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He G, Ren J, Chen X, Pan Q, Pan T. GP's GP, general practitioner's health and willingness to contract family doctors in China: a national cross-sectional study. BMC PRIMARY CARE 2024; 25:253. [PMID: 38997659 PMCID: PMC11245823 DOI: 10.1186/s12875-024-02492-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 06/26/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVES General practitioners are trained to care for patients with a high level of responsibility and professional competency. However, there are few reports on the physical and mental health status of general practitioners (GPs) in China, particularly regarding help seeking and self-treatment. The primary aims of this study were to explore GPs' expectations of their own family doctors and their reflection on role positioning, and to explore the objective factors that hinder the system of family doctors. STUDY DESIGN Cross-sectional study. METHODS We conducted an online survey of Chinese GPs. Descriptive statistics were used to summarize the findings. RESULTS More than half of the participants (57.20%) reported that their health was normal over the past year. A total of 420 participants (23.35%) reported having chronic diseases. For sleep duration, 1205 participants (66.98%) reported sleeping 6-8 h per day; 473 participants (26.29%) reported chronic insomnia. Two hundred thirty-one participants (12.84%) had possible depression. A total of 595 (33.07%) participants reported that they had contracted a fixed family doctor. In terms of preventing themselves from contracting for a family doctor, the following factors were identified: lack of sufficient time (54.81%), could solve obstacles themselves (50.97%), and embarrassment (24.24%). The proportion of the contract group (12.44%) taking personal relationship as a consideration was higher than that of the non-contract group (7.64%) (χ2 = 10.934 P = 0.01). Most participants (79.90%) in the non-signed group reported never having seen a family doctor. In terms of obstacles, more than half of the signed group thought that they could solve obstacles themselves, while the non-signed group (39.20%) was less confident in the ability of family doctors than the signed group (29.75%) (χ2 = 15.436, P < 0.01). CONCLUSIONS GPs work under great pressure and lack of self-care awareness, resulting in an increased prevalence of health conditions. Most GPs did not have a regular family doctor. Having a family doctor with a fixed contract is more conducive to the scientific management of their health and provides a reasonable solution to health problems. The main factors hindering GPs from choosing a family doctor were time consumption, abilities to solve obstacles themselves, and trust in the abilities of GPs. Therefore, simplifying the process of family doctor visits, Changing the GPs' medical cognition, and strengthening the policy of GP training would be conducive to promoting a family doctor system that enhances hierarchical diagnosis and treatment. International collaboration could integrate GP health support into global healthcare system.
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Affiliation(s)
- Guoshu He
- Department of General Practice, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China
| | - Jingjing Ren
- Department of General Practice, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China.
| | - Xiaoyang Chen
- Department of General Practice, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China
| | - Qi Pan
- Department of General Practice, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China
| | - Tianyuan Pan
- Department of General Practice, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China
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Albawardi IM, Abdullah LAA, Alzouri FS, Aldar HM, Al-Shiban MA, AlBakr DM, AlMusailhi JA, AlSaidan SM, Sonbaa AM. Self-prescription with psychotropic medications by healthcare professionals working at mental health institutions in Saudi Arabia. J Family Community Med 2024; 31:230-236. [PMID: 39176011 PMCID: PMC11338394 DOI: 10.4103/jfcm.jfcm_1_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Healthcare professionals who work in mental health institutions are more exposed to psychotropic medications than those in other healthcare institutions and are, therefore, more likely to self-prescribe. Self-prescription is a concerning phenomenon because of the potential for medication misuse, drug interaction, addiction, and other social, physical, and psychological consequences. This study investigated the prevalence of self-prescription of psychotropic medications and the most common self-prescribed psychotropic medications by healthcare professionals in mental health institutions in Saudi Arabia. It also aimed to determine the possible side effects and factors associated with self-prescription of psychotropic medications. MATERIALS AND METHODS This was a cross-sectional study using an electronic survey consisting of a researcher-designed checklist, targeting healthcare professionals in mental health institutions in Saudi Arabia. The independent variables were sex, nationality, occupation, place of residence, place of work, previous diagnosis of mental illness, marital, and living status. Data were analyzed, using SPSS, and frequency distribution and percentages were calculated. Chi-square test was employed to determine association between self-prescription and various independent variables. RESULTS The final sample size was 588; 9.5% healthcare professionals working at mental health institutions in Saudi Arabia admitted to self-prescription with psychotropic medications. Almost half of those who admitted to self-prescription (48.2%) and about 1/4 (23.2%) self-prescribed selective serotonin reuptake inhibitors and benzodiazepines, respectively. The most commonly reported side effects of self-prescription were gastrointestinal symptoms and drowsiness. The study also suggested that males were significantly more prone to self-prescribing than females (P < 0.001). CONCLUSION To our knowledge, this is the first study in Saudi Arabia to assess the self-prescription of psychotropic medications by healthcare professionals at mental health institutions. This study is important for decision-makers in their planning and updating of prescription policies. It is also equally important to spread awareness among healthcare professionals about the consequences of self-prescription.
