Doctors in Malta may soon find it easier to resort to mental health assistance, amid mounting stress and burnout in the medical profession.

Clare Gerada, medical director of the UK’s Practitioner Health Programme, who runs a service for doctors with mental health problems, has held talks with the Medical Association of Malta with a view to removing barriers to treatment and providing the right type of care. Doctors suffer from higher rates of mental illness than most other professional groups. Some specialities are more at risk than others, but all doctors, irrespective of age, level of training or seniority, are at risk of mental illness.

Dr Clare Gerada

Doctors are much less likely than other healthcare workers to take days off sick, with official figures showing that medics are the government employees who take least sick leave. Furthermore, working in teams, many doctors feel they should not let their colleagues down.

“What I have done in England is improve ways in which doctors can access confidential help so that they can seek proper care rather wait until they are in crisis,” Dr Gerada told The Sunday Times of Malta.  

The plan there is to ensure doctors are able to get the confidential help they need, when they need it, provided by skilled practitioners.

John Paul Tabone, MAM secretary, said: “The problems tend to be worse in understaffed areas. This is often compounded by the difficulty doctors have in taking their annual leave.”

According to Martin Balzan, MAM president, burnout especially impacts doctors on duty at the accident and emergency department and manifests itself in the large number of young doctors leaving the department each year.

While they work 40 hours per week, the work is very intense and stressful, he said.

Burnout does occasionally occur in other specialities, and MAM – with the help of Mater Dei CEO Ivan Falzon – is trying  to find ways of supporting doctors who experience it.

Challenges at the emergency department

Emergency medicine is the speciality which deals with the most acute of medical situations.

Apart from the extensive training required, it takes a particular personality to be able to take very complex decisions within a very short time period and with very limited information, said Michael Spiteri, Mater Dei Hospital’s clinical chairperson and consultant at the emergency department.

“On the other hand, emergency departments offer excellent training opportunities to young physicians who want to develop the capacity and gain the confidence in dealing with seriously sick patients. Although the number is not large, some doctors opt for a career change after just a few months on the job.”

Some physicians might have excellent knowledge and medical skills but find it hard to adapt to the fast paced, quick-decision environment of emergency medicine. Dr Spiteri said the workload has increased significantly and in the first seven months of this year, the number of registrations rose to more than 350 patients per day.

By December, the number of 112 ambulance calls is expected to top 40,000 per year. There are few, if any countries, who have just one Emergency Department facing such a high population density. Undoubtedly, the fact that the staff within the department strives to provide a very high level of care in the shortest possible time comes at a cost: burnout.

However, there are several ways by which staff burnout may be reduced.

“As a department we are always trying to find more efficient ways how to cater for the ever-increasing public expectations; these interventions vary from more efficient pathways, investment in a bigger working force and procurement of more modern equipment which reduces patient processing time,” Dr Spiteri explained.

The introduction of a junior doctor mentoring system allows for senior emergency specialists to act as a point of reference to the junior doctors.

The emergency department has also been experimenting with novel staff rostering systems which allow some of its doctors to identify shifts which better suit their personal lifestyles. Other services such as psychological support and employee support programmes are also available.

“The appropriate and wise use of the emergency medical services, both in terms of the number of 112 ambulance calls and emergency department attendances, will go a long way to ensure that our staff is given the opportunity to focus on those patients who really require immediate life-saving interventions,” he added.

Unfortunately, a very significant proportion of patients who visit the department are bypassing the primary healthcare system and consequently risk overloading the emergency department, Dr Spiteri said.