Abstract

Background

Around 1.1 million people suffer from occupational health diseases in the UK. Work-related conditions reported by doctors include mental health disorders, musculoskeletal problems and skin disorders.

Aims

To investigate the prevalence of occupational illness in UK doctors from different specialties.

Methods

A literature search conducted on PubMed, EMBASE, MEDLINE® and Health Management Information Consortium (HMIC) identified relevant research about doctors between the years 1990 and 2013.

Results

Seventy-two papers were identified. The majority of studies were cross-sectional with no random ized controlled trials or meta-analyses found. Mental health issues including burnout were widely reported and were attributed to greater job constraints, managerial issues, difficulty with clinical cases and lack of job satisfaction. Substance abuse in doctors was reported to be a risk of maladaptive coping mechanisms and was associated with early retirement. Surgeons were reported as being at greatest risk of needle-stick injuries and musculoskeletal pain. Orthopaedic surgeons were reported to be at risk of noise-induced hearing loss as a result of the use of air-powered and electric drills. There was limited research found concerning contact dermatitis and work-related malignancies amongst doctors in the UK.

Conclusions

Our literature review found research on UK doctors for a variety of work-related illnesses with the prevalence varying depending on both specialty and seniority. This could have adverse effects both on the individual and the provision of patient care. Further studies are required to investigate the epidemiology of noise-induced hearing loss, nosocomial infections, skin-related disorders and work-related malignancies.

Introduction

In 2011/12, an estimated 1.1 million people in the UK suffered from an illness that was caused or made worse by their work [1]. This resulted in an overall loss of 27 million working days with an associated economic cost of £13.8 billion. Mental health disorders were by far the commonest form of work-related illness in the UK, constituting 59% of all cases. This was followed by musculoskeletal disorders (28%) and skin-related diseases (5%) (Figure 1) [2–4].

Figure 1.

Types of occupational ill-health amongst all workers in the UK. Source: Health & Safety Executive [3]. The Health and Occupation Research Network (THOR) 2012.

Figure 1.

Types of occupational ill-health amongst all workers in the UK. Source: Health & Safety Executive [3]. The Health and Occupation Research Network (THOR) 2012.

Diagnoses of ill-health in doctors reported to The Health and Occupation Research Network (THOR) include stress, burnout, anxiety and depression, substance abuse, needle-stick injuries, musculoskeletal injuries, skin and respiratory illnesses, noise-induced hearing loss and nosocomial infections (Table 1) [3,4]. Although these have been well documented, there is a paucity of evidence on the prevalence of these disorders amongst UK doctors and how they affect both individuals and the health care organizations. We conducted a literature review to investigate work-related illness amongst the various specialties of doctors in the UK. We limited our review to doctors in the UK as the stressors and injuries may vary in different health care systems.

Table 1.

Diagnoses of ill-health in doctors reported to THOR, 2001–12 (2006–12 for THOR-GP)

