Impact of hospital consultants' poor mental health on patient care

In a survey of 1794 UK NHS hospital consultants 1308 (73%) responded. Psychiatric morbidity (General Health Questionnaire–12score $≥$ 4) was present in 32% of responders, who were twice aslikely to report drinking hazardous levels of alcohol, beingirritable with patients and colleagues, reducing their standardsof care and intending to retire early (all P < 0.001). Maleand mid-aged consultants were also particularly at risk. Approachesthat support consultants to practice medicine safely throughout their careers are required.

INTRODUCTION

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INTRODUCTION

Up to a third of hospital consultants are estimated to experience psychiatric morbidity at any one time (Graham & Ramirez, 1997; Taylor et al, 2005). Poor mental health is clearly detrimentalto doctors' lives, but less is known about the extent of itsimpact upon patient care. Harmful alcohol consumption, impairedclinical performance and planned early retirement detract from patient care. We have estimated the prevalence of these behaviours,identified demographic risk factors and explored the relationshipbetween these behaviours and poor mental health.

METHOD

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METHOD

A confidential postal survey was sent to 1794 UK NHS hospitalconsultants in late 2002. The sample included all surgicaloncologists, medical oncologists and clinical oncologists,a random sample of gastroenterologists (two in three) and arandom sample of radiologists (one in five). Consultants wereascertained through the UK medical Royal Colleges and professionalbodies to which they were affiliated. Sampling and ascertainmentare described in detail elsewhere (Taylor et al, 2005). Psychiatricmorbidity was estimated using the General Health Questionnaire–12(GHQ–12; Goldberg & Williams, 1988). Harmful alcoholconsumption was screened using the World Health Organization's Alcohol Use Disorders Identification Test (AUDIT; Saunders et al, 1993). Impaired clinical performance was measured using a scale adaptedfrom Firth-Cozens et al (1997), whereby the frequency thatstress at work had caused irritability with colleagues, irritabilitywith patients and reduction in standards of care (such as takingshort cuts) was rated on four-point scale from `never to myknowledge' to `at least weekly'. Early retirement was definedas intending to retire aged $≤$ 55 years. Demographic measuresincluded gender, age and marital status. Hierarchical logistic regression models were developed. Each univariately significantdemographic variable was entered into a multivariate model(model 1) followed by the additional impact, if any, of poormental health (GHQ score $≥$ 4; model 2). Analysis of relationshipswith planned early retirement necessarily excluded consultantsaged over 55. Individuals with missing data were excluded ona test-by-test basis. Missing data constituted less than 5%except AUDIT scores (9%) and intended retirement age (7%).All tests were two-tailed, using a 5% significance level, andall analysis was conducted using SPSS v.12.0.1 for Windows.

RESULTS

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RESULTS

Questionnaires were returned by 1308 consultants (73%), of whom19% (251) were women, 89% (1151) were married or cohabiting,4% (52) were aged < 35 years, 41% (534) were aged 36–45,36% (473) were aged 46–55 and 19% (242) aged > 55years (Table DS1 in the data supplement to the online versionof this paper).

In all, 32% of consultants (414) were estimated to have psychiatric morbidity (Table DS1 in the data supplement); 17% of consultants(207) reported consuming hazardous quantities of alcohol; 33%(432) reported that, at least monthly in the last 6 months,stress at work had caused them to be irritable with colleagues;16% (212) reported being irritable with patients; 17% (221)had reduced their standards of care through, for example, taking short cuts or not following procedures; and 18% (176) plannedto retire early.

Male consultants were more likely to report harmful consumptionof alcohol; consultants aged between 36 and 45 years (mid-aged)and those who were unmarried were more likely to report beingirritable with colleagues; younger consultants were more likelyto report being irritable with patients; male consultants andmid-aged consultants were more likely to report reducing their standards of care; and female consultants and mid-aged consultantswere more likely to intend to retire early (Table 1: model1). Poor mental health independently increased consultants'likelihood of reporting all of these behaviours (Table 1: model2).

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Table 1 Predictors of harmful alcohol use (score $≥$ 8 for men, $≥$ 7 for women on the Alcohol Use Disorders Identification Test), impaired performance at work (being irritable with colleagues or with patients, or reducing standards of care, at least monthly in the past 6 months) and intention to retire early (aged $≤$ 55 years): logistic regression

DISCUSSION

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DISCUSSION

These findings suggest that hospital consultants with poor mentalhealth are substantially more likely to report harmful consumptionof alcohol, being irritable with patients, being irritablewith colleagues, reducing their standards of care at work and/orplanning to retire early. In addition, we have shown that maleand mid-aged consultants are particularly at risk.

Our study included a large national cohort of consultants fromfive specialties. Despite the sensitive nature of the surveyquestions, the response rate was high, giving us confidencethat the sample is representative. The cross-sectional designlimits interpretation of causality, and assessments of mentalhealth and consultant behaviours relied upon self-report measures.However, both the GHQ–12 and the AUDIT have been shownto be reliable and valid screening tools.

To our knowledge, this is the first study to examine the relationship between the mental health of hospital consultants and behavioursthat detract from patient care.

Our finding that male consultants were more at risk of harmfulalcohol consumption is consistent with findings from generalpopulation surveys. Perhaps more surprising is the increasedrisk of impaired clinical performance and planned early retirementat mid-age. Consultants appear to be particularly vulnerableat this phase in their career (e.g. Spickard et al, 2002), which may be due to the fact that the honeymoon period of achievingconsultant status is over but retirement is far from sight.They will have accumulated all of the responsibility and associatedpressures, and are also more likely to have high demands ontheir time from home, with many having young families.

This study adds to the growing literature which highlights thecritical importance to patients, as well as to doctors, ofidentifying approaches that protect consultants' mental healthand support them to practice medicine safely throughout theircareers.

ACKNOWLEDGMENTS

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ACKNOWLEDGMENTS

We thank the consultants who took part in the survey, RoyalColleges of Physicians and Radiologists, British Society forGastroenterology and British Association of Surgical Oncologistsfor their support.

This study was jointly funded by the Charitable Foundation ofGuy's and St Thomas' Hospitals (London, UK) and Cancer ResearchUK.

REFERENCES

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