“A common fallacy is that if doctors don’t stick with it, there’s something wrong with the doctor”

Depending on age and specialism, 25 to 63 percent of doctors in burnout say they have complaints or are even considering stopping. Not only burnout, but also addiction and suicide among doctors remains an underexposed phenomenon. Psychiatrist, trainer and author Hans Rode wrote the book ‘It’s just work – anti-burn book for doctors’. Hans argues for prevention, role models that reflect a healthy lifestyle, the prevention of burnout and other (mental) disorders in doctors, but above all a health system that cares just as much for the patients as for the people who work there.

“Medical students have better mental and physical health at the beginning of their study years than students in other fields of study. They have a more altruistic attitude and see their future work more as a calling than other students. During their studies, these morals are quickly crushed and the rates of depression and burnout increase dramatically. By the time they have to start their internships, half of them meet the criteria for a burnout. So the training that should strengthen their compassion and dedication nips them in the bud.” (from the book It’s Just Work)

“They understand there that they are an important link in the care process”

Burnout among doctors was already a problem before the corona pandemic broke out. Ten years ago, Hans observed that things were not going well for doctors and healthcare staff in the Netherlands. That was the reason why he set up a support center for addicted doctors with the KNMG for ABS doctors. It is a well-known phenomenon, which not only our country has to deal with. Over the past ten years, Hans has regularly traveled to North America to visit his colleagues. A country where, according to him, they are much further along in taking care of doctors and preventing them from dropping out. “They understand there that they are an important link in the care process. The burn-off figures among doctors are much higher there. Before the pandemic, the numbers had already risen to fifty percent. This has now risen to 70 percent among healthcare providers under the age of 30. So it hasn’t gotten any better.”

“We want to have an awake and fit doctor at our bedside”

All these people continue to work, but the question is: how is the quality of their work? “That is the problem. We want to have an awake and fit doctor at our bedside. It’s an important topic. It is an expensive and painful event when doctors have to leave their job or when they no longer feel like it. Training a medical specialist costs on average 1 million euros. And if a doctor develops burnout symptoms, the chance of depression, addiction or suicide is made easier. The impact is huge. Patients no longer have a doctor, doctors are more likely to make a mistake if they are not feeling well and patients are less satisfied.”

Why do so many doctors suffer from burnout complaints? “That has to do with the personal profiles that many doctors generally identify with. They are people who work hard, are 110 percent available, want to do well and are not allowed to make mistakes. These are qualities that every patient can appreciate in his or her doctor, but which also make doctors susceptible to burnout. I have seen that during my many years of work at the support center for ABS doctors. Physicians who become addicted or drop out are not spineless doctors. They are not people who exert as little effort as possible. It is precisely doctors who do their best and are always available.”

“It always goes on, day and night”

A disadvantage of care, according to Hans, is that if you don’t take a holiday yourself, there is no natural break that ensures that the care stops for a while. Many people in education also suffer from burnout complaints, but there you have at least six weeks off every year during the summer holidays. “Whether you like it or not: you have a number of obligatory breaks that are inserted. It always goes on in healthcare. You don’t say in the summer: the equipment and the staff need a break. That’s why we are closed for a week. It always goes on, day and night. It’s in the culture, and that culture is always a few generations behind, that you go on and on, that you are not allowed to make mistakes, that you do not give up, that you sacrifice and efface yourself and deny your needs, even going to the toilet and sleeping. Such a culture makes doctors susceptible to falling into such a burnout pitfall.”

According to Hans, a lot of doctors worked themselves to pieces during the corona pandemic, and this is still going on. “If you end up in a pandemic, you suddenly have to do things differently. That takes a lot of energy and is exhausting. It’s like a triathlon that goes on and on, unpredictably, with no end in sight. Many doctors had to work extra hours, while some specialties had little to do. They were unable to operate, threatening a bore-out. Every doctor has his or her own field of tension. I hear from healthcare providers that it is frustrating to see patients with a condition that was relatively easy to prevent. I also recognize this from my African years: having too few beds and therefore having to disappoint people, because there are patients with relatively easily preventable disorders. Doctors have patients in their office who have serious conditions, who have to wait and can die as a result. And as a doctor you want to help people.”

Crossing the threshold to go to the doctor

In recent decades, a lot has been invested in patient care, but not in ourselves, says Hans. That part of self-care and learning to ask for help is also not part of the training. And when doctors become ill, they have to cross a high threshold to see a doctor. “They don’t think it’s that important and often deny that something is going on. Or they want to solve it themselves and start self-medication. I notice it myself: I have to go to a specialist for a check-up. An appointment like this costs me my entire outpatient consultation hour. I find that very difficult and then I tend to postpone it. We think we know a thing or two about our own health, but we’re not good doctors to ourselves.”

“It is cost neutral to take care of your doctors”

The healthcare system is about production and is not based on top-fit ​​care providers. “It’s not about the quality of the care provider, which is so essential for the quality of care. If you deploy fit doctors with a high degree of well-being, the quality of care improves. Too little attention is paid to that. In North American hospitals, they understand that the business model depends on the fitness of their employees. There is a lot of scientific research to back this up. It is cost neutral to take care of your doctors. You can sometimes save money and there are plenty of reasons to invest in it. That’s why I wrote this book. I notice that this message does not want to land with drivers. A common fallacy is that if doctors don’t keep up, there’s something wrong with the doctor. Then it is advised that you should take mindfulness or a time management course. So it’s up to them, but that’s not the point. It depends on the system. That’s not to say that a healthy lifestyle isn’t important among doctors. Nutrition, exercise, mental well-being, they are all important. But with my book and my training sessions I focus on the doctor and the system.”

“Doctors try to indicate their limits more”

In the meantime, things have changed. In the past, doctors were proud if they had worked many hours in a row and it was cool if you had slept little and immediately went back to work afterwards.” That has changed. Doctors are trying to indicate their limits more. And yet that remains difficult. If after the evening transfer I am asked if I want to do another emergency admission, because they know that I have admitted the patient before, what do I do? If I say no because I’m tired, want to go home on time and be with my family, I feel guilty. If I say yes, I feel like an asshole. Then afterwards I am tired of a too long working day and I disappoint my family. Then I am faced with a dilemma.”

Hans is just like other doctors: he has not been given instructions for how to persevere mentally as a physician. “There is no shelter for doctors in the event of calamities, while we also have traumatic experiences. You just have to be able to handle that and just keep going.” You should not wait for doctors to ask for help, you should make sure that help is there. According to Hans, this must be arranged and facilitated internally. “A third of healthcare workers are considering stopping. That is not without reason. I think a lot still needs to be done to make our profession attractive again and to ensure that people enjoy going to work and that they can keep it up for a long time.”

“A common fallacy is that if doctors don’t stick with it, there’s something wrong with the doctor”
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