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Affiliation(s)
- Ibrahim M. Albawardi
- Department of Psychiatry, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Fatimah S. Alzouri
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hawra M. Aldar
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Manar A. Al-Shiban
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Dalal M. AlBakr
- Department of Psychiatry, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jawaher A. AlMusailhi
- Department of Psychiatry, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saleh M. AlSaidan
- Department of Psychiatry, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ali M. Sonbaa
- Department of Psychiatry, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Li Q, Wu J, Chen Z, Wang J, Gong Y, Yin X. Prevalence of self-medication with antibiotics and its related factors among the general public and health professionals during the COVID-19 pandemic: A cross-sectional study in China. Am J Infect Control 2024; 52:759-764. [PMID: 38401644 DOI: 10.1016/j.ajic.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Self-medication with antibiotics (SMA) is a common public health concern. This study aimed to assess the prevalence of SMA in the general public and health professionals during the COVID-19 pandemic and identify the associated factors. METHODS A cross-sectional study was conducted from October 28, 2022, to November 6, 2022. Logistics regression analysis was used to examine the associated factors. RESULTS The rate of SMA was 10.25% in the general public and 12.69% in health professionals. For the public, those who perceived themselves as average or good health, had moderate antibiotic knowledge, and had easy access to nearby health facilities were less likely to SMA; while those who live in rural areas, found it easy to purchase antibiotics without prescriptions, and those who frequently encountered antibiotics recommended by pharmacy staff were more likely to SMA. For health professionals, those who were female, perceived themselves as good health, had moderate or high antibiotic knowledge, and had easy access to health facilities were less likely to SMA; while those who found it easy to purchase antibiotics without prescriptions were more likely to SMA. CONCLUSIONS SMA is prevalent in both the general public and health professionals. Promoting the rational use of antibiotics requires joint participation and effort.
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Affiliation(s)
- Qinnan Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianxiong Wu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhenyuan Chen
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Mark Anderson D, Diris R, Montizaan R, Rees DI. The effects of becoming a physician on prescription drug use and mental health treatment. JOURNAL OF HEALTH ECONOMICS 2023; 91:102774. [PMID: 37451143 DOI: 10.1016/j.jhealeco.2023.102774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 07/18/2023]
Abstract
There is evidence that physicians disproportionately suffer from substance use disorder and mental health problems. It is not clear, however, whether these phenomena are causal. We use data on Dutch medical school applicants to examine the effects of becoming a physician on prescription drug use and the receipt of treatment from a mental health facility. Leveraging variation from lottery outcomes that determine admission into medical schools, we find that becoming a physician increases the use of antidepressants, anxiolytics, opioids, and sedatives. Increases in the use of antidepressants, anxiolytics, and sedatives are larger among female physicians than among their male counterparts.