Reporting group Diagnosis Number of diagnoses (% of total cases) 
SWORD (chest physicians) Asthma 6 (35) 
Infectious disease 6 (35) 
Rhinitis 4 (24) 
Mesothelioma 3 (18) 
Allergic alveolitis 1 (6) 
Non-malignant pleural disease 1 (6) 
Total actual cases 17 (100) 
Total diagnoses 21 
EPIDERM (dermatologists) Contact dermatitis 207 (92) 
Contact urticarial 21 (9) 
Other dermatoses 1 (<1) 
Neoplasia 1 (<1) 
Total actual cases 224 (100) 
Total diagnoses 230 
OPRA (occupational physicians) Work stress 114 (38) 
Anxiety and depression 111 (37) 
Contact dermatitis 31 (10) 
Lumbar spine/trunk MSDs 7 (2) 
Other psychiatric problems 6 (2) 
Post-traumatic stress disorder 4 (1) 
Hand/wrist/arm MSDs 4 (1) 
Other respiratory disease 4 (1) 
Alcohol or drug abuse 3 (1) 
Shoulder MSDs 3 (1) 
Asthma 2 (1) 
Diarrhoeal disease 2 (1) 
Pulmonary tuberculosis 2 (1) 
Other problems 17 (5) 
Total actual cases 299 (100) 
Total diagnoses 311 
THOR-GP (GPs) Work stress 4 (31) 
Anxiety and depression 6 (46) 
Hand/wrist/arm MSD 1 (<1) 
Contact dermatitis 1 (<1) 
Pneumonia 1 (<1) 
Total actual cases 13 (100) 
Total actual diagnoses 13 
Reporting group Diagnosis Number of diagnoses (% of total cases) 
SWORD (chest physicians) Asthma 6 (35) 
Infectious disease 6 (35) 
Rhinitis 4 (24) 
Mesothelioma 3 (18) 
Allergic alveolitis 1 (6) 
Non-malignant pleural disease 1 (6) 
Total actual cases 17 (100) 
Total diagnoses 21 
EPIDERM (dermatologists) Contact dermatitis 207 (92) 
Contact urticarial 21 (9) 
Other dermatoses 1 (<1) 
Neoplasia 1 (<1) 
Total actual cases 224 (100) 
Total diagnoses 230 
OPRA (occupational physicians) Work stress 114 (38) 
Anxiety and depression 111 (37) 
Contact dermatitis 31 (10) 
Lumbar spine/trunk MSDs 7 (2) 
Other psychiatric problems 6 (2) 
Post-traumatic stress disorder 4 (1) 
Hand/wrist/arm MSDs 4 (1) 
Other respiratory disease 4 (1) 
Alcohol or drug abuse 3 (1) 
Shoulder MSDs 3 (1) 
Asthma 2 (1) 
Diarrhoeal disease 2 (1) 
Pulmonary tuberculosis 2 (1) 
Other problems 17 (5) 
Total actual cases 299 (100) 
Total diagnoses 311 
THOR-GP (GPs) Work stress 4 (31) 
Anxiety and depression 6 (46) 
Hand/wrist/arm MSD 1 (<1) 
Contact dermatitis 1 (<1) 
Pneumonia 1 (<1) 
Total actual cases 13 (100) 
Total actual diagnoses 13 

Source: Health & Safety Executive [3] and The Health and Occupation Research Network (THOR) 2012 [4]. MSD, musculoskeletal disease.

Methods

A systematic literature review was conducted of peer-reviewed articles published in the English language from 1990 to 2013 Inclusive. PubMed, EMBASE, MEDLINE® and Health Management Information Consortium (HMIC) were searched using the following keywords in varying combination: ‘occupational health’, ‘occupational disease’, ‘occupational illness’, ‘work-related illness’, ‘work-related disease’, ‘hospital doctors’, ‘hospital physicians’, ‘junior doctors’, ‘residents’, ‘surgeons’, ‘hospitalist’, ‘consultant’, ‘general practitioners’, ‘mental health’, ‘mental illness’, ‘hearing loss’, ‘back pain’, ‘lumbar pain’, ‘neck pain’, ‘carpal tunnel’, ‘repetitive strain injury’, ‘musculoskeletal injuries’, ‘stress’, ‘burnout’, ‘needle stick’, ‘sharps injuries’, ‘contact dermatitis’, ‘occupational dermatitis’, ‘occupational eczema’, ‘industrial dermatitis’, ‘United Kingdom’, ‘Great Britain’, ‘England’, ‘Scotland’, ‘Wales’, ‘Ireland’, ‘English’, ‘Scottish’, ‘Welsh’, ‘Irish’, ‘Northern Ireland’ and ‘National Health Service’.

Results

The literature review yielded 72 articles, 22 of which were excluded for the following reasons; 12 were letters to the original articles already included in our review, 6 were studies conducted outside the UK and hence their findings may not be relevant to our population, while the remaining 4 were not about the occupational health of doctors specifically. We extended our search for occupational-related skin disorders and risk of developing cancer to other health care professionals worldwide, as there were no UK studies amongst doctors on these illnesses. No randomized controlled trials were found.

Stress, burnout and mental health

Our search identified 34 papers pertaining to stress, burnout and mental health disorders within the UK literature. Using the Royal College of General Practitioners (RCGP) star rating system (Table 2), six of these papers had three-star ratings with large sample sizes while the majority were two-star rating cross-sectional studies within single institutions (Supplementary Tables 1 and 2, available at Occupational Medicine Online). Most of these studies were carried out using validated questionnaires (General Health Questionnaire, Maslach Burnout Inventory, Hospital Anxiety and Depression Scale).

