Public Health, Private Lives: Live Chat on December 8, 2010

When lives are at stake, we depend on doctors and nurses to pull us through. This week, the CBC News series Public Health, Private Lives gives Canadians a close look at four health professionals who work at one of Canada's busiest hospitals. Cutbacks, increasing demands and long hours are causing unprecedented stress among Canada's healers.  Today, I'm hosting an online discussion as part of the CBC News series from 12pm-1pm ET.

Click on the link to participate in the Live Chat or to read the entries.

A study by the Canadian Medical Association found that 64% of doctors here say their workload is too heavy.  At that, nearly half said they'd had an increase in their workload over the past year.  And 18% of Canadian doctors admitted to being depressed, yet only one quarter of them considered getting treatment for depression.  For nurses, the numbers are worse.  A study of junior nurses across Ontario suggests 66 per cent had symptoms of burnout, such as emotional exhaustion and depression, less than two years into their jobs, said researchers at the University of Western Ontario.  Studies have documented high rates of burnout and even post-traumatic stress disorder or PTSD among paramedics.  And it's not just affecting health professionals in mid- career.  Many studies have documented stress and burnout among residents and even students.

There are obvious factors why rates of stress and burnout are on the rise.  A declining economy means nursing layoffs and forcing health care still employed to work longer hours caring for sicker patients.  That means seeing lots of patients who don't make it and families that have to deal with tragic circumstances.   Nurses are especially hit hard by economic factors.  There are nurses who are forced to work extra shifts and overtime because they're having trouble making ends.  There are parts of Canada where nurses are subject to what is knows as forced overtime.  If a ward is short staffed, nurses who work in places like that can be phoned on their day off and ordered to work.  And if they don't answer their phone, a hospital supervisor comes the nurse's home and knocks and orders them to work - in person.   If you're a nurse or a doctor or a paramedic who works long stretches like that, you're not only exhausted; you're probably have to deliver health care that forces you to compromise on your values.  Experts call that moral distress.

How does that affect the personal lives of health care workers?  Imagine an adrenaline-junkie trauma nurse who witnesses life and death on each and every shift.  As they begin to burn out, they can go one-way or the other.  Some become hyper vigilant with their kids.  Because they see young people die every day, they watch their kids like a hawk and make them afraid to take reasonable risks because they're convinced that their kids will die if they do.  Or, they can't respond to the needs of their kids because a teenage daughter's dating angst seems so trivial compared to the young woman the nurse treated at work who became a quadriplegic after she jumped off a balcony.  Health professionals can become detached from their families.  Divorce rates are high, as are rates of depression and substances abuse.

Stress and burnout also affect the care you receive.  Studies have demonstrated that stress and burnout reduce the health care worker's ability to concentrate and recall important information.  You'd have to be a fool to believe it has no effect on the quality of patient care.  And yet, a recent study demonstrated that overstressed nurses believe they function at a high level than objective testing indicates.  And just because I'm talking about nurses doesn't mean the same can't be said for doctors, paramedics and others. 

Do these mistakes kill patients?  They probably do.  The trouble is, researchers may not be in a position to collect these kinds of statistics.  Some have suggested that hospitals might be reluctant to permit these kinds of studies because their leadership doesn't want to admit there's a problem.  Beyond mistakes, when health care workers are overloaded with tragic stories, they develop what's knows as compassion fatigue, a term that refers to a lessening of compassion and caring over time, and detachment from our patients.

What can be done to address the problem?  We're talking about nothing less than a seismic shift in the culture of medicine.  The culture that tells health care workers to 'suck it up' needs to change.  The only way that will happen is for senior people in medicine and nursing to make dealing with stress and burnout a priority.  The only way students and residents will recognize how important this is if they see mentors treating stress like it's important.  We also need to teach health care workers on the front lines how to recognize stress and burnout in them and others so they can be supported if they're in the grip of stress and so they can offer support to those who need it.

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