Morbidity and early retirement among anaesthetists and other specialists

Chronic stress indicated by hair cortisol concentration in anaesthesiologists and its relationship to work experience and emotional intelligence: A cross-sectional biomarker and survey study

BACKGROUND

Anaesthesia is a stressful medical specialty. The reaction to stress is constituted by behavioural, psychological and physiological components. Chronic physiological stress can have negative consequences for health.

OBJECTIVES

First, we hypothesised that chronic physiological stress is higher for both beginning and late-career consultant anaesthesiologists. Second, we hypothesised that individuals high in emotional intelligence endure lower physiological stress.

DESIGN

Cross-sectional biomarker and survey study.

SETTING

Participants were recruited during the May 2019 annual meeting of the Dutch Anaesthesia Society.

PARTICIPANTS

Of the 1348 colleagues who attended the meeting, 184 (70 male/114 female) participated in the study. Of the study participants, 123 (67%) were consultant anaesthesiologists (52 male/71 female) and 61 (33%) were resident anaesthesiologists (18 male/43 female). Exclusion criteria were endocrine disorders and not having enough hair. Also, experience of a recent major life event led to exclusion from analysis of our hypotheses.

MAIN OUTCOME MEASURES

Chronic physiological stress was measured by hair cortisol concentration. Emotional intelligence was assessed using a validated Dutch version of the Trait Emotional Intelligence Questionnaire. As secondary measures, psychological sources of stress were assessed using validated Dutch versions of the home-work interference (SWING) and the effort-reward imbalance questionnaires.

RESULTS

In support of Hypothesis 1, hair cortisol concentration was highest among early and late-career consultant anaesthesiologists (quadratic effect: b = 45.5, SE = 16.1, t = 2.8, P = 0.006, R2 = 0.14). This nonlinear pattern was not mirrored by self-reported sources of psychological stress. Our results did not support Hypothesis 2; we found no evidence for a relationship between emotional intelligence and physiological stress.

CONCLUSION

In the early and later phases of an anaesthesiologist's career, physiological chronic stress is higher than in the middle of the career. However, this physiological response could not be explained from known sources of psychological stress. We discuss these findings against the background of key differences between physiological and psychological stress.

Stress levels of critical care doctors in India: A national survey

Background:

Doctors working in critical care units are prone to higher stress due to various factors such as higher mortality and morbidity, demanding service conditions and need for higher knowledge and technical skill.

Aim:

The aim was to evaluate the stress level and the causative stressors in doctors working in critical care units in India.

Materials and Methods:

A two modality questionnaire-based cross-sectional survey was conducted. In manual mode, randomly selected delegates attending the annual congress of Indian Society of Critical Care Medicine filled the questionnaire. In the electronic mode, the questionnaires were E-mailed to critical care doctors. These questionnaires were based on General Health Questionnaire-12 (GHQ-12). Completely filled 242 responses were utilized for comparative and correlation analysis.

Results:

Prevalence of moderate to severe stress level was 40% with a mean score of 2 on GHQ-12 scale. Too much responsibility at times and managing VIP patients ranked as the top two stressors studied, while the difficult relationship with colleagues and sexual harassment were the least. Intensivists were spending longest hours in the Intensive Care Unit (ICU) followed by pulmonologists and anesthetists. The mean number of ICU bed critical care doctors entrusted with was 13.2 ± 6.3. Substance abuse to relieve stress was reported as alcohol (21%), anxiolytic or antidepressants (18%) and smoking (14%).

Conclusion:

Despite the higher workload, stress levels measured in our survey in Indian critical care doctors were lower compared to International data. Substantiation of this data through a wider study and broad-based measures to improve the quality of critical care units and quality of the lives of these doctors is the need of the hour.