Table 2.

RCGP ‘three-star’ evidence rating system

Level of evidence Type of evidence 
*** Generally consistent finding in a majority of multiple acceptable studies. 
** Either based on a single acceptable study or a weak or inconsistent finding in some of multiple acceptable studies. 
Limited scientific evidence, which does not meet all the criteria of acceptable studies. 
Level of evidence Type of evidence 
*** Generally consistent finding in a majority of multiple acceptable studies. 
** Either based on a single acceptable study or a weak or inconsistent finding in some of multiple acceptable studies. 
Limited scientific evidence, which does not meet all the criteria of acceptable studies. 

A 2005 large multi-centre study of consultants from five specialties at two cross-sectional periods, 880 participants in 1994 and 1308 participants in 2002, showed a 5% increase in psychiatric morbidity and 9% increase in burnout between the time frames [5]. Two years later, a national cross-sectional survey of 1308 hospital consultants found the incidence of mental health problems to be 32% with depression being the commonest illness [6]. This group also exhibited hazardous levels of alcohol consumption, reduced standards of patient care and early retirement plans, which were detrimental to their personal and professional life [6].

A national survey of 201 accident and emergency (A&E) consultants and senior registrars in 1993 did not find high levels of stress or depression and respondents generally evaluated aspects of their work environment favourably [7]. This appeared to be related to clearly defined job roles, supportive work groups and efficient units.

In contrast, a UK-wide postal questionnaire to 350 A&E consultants in 2002 found that there were high levels of psychological distress amongst doctors working in A&E (44%) in comparison to other groups of doctors (28%) [8]. This was perceived to be a result of unpredictable workload, high patient attendances, limited resources and critical decision-making often based on incomplete information. The authors also found a high rate of job satisfaction amongst 65% of respondents attributed to the ‘hands on’ approach in A&E and the ‘excitement and adrenaline rush’ of the specialty. A replicated study in 2003 looking at senior house officers (SHO) in A&E showed similar results to their consultant colleagues [9].

Whitley et al. reported no statistical differences in work-related stress between emergency physicians from the USA, UK and Australia [10].

In a single comparison study between general practitioners (GPs) and hospital consultants in Scotland, it was found that consultants reported higher levels of stress [11]. This was attributed to the managerial aspects of their job. Conversely, consultants also reported higher levels of job satisfaction in comparison to their GP colleagues. Overall, it was concluded that male GPs, as a group, had the greatest levels of stress with the least job satisfaction as a result of the ‘intrinsic factors’ of their job. This related to reduced motivators such as recognition, achievement and personal growth.

A cross-sectional questionnaire study of 138 psychiatrists in three Manchester teaching hospitals revealed no significant difference in psychological morbidities between the varying grades of SHOs, registrars and consultants [12]. Seventy-eight per cent of respondents reported a stressful incident with the stressors differing between the grades. Consultants found administrative difficulties and career threats most distressing while SHOs and registrars struggled with working alongside difficult or disturbed patients and managing their personal problems simultaneously. Consultant psychiatrists reported higher levels of burnout and more severe depression compared with their surgical and physician colleagues despite working fewer hours [12]. The study authors postulated that this could stem from either the nature of their work, dealing with extremely distressed and disturbed individuals, or personality characteristics, which make them more vulnerable. Junior psychiatrists (SHOs and junior registrars) were found to report significantly higher levels of exhaustion compared to their senior colleagues (senior registrars and consultants). On the other hand, Sochos et al. reported that psychiatric trainees experienced less burnout, fewer time demands and more consultant and emotional support than their general medical counterparts, which they attributed to recent changes within their training [13].

A postal questionnaire survey of 672 members of the Association of Surgeons of Great Britain and Ireland (ASGBI) in 1990 found that the major individual stressors were interference of job with personal life, general administration and number of patients seen in clinic [14]. A study from the Imperial College Healthcare group suggested that the operating theatre itself could be a hazardous and stressful environment [15]. Using the novel, validated Imperial Stress Assessment Tool (ISAT), which captures both objective (heart rate, salivary cortisol) and subjective (State Trait Anxiety Inventory questionnaire) indicators of stress, Arora et al. highlighted that excessive stress intra-operatively could impair a surgeon’s mental and technical ability [15]. They proposed that in an era of competence-based training, surgical trainees should be well equipped with effective coping strategies. In a study by Upton et al., one third of 342 surgeons surveyed reported high levels of burnout irrespective of their surgical specialty, age group, gender or surgical grade [16]. The incidence rates were consistent with a separate study of 501 colorectal and vascular surgeons where 32% reported high levels of job-related exhaustion [17].

