Doctors’ moral distress: NHS impact

As reported by GP online, over three-quarters of UK GPs face moral distress, impacting mental health and professional practice, with 40% contemplating leaving due to NHS challenges and the cost-of-living crisis, reveals MDDUS survey

A BMA report in 2021 defined moral distress as the ‘psychological unease generated where professionals identify an ethically correct action to take but are constrained in their ability to take that action’. This could be due to factors including insufficient staff, resources, or time, the report said.

Of those doctors experiencing moral distress 83% said it was due to the current challenges in the NHS and 65% said the cost-of-living crisis was a contributing factor.

The MDDUS poll found that the moral distress doctors are experiencing could have a significant impact on retention. Some 40% said they had considered leaving the medical profession or retiring early as a direct result of the impact it was having.

Doctors experiencing moral distress reported feeling unhappy at work, trouble sleeping at night, and having more arguments with friends and family. The vast majority of these – 81% – said that their unhappiness at work was affecting their mental health and three-quarters said they were concerned this could impact on their ability to practise safely.

GPs responding to the poll said that increasing numbers of patients were presenting with conditions as a direct result of the cost-of-living crisis, including severe psychological problems and illnesses that would be preventable through better diet and living conditions.

Some 14% of doctors said they had seen an increase in cases of scurvy and 76% had seen an increase in severe mental health problems.

Cost-of-living crisis

The poll found that the impact of the cost-of-living crisis on children’s health was particularly affecting doctors. One doctor said that had patients living in ‘inappropriate housing that was unsanitary and unsafe for a toddler’. Another described ‘unkempt children with poor fitting shoes causing blistering and sores’.

MDDUS chief medical officer Dr John Holden said the poll painted ‘an alarming picture’ of the impact moral distress was having on doctors’ professional practice and emotional wellbeing.

He said: ‘Being a doctor can, and should, be one of the most fulfilling jobs in the world. But right now, the scale of the pressure on the healthcare system is preventing doctors from being able to care for their patients the way they want to.

‘The results reveal the full extent of the psychological damage a worryingly large number of doctors experience because of problems they encounter in their working lives that they feel powerless to fix.

‘The range of issues doctors face as a byproduct of their moral distress is extensive, including anger, sadness, insomnia, relationship difficulties and more. And what’s most concerning is how this can impact doctors’ safe practice.

‘The emotional toll of moral distress should not be downplayed, as it has the capability to erode the morale and resilience in already overburdened doctors.’