Perfectionist Traits = Biggest ‘Burnout’ Red Flags

Around the globe, healthcare workers who spent 2020-21 ‘in the trenches’ treating the COVID-19 pandemic are emerging as major victims of stress, anxiety, anger, depression and significant career burnout.

Two recent Australian studies have produced a new clinical checklist and predictor of which personalities are most at risk, with perfectionist and work-focused traits – often common among aesthetic practitioners – the biggest red flags.

And in the US, a major new survey across medical specialties has revealed an alarming 17% of plastic surgeon respondents admitted recent suicidal thoughts.

COVID-19 initially bombarded the world’s medical workforce with daily fear and apprehension for their own welfare, exacerbated by both constantly frightening rumours and wildly differing international responses.

Two years later, while their patients emerge from mandatory quarantine isolation, an alarming number of doctors are themselves reporting widespread burnout and depression.

In Australia, a team from the University of NSW’s School of Psychiatry and Black Dog Institute has looked into the common symptoms of those experiencing ‘burnout’ and discovered ‘there may be more cardinal symptoms than previously thought’.

They reported perfectionist and work-focused traits have been discovered to be the biggest red flags for those developing burnout. (See accompanying box: Aust study: ‘perfectionist’ biggest red flag)

Meanwhile in the US, trusted industry monitor Medscape.com has just shocked the medical establishment with its survey Physician Burnout & Depression Report 2022: Stress, Anxiety, and Anger – with more than 13,000 physicians in 29 specialties revealing confronting details about their battles with mental health and how they’re coping with burnout.

For the aesthetics industry generally, a particularly worrying revelation is that a shocking 17% of plastic surgery respondents admitted recent ‘suicidal thoughts’. (See accompanying box: US doctors: 47% burnout, 24% clinical depression)

Similarly in Australia recently:

• Dr Jacqueline Small, president of the Royal Australasian College of Physicians (RACP), told The Sydney Morning Herald that ‘pandemic- fuelled burnout in healthcare workers is a crisis demanding urgent action’ – and called for their wellbeing ‘to be the top priority as the nation’s healthcare system grapples with the combination of rising flu and coronavirus cases, delayed medical care and severe staff shortages’.
• A wellbeing survey undertaken by the RACP found 87% of respondent doctors were experiencing burnout.
• Another study also led by Sydney’s Black Dog Institute and the University of NSW – separate from those noted above – and published in The Lancet, found doctors ‘are at an increased risk of suicide and, in their early years of training, one-quarter to one-third reported significant mental ill-health’.
• That review also suggested female doctors ‘appeared to be at particular risk, with a suicide rate that is significantly higher than women in the general population’.
• Another study led by the Royal Melbourne Hospital – which received more than 5,600 submissions – found over 70% of frontline healthcare workers were ‘working beyond exhaustion, with rising numbers leaving the industry or seriously pondering new careers’.
• A recent cover story in the Good Weekend magazine shouted the headline: ‘What’s up, Doc? More stress, less status, piles of paperwork, never enough time: life as a modern-day GP.’
• Amid that lengthy analysis, rural GP Dr Martin Carlson reported, ‘whereas before COVID I’d say 10% of my practice was mental health, now it’s 70%. There’s not a day that goes by when I don’t have three or four people whose lives are falling apart.’ And his practice’s registered nurse Tarryn Beatty summed up: ‘I never thought I’d burn out. But now
• I’m totally, utterly done. I still love our patients, but the passion has gone.’

‘We need urgent government intervention’

In her first interview following appointment as the new president of the Royal Australasian College of Physicians (RACP) in June, Dr Jacqueline Small told The Sydney Morning Herald bluntly: ‘Burnout has to be number-one priority because it is immediate, it’s happening now.

‘It is compromising the wellbeing of the workforce, and that affects the care the health system can provide. If we don’t have a healthy workforce, how can we actually be responding to the ongoing challenges?

‘We need urgent government intervention from both state and federal governments – to step in and start taking action to alleviate the pressures on frontline staff, and put in place a better workforce plan to protect the welfare of our physicians.’

A similar previous report in Melbourne’s The Age newspaper noted health unions ‘have repeatedly warned doctors and nurses are working unsustainable amounts of double shifts due to staffing shortages, leading to prolonged stress and dangerous levels of burnout’.

It also revealed ‘thousands of healthcare workers are furloughed each day due to illness or coronavirus exposures’.

Both The Age and The Sydney Morning Herald reported they had ‘also been told of cases where doctors have worked a month without a day off, while other healthcare workers were told to delay their leave as there was no staff to cover for them’.