All surgical specialties showed similar rates of psychological morbidity with no association between number of hours worked, workload and level of burnout experienced [16–18]. Instead, observed contributing factors included certain personality traits, mood profiles, loss of autonomy and perceived poor treatment by management [18]. Overall, surgeons only comprised 10–15% of doctors seeking stress counselling, thought possibly to be due to the high job satisfaction or fear of stigmatism and threat of career change [19].

In a study of microbiologists and virologists, stress levels were noted to be of concern due to demanding on-call commitments, working in excess of the European Working Time Directive, rising workload (especially in units with single practitioners) and declining morale amongst consultants [20]. Recruitment from the specialty was reported to be extremely low, with figures between 1987 and 1997 showing a 12.5% rise compared with a 105% rise in emergency medicine over the same period [20].

A 1990 paper by Firth-Cozens found that the majority of distress experienced by junior doctors was related to overwork, followed by effects on personal life, serious failures of patient treatment and talking to distressed relatives [21]. In addition, neuroticism was found to be a predisposing factor to stress in both males and females [22,23]. The introduction of the Medical Training Application System (MTAS) and Modernising Medical Careers (MMC) was associated with significant psychological issues and poor coping for many doctors in transition [24]. On the other hand, good team working, adequate sleep and longer time spent in a rotation were reported as protective against stress amongst junior doctors [25,26]. In a study by Brewin and Firth-Cozens, depression levels were greatest in the first year post-graduation. Self-criticism, as a result of the steep learning curve and frequent mistakes made, was highlighted as a significant predictor amongst both males and females [27].

Palliative physicians, on the whole, reported less stress and more job satisfaction from a managerial and resource perspective in comparison to their colleagues from gastroenterology, radiology and surgery [28]. Hospital-based palliative physicians were found to be more stressed than their hospice-based colleagues [28]. No significant differences were found between palliative care and oncology with common triggers, such as effect on personal and family life alongside dissatisfaction with choice of specialty, identified in both [29]. A national questionnaire-based survey of 393 non-surgical cancer clinicians in 1995 found that clinical oncologists experienced higher levels of burnout compared with medical oncologists and palliative care specialists. The estimated prevalence of psychiatric disorders within the study group was 28%, similar to UK medical students and junior doctors [30]. Associated risk factors included feeling overloaded, dealing with treatment toxicity, low job satisfaction, inadequate resources and insufficient training in communication and management skills [30].

For other specialists, a UK-wide survey of 882 surgeons, oncologists, radiologists and gastroenterologists in 1996 showed that radiologists reported the highest levels of job-related exhaustion due to low personal accomplishment [31]. The estimated prevalence of psychiatric morbidity amongst radiologists and gastroenterologists was 27%.

Substance misuse

We identified four references (two systematic reviews and two cross-sectional studies) pertaining to substance misuse amongst doctors in the UK. A systematic review conducted by the Institute of Occupational Medicine (IOM) in 2009 found moderate evidence from two studies that over 25% of doctors suffering from chronic health problems (particularly psychiatric illnesses) reported misuse of alcohol and to a lesser degree, prescription drugs [32]. A UK study of 144 doctors with substance misuse problems revealed that the mean age of referral was 43.1 years and substances abused were in the following proportions: 42% alcohol, 31% drugs and alcohol and 26% drugs solely [33]. The commonest illicit drugs were opiates, barbiturates, benzodiazepines and amphetamines. Identified risk factors included personality problems, stress at work, anxiety or depression, non-specific drift into drinking, pain, injury or accident, family issues.

In a separate review by Tyssen et al. in 2007, the highest prevalences of alcohol abuse amongst the medical profession were found in female medical students, doctors under 40 and surgeons [34]. Doctors who abused alcohol and illicit substances as coping mechanisms were noted to have a 2-fold increased risk of psychiatric morbidities [35].

