It has become imperative that we discuss this issue surrounding mental health amongst Doctors and other healthcare workers. The sanity and mental wellbeing of a healthcare worker including the Doctor forms the bedrock of patient safety. It takes a safe and sane person to deliver safe healthcare and we have to give this attention also even as we navigate daily trying to find ways towards improving quality of care within our healthcare systems.
Within the last two weeks in Nigeria, we have had two very shocking incidents which have left everyone rattled and disturbed. The first case was that of a Medical Doctor named Emmanuel Ogah who stabbed his 62 years old mother to death in Lagos. As we were all still trying to come to terms with that incident, on the 19th of March 2017 another Medical Doctor identified as Dr Allwell Orji asked his driver to stop at the middle of third mainland bridge, came down from his car and jumped into the lagoon where he drowned to death before help could come his way. These two incidence happened within a space of one week bringing the loss suffered within the Medical profession to two in just one week.
This has got me thinking as an Occupational Health Consultant and a Patient Safety Advocate, I am battling so hard to balance this out and looking at how it further increases the risk exposure to the patients. These are both Doctors who were trained to care for patients, could they have been overworked? Are there issues surrounding their personal lives as families and other very personal issues responsible for these acts? Nigerians were not known to commit suicide, the suicide index in Nigeria has been very low and non-significant but we cannot boast of that any more, we are fast losing our resilience and copping capacity. Let’s take the issue of being overworked as an example, the population of Nigeria is 173.6 million people according to 2013 report and if we go by this report, Nigeria needs a minimum of 237,000 Medical Doctors to care for the population in line with the World Health Organisation (WHO) ratio of 1 Doctor to 600 people within a population group. But from all reports available within this context, there are only 35,000 Doctors actively working as Medical Doctors in Nigeria and this is just not a good enough ratio and there is no need Doctors will not be overworked. We are invariably having 1 Doctor to 4,960 people following the figures above. By this figure, we can almost conclude that workload may have just been a strong contributing factor to suicide or death amongst Doctors and healthcare workers in Nigeria. Though the Nigeria Medical College has trained more than this number of Doctors, a number of them have long delved into something else as music, sales and marketing, importation and other viable entrepreneurship ventures.
The question is, how does this impact on patient safety?
It is even sad that mental health was not included amongst the list of Occupational Health diseases or illness in International Labour Organisation list of occupational diseases until much later when the toll became so obvious. Psychosocial hazard has become a very huge issue within the healthcare work environment leading to burnout, fatigue, exhaustion, stress, tiredness and sleep deprivation amongst healthcare workers and these outcomes impact negatively on the safety and quality of care within treatment cycle. The need to keep the healthcare workers safe and mentally stable is a thing that needs our collective action and support, it takes a safe healthcare worker to deliver safe healthcare to patients.
We should be looking at the workload and duration of duty shifts within the healthcare sector which has long changed over the years, making workers to engage in longer hours per shift dealing with excess workload beyond their copping capacity. We all agree that in healthcare, we deal with lives and any mistake within the line of service delivery is always a costly one which innocent people pay for with their lives. Work overload is a critical issue surrounding daily patient harm in the hospital, it hurts the patient as a much as it hurts the healthcare workers. This load, if allowed to persist for too long, alters the mental wellbeing of the healthcare worker leading to cheap mistakes, irrational behaviour, lack of co-ordination and a total disrespect towards the right and dignity of patients. This is never in any one’s best interest.
There are many Doctors, Nurses and others who love their jobs and keep giving all they have, giving mutual support to other Nurses who they perceive to be overwhelmed with work, this sometimes lead to collective burnout within a team leading to patient harm. Such healthcare workers are seen as trusted by everyone and tagged “MR FIX IT” because of the willingness he always shown to help or assist. The worker becomes a victim of patients continuous demand, he does not say NO but always there to help, overtime he becomes emotionally overdrawn and this can also lead to patient harm.
Mental health amongst Doctors and healthcare workers should at this point be taken so seriously owing to the new and emerging conditions and disruptive behaviour noticeable amongst healthcare workers. The two Doctors whose cases were sited at the beginning of this write-up are supposed to be managing patients trusted in their care, any Doctor that thinks suicidal for whatsoever reason is a risk within the hospital environment no matter the department or unit he works from. I really think this is where we must be looking deeply into Human Resources management in healthcare environment, this is not a function assigned to a new comer but a role played by a very experienced professional with a strong analytical background in Human Psychology. We cannot rule out the fact that these two Doctors never displayed such violent or suicidal behaviour that would have attracted the attention of co-workers or even the Human Resources Managers who would be expected to have an audience with such an employee with obvious suggestive indicators. We need to start engaging our colleagues, we need to start setting up Employees Assistance Programs (EAP), we need to start looking beyond work and also start getting quick and smart peeps into what happens in the home of our employees. Are there issues? Are there smart ways we can help out? This should be the thinking, it will save both the patient entrusted into the care of such employees and the employees themselves and maintaining good reputation of the healthcare facility.
We must understand that healthcare workers are human beings just like us all, they are not super men, and they are fallible like every one of us. We need to start re-humanise our workplaces, let’s start reviewing the workloads, timelines and deadlines, let’s once again treat these people the way we would want them to treat our patients. Let’s bring dignity of labour back to healthcare, let’s again work like one big family where we all continuously watch each other’s backs, let’s rebuild the lost confidence while having the patient at the centre of these thoughts.
Losing more Doctors and seeing others behind bars due to homicide and seeing others incapacitated and almost invalid when we know the work pressure and work environment contributed to these conditions and states is not a plus to us all, we can change it.
It just takes a SANE Doctor to offer a SAFE healthcare.