Risk and safety concerns in anesthesiology practice: The present perspective

Newer developments and advancements in anesthesiology, surgical, and medical fields have widened the functional scope of anesthesiologist thus increasing his professional responsibilities and obligations. While at workplace, anesthesiologist is exposed to a wide array of potential hazards that can be detrimental to his overall health. Numerous risks and safety concerns have been mentioned in the literature, but the magnitude of challenges in anesthesiology practice are far greater than those cited and anticipated. Many times these challenging situations are unavoidable and the attending anesthesiologist has to deal with them on an individual basis. These hazards not only affect the general health but can be extremely threatening in various other ways that can increase the potential risks of morbidity and mortality. This article is an attempt to bring a general awareness among anesthesia fraternity about the various health hazards associated with anesthesia practice. Also, a genuine attempt has been made to enumerate the various preventive methods and precautions that should be adopted to make practice of anesthesiology safe and smooth.

Increasing the Retirement Age in Intensive Care Medicine: Perception of the Effect on Patient Safety and Personal Health

The government has recently increased the retirement age and as a result doctors are going to have to work longer. Intensive care medicine is a demanding specialty with significant on-call commitment, and this paper looks at the potential ramifications of this policy change on patient safety and personal health of intensivists. All consultants working in Wales with sessions in intensive care medicine were asked to complete a survey to ascertain their opinion on whether increasing age would affect patient safety or their personal health. If asked to work beyond the age of 60, 80% of respondents thought that patient safety would be jeopardised and 67% of respondents felt their personal health would be affected. Twenty-seven respondents (43%) have had or currently have health problems linked with work, and this correlates with the intensity of the on-call (p<0.004). Intensivists have substantial concern about whether increasing the retirement age is a realistic proposition in this specialty. If a consultant feels that he or she is not providing safe care it is important that the problem can be raised and addressed with the full support of the employers and the profession, and without penalty.

Job burnout in 159 anesthesiology trainees

Background:

Anesthesiology may be stressful and most anesthesiologists develop mechanisms for coping. However, inexperienced trainee anesthesiologists seem to be vulnerable. We studied stress perception and job burnout in trainee anesthesiologists.

Methods:

Responses to perceived stress scale (PSS) and Maslach Burnout Inventory (MBI) were evaluated in 159 trainee anesthesiologists.

Results:

In our results, when perceived stress was increased, emotional exhaustion and depersonalization increased but personal accomplishment decreased, as expected. Perceived stress was very high in the early years of training. There was a negative correlation between age and emotional exhaustion and depersonalization, but positive correlation with personal accomplishment. Female anesthesiologists had higher personal accomplishment, but lower depersonalization points than male anesthesiologists in our study. There was no statistical association between marital status, PSS, and MBI; ≥2 children group had a significant high personal accomplishment but low depersonalization and emotional exhaustion scores. Line regression analysis showed a statistically significant relationship between PSS and emotional exhaustion and between age and depersonalization.

Conclusions:

Social factors such as gender and number of children affect the work life of our trainees.

Mitigating on-call symptoms through organizational justice and job control: a cross-sectional study among Finnish anesthesiologists

BACKGROUND

On-call duty has been shown to be associated with health problems among physicians. However, it cannot be abolished, as patient safety has to be assured. Thus, we need to find factors that could mitigate the negative health effects of on-call duty.

METHODS

The cross-sectional questionnaire of the buffering effects of organizational justice, job control, and social support on on-call stress symptoms was sent to all working Finnish anesthesiologists (n=550).

RESULTS

The response rate was 60% (n=328, 53% men). High organizational justice, job control, and social support were associated with a low number of symptoms while on call or the day after in crude analysis and when adjusted for age, gender, and place of work. Only the association between justice and symptoms was robust to additional adjustments for on-call burden and self-rated health. In the interaction analysis among those being on call at the hospital, we found that the higher the levels of job control or organizational justice, the lower the number of symptoms.

CONCLUSIONS

Job control and organizational justice successfully mitigated stress symptoms among those who had on-call hospital duties. It would be worth enhancing decision-making procedures, interpersonal treatment, and job control routines when aiming to prevent on-call stress and related symptoms.

Suicidality among Finnish anaesthesiologists

BACKGROUND

Suicide rates among physicians have constantly been reported to be higher than in the general population and anaesthesiologists appear to lead the suicide statistics among physicians.

METHODS

A cross-sectional questionnaire study was sent to all working Finnish anaesthesiologists (n=550) investigating their suicidality (ideation and/or planning and/or attempt). The response rate was 60%.