Sharps injury

We found eight studies looking at sharps injuries in UK doctors. Six of these were single-centred cross-sectional studies while the remaining two include a longitudinal study over a 3-year period and a literature review on sharps injuries and occupational blood-borne virus transmission (Supplementary Table 3, available at Occupational Medicine Online). We found evidence to suggest that most sharps injuries go unreported as many doctors find the policies cumbersome and consider the risks negligible [36–38].

The operating theatre environment was reported as the second most common setting for sharps injuries, after the wards, and surgeons were at a higher risk compared with their colleagues from other individual specialties [36,39]. Adherence to sharp safety policies was found to be poor, especially amongst consultants and senior surgeons who conversely were found to have higher rates of injuries from more time spent operating [36,40]. The reasons cited included lack of time, excessive paperwork, unable to leave the surgical procedure/theatre list and inadequate support for reporting out of hours [40,41]. Au et al. found that out of 840 needle-stick injuries, only 19 (2.26%) were reported with reporting rates being low in all subspecialties [40]. A literature review of 24 publications on sharps injuries conducted in 2006 found that the degree of under-reporting may be as high as 10-fold [38]. It concluded that although the injuries are common, confirmed viral hepatitis and HIV transmission in the UK has been rare [38].

Junior doctors, although less aware about local sharp injury protocols possibly from their nomadic nature of training, were found to be more adherent than their senior colleagues [36,42]. They were, however, noted to be at higher risk of blood and body fluid exposure. A study of 175 cases found accidental contamination during sharps injuries in 54% of junior doctors compared with 46% in their senior colleagues [39]. In a separate study on 80 needle-stick injuries amongst junior doctors by Naghavi et al., 12% went on to develop post-traumatic stress disorder [43].

Hand dominance and role during surgery were shown not to affect the risk of needle-stick injuries, whereas the use of a no-touch technique was found to be protective [42].

Musculoskeletal pain

We identified three cross-sectional studies on musculoskeletal pain, all of which were conducted on surgeons and of two-star rating based on the RCGP system (Supplementary Table 4, available at Occupational Medicine Online). A nationwide postal questionnaire with 77 consultant surgeons from various disciplines found that 82% experienced pain while operating, with plastic surgeons having the most frequent episodes in a non-statistical comparison with general surgeons, otolaryngologists, orthopaedics and neurosurgeons [44]. The study authors postulated that a possible explanation may be that the use of microscope, surgical loupes and head-mounted lights, which were highlighted as the commonest contributing factors beyond posture, are frequently utilized in plastic surgical procedures.

In a national cross-sectional survey by Babar-Craig et al. of 325 ENT consultants, 72% had experienced either back or neck pain or both with most reports coming from otologists, relating their symptoms to lengthy microscopic work and prolonged sitting [45]. Fifty-three per cent of respondents attributed their symptoms directly to previously performed ENT surgery. Other predisposing factors included static postures and bending during endoscopic procedures, similar to their general surgical colleagues [44,45]. Eighty-three per cent (270) of these ENT surgeons had physiotherapy input with two requiring operative interventions [45].

In a study by Chatterjee et al., 54% (174/325) ophthalmologists reported severe neck, back and leg pain with the longest serving consultants noted to be at increased risks [46]. Although the number and duration of episodes increased with years spent in the specialty, they were unrelated to time spent operating. Most of the episodes were treated with analgesia although 49 ophthalmologists (28%) sought medical attention and nine required surgery.

Noise-induced hearing loss

In a single-centred, low-powered study, Willet demonstrated that the noise produced from a number of air-powered and electric drills (90–100 dB) used in routine orthopaedic procedures exceeded the recommended daily personal exposure levels (85 dB) [47]. Twenty-two senior orthopaedic personnel, consisting of 12 consultants, four senior registrars, one theatre nurse and five plaster technicians, were found to have noise-induced hearing loss on pure tone audiograms.

These findings were corroborated by Siverdeen et al. who used sound-level meter measurements during various orthopaedic operations involving high-powered tools and showed that the noise levels in orthopaedic theatres can be at unacceptable levels [48]. The mean value of noise generated by saws was 95 dBA, whereas drills produced 90 dBA, K-wire drivers 85 dBA and hammers 65 dBA. The authors concluded that this could potentially lead to hearing problems in the staff and patients within the theatre environment [48].

