Doctors and their spouses speak: stress in medical practice

Personality Traits, Strategies of Coping with Stress and Psychophysical Wellbeing of Surgical and Non-Surgical Doctors in Poland

The aim of the study was to determine the personality traits, strategies of coping with stress and psychophysical wellbeing of surgical and non-surgical Polish doctors. The study used the following questionnaires and scales: the Resiliency Assessment Scale, the Type D Personality Scale, the Framingham Type A Scale, the Mini COPE—Coping Inventory and the Wellbeing Scale. Doctors performing surgical specialties were characterized by a significantly higher level of resilience components, a more frequent occurrence of the type B behaviour pattern and less frequent type D personality than doctors performing non-surgical specializations. The Mini COPE point values were comparable between surgical and non-surgical physicians. The sense of psychological wellbeing was higher in surgical specialists. The higher the values of the Optimistic approach to life and the ability to mobilize oneself in difficult situations, the lower the values of the Turning to religion domain and the higher the values of the Denial domain correlated with the performance of surgical specialization. Men performing surgical specializations were more often optimistic and inclined to consume alcohol, while women with non-surgical specialization more often coped with stress by turning to religion. We conclude that the personality traits of Polish doctors vary depending on their specialization. Physicians’ coping strategies do not differ depending on their specialization. The sense of mental wellbeing is higher in surgical specialists compared to non-surgical specialists. An optimistic approach to life and the ability to mobilize oneself in difficult situations, as well as coping with stress by denial are associated with the surgical specialization. Men performing surgical specialties more often declare optimism and a tendency to cope with stress by consuming alcohol or psychoactive substances, while women who perform non-surgical specializations more often cope with stress by turning to religion. Psychological screening tests and appropriate training, taking into account medical specialization, could be one way of improving resilience and coping with stress among doctors.

Plastic Surgeon???s Life: Marvelous for Mind, Exhausting for Body

Surgery is accepted as one of the most demanding professions that create both physical and mental strain on the performers. Therefore, the authors aimed to elucidate the mental burden of surgeons, which is dedicated to operative stress. They also tested the hypotheses that participating in surgery creates mental stress on surgeons that leads to cardiovascular changes, and that this stress is more pronounced for actual operators than for first assistants. The method chosen for this purpose was an analysis of heart rate variability. Twelve surgeons (five plastic surgery staff and seven plastic surgery residents) were monitored by a digital ambulatory Holter recorder on at least two occasions. Half of the recordings were carried out on operating days and the other half on office days. Heart rate variability indices (low frequency, high frequency, high frequency/low frequency ratio, and heart rate) were analyzed from those recordings using computerized research tool software. The heart rate variability indices of the operators showed statistically significant differences between operating days and office hours in favor of an increased sympathetic and decreased parasympathetic activity for the former. For first assistants, three of the parameters, with the exception of heart rate, changed in favor of a sympathetic predominance over parasympathetic activity; these changes were also statistically significant. These results showed a sympathetic hyperactivity for both operators and first assistants during the operations. When the sympathovagal balance of the actual operators was compared with that of assistants, the former group showed a more pronounced sympathetic arousal. This difference is accepted as a proof for the mental stress of the surgery being the main factor responsible for the sympathetic hyperactivity that we detected during the operations. Surgeons continuously face a unique mental strain that other professions rarely bring forth, and these psychological stressors are associated with alterations in cardiac autonomic control that may contribute to the development of cardiac disease. Prolonged sympathetic hyperactivity could anticipate cardiac discomfort in more experienced surgeons with marginal cardiac reserve. Such cardiac diseases would be reconsidered as occupation-related illnesses, which might be reimbursed to the physician. In addition, the legal responsibility of surgeons concerning their unfavorable results might be assessed with more understanding with a realization of their undue working conditions.

Surgeon, don't heal thyself: a study of the health of Australasian urologists

BACKGROUND

Modern surgical practice is stressful and anxiety-producing. We investigated urologists health and their attitude to their own health care.

METHODS

Two hundred and seventy-five Australasian urologists were surveyed to ascertain their attitudes to their physical and psychological health; 205 responses were received.

RESULTS

Ten per cent reported serious physical illnesses. Fewer than half had their own general practitioner (GP), and fewer than one-third had seen a doctor in the previous 12 months. A majority had, at some time, prescribed themselves medication, including antibiotics, narcotic and non-narcotic analgesia and benzodiazepams. Nearly all reported that aspects of their urological practice caused them anxiety. More felt that this anxiety was the result of pressures experienced outside the operating theatre than problems directly related to performing surgery. A small number of psychological problems were reported, and fewer than 10 per cent had ever a visited a psychiatrist. It was evident that most Australasian urologists were unwilling to discuss any psychological problems that they may have. Even when a specific problem had been identified, few sought the appropriate care.

CONCLUSIONS

It would be advantageous for Australasian urologists and doctors in general to see their GP more regularly, and be more willing to discuss any psychological difficulties that they may experience.

The stress of metropolitan general practice

OBJECTIVE

To identify the work-related stressors of Australian metropolitan general practitioners (GPs).

DESIGN AND SETTING

A descriptive postal survey of metropolitan GPs from all States and Territories selected at random from the Health Insurance Commission database.