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Affiliation(s)
- D Mark Anderson
- Department of Agricultural Economics and Economics, Montana State University, NBER, United States; IZA - Institute of Labor Economics, Bonn, Germany.
| | - Ron Diris
- Department of Economics, Leiden University, the Netherlands; IZA - Institute of Labor Economics, Bonn, Germany
| | - Raymond Montizaan
- Research Centre for Education and the Labour Market, Maastricht University, the Netherlands; IZA - Institute of Labor Economics, Bonn, Germany
| | - Daniel I Rees
- Department of Economics, Universidad Carlos III de Madrid, Spain
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Lillqvist J, Sommar JN, Gustafsson PE, Glader EL, Hamberg K, Rolandsson O. Are doctors using more preventive medication for cardiovascular disease? A Swedish cross-sectional study. Scand J Prim Health Care 2023; 41:297-305. [PMID: 37467115 PMCID: PMC10478618 DOI: 10.1080/02813432.2023.2234439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/05/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Despite decreasing mortality from cardiovascular disease (CVD), there are persistent inequities in mortality between socioeconomic groups. Primary preventative medications reduce mortality in CVD; thus, inequitable treatments will contribute to unequal outcomes. Physicians might contribute to inequality by prescribing preventative medication for CVD to themselves in a biased manner. AIM To determine whether primary medications for preventing CVD were prescribed inequitably between physicians and non-physicians. DESIGN AND SETTING This retrospective study retrieved registry data on prescribed medications for all physicians in Sweden aged 45-74 years, during 2013, and for reference non-physician individuals, matched by sex, age, residence, and level of education. The outcome was any medication for preventing CVD, received at least once during 2013. METHOD Age and the sex-specific prevalence of myocardial infarction (MI) among physicians and non-physicians were used as a proxy for the need for medication. Thereafter, to limit the analysis to preventative medication, we excluded individuals that were diagnosed with CVD or diabetes. To analyse differences in medication usage between physicians and matched non-physicians, we estimated odds ratios (ORs) with conditional logistic regression and adjusted for need and household income. RESULTS MI prevalences were 5.7% for men and 2.3% for women, among physicians, and 5.4% for men and 1.8% for women, among non-physicians. We included 25,105 physicians and 44,366 non-physicians. The OR for physicians receiving any CVD preventative medication, compared to non-physicians, was 1.65 (95% confidence interval 1.59-1.72). CONCLUSION We found an inequity in prescribed preventative CVD medications, which favoured physicians over non-physicians.
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Affiliation(s)
- Joel Lillqvist
- Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Johan N. Sommar
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umea, Sweden
| | - Per E. Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Umea, Sweden
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umea, Sweden
| | - Katarina Hamberg
- Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Olov Rolandsson
- Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
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Jonsson P, Christiansen F, Brulin E. The association between self-treatment and mental health among Swedish physicians. Occup Med (Lond) 2023; 73:243-248. [PMID: 37210591 PMCID: PMC10292679 DOI: 10.1093/occmed/kqad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Despite a high prevalence of mental health problems among physicians, the rate of help-seeking behaviour is low. Instead, physicians tend to self-treat. This can have a negative impact on individual physicians and society. AIMS The aim was to explore the relationship between self-rated depression, the use of psychotropic medication, and the extent of self-treatment across gender and hierarchical position among Swedish physicians. In addition, the aim was to investigate whether social support can buffer against self-treatment. METHODS This study draws on data from the Longitudinal Occupational Health for Health Care in Sweden 2021 study, comprising a representative sample of physicians. Descriptive statistics and logistic regressions were carried out. RESULTS The present study showed that approximately 60% of the physicians using narcotic or non-narcotic psychotropic medication were self-prescribing. Male and more senior physicians self-treated to a greater extent. Physicians without depression were self-treating to a greater extent than those with depression. Those who used non-narcotic psychotropic medication intermittently were more likely to self-treat than those who used these medications regularly. The frequency of use was insignificant in relation to self-treatment with narcotic psychotropic medication. No buffering effect from social support at work was found. CONCLUSIONS Self-treatment was common among physicians in Sweden, particularly among those who reported mild or no symptoms of depression. This may have negative long-term effects on an individual level and for Swedish health care at large.