Nosocomial infection

Perkin et al. conducted two week-long audits in 1993 and 2001 looking at time off work from nosocomial infections in junior doctors [49]. The authors found that although there was an increase in proportion of doctors suffering from work-related infections taking sick leave between 1993 and 2001, the majority remained at work. The common types of nosocomial infections reported were diarrhoea and/or vomiting, upper respiratory tract infections and skin infections.

Skin disorders

There were no published studies on work-related skin disorders specific to doctors within the UK identified. We were, however, able to extract some information regarding these occupational illnesses through EPIDERM (a dermatology-reporting scheme), OPRA (an occupational physician reporting scheme) and THOR-GP (a GP reporting scheme) (Table 1) [3,4]. In addition, there was a number of studies investigating skin disorders in a variety of health care workers, which included doctors.

Based on data from THOR, Turner et al. (2007) found that nursing staff and midwives were the most affected health care workers followed sequentially by health care assistants, doctors, medical students, dentists and dental nurses [50]. Common disorders included contact dermatitis, contact urticaria and infective skin disease. The frequently reported suspected agents were soaps and detergent, latex, personal protective equipment, wet work and sterilizing agents.

In a separate study of 867 medical (doctors) and nursing staff in a district general hospital, Handfield-Jones found that eight staff (0.9%) were allergic to latex with resultant hand eczema and/or urticaria. The risk was higher in atopics, who were more likely to succumb to anaphylactic episodes [51]. The author stressed the importance of increasing awareness and pre-employment advice regarding their hand care. Other common allergens reported were fragrance and glove chemical [52].

Forrester et al. (1998) reported that health care workers who washed their hands >35 times a shift were >4 times more likely to report occupational-related hand dermatitis in comparison to staff who washed less frequently [53]. These findings were corroborated by Callahan et al. (2013) from Cleveland in the USA who found that hand washing >10 times a day was associated with a 1.55 incidence rate ratio of irritant hand dermatitis [54].

Risk of cancer

No UK studies were found, however Maitre et al. conducted a retrospective cohort study in Grenoble amongst 936 physicians, surgeons, anaesthetists, radiologists and physicians working in labs and found that the incidence was the same as in the reference population [55]. Haematological malignancies (e.g. leukaemia, lymphoma) were the only form of cancer that doctors were more likely to develop (standardized incidence ratio = 5.45, 95% confidence intervals 2–11.9).

Discussion

Our literature search identified 50 research papers about the work-related health of doctors in the UK. The vast majority of studies (34 papers) concerned the mental health of doctors (stress, burnout and psychiatric disorders). We also found papers relating to substance abuse, sharps injuries, musculoskeletal pain, noise-induced hearing loss and nosocomial infections amongst UK doctors (Table 3).

Table 3.

List of reported occupational illnesses and injuries by specialty as noted in the UK literature

Specialties affected Subspecialty/subgroup Reported occupational hazards 
Physicians  Burnout, depression, haematological malignancies 
Palliative care physicians Stress, burnout, psychiatric illness 
Oncologists Stress, burnout, psychiatric illness 
Microbiologists and virologists Stress, haematological malignancies 
Gastroenterologists Burnout, psychiatric illness 
Surgeons  Stress, burnout, psychiatric illness, needle-stick injuries, haematological malignancies 
ENT Back and neck pain 
Plastics Musculoskeletal pain 
Orthopaedics Noise-induced hearing loss 
Doctors in general  Substance abuse, contact dermatitis 
Junior doctors Stress, needle-stick injuries, nosocomial infection 
Psychiatrists  Stress, burnout, depression 
Emergency physicians  Stress 
Ophthalmologists  Musculoskeletal pain 
General practitioners  Stress 
Anaesthetists  Haematological malignancies 
Radiologists  Burnout, psychiatric illness, haematological malignancies 
Specialties affected Subspecialty/subgroup Reported occupational hazards 
Physicians  Burnout, depression, haematological malignancies 
Palliative care physicians Stress, burnout, psychiatric illness 
Oncologists Stress, burnout, psychiatric illness 
Microbiologists and virologists Stress, haematological malignancies 
Gastroenterologists Burnout, psychiatric illness 
Surgeons  Stress, burnout, psychiatric illness, needle-stick injuries, haematological malignancies 
ENT Back and neck pain 
Plastics Musculoskeletal pain 
Orthopaedics Noise-induced hearing loss 
Doctors in general  Substance abuse, contact dermatitis 
Junior doctors Stress, needle-stick injuries, nosocomial infection 
Psychiatrists  Stress, burnout, depression 
Emergency physicians  Stress 
Ophthalmologists  Musculoskeletal pain 
General practitioners  Stress 
Anaesthetists  Haematological malignancies 
Radiologists  Burnout, psychiatric illness, haematological malignancies 

