Doctors on the brink
Heavy workloads, long hours, stress taking their toll, writes Estelle Ellis
Following the tragic death of high-profile cardiologist, researcher and University of Cape Town Faculty of Health Sciences dean Professor Bongani Mayosi last weekend, the South African Medical Association (Sama) this week set up a support structure to address the underlying problems of heavy workloads and long hours that lead to doctors suffering from stress and depression.
Mayosi’s family said he had suffered from depression, resulting in suicide.
“Society forgets that we are human. Mayosi’s death has reminded us of the stark reality we all need to face: Yes, I am a doctor. I am human too,” Dr Zukiswa Zingela, head of the Department of Psychiatry at Walter Sisulu University said.
“A neglected doctor within our already dysfunctional health systems is a recipe for disaster. If society ignores doctors’ pain and suffering, it shall eventually become society’s pain too,” she said.
The Eastern Cape department of health this week admitted that public sector doctors were working under tremendous pressure in the province’s public hospitals.
For every 100,000 patients needing medical help in the Eastern Cape, there are only three specialists available.
There also are only 18 medical officers [working as general practitioners) for every 100,000 residents.
Eastern Cape department of health spokesperson Lwandile Sicwetsha said the department only had 49% of the specialists it needed.
One of the specialists said this week this severe shortage had led to such long waiting lists for urgent cancer treatment that he was compelled to do 10 surgeries a day.
South African Society of Psychiatrists (Sasop) president Prof Bernard Janse van Rensburg said they pledged their strong support for recent interventions by Sama to facilitate awareness of depression and other mental challenges for members of the medical profession.
Sicwetsha said: “The department does have an internal employee wellness programme, in accordance with public service policy.”
“The programme offers individual and group counselling and case management for employees.
“Our policies require supervisors to refer employees whom they observe to be experiencing personal or workrelated problems.
“Employees can also access the service directly.”
A 2012 study published in the South African Journal of Psychiatry found stress and burnout were common among healthcare professionals.
The study found that doctors had a work-related stress rate that was 10% higher than that of the general working population.
Researchers also expressed heightened concern for doctors working in the public sector after they found that 27% of doctors interviewed in public hospitals in North-West were highly stressed.
Zingela said: “Work related stress is very high, both in the private and the public sector.
“Private colleagues have to deal with working mostly in isolation, an increasingly litigious public, rising costs of medical profession cover against law suits, a shrinking number of people who can afford private healthcare and medical aid companies which are accused of bullying doctors.
“In the public sector it is a combination of overwork due to short-staffing causing very high patient/doctor ratios, lack of equipment, including basic medication at times, to treat patients, ‘disempowerment’ in decision-making, which is often left in the hands of managers, especially those with a top-down management style which excludes clinicians.
“There is significant stigma associated with mental illness, which unfortunately adds to the problem.
“This further compounds the problem for colleagues who find themselves with mental health problems. The HPCSA also places an obligation for registered health professionals to self-declare when they have a health problem that may af-
fect their ability to practise. This carries with it a fear of losing your licence. So, one can see that the odds weigh heavily against disclosure,” she said.
“Without disclosure, however, one struggles to get help and support that is so needed to regain one’s mental health.”
She said she doubted the efficacy of the employee assis-
tance programmes in the public sector.
“These programmes are either unmanned or if there is someone who is designated as an EAP officer, it’s just to tick a box, with little focus given to ensuring that the appointed person is a clinical psychologist or mental health social worker.
“In most cases, the very person who is supposed to be your EAP officer is also someone who works alongside you in the hospital, which in itself is completely inappropriate due to ethical issues to do with confidentiality and boundaries that govern therapeutic relationships.
“So what choices do distressed doctors have in their workspace to address their mental health? “Very little, I’m afraid. “In this ever increasingly demanding field of medicine, doctors are expected to be generous heroes who are superhuman enough to be available for everybody else 24/7 without complaints,” Zingela said.
The dean of the Faculty of Health Sciences at Nelson Mandela University, Dr Lungile Pepeta, said it would introduce a module in its medical curriculum to teach doctors how to cope with stress and depression.
“Our doctors are placed under an increasing amount of stress in both private and in the public sector,” he said.
“The doctor/patient ratios in this province are terrible.
“It places doctors in the public sector under incredible pressure.”
“It is also compounded by the absence of other health personnel, like nurses and physiotherapists,” he said.
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