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Affiliation(s)
- P Jonsson
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm 113 65, Sweden
| | - F Christiansen
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm 113 65, Sweden
| | - E Brulin
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm 113 65, Sweden
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Siraj EA, Yayehrad AT, Kassaw AT, Kassahun D, Solomon E, Abdela H, Gizachew G, Awoke E. Self-Medication Prevalence and Factors Associated with Knowledge and Attitude Towards Self-Medication Among Undergraduate Health Science Students at GAMBY Medical and Business College, Bahir Dar, Ethiopia. Patient Prefer Adherence 2022; 16:3157-3172. [PMID: 36506105 PMCID: PMC9733564 DOI: 10.2147/ppa.s390058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background Reports indicate that health science students are among the frontline of self-medication practitioners. The main objective of this study was to evaluate the self-medication (SM) practice and associated factors with knowledge and attitude of undergraduate health science students at GAMBY Medical and Business College, Bahir Dar, Ethiopia. Methods An institutional-based cross-sectional quantitative study was conducted using a self-administered questionnaire from May to July, 2022. A stratified random sampling method was applied to collect the data. The collected data were checked, and exported into SPSS 26. Descriptive statistics and regression analysis were performed to determine the results and the associated factors. Variables with p < 0.05 were regarded as significant. Results 301 students (31 medicine, 163 pharmacy, and 107 medical laboratory students) responded (99% response rate). 68.1% of the respondents had practiced SM at least once within the last six months. 58.8% had good knowledge, while 55.5% have a positive attitude towards SM. Headache (33.7%) and cough (29.8%) were the primary disease conditions for SM. Analgesics (37.1%) and antimicrobials (29.8%) are most frequently self-consumed agents. Being a medicine student (AOR = 3.872; 95% CI: (1.263-11.866); p = 0.018), not having health insurance (AOR = 2.431; 95% CI: (1.383-4.274); p = 0.002), and not having a known medical illness (AOR = 2.241; 95% CI: (1.226-4.127); p = 0.010) were independently associated with good knowledge. While, living in an urban area was significantly associated with a positive attitude (AOR = 3.593; 95% CI: (1.404-9.197); p = 0.004). Conclusion The SM rate in GAMBY is significantly higher. Besides, not more than half the students had acceptable knowledge and attitude towards SM. The college and the surrounding regulatory authorities should consider ways of controlling and recapitalizing SM practices by the students.
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Affiliation(s)
- Ebrahim Abdela Siraj
- Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, North-West Ethiopia
| | - Ashagrachew Tewabe Yayehrad
- Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, North-West Ethiopia
| | - Abebe Tarekegn Kassaw
- Department of Pharmacy, College of Medicine and Health Sciences, Woldia University, Woldia, North-East Ethiopia
| | - Dagmawit Kassahun
- Department of Pharmacy, Medical School, GAMBY Medical and Business College, Bahir Dar, North-West Ethiopia
| | - Eyerus Solomon
- Department of Pharmacy, Medical School, GAMBY Medical and Business College, Bahir Dar, North-West Ethiopia
| | - Hadra Abdela
- Department of Pharmacy, Medical School, GAMBY Medical and Business College, Bahir Dar, North-West Ethiopia
| | - Getasew Gizachew
- Department of Pharmacy, Medical School, GAMBY Medical and Business College, Bahir Dar, North-West Ethiopia
| | - Efrem Awoke
- Department of Pharmacy, Medical School, GAMBY Medical and Business College, Bahir Dar, North-West Ethiopia
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Amran MM, Kopit AB, Kranc HA, Peleg R. The prevalence, reasons and attitudes for the practice of informal medicine. BMC FAMILY PRACTICE 2021; 22:30. [PMID: 33535980 PMCID: PMC7860190 DOI: 10.1186/s12875-020-01362-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Informal medicine, entailing undocumented medical advice, has been described in diverse medical disciplines and geographical regions. We assessed the current prevalence and characteristics of informal medical consulting, the reasons physicians provide it, and their attitudes toward it. METHODS We conducted a survey among family physicians in Israel, a country with a national health insurance system. A questionnaire was emailed to all primary care physicians in the two largest HMOs in southern Israel. Fifteen questions addressed the prevalence, practice and attitudes to informal medical consulting. Ten questions assessed demographics and professional experience. RESULTS Of 143 respondents (mean age 41 years), 55% were women. Ninety-five percent of the respondents reported requesting informal medical consulting from other physicians. Fifty-four percent reported often providing informal consulting to family and friends; and an additional 27% reported doing so under exceptional circumstances. The main reasons given for informal consulting requests were availability and accessibility (81% of respondents), and not financial savings. Only 17.5% stated being in favor of informal consulting for family and friends. Only 11% expressed feeling satisfaction after providing such consultation; 49% expressed discomfort. Sixty-six percent thought a position paper on informal consulting to family and friends is needed. CONCLUSIONS Our survey of primary care physicians shows very frequent informal medical consulting, despite high dissatisfaction with such, and an interest in receiving guidelines on this practice.
