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New rehabilitation model is being tested for clinicians with fatigue syndrome

New rehabilitation model is being tested for clinicians with fatigue syndrome

“Now that we’ve heard each other’s stories, it’s very clear that this is a mistake in the national system,” says a participant in the rehabilitation boarding school. Photo: Stefan Estasi

Seven doctors sit around a table at the Högbo mill hotel in Gästrikland. Outside, the birch has received its first leaves and the sun is shining over the old working environment. Spring is in full swing.

But for the Seven Doctors, life is a struggle now.

The group includes senior physicians with many years in the profession, specialists in ear, nose and throat, cardiology, internal medicine, radiology and psychiatry, an ST physician in general medicine and an assistant physician prior to AT. There are five women and one man. They had all been on sick leave for about a year and had been diagnosed with fatigue syndrome.

In September last year, the government commissioned Karolinska Institutet to investigate whether multimodal rehabilitation in boarding school could be used to increase the return to work of fatigue syndrome nurses and doctors.

Full-time therapy lasts for three weeks and consists of 50 percent physical exercise, including the support of a physical therapist. The second part is group discussion groups, one-on-one conversations with a psychologist, brain training and lectures on, among other things, diet and lifestyle. The conversations are solution-oriented and based on the participants’ work experiences.

The rehabilitation method has previously been tested on teachers.

“We’ve done well with teachers and hopefully with doctors and nurses as well,” says Åke Nygren, professor emeritus in personal injury prevention who is leading the pilot project with the rehabilitation model he developed with a psychiatrist.

The seven doctors are part of the first treatment group, which also consists of eight nurses. Åke Nygren found both of them and the control group through a registry he created at Afa Försäkringar.

Åke Nygren, Professor Emeritus of Personal Injury Prevention. Photo: Stefan Estasi

– We learn a lot about the problems of doctors. It’s not a psychological problem, but a workplace problem, says Aki Negrin, who also linked psychologist Bjorn Loveman and Emma Hackvist, an associate professor of occupational and environmental medicine.

Among other things, Emma Hagqvist conducts research on how psychosocial factors in the work environment affect health. In another ongoing study, it looks at the prevalence of mental illness among Swedish physicians, the causes of ill health and the social consequences of it.

– We have a good survey of what contributed to the doctors’ sick leave. Emma Hagqvist says most respond to large workloads.

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Difficulties in combining professional and private life and moral pressures are another common answer. It is common for doctors to “buffer” by, for example, reducing working hours.

Only 46 percent of GPs work full time. The corresponding figure for hospital doctors is 71 percent. At the same time, 60 percent of everyone thinks they need to work one to several days a week to catch up with their job, says Emma Hackvist.

Another thing that stands out is the shame of doctors who get sick.

17% of physicians who are on sick leave due to mental illness say they believe their colleagues will treat them with less respect when they return from work.

The seven doctors seated around the table in the Mill Hotel have commissioned them to narrate their experiences. Nobody wants to give their name. They say the stigma is too great.

Everyone is getting sick for the same main reason: an unreasonably heavy workload.

– Now that we have heard each other’s stories, it is clearly a mistake in the national system. Although we’ve come from Norrbotten to Skåne and from all disciplines, everyone has had equally strange stories, says a psychiatrist who recently started working part-time again.

She completes:

It was too certain and partly healing for me to hear the stories of the other stories. It gives insight that it’s not my fault. It is not my clinic or my region that is at fault.

During the three weeks in the Högbo mill, they dared for the first time in earnest to open up to their other colleagues. Which is also what they believe was the most valuable.

– It’s the first time in ten years that I’ve spoken to people who understand anyone. This is not what doctors talk about otherwise. It’s a taboo, says a dual specialist who was on long-term sick leave for the first time in just over ten years and was on sick leave again at the beginning of last year.

She does not believe that doctors’ work environment is given enough priority by employers.

Feeling like it’s not a priority is one of the big reasons we’re exhausted at work.

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All participants describe how they themselves took the blame for not having time, feeling ashamed and not daring to entrust themselves to their colleagues or ask for help. Instead, they worked overtime in secret, lost time to get fit, slept through work weeks and stopped training and meeting friends.

We are all trained in nursing and know how to take care of ourselves. But what happens is you’re cutting important pieces that give you the flexibility to catch up on the job, says the psychiatrist.

The experience is also the same when it comes to illness. They initially developed various physical symptoms such as headaches, trouble sleeping and stomach ulcers, which they either ignored or treated themselves.

I feel ashamed that I ignored them. One specialist says it’s like I’ve abused myself.

She had such severe daily headaches that she had to take medications and vomit every morning before work.

– However, I never thought that I should go home and rest. If a patient had come and told me this, I would have thought it might be a brain tumor. But I myself did not have time to check it.

Then came the cognitive and mental symptoms, from which it was difficult to close your eyes.

One in the group said she forgot so many words she could barely speak, another was a hair’s breadth from driving over E4 in the wrong direction and was finally accepted urgently during the shift.

– On the Hia tour, I suddenly did not understand what I was reading. On the way to the patient, I fainted in the corridor and was admitted to the Hia myself.

Some in the group believe they have had good support since they were listed on the sick list. Others say they were basically left completely alone. Many also testify about the difficult battles and incomprehensible officials of the Swedish Social Insurance Agency, which made recovery difficult.

They describe the three weeks as free zone. All participants bring with them three concrete things that they must change in their work situation. They have also started a chat group to support each other. At the same time, there is a marked fear of returning to everyday life.

– I’m thinking of throwing in the towel, because I don’t see it possible to get better working conditions, says one of the doctors.

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After one month, six months, and one year, both participants and the control group are followed up. If the rehabilitation model works, Åke Nygren and Emma Hagqvist hope it will become permanent.

Emma Hackvist. Photo: Stefan Estasi

We would like to have a place of rehabilitation where we can have frequent groups of health and medical workers. Emma Haggqvist says it’s found in many other countries, but not in Sweden.

But Åke Nygren has a bigger goal, too. He wants to see private insurance for doctors and other at-risk professions. He is convinced that this will lead to a better structure and provide an incentive to provide assistance at an early stage. One method could be to measure physicians’ stress levels, psychosocial mood, and risk of sick leave during regular medical check-ups and take measures if necessary.

– Swedish health care and Swedish social insurance do not have time to deal with this in the right way. Therefore, it must be financed by private insurance that catches the groups that have the most problems in time.

Final report next year

  • The pilot study will be designed so that it will be possible to see if the model leads to more doctors and nurses who are on long-term sick leave due to fatigue syndrome to be able to start working again.
  • Åke Nygren and his research group also have plans to test the model on doctors and nurses who have been on sick leave for a short period, ranging from one to two months.
  • The rehabilitation method has previously been tested on teachers. After one year, the average recruitment rate for the treatment group was 74 percent, compared with 58 percent for the control group. After three years, 81.5 percent in the treatment group returned to work and 71.9 percent in the control group.
  • In January next year, a final report will be submitted to government offices.

The researchers are currently recruiting doctors for the next round of rehabilitation; Interested parties can contact [email protected]