RESULTS

One in four had at some time seriously been thinking about suicide. Respondents with poor health (crude odds ratios 11.2 and 95% confidence interval 3.8-33.0), low social support (10.5, 4.0-27.9), and family problems (6.5, 3.4-12.5) had the highest risk of suicidality. The highest risks at work were conflicts with co-workers (4.1, 2.3-7.1) and superiors (2.1, 1.2-3.6), on-call-related stress symptoms (3.9, 1.9-8.3) and low organizational justice (1.9, 1.1-3.2). If a respondent had several risk factors, the risk of suicidality doubled with each cumulating factor.

CONCLUSIONS

The reported level of suicidal ideation among Finnish anaesthesiologists is worth concern. It should be of utmost importance to screen the risk factors and recognize suicidal physicians in order to help them. Interpersonal relationships, decision-making procedures, and on-call-burden should be focused on when aiming to prevent suicidality among physicians.

Comparison of Stress in Anaesthetic Trainees between Hong Kong and Victoria, Australia

A postal survey was sent to anaesthetic trainees in Hong Kong and Victoria, Australia to compare work-related stress levels. Demographic data were collected. Anaesthetist-specific stressors, Maslach Burnout Inventory and Global Job Satisfaction scores were used for psychological testing. The response rates from Hong Kong and Melbourne were 64 of 133 (48.1%) and 108 of 196 (55.1%), respectively. Victorian respondents were older with greater family commitments, but more advanced in fulfilling training requirements. Hong Kong respondents, being faced with both the challenge of dual College requirements, exhibited consistently higher indices of stress (P <0.001) and less job satisfaction (P <0.001). Common occupational stressors related to dealing with critically ill patients and medicolegal concerns. Higher stress scores observed in Hong Kong trainees related to service provision and a perceived lack of resources. Despite the complex nature of stress, its antecedents and manifestations, an inverse relationship between emotional exhaustion and job satisfaction was evident in correlation analysis (P <0.001). This survey suggests that stress was present in some trainees in both areas. Hong Kong trainees may benefit from local development to address mental wellbeing as being important to fulfil this highly competitive training program.

Crisis management during anaesthesia: recovering from a crisis

Preventing harm to the patient is the priority during a crisis. After a major incident, and especially when a patient has been harmed, there are a number of matters to be addressed: the ongoing care of the patient; documentation of the incident; investigation of the root causes; completion of reports; interviews with the patient and/or the next of kin, together with apologies and expression of regret; updates and ongoing support for friends and relatives; a word of thanks to the staff involved for their assistance; formal debriefing of staff for quality assurance and possibly ongoing support and a separate debriefing for psychological purposes; ensuring that the recommendations of the root cause analysis are carried out; or, failing that, that the issues are logged on a risk register. The extent and depth of the follow up protocol depends on what, if any, harm may have been done. This may constitute completion of an incident report; notification of an equipment failure to a federal regulatory authority; arranging consultations with a mental health professional to manage psychological sequelae (especially following an awareness episode); follow up during weeks of intensive care treatment; or, when a death has occurred, a full medico-legal and/or coronial set of procedures. A precis is appended in an action card format.

On-call stress among Finnish anaesthetists

We investigated on-call stress and its consequences among anaesthetists. A questionnaire was sent to all working Finnish anaesthetists (n = 550), with a response rate of 60%. Four categories of on-call workload and a sum variable of stress symptoms were formed. The anaesthetists had the greatest on-call workload among Finnish physicians. In our sample, 68% felt stressed during the study. The most important causes of stress were work and combining work with family. The study showed a positive correlation between stress symptoms and on-call workload (p = 0.009). Moderate burnout was present in 18%vs 45% (p = 0.008) and exhaustion in 32% and 68% (p = 0.015), in the lowest vs highest workload category, respectively. The symptoms were significantly associated with stress, gender, perceived sleep deprivation, suicidal tendencies and sick leave. Being frequently on call correlates with severe stress symptoms and these symptoms are associated with sick leave.

