Physicians burnout update. An effective response of health care systems to this issue is key in the strategy to stop the virus and improve patients health care

As is known in the current coronavirus pandemic, one of the sectors hard-hit by the crisis is health care professionals. About this issue, many articles have been published and it is unanimously recognized by public opinion.

A recent article published in the English journal The Lancet, Editorial, wrote by the President of the Royal College of Physicians with the title The changing face of medical professionalism and the impact of COVID-19 approaches these workers’ morale crisis in our societies. In this respect, we have written an article before the outbreak of the pandemic (read HERE) with this global health care issue and the news of the WHO’s redefinition of burnout between doctors as a syndrome (read HERE) in the new version of its handbook of diseases, the International Classification of Diseases — ICD-11 — which will go into effect in January 2022.

A worldwide drastic change in the health care systems is needed

Last June, in the middle of the pandemic health care crisis, several articles published on the British Jornal BMJ – Post Graduate Medical Journal (read the full article HERE) treat the subject, where studies of renowned specialists explain from different points of view the issue. One relevant topic is the incidence of burnout in juniors doctors and residents (read our article HERE).

We excerpt from the aforementioned Lancet’s article by Andrew F Goddard, the President of the Royal College of Physicians some opinions of the new condition that imposed the COVID-19 pandemic in the UK and on some measures worldwide.

The author begins with the new scenario of the COVID-19 era to make a full review of the issue quoting several studies, “[…] (It) has exacerbated these tensions between medical professionalism and physician wellbeing. The pandemic has placed substantial demands on already overstretched, understaffed, and under-resourced health systems. COVID-19 has tested doctors and health-care workers to the limits of their professional competence and taken a considerable toll on their health and wellbeing (Physician burnout: a global crisis. Lancet. 2019; 394: 93.)”

Worldwide physicians burnout update

He explains, with great precision, the worldwide change in the work of medical professionals prioritizing patient care in consideration to the insufficient resources of many kinds and making difficult decisions, including “withholding and withdrawing potentially life-saving treatments”, which in some cases was in contradiction with the “core principles of medical professionalism—ie, the primacy of patient welfare, patient autonomy, and social justice”.

Goddard continues with the particular conditions of the current pandemic, in which Doctors have to balance their personal risk with their duty to care for patients as well as balance professional versus caring responsibilities for household members in high-risk groups. To this must be added the self-isolation when they or their family members have symptoms of COVID-19.

3 effects of the current circumstance of health care systems on medical professionals:  a sense of guilt, tension, and moral injury. In the opinion of the authors, these factors have caused a sense of guilt, tension, and moral injury. He continues explaining that moral injury occurs when doctors are forced to make decisions that contradict their professional and moral commitments—” the challenge of knowing what care patients need but being unable to provide it due to constraints beyond their control. The moral injury concept helps reframe such challenges from a focus on the individual to a system-wide perspective.”

The author continues evaluating the global effect of COVID- 19 in this collective “[…](M)ore than 300 000 health-care workers have been infected with COVID-19 in 79 countries, over 7000 have died, and many more have suffered as a result of stress, burnout, and moral injury (Covid-19: balancing personal risk and professional duty. BMJ. 2020; 369m1606)” In this respect, we published an article about the impact of it in our medical professionals in Spain (read HERE).

The health care systems should prioritize organizational culture and staff wellbeing as integral to professionalism and central to patient care.

Goddard affirms that there is an urgent need for a system-level approach to address the issues that COVID-19 has created to better protect and safeguard our medical workforce for the future and in our opinion also is need an immediate response to the fair reclamation that this collective is demanding.  He continues highlighting the importance of prioritizing “organizational culture and staff wellbeing as integral to professionalism and central to patient care.” In this respect, he proposes that health care systems must move away from a model of medical professionalism that can lead to moral injury and towards one that provides support for professionals in a systematic way and is focused on supporting moral repair, recognizing that Physicians’ well-being is a care quality indicator for all health systems.

Short but consistent conclusion

Goddard concludes his review with this statement “Improving the working lives of clinicians can optimize the performance of health systems, improve patient experience, drive population health, and reduce costs.” This issue as we can appreciate in our country is far from being achieved despite the evidence of its dire need.

Our statement

A radical cultural change is required to improve current healthcare systems so that they more effectively and systematically support professionals and focus on supporting moral repair in the new challenges presented by the coronavirus pandemic.