The Australian College of Critical Care Nurses has also warned intensive care nurses were cutting back their hours and ‘leaving in droves’.

Dr Small’s predecessor Professor John Wilson left as RACP president in May ‘foreshadowing a mass exodus of staff due to burnout’.

He cited ‘untenable and deteriorating conditions’ in Victoria’s healthcare system as the reasons for his resignation from Melbourne’s leading teaching hospital The Alfred after 30 years – and warned conditions inside hospitals ‘continued to put lives at risk and push healthcare workers to breaking point’.

An open secret among doctors

The worrying study led by Sydney’s Black Dog Institute and the University of NSW was headlined: ‘Doctor mental health concerns increase as COVID surge hits hospitals.’ It began with the confronting assessment: ‘There is increasing concern about rising rates of mental ill-health and suicide among doctors.’

The COVID-aggravated crisis was summed up bluntly: ‘We seek their advice when we’re not well. They comfort us with their expertise, and we trust them to perform life-saving procedures in high-risk scenarios.

‘Yet, from the outside, we often don’t appreciate the stressors that come with being a highly skilled medical doctor and the mental health toll this uniquely high- pressure occupation can take.’

Noting the aforementioned finding that doctors ‘are at an increased risk of suicide and, in their early years of training, one- quarter to one-third reported significant mental ill-health’, lead author of the study Professor Samuel Harvey (who runs the Workplace Mental Health Research Program at the Black Dog Institute and UNSW) explained: ‘There is a need – now more urgent given COVID – to intervene to protect and improve the mental health of doctors, with interventions needing to target not only individuals but, more importantly, their organisations and the wider systems within which they work.

‘The acute nature of the COVID-19 pandemic in many parts of Australia at the moment highlights the importance of this issue. The mental health of doctors, along with other healthcare staff, is something we are all depending on.’

The researchers noted concerns that ‘there might be something inherently psychologically toxic about their work that contributes to the high rates of mental ill-health reported’ were escalated within the medical community ‘after several high-profile suicide clusters among doctors, forcing the medical profession to reconsider its own vulnerability’.

Study co-author Professor Kimberlie Dean, Chair of Forensic Mental Health at UNSW, commented: ‘What has been an open secret among doctors, is now being investigated and the importance is increasingly recognised.

‘Doctors are a key element of our frontline healthcare system, even more so in the context of a pandemic, and we need them to be as supported and resilient as possible.

‘We were concerned by the emerging evidence that indicates the situation may be worsening over time.

‘While being a doctor has always been challenging and hard work, it may be that some factors that have previously acted as protective, in terms of mental health impact
– such as job security, autonomy of decision-making and financial stability – have been eroded.’

‘Up to half’ reporting symptoms

Professor Dean said ‘what is also worrying is that studies emerging from countries significantly affected by the COVID-19 pandemic indicate up to half of doctors are reporting symptoms of depression and anxiety.

‘From previous pandemics, we also know that long-term mental health impacts can be seen in up to 10% of affected doctors.’

The study also noted that ‘prospective studies have revealed depressed doctors make six times more medication errors than healthy staff, with mental ill-health or substance misuse a common cause for impairment inquiries by medical regulators’.

Another cause for concern is that the study suggested doctors ‘with mental health problems might be more reluctant than non-medical professionals to seek help for several reasons including fears regarding confidentiality, the potential consequences for their career, medical registration and licensure, as well as insufficient time and a belief they can manage any symptoms by themselves’.

‘No help, no support, nothing.’

The Good Weekend described Australia’s GPs as ‘stressed out by the pressures of COVID-19’ and ‘overloaded with admin’ and summed up: ‘What they’re angry about is the ever-increasing hell of paperwork, and the pressures of a funding model that inexorably links pay to speed, rather than quality of patient care.’

Sydney inner west GP Dr Annie Marshall explained she and the 14 doctors at her practice are ‘still in the office two hours after the last patient leaves, just dealing with the admin from that day, never mind all the results coming in, the people you need to call, the follow-up appointments you need to make’.

She described how COVID-19 and its attendant telehealth consults, remote prescription processing and the desperate push to vaccinate – GPs have administered half our pandemic vaccines – have all added to the administrative load, while the past two years have also ‘vastly increased patient numbers in areas such as mental health, domestic violence, obesity and addiction’.

Dr Marshall declared: ‘No one’s got our back. Every time ScoMo opened his big mouth during the pandemic, he was saying, ‘Just call your GP’. But there was no help, no support, nothing.’ AMP