The overall quality of the evidence reviewed was low with most papers being cross-sectional. We included systematic reviews done by individual authors and institutions, however, no meta-analyses or randomized controlled trials were found. The studies were conducted amongst a number of different disciplines within medicine but there was a relative paucity of literature about some of the larger specialties such as paediatrics, obstetrics and gynaecology as well as anaesthetics.

Occupational stress is a well-documented problem amongst doctors. The 24 papers reviewed (Supplementary Table 1, available at Occupational Medicine Online) provide evidence on its prevalence, however, it was difficult to ascertain the overall incidence rate as there was a lack of comparison with the general population and most studies were done within individual specialties rather than across the profession. We found that stress and anxiety levels increased with the seniority of a doctor possibly as a direct consequence of their role and responsibility. The evidence across specialties suggested that stress was related to greater job constraints, managerial issues, high levels of personal accomplishment and problems with clinical diagnosis and treatment [56–58]. Within the A&E cohort, we found that work-related stress and job satisfaction could co-exist, making it appealing to certain individuals. The evidence suggested an increase in stress experienced by these clinicians between 1993 and 2002 possibly from the growing complexities of medical care coupled with rising patient expectations and demand [7,10].

If not addressed, work-related stress may lead to burnout and mental health problems [16,58]. Burnout has been defined as a physical, emotional and mental exhaustion from one’s job or career and is a consequence of increasing job stress without a comparable increase in job satisfaction [5]. Suggested causes for this discrepancy included rising workload, perceived poor treatment by management and loss of autonomy, interference of work with personal life, feeling inadequately resourced and the unpredictable nature of certain jobs.

Studies from other countries with different health care systems reveal similar findings, corroborating the evidence we found from within the UK. Tyssen (2007) reported that some mental health illness, particularly depression and suicide, were more prevalent in the Norwegian medical community due to loss of autonomy, time pressure and demanding patients [34]. Similarly, Shanafelt et al. found that American oncologists with longer working hours were at higher risk of burnout compared with their peers [59]. Correlations were also found for substances abuse. The Ontario Physician Health Programme identified that alcohol was the commonest misused drug amongst doctors followed by opioids. These findings were in contradiction to American physicians who had higher rates of prescription drug misuse but similar alcohol and lower illicit drug consumption in relation to the general population [32].

Understanding and overcoming the barriers to seeking help is vital in combating work-related stress, burnout and psychiatric illnesses and many professional bodies have set up programmes to promote awareness and guide early treatment. The Faculty of Occupational Medicine has been working with the RCGP and Royal College of Psychiatrists in a bid to address this issue. A collaborative ‘Health for Health Professionals’ programme was developed to train occupational physicians around the country who see doctors as their patients with the aim of promoting good health and well-being [60]. Recognizing the stigma within surgeons, the Royal College of Surgeons (RCS) set up an afternoon workshop in November 1999 to debate its role on providing pastoral support to its members and a Confidential Support and Advice Service for Surgeons was established [19,61].

A brief literature search outside the domain of doctors revealed that many of the elements that contribute to stress in the workplace also apply to nurses and allied health professionals. Cumulatively, this may impact on the working relationship between doctors and other health care workers with possible adverse effects on patient care [62,63].

From the eight studies reviewed, we found that surgeons were at higher risk of sharps injuries compared with colleagues from other individual specialties although no true comparative studies were undertaken [36]. Despite the risk of blood-borne virus exposure, albeit small [38], most sharps injuries were unreported [36]. The majority of the studies reviewed were based on small-sized single centre data (Supplementary Table 2, available at Occupational Medicine Online), suggesting a need for larger, multi-centric trials. A comparative trial between specialties could also shed further light if other specialties that use sharps frequently such as obstetricians and gynaecologists, anaesthetists and interventional radiologists are equally at high risk of such injuries

Most NHS organizations have established protocols based on the EU Directive on the Prevention from Sharp Injuries in the Hospital and Healthcare sector [64]. The provisions of this directive were incorporated into UK law in 2013 and added new requirements to the existing guidelines of counselling, blood tests and post-exposure prophylaxis. Amongst the additions were the promotion of safe use and disposals of medical sharps as well as detailed information and training for employees, outlining the risks of injuries involving sharps, good practice on preventing injuries and the legal duties placed on them [65].

