Even heroes are prone to burnout, particularly when their battles are ongoing, with little hope of resolution

The headline “Not all heroes wear capes” was commonly touted during the early months of the Covid-19 pandemic, referring to healthcare workers who put their lives at risk to look after a global population whose collective immune system had never before encountered this particular coronavirus.

In fact, there were lots of heroes – doctors, nurses, other health professionals, domestic staff, laboratory workers and patients – all trying to do their best in previously unimagined circumstances.

Most survived, but many did not, and some still carry the physical and psychological burdens of these experiences today, particularly in a health service which remains encumbered by long waiting lists, crowded emergency departments, staff shortages and operating theatre closures.

It is always important to acknowledge bravery, altruism, innovation and success. These characteristics give us hope and encouragement, a belief in the future, and inspire us towards greater achievements. In many ways, we need heroes – people we can admire, trust, emulate and depend upon.

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But heroes sometimes inhabit a special kind of hell, a world of perfectionism and isolation, unwilling to admit vulnerability or mistakes. If heroes are considered in some way superhuman, then they are also not-quite human, with apparently fewer physical and emotional needs, and, perhaps, less empathy for others.

Heroes are prone to burnout, particularly when their battles are ongoing, with little hope of resolution. The World Health Organisation recognises burnout (a triad of ongoing exhaustion, detachment and reduced professional achievement) as a consequence of work-related stress, where solutions involve changing the workplace environments rather than blaming the sufferers. Burnout is a significant problem in healthcare with rates of up to 80 per cent among doctors in some specialties. Studies in the US report approximately 400 physician suicides per year as a result of burnout, more than one per day on average.

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The Irish Medical Organisation undertook a survey in mid-winter 2020/2021 of doctors at all career stages, both community and hospital-based. Of 1,082 respondents, 90 per cent had experienced mental health difficulties related to or made worse by their work, with the majority keeping this information private because of fear of stigma. Almost 60 per cent did not have time to eat, drink or even use the toilet while at work.

A subsequent poll in the summer of 2023 by the Medical Protection Society resulted in 882 replies. More than 40 per cent of responding doctors experienced such severe exhaustion that they felt it impacted on patient safety and 36 per cent were unable to take normal breaks during their shifts.

One-third noted ongoing moral distress, a condition that occurs when there is a gap between the standard of care that needs to be delivered and the ability to do so in the context of resource deficiencies and/or staffing shortages.

Burnout has major consequences for our health service, most importantly impacting on patient safety. Mortality rates are higher for patients in the care of medical teams who show signs of burnout. The economic effects of burnout are reflected in the enormous costs of absenteeism, payment for locum or agency staff, as well as the vast medicolegal expenses for mistakes made by burnt-out workers. Unsupportive or uninspiring work environments find it difficult to retain staff whose skills are greatly valued in other parts of the world where healthcare facilities are more highly resourced and the opportunities for training are better supported.

Burnt-out staff are poor role models for younger healthcare professionals – it is important to see excellence in order to strive towards this goal. In turn, burnout leads to mediocrity as a method of survival, reducing personal potential and wasting the talents of the most valuable resource – our people. This alone is a tragedy for the Irish healthcare system and its place on the world stage of clinical care and medical research.

Burnout is both treatable and preventable.

Although advice tends to be focused on the person admitting to burnout, ongoing organisational solutions are imperative. If one individual on a team has recognisable burnout, it is likely that others are also silently affected. The known tenets of self-care, such as restorative sleep, a healthy diet, regular exercise, avoidance of harmful substances and a fulfilling social life, are well-vocalised, but typically poorly modelled by healthcare professionals, often a result of excessive work and training pressures that prevent them practising what they preach.

Within each organisation, big or small, wellbeing leadership is essential, with explicit emphasis on the health and wellbeing of all workers. This is more than the production of benign mission statements – it involves specific interventions with measurable outcomes. Regular evaluation of wellbeing at individual and team levels, upholding a commitment to scheduled breaks for all, and ensuring healthy food on site around the clock, are some simple approaches with major benefits. Active strategies to deal with bed shortages, infrastructural inadequacies and staffing issues need to be clearly and frequently communicated.

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Chief wellness officers, perhaps shared among institutions and community services, supported by a team with expertise in finance, career planning, coaching and psychology, and separate from HR, would be in an ideal position to guide policies and research, recommend change and advocate for improvements. Although data in Ireland is lacking, there is a wealth of information from other countries that could be easily translated to the Irish setting.

Burnout is not just about excessive workload. It is exacerbated by learned helplessness and is reduced by inexpensive interventions, including involvement in organisational change and the provision of time for collegiality and creative solutions to common problems. Burnout is dissipated by ensuring that each person has a purpose that is acknowledged and a voice that is heard.

The recognition that all healthcare workers have at least two essential roles – work-life and home-life – underpins the concept of wellness.

The creation of a hero status suggests that personal commitments are less important than professional achievements, a situation that for most is only temporarily sustainable and usually significantly depends on others outside the spotlight.

Heroes don’t require stethoscopes or capes, but everyone deserves to be treated as human.

• Prof Gaye Cunnane is clinical professor of rheumatology at Trinity College Dublin and St James’s Hospital, and outgoing director of health and wellbeing at the Royal College of Physicians of Ireland