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Affiliation(s)
- Menashe Meni Amran
- Maccabi Health Services, Tel Aviv, Israel.
- Ben Gurion University of the Negev, Be'er Sheva, Israel.
| | | | | | - Roni Peleg
- Ben Gurion University of the Negev, Be'er Sheva, Israel
- Clalit Health Services, Tel Aviv, Israel
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Braquehais MD, González-Irizar O, Nieva G, Mozo X, Llavayol E, Pujol T, Cruz CM, Heredia M, Valero S, Casas M, Bruguera E. Assessing high risk of suicide amongst physicians and nurses in treatment. Psychiatry Res 2020; 291:113237. [PMID: 32619824 DOI: 10.1016/j.psychres.2020.113237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 11/19/2022]
Abstract
Little is known about the suicidal behaviour of health professionals admitted to specialised programmes. This study aims to describe the factors associated with high risk of suicide (HRS) of physicians and nurses in treatment at the Galatea Care Programme. We conducted a retrospective naturalistic study with data from 1,214 electronic medical records of physicians and nurses working in Catalonia and in treatment at the Galatea Clinic during 2017 and 2018. HRS was registered in the medical record according to the screening criteria of the Catalonia Risk Suicide Code; 62.4% (n = 757) were physicians and 37.6% (n = 457) were nurses. HRS was identified in 5% physicians and 5.2% nurses. Patients who were in a relationship or were not on a sick leave were less likely to have HRS, whereas those with affective disorders were more likely to have HRS compared with those with anxiety disorders or substance use disorders. Patients with HRS were more likely to have concurrent mental disorders. Specialised treatment programmes for health professionals should regularly screen for suicide risk, especially amongst those having affective disorders, comorbid mental disorders or when their working and interpersonal life areas are impaired.
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Affiliation(s)
- Maria Dolores Braquehais
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Barcelona, Spain; Group of Psychiatry, Mental Health and Addictions, Vall Hebron Research Institute, Barcelona, Spain.
| | - Olga González-Irizar
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Barcelona, Spain.
| | - Gemma Nieva
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Barcelona, Spain; Group of Psychiatry, Mental Health and Addictions, Vall Hebron Research Institute, Barcelona, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron. Barcelona, Spain.
| | - Xulián Mozo
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Barcelona, Spain.
| | - Enric Llavayol
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Barcelona, Spain.
| | - Tània Pujol
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Barcelona, Spain.
| | - Cristo M Cruz
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Barcelona, Spain.
| | - Meritxell Heredia
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Barcelona, Spain.
| | - Sergi Valero
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Barcelona, Spain; Research Center and Memory Clinic, Fundació ACE, Insitut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Miquel Casas
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Barcelona, Spain; Group of Psychiatry, Mental Health and Addictions, Vall Hebron Research Institute, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Eugeni Bruguera
- Galatea Care Programme for Sick Health Professionals, Galatea Clinic, Barcelona, Spain; Group of Psychiatry, Mental Health and Addictions, Vall Hebron Research Institute, Barcelona, Spain; Department of Psychiatry, Hospital Universitari Vall d'Hebron. Barcelona, Spain.
