Some doctors say taking time off for mental wellbeing issues is not acceptable at their work: survey

One member who engaged in survey anonymously said they attempted suicide but had to go in to treat patients the next day as there were no other doctors

Almost three-quarters of healthcare practitioners (72%) say they have continued working despite not feeling mentally well enough to do so.

This is according to a new Medical Protection Society (MPS) survey of 802 doctors in South Africa, which also shows 45% say they feel pressured due to an increasing patient workload. 

Two in five (40%) said taking time off because of mental wellbeing issues was not acceptable at their work.

“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,” said a doctor who participated anonymously in the survey.

Another doctor said: “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.”

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%).

About 55% also suspected that it may have contributed to a lower standard of patient care while a quarter (26%) suspected it may have led to a missed or incorrect diagnosis.

Here is a sample of comments made by medics in the survey:

• “My main concern is that if I continue to work while mentally unwell, I am not offering my patients the care that they deserve. I feel that my preoccupation with my own mental health takes away from my ability to remain empathetic and be 'present' with my patients.”
• “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.”
• “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.”

Delay in dealing with issue only pushes the problem down the road

MPS, which protects the professional interests of some 300,000 healthcare professionals worldwide, including more than 30,000 in South Africa, said more needs to be done to ensure doctors working in both public hospitals and private clinics can access mental wellbeing support when they need it.

Medicolegal consultant at MPS Dr Volker Hitzeroth said it was 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 worsen the problem, result in them taking more time off in the longer term, or even leaving the healthcare profession altogether.”

Hitzeroth said working despite not being mentally well enough to do so can also affect patient care.

“Our survey shows the variety of ways this can manifest — from lack of empathy with patients, right through to a missed or incorrect diagnosis,” he said.

According to Hitzeroth, what is equally worrying is the factors driving the 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.”

He believes that more needs to be done to enable and support all healthcare practitioners to take time off when they are unwell. “This includes considering a range of measures to increase capacity, to allow doctors to take time off when they need to.” 

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