeling mentally well enough to do so contributed to them practising defensive medicine
- 5% said working while not feeling mentally well enough to do so contributed to a lower standard of patient care
- 26% said working while not feeling mentally well enough to do so contributed to a missed or incorrect diagnosis
- 55% said they have been concerned a colleague has continued to work while not feeling mentally well enough to do so
- 89% said introducing measures to ensure the healthcare system has the capacity to allow doctors time off if needed may reduce instances of presenteeism
- 62% said there was not sufficient funding for mental wellbeing support
- 58% said healthcare leaders do not care that poor mental wellbeing can affect patient safety
About MPS
The Medical Protection Society Limited (“MPS”) is the world’s leading protection organisation for doctors, dentists and healthcare professionals. We protect and support the professional interests of more than 300,000 members around the world. Membership provides access to expert advice and support and can also provide, depending on the type of membership required, the right to request indemnity for any complaints or claims arising from professional practice.
Our in-house experts assist with the wide range of legal and ethical problems that arise from professional practice. This can include clinical negligence claims, complaints, medical and dental council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal accident inquiries.
Our philosophy is to support safe practice in medicine and dentistry by helping to avert problems in the first place. We do this by promoting risk management through our workshops, E-learning, clinical risk assessments, publications, conferences, lectures and presentations.
MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.