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Zacay G, Hershkowitz Sikron F, Heymann AD. Israeli general practitioners’ dissatisfaction with their own primary healthcare. Occup Med (Lond) 2018. [DOI: 10.1093/occmed/kqy037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Galia Zacay
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
- Department of Family Medicine, Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
| | | | - Anthony David Heymann
- Department of Family Medicine, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
- Department of Family Medicine, Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel
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Alotaibi MN, Abdelhay O. Family physicians health-related absenteeism at the Al-Wazarat Healthcare Center. J Family Med Prim Care 2018; 7:823-827. [PMID: 30234061 PMCID: PMC6131990 DOI: 10.4103/jfmpc.jfmpc_42_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: In general, physicians and family physicians more specifically tend to treat themselves in an informal matter. The evidence suggests that family physicians have a tendency not to consult other physicians while they are sick and tend to self-treat. Health-related absenteeism among family physicians in primary care settings is an issue that needs to be addressed. Aim: The aim of this study is to identify the prevalence of health-related absenteeism among family physicians in Al-Wazarat Health Center and to investigate the medical causes associated with sickness absence. Methods: The study used cross-sectional design to investigate the prevalence of health-related absenteeism among family physicians in a primary care setting. Results: The study included 108 physicians from the Al-Wazarat Healthcare Center in Riyadh, KSA. On average, the physicians were absent for 2 days over the last year with 53.3% (64/108) have no health-related absence days. The most common recorded reasons for work absence are the severity of illness 75.0% (81/108) and workload 63.0% (68/108). Influenza was the most common health condition that causes absenteeism 60.2% (65/108). The attitude toward working while ill scored 2.3 ± 2.5, being responsible for affecting the patients if working while ill 8.0 ± 2.8, physicians with chronic diseases should stay away from work 3.7 ± 3.7, and the quality of healthcare service could be affected by the physician's illness 7.5 ± 2.5. Conclusions: Further investigations are needed for more understanding of the physicians’ tendencies and casual approach toward working with illness. Such understanding will help to formulate better guidelines for medical practices.
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Affiliation(s)
- Meshari Nawar Alotaibi
- Department of Family and Community Medicine, Family Physicians Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Osama Abdelhay
- Department of Family and Community Medicine, Medical Statistics and Epidemiology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Topor G, Grosu IA, Ghiciuc CM, Strat AL, Lupuşoru CE. Awareness about antibiotic resistance in a self-medication user group from Eastern Romania: a pilot study. PeerJ 2017; 5:e3803. [PMID: 28924507 PMCID: PMC5600173 DOI: 10.7717/peerj.3803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/23/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Awareness about antibiotic resistance depends on the attitudes and information about antibiotic resistance of both patients and physicians. Persons who practice self-medication are at high risk of also self-medicating with antibiotics. The purpose of the present study was to evaluate the awareness about antibiotic resistance by investigating the practice in a group of self-medication users in a sample of adults in Romania and the variables associated with such practice. MATERIAL AND METHODS A cross-sectional self-filled questionnaire based study was conducted from December 2016 through January 2017 amongst 218 self-medication users (SMUG). The attitudes, the level of knowledge, the perceptions, about antibiotic use (ABU) and about antibiotic resistance (ABR) were compared to a reference group represented by medical residents group in their specialty training (MRG) considered to have a higher level of knowledge and awareness about ABU and ABR. RESULTS The response rate was 87.2% in the SMUG group and 100% in the MRG group. The SMUG group reported self-medication practices for antibiotics with a high frequency at any time in life (72%), but with a very low frequency from the month previous to the date of the study (12%), comparative with the MRG group (75% and 7%, respectively). The multivariate logistic regression analysis showed that self-medication with antibiotics at any time in life in the SMUG group could be predicted by the answers to two questions regarding the practices and knowledge about ABU (Q13 and Q20). On the other hand, in the MRG group, a question about ABR perception (Q23), could be predictor for self-medication with antibiotics. Self-medication with antibiotics in the month previous to the date of the study in the SMUG group could be predicted with three questions: one about ABU practice (Q14), one about ABR perception (Q26) and one referring to ABR knowledge (Q28). On the other hand, in the MRG group, a question about ABR knowledge (Q32) could be predictor for self-medication with antibiotics. The reduced awareness about ABR in the SMUG group, is revealed by the reduced number of subjects (38%), who did not know that missing an antibiotic dose during a medical treatment contributes to ABR, comparative with the MRG group (84%). Indirectly, low ABR awareness in the SMUG group is revealed by the confusion about the appropriate use of antibiotics in bacterial or viral infections (that antibiotics are not used against viruses). CONCLUSIONS The findings from our study on the awareness about antibiotic resistance in the SMUG group might help the policy makers and regulatory authorities to develop educational programs directed to change the perceptions and attitudes about the appropriate use of antibiotics in order to diminish self-medication practices with antibiotics.