Anesthesiologists are living longer: mortality experience 1992 to 2001

STUDY OBJECTIVE

To determine whether there has been any recent change in the mortality experience of American anesthesiologists.

DESIGN

Retrospective analysis of obituary reports to the Physician Master File (PMF) of the American Medical Association.

MEASUREMENTS

Data were collected from the PMF of anesthesiologists and obstetricians. All data were identified from the PMF. A total of 1525 obituaries of anesthesiologists and 2773 obituaries of obstetricians during the study period, 1992 to 2001, were reviewed. Mean age of living or mean age at death of anesthesiologists and obstetricians, as well as age-adjusted death rates was calculated.

MAIN RESULTS

A gradual increase in age at death was noted from 1992 (65.30 +/- 15.61 years) to 2001 (78.13 +/- 12.89 years) for anesthesiologists (P < 0.005). There was a significant linear decrease from 4.3 deaths per thousand to 2.3 deaths per thousand for anesthesiologists in this same period.

CONCLUSIONS

We observed a significant increase in the average age at death and a decreased risk of death among anesthesiologists who died in the years 1992 to 2001. Parallel changes were observed in the control population of obstetricians.

Are anaesthetists prone to suicide? A review of rates and risk factors

Suicide represents a major source of mortality in Western countries. There is an emerging literature about suicide and the medical profession. The suicide of an anaesthetist represents a catastrophic event, with painful consequences for family, colleagues and the community at large. This review will examine the literature regarding suicide amongst anaesthetists and trainees in the field. It is presented in three sections. First, it provides an overview of existing epidemiological data, comparing rates in the general population, the medical profession, in general, and in anaesthesia, in particular. Second, risk factors that may account for differences in rates will be discussed. Finally, a series of recommendations has been formulated.

Stress in UK intensive care unit doctors

BACKGROUND

Doctors have long been considered at risk of occupational stress.

METHODS

A postal survey of all members of the Intensive Care Society using validated instruments.

RESULTS

Eight-five per cent of members returned questionnaires and 70% were eligible for the study. Twenty-nine per cent were suffering General Health Questionnaire-12 (GHQ-12) identified distress and 12% Symptom Checklist-Depression (SCL-D) defined depression. There were no significant age or sex differences between staff suffering distress or depression and those who did not. Dissatisfaction with career correlated highly with both distress and depression (P<0.01). Twenty doctors (3%) were bothered by suicidal thoughts. The most stressful aspects of work were bed allocation, being over-stretched, effect of hours of work and stress on personal/family life, and compromising standards when resources are short. Logistic regression revealed mental health problems were predicted by five stressors: 'lack of recognition of one's own contribution by others'; 'too much responsibility at times'; 'effect of stress on personal/family life'; 'keeping up to date with knowledge'; and 'making the right decision alone'.

CONCLUSIONS

Nearly one in three ICU doctors appeared distressed (GHQ), and one in 10 depressed (SCL-D); this is no greater than that reported in other specialities. Perceived stressors reveal some key areas of concern for the employer and the specialty.

Unpacking the burden: gender issues in anaesthesia

A survey carried out by the Australian Society of Anaesthetists explored gender issues in the personal and professional lives of anaesthetists. Issues highlighted include training and career paths, combining anaesthetic training with domestic responsibilities, personal relationships, pregnancy and childrearing, private practice, part-time work, parental leave, the single anaesthetist, doctor spouses, sexual harassment, and negative attitudes in colleagues. Particular problems were identified in the training years, in part-time work, in private practice, and in combining parental and domestic responsibilities with a career in anaesthesia. Strategies to address relevant issues are discussed, with reference to the increasing proportion of women in medicine and anaesthesia.

Occupational stress in anaesthesia

Anaesthetists, like most in the medical profession, often deny that they may be suffering from work-related stress. This article explores the sources and effects of occupational stress with suggestions for dealing with the stresses of our specialty.

The practice of anaesthesia--a stressor for the middle-aged?

