Doctors at state-run hospitals at risk of burnout

After spending a decade on the front lines of one of Athens’s biggest state-run hospitals, a 46-year-old neurologist who wished to remain unnamed finally decided to hand in her resignation and quit the “coal mine,” as she and her colleagues referred to their workplace. Speaking to Kathimerini recently, she said that she had always wanted to be a doctor at a hospital. She loved the challenge of the emergency room, working with colleagues who were just as committed as she was and constantly expanding her knowledge and expertise. Even at the start of her hospital career, she had to accept that state hospitals are notoriously understaffed and she would have to be ready to do as many double shifts as needed.

“You feel kind of heroic when you start working in such an environment,” she explained. “The problems appear when you pass your breaking point and the job starts taking a toll on your mental and physical health.”

Even though it has been eight months since she resigned, she was still not comfortable with the idea of giving her name or that of the hospital where she worked for fear that it may appear she was “turning against the management.”

In her last years on the job, as the situation at the hospital deteriorated further, she had to be on emergency duty four times a month and on call 12 days a month, meaning that she had to be ready to come into work every time she received a call – and that was on top of her regular shifts. In the last three years, the 24-hour shifts became harder and harder for the 46-year-old neurologist. The hospital did not have interns on a regular basis to help out as the flow of patients kept rising. There were often days when there was no secretarial support, a task that was sometimes covered by a retired staff member on a voluntary basis.

“We didn’t have an on-call room where we could sleep or rest during our shifts and had to use a couch instead,” she said.

As the pressure mounted, the neurologist began to notice the fatigue was affecting her behavior. She said she often went into automatic mode and rarely got any pleasure from her work. She became neglectful of her family and often had “an unbearable feeling of exhaustion.” It was these symptoms of burnout that eventually compelled her to resign.

After speaking with doctors from hospitals both in Athens and elsewhere around the country, it became clear to me that her story is similar to those of other neurologists working under such conditions.

Most admit to ignoring the symptoms or putting them down to stress. Others felt them setting on gradually and others still became overwhelmed all of a sudden. A handful never connected what they were feeling with burnout – the National Health System has no system for preventing or detecting burnout among hospital workers, so exhausted staff are simply required to keep working.

Workload

There are a number of specializations that are especially demanding. For the past four months, the recently opened thoracic surgery clinic at the Attikon Hospital in Athens has been operating with a staff of two.

“I have applied for an assistant, someone who is specialized in what we do here, to be temporarily reassigned from another hospital, but what can they do when every hospital is understaffed?” noted the clinic’s director, Pericles Tomos. He has one intern when the work calls for four. Over three months, the two of them conducted 37 surgeries, and they work more than 12 hours a day. The shortage of thoracic surgeons has also hit other hospitals in the country. Over 70 percent of the positions for this specialization remain open as young doctors with expertise prefer to work abroad.

Similar shortages in other specializations put a greater burden on doctors working at public hospitals.

At the capital’s Evangelismos Hospital, heart surgeon Panagiotis Dedeilias works more than 80 hours a week.

“I have often felt completely exhausted after working for 36 hours straight,” he told Kathimerini. “I have had interns faint in the operating room because of exhaustion, while I have also seen others growing indifferent toward the job. They may not have lost their ability to diagnose a patient and do what they need to do, but they are cold toward patients’ relatives and seem to be losing their ambition.”

Dedeilias has never taken a day off after being on emergency duty for 24 hours.

“You can’t leave a patient behind when you know there’s no one to replace you,” said Giorgos Marinos, a doctor who is in charge of running the emergency room at the Laiko Hospital, also in Athens.

Working straight through an emergency shift into the following day is a problem we also encountered at hospitals outside Athens.

A few months ago, Dina Vogiatzi, a cardiology intern, experienced one of her toughest shifts yet at a hospital in the Peloponnese when she was left manning the emergency room alone after the other intern was sent to Athens on a patient transfer. The attending doctor, said Vogiatzi, never turned up for his shift as he should have done, leaving her alone.

Vogiatzi now works at Evangelismos Hospital in Athens, where she’s continuing her internship. The conditions are better, but she’s still being pushed to her limits.

“I chose to come to a big hospital because I would learn more, but it is very tiring,” she said. “Every day we talk about whether we managed to get any sleep during or after the emergency shift. Every once in a while it gets you down. You don’t want to go out or talk to anyone. You become antisocial. You get up in the morning and don’t want to go to work.”

Support

All hospitals should have a specialized department or doctor tasked with spotting the signs of burnout among staff.

“Every hospital should have an in-house doctor who has a file on every worker and supervises the working environment so they can prevent any illness,” said Evgenia Pantazi, president of the association of in-house doctors.

Based on the law, private and public businesses employing more than 50 workers should have an on-site doctor. According to data compiled by the association, just one in 10 hospitals in Athens provide that service. Where it does exist, it is usually conducted by a doctor from another specialty.

“Unfortunately, most hospitals do not have a doctor for the doctors,” said Pantazi.

The General Hospital of Argos in the northern Peloponnese is the exception, and thanks to the initiative of its psychologist, Aristotelis Koinis, who provides counseling to his colleagues, it sets the standard for other hospitals in the country.

“Sometimes they’ll run into me in the hallway and ask for help,” explained Koinis. “They show signs of denial; they don’t take any pleasure from the working environment; they’re on edge, anxious.”

In a study he did at the Argos hospital in 2012-13, he found that one in five interns was showing signs of burnout. The numbers are even higher among nurses.

In the past four years, he has treated eight colleagues for burnout, as well as counseling five nurses, one doctor and two administrators. All of them had to take antidepressants while attending sessions in a remote part of the building where they couldn’t be seen by other colleagues.

He has also set up three self-help groups to provide support to other staff.

“Those interventions came in response to a need,” said the psychologist. “Hospital workers needs to be calm and balanced so they can perform.”