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Affiliation(s)
- Gabi Topor
- Department of Pharmacology—Morphofunctional Sciences II, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
| | - Ionela-Alina Grosu
- Department of Pharmacology—Morphofunctional Sciences II, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
| | - Cristina Mihaela Ghiciuc
- Department of Pharmacology—Morphofunctional Sciences II, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
| | - Aurel Lulu Strat
- Department of Pharmacology—Morphofunctional Sciences II, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
- Laboratory of Microbiology, Hospital of Infectious Diseases Saint Parascheva, Iasi, Romania
| | - Cătălina Elena Lupuşoru
- Department of Pharmacology—Morphofunctional Sciences II, University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania
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Carvour ML, Ayyar BK, Chien KS, Ramirez NC, Yamamoto H. A Patient-Centered Approach to Postgraduate Trainee Health and Wellness: An Applied Review and Health Care Delivery Model. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1205-1210. [PMID: 27415444 DOI: 10.1097/acm.0000000000001301] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Attention to the health and wellness of postgraduate medical trainees has increased considerably in recent years, yet the scholarly literature consistently indicates that, in many instances, the medical and mental health care needs of this population remain unmet or only partially met. As a result, trainee health care often falls short of the current standards of the medical profession. Combined with the prevalence of burnout and other mental health conditions among trainees, inadequate health care for this patient population may result in significant negative consequences for trainees' health, safety, and performance.Here, the authors review the scholarly literature explicating the health care needs of postgraduate trainees. They explore the patient-centered medical home model as a potentially effective solution to address the unmet and partially met health care needs of trainees. The authors describe several practical interventions to improve access to care. These include care coordination and referral support, confidential care without perceived conflicts of interest in the training environment, co-location of medical and mental health care, and accommodations for schedule constraints. Finally, the authors explore the role of the medical home in developing and supporting broader institutional efforts to promote wellness.