Surveys conducted in the United Kingdom over the last few years have revealed decreased job satisfaction and increased anxiety and depression in both hospital specialists and general practitioners. Anaesthesia is perceived to be a stressful specialty and there is evidence, albeit patchy, that certain stress-associated conditions are more common in anaesthetists. The 'middle years' seem to be a danger period. The analogy between the work of anaesthetists and airline pilots is often drawn and the principles underlying the assessment and maintenance of pilot competence could be adopted in anaesthesia. While outcome studies are numerous much less attention has been paid to the structure and process of anaesthetic practice. Models for studying these aspects have been developed for investigating stress in general practitioners and doctors in training. Even minor degrees of professional impairment may place patients at risk and an investigation into the effects of the specialty on those who practise it is justified.

Survey of perceived stress and work demands of consultant doctors

OBJECTIVES

The objectives of this study were to assess the work demands as potential stressors of health service consultants, and to describe the development of tools for measuring stress experiences of consultants.

METHODS

A stratified random sample of 500 NHS consultants in Scotland was targeted by a postal questionnaire and 375 (75%) returned a valid response. They completed questionnaires, including information on demographic factors, work demands, occupational stressors, and burnout.

RESULTS

Principal components analysis showed that professional work demands of consultants fell into three categories: clinical, academic, and administrative. Their perceived stressors separated into four main factors: clinical responsibility, demands on time, organisational constraints, and personal confidence. These were assessed by 25 questions in the specialist doctors' stress inventory. Specific questions about perceived stressors which resulted in a high positive response included questions about demands on time, and organisational change in the NHS.

CONCLUSION

These self reported data characterise and measure the consultants' work demands and their role as potential stressors. These measurements could form the basis for strategies to reduce occupational stress in these workers.

Age-dependent haematological disturbances in anaesthetic personnel chronically exposed to high occupational concentrations of halothane and nitrous oxide

Anaesthetic staff chronically exposed to high occupational concentrations of halothane and nitrous oxide were tested for numerous haematological and cellular function parameters at the peak of the working season and after 3 weeks vacation. The analysis of data was performed to compare differences in subjects younger and older than the age of 40 years, respectively when compared with normal controls. The analysis revealed a higher recovery of erythrocyte count in the blood of older staff, and stronger disturbance of leucocyte formation in younger staff. In contrast, monocytes appeared to be more stable in the younger staff as were the T and B lymphocyte counts. After stimulation with PHA, Con A and PWM mitogens, lymphocytes from the older age group incorporated a significantly higher amount of tritiated thymidine, but stimulation indices did not differ. Natural killer cell numbers appeared equally affected; natural killer cell activity was unaffected, but there was an increase in activity in the younger staff after the vacation. Serum immunoglobulin concentrations tended to be more affected in older individuals at the peak of the working season.

Death on the table. Some thoughts on how to handle an anaesthetic-related death

This describes one way to handle the aftermath of anaesthetic catastrophe. The techniques of how to share bad news, interview relatives, complete official forms, deal with the legal process and debrief colleagues are outlined. It is hoped that this article will promote discussion on this topic and improve communication with all those affected by mishaps in the operating suite.

Mortality among male anaesthetists in the United Kingdom, 1957-83

A cohort of 3769 male anaesthetists resident in the United Kingdom between 1957 and 1983 was followed up for a total of 51,431 person years of observation. All subjects were fellows of the Faculty of Anaesthetists and held full registration with the General Medical Council. With all men in social class I being taken as the standard, the standardised mortality ratio among anaesthetists for all causes of death was 68 (95% confidence interval 59 to 77) and the standardised mortality ratio for all cancers was 50 (95% confidence interval 36 to 67). There was no significant excess mortality from lymphomas or leukaemias, but 16 of the 221 deaths in anaesthetists were due to suicide, giving a standardised mortality ratio of 202 (95% confidence interval 115 to 328). When anaesthetists were compared with all doctors the standardised mortality ratio for suicide was only 114, a nonsignificant excess. These findings confirm that the risk of suicide among anaesthetists is twice as high as among other men in social class I but suggest that the risk does not differ significantly from that among doctors as a whole. There was no evidence of a significant excess risk of cancer, and, in particular, the small excess of cancer of the pancreas reported previously could not be confirmed.