The three national surveys on musculoskeletal pain were cumulatively convincing that it is common amongst surgeons (Supplementary Table 4, available at Occupational Medicine Online) [44–46]. Back and neck were the commonest areas affected followed by hand. Not surprisingly, episodes of musculoskeletal pain were found to increase over years spent operating with symptoms worsened by performing surgery at an earlier age. This may impact on the surgical workforce through sickness absence and early retirement from the NHS. It has been suggested that the working environment of the operating theatre is improved and surgical trainees are taught about the ergonomics of surgery in a bid to address this [40–42]. Further studies looking at specialties that are equally involved in regular technical procedures (such as cardiology, gastroenterology and interventional radiology) may help us understand the epidemiology and guide preventative management of musculoskeletal pain.

It was difficult to draw a conclusion from the two papers on noise-induced hearing loss during orthopaedic procedures [47,48]. Both papers did not objectively calculate the duration of daily exposure to noises above 90 dB making it difficult to ascertain the risk of continuous noise damage to the doctors’ hearing. We can only postulate if similar hazards may exist in other specialties that use electronic and air-powered drills, particularly ENT, maxillofacial and neurosurgeons. Further evidence is required.

Despite the lack of published UK literature, Perkin et al.’s results on British doctors taking fewer amounts of days off sick were corroborated by Tyssen (2007), who reported that Finnish and Norwegian doctors were equally more likely to remain at work and self medicate [34,50]. Reasons cited for doctors refraining from taking sick leave as a result of nosocomial infections included not wanting colleagues to do extra work, pressure to come/stay at work by consultants, illness not affecting capacity to work and perceived negligible risk of transmission to patients. Most junior doctors were also not aware of local policies on reporting their illness and were more likely to inform their consultant/department rather than the occupational health team [50].

We were surprised with the paucity of studies on work-related skin disorders amongst doctors in the UK despite this being the third commonest occupational illness nationwide (Figure 1). There is certainly a need for further research to investigate its incidence within the medical profession, particularly within specialties that are frequently exposed to soaps, detergent, latex, personal protective equipment, sterilizing agents and wet work, which have all been shown to increase the risk of occupational-related hand dermatitis [51,54].

In summary, we found evidence for a variety of work-related illnesses amongst UK doctors, with the prevalence varying depending on both specialty and seniority. The overall quality of evidence is low with most papers being cross-sectional studies; no meta-analyses or ran domized controlled trials were found. Work-related stress is a well-documented problem amongst doctors and if not addressed, may lead to burnout and mental health problems. This calls for the further development of interventional strategies and high level comparative trials leading to a more evidence-based approach to the management of doctors suffering from such psychological distress. Further studies are required to investigate the epidemiology of noise-induced hearing loss, nosocomial infections, skin-related disorders and work-related malignancies amongst doctors before a justifiable conclusion can be formed.

In addition to existing protocols, we suggest that the importance of sharps injuries prevention and the ergonomics of surgery are incorporated into the Intercollegiate Surgical Curriculum Programme (ISCP) syllabus of trainee surgeons.

Key points
  • Occupational illnesses are commonly reported amongst UK doctors with varying effects on different specialties.

  • Reported illnesses include stress, burnout, psychiatric illnesses, substance abuse, needle-stick injuries, musculoskeletal pain, noise-induced hearing loss, nosocomial infections and skin-related diseases.

  • The overall quality of evidence is low with most papers being cross-sectional studies. No meta-analyses or randomized controlled trials were found.

  • Further higher quality trials as well as studies investigating the epidemiology of noise-induced hearing loss, nosocomial infections, skin-related disorders and work-related malignancies are necessary.

Conflicts of interest

None declared.

Acknowledgements

Special thanks to Janet Bayliss, librarian at Ipswich Hospital Trust and Dr Melanie Carder, THOR Project manager, for their help with the data collection and literature search.

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