PARTICIPANTS

296 of 464 GPs (64%) surveyed in June 1996; 67% were male; 87% worked full-time (more than 6 sessions per week).

MAIN OUTCOME MEASURES

Frequency and severity of work stressors in general practice; overall feelings of stress at work in the past 12 months; effects of the stressors on work satisfaction; contribution of work stress to overall life stress; responses to the 12-item General Health Questionnaire (GHQ) as potential correlates of occupational stress.

RESULTS

"Time pressure to see patients" was the most frequently reported stressor. Threat of litigation was perceived as the most severe stressor. Of the top 10 severe stressors, seven were also in the top 10 for stressor frequency. Work was the major stressor in GPs' lives. The GHQ scores did not correlate significantly with major stress outcome measures, but 12.8% of GPs had scores indicative of severe psychiatric disturbance. Fifty per cent of respondents had considered leaving their current workplace and 53% had considered abandoning general practice because of occupational stress. GPs working 6 or more sessions per week were more likely to be moderately or severely stressed than those working part-time (P< 0.02, Fisher's exact test). Those who had considered leaving their current workplace or careers were also more likely to be moderately or severely stressed (P< 0.0001, Fisher's exact test).

CONCLUSIONS

The most frequent and relatively severe stressful events in general practice involved time pressures. There are implications for government, which, through remuneration policies, might influence GPs to work at a rate beyond their capacity to cope. Strategies are required to manage or prevent stress in metropolitan GPs.

Occupational health in surgery: risks extend beyond the operating room

Surgeons routinely work with potentially infectious materials. The risk of acquiring a disease from one percutaneous exposure is 0.3-0.4% for human immunodeficiency virus (HIV) 6-30% for hepatitis B virus (HBV) and 2.7-10% for hepatitis C virus (HCV). Rates of blood contacts vary but may reach up to 11.9 per 100 h in the operating room. Residents are at highest risk, and obstetrics and gynaecology surgeons suffered the highest rate of exposures (10%) as a group. Contributing risk factors include trauma or emergency orthopaedic procedures, high patient blood loss, long procedures and holding tissue by hand while suturing. However, across occupations, nurses and other health workers experience greater risks than surgeons regarding potentially infectious exposures. Preventive measures such as the HBV vaccine and protective devices (i.e. self-capping needles, needle-free i.v. systems and improved barrier materials) have reduced the occupational risk of acquiring a blood-borne infection, which allows attention to be given to the psychosocial risks which may be more significant, yet are often overlooked. Doctors are at greater risk of divorce, alcoholism, substance abuse and suicide than are members of comparable professional groups. One study found that general surgeons had the highest rates of suicide of all doctors. According to family surveys, surgeons tend to be oblivious to the effects of work stressors, and may benefit from greater self-awareness; sharing of feelings and responsibilities with colleagues, family and patients; being willing to delegate work to others; setting work limits; and broadening perspectives in their approach to work.

Occupational stress and work satisfaction among Canadian women physicians

The present study examined relationships among occupational stress, job satisfaction, and various individual characteristics and job-related variables in a population of 303 women physicians. Analysis showed that time pressures and threat of malpractice litigation were sources of stress and that over-all satisfaction was related to satisfaction with both professional and social aspects of the job. Low satisfaction was related to wanting higher income, changes in practice procedures, and several stressors, such as time pressures. Stress and satisfaction were also related to attitudes toward health care. Women who experienced high stress and low satisfaction were more likely to have negative views of the functioning of the health care system. In addition, demographic and practice variables contributed to negative attitudes.

Occupational stress and job satisfaction among physicians: sex differences

The present study provides empirical findings from a national survey of physicians and addresses issues of sex differences in the nature of occupational stress experienced by physicians, and the sources of satisfaction in medical practice. Data were collected using questionnaires from 2584 physicians. The sample was randomly selected to represent physicians in all Canadian provinces. About 10% of the respondents were female. Measures included self-reports of stress and satisfaction, demographic variables, practice characteristics, and attitudes about health care. Major sources of stress indicated by female and male physicians were time pressures on the job, and major sources of satisfaction were relationships with patients and colleagues. Sex differences were found in terms of the specific variables that predicted job stress and satisfaction. However, for both women and men, various work setting variables positively predicted occupational stress and negatively predicted job satisfaction. Significant sex differences were present in both demographic and situational variables as well as measures of occupational stress and attitudes about health care. Correlations indicate that for both female and male physicians, high levels of occupational stress was associated with less satisfaction with medical practice and more negative attitudes about the medicare system and health care in general, and high job satisfaction was related to fewer specific work stressors and more positive attitudes about health care. Several methodological limitations necessitates caution in interpreting the findings. Nevertheless, the results may have some implications for future health care policies and procedures.

Sources of satisfaction and stress among Canadian physicians

This study examined major sources of stress identified by Canadian physicians and explored potential antecedents and consequences of self-reported stress. Data were collected from 2087 physicians using anonymously completed questionnaires. Of the sample 38% described medical practice as very or extremely stressful. Major sources of stress involved difficulties with patients and concerns about work-overload. Physicians reporting greater stress were less satisfied with the practice of medicine, had more negative attitudes about the quality of hospital and medical care, held more militant views and responses toward government, and saw physicians losing ground economically compared to other professions.