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Affiliation(s)
- Martha L Carvour
- M.L. Carvour is an infectious diseases fellow, University of New Mexico, Albuquerque, New Mexico. When the idea in this Perspective was conceived and developed, she was a postdoctoral fellow, University of Texas Southwestern Medical Center, Dallas, Texas. B.K. Ayyar is an internal medicine resident, University of Texas Southwestern Medical Center, Dallas, Texas. K.S. Chien is an internal medicine resident, University of Texas Southwestern Medical Center, Dallas, Texas. N.C. Ramirez is a psychiatry resident, University of Texas Southwestern Medical Center, Dallas, Texas. H. Yamamoto is an internal medicine resident, University of Texas Southwestern Medical Center, Dallas, Texas
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Kumar R, Goyal A, Padhy BM, Gupta YK. Self-medication practice and factors influencing it among medical and paramedical students in India: A two-period comparative cross-sectional study. J Nat Sci Biol Med 2016; 7:143-8. [PMID: 27433064 PMCID: PMC4934103 DOI: 10.4103/0976-9668.184700] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: Self-medication is widely practiced with varying dimensions in India. This practice has many implications, especially among medical and paramedical students having some knowledge and good exposure to drugs. We conducted a two-period observational study to evaluate the change in knowledge and practice of self-medication, over 5 years of time period, among medical and paramedical students from different parts of India. Materials and Methods: A structured questionnaire was administered to medical (MBBS), dental (BDS), and paramedical students, who come to attend pan India annual cultural, literary, and sports event at New Delhi. The study was conducted in two phases (2007 and 2012) in different respondents of same categories (medical and paramedical) of students. Three-hundred and thirty students from 39 colleges in 2007 and 356 students from 38 colleges in 2012 participated in the study. Results: The prevalence of self-medication remained high in both 2007 and 2012 (74.6% and 69.4%), although no significant difference was observed between the two phases (P = 0.14%). Oral antibacterial agents, oral anti-inflammatory agents, and antipyretics were the most common group of drugs used in both phases of study. A significant increase was observed in number of students who took complete course of oral antibiotics (28.3-38.3%, P = 0.01). Conclusion: The prevalence of self-medication among undergraduate students remains unaltered over the span of 5 years. Nevertheless, there was a better sensitization toward appropriate antibiotic usage and the practice of responsible self-medication needs to be promoted among future healthcare providers.
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Affiliation(s)
- Ritesh Kumar
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Aman Goyal
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Biswa Mohan Padhy
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Yogendra Kumar Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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Saleem Z, Saeed H, Ahmad M, Yousaf M, Hassan HB, Javed A, Anees N, Maharjan S. Antibiotic Self-Prescribing Trends, Experiences and Attitudes in Upper Respiratory Tract Infection among Pharmacy and Non-Pharmacy Students: A Study from Lahore. PLoS One 2016; 11:e0149929. [PMID: 26919465 PMCID: PMC4769098 DOI: 10.1371/journal.pone.0149929] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/05/2016] [Indexed: 11/24/2022] Open
Abstract
Pharmacists are the custodians of drugs; hence their education, training, behaviors and experiences would affect the future use of drugs at community and hospital pharmacies. Therefore, we aimed at evaluating the self-prescribing antibiotic trends, knowledge and attitudes among pharmacy and non-pharmacy students. We found that pharmacy students had higher risks of experiencing URIs related symptoms such as cough (RR; 1.7, p = 0.002), allergy (RR; 2.07, p = 0.03) and running nose (RR; 3.17, p<0.005), compared to non-pharmacy students -resulting in higher probabilities of selecting cough syrups (OR; 2.3, p<0.005), anti-histamines (OR; 1.8, p = 0.036) and anti-inflammatory/anti-pyretic (OR; 2.4, p<0.005) drugs. Likewise, bachelor’s degree pupils (OR; 2, p = 0.045), urban area residents (OR; 2.44; p = 0.002) and pharmacy students (OR; 2.9, p<0.005) exhibited higher propensities of antibiotic self-use–notable classes include, b-lactams (45.9%) followed by macrolides (26.5%) and augmentin (28.94%), respectively. Surprisingly, pharmacy and non-pharmacy students had higher odds of using antibiotics in common cold (OR; 3.2, p<0.005) and pain (OR; 2.37, p = 0.015), respectively. Unlike non-pharmacy students, pharmacy students were likely to select alternative therapy, such as Joshanda (OR; 2.22, p = 0.011) and were well acquainted with antibiotic hazards, with 77% reduction in risk of antibiotics re-use. In conclusion, university students exhibited antibiotic self-prescribing trends in conditions that does not warrant their use, thus are irrational users. The pharmacy education confers very little benefit to rational self-prescribing practices among students, while non-pharmacy students are more vulnerable to repeated antibiotic usage. Thus, the educational and training modules should be designed for university students to disseminate targeted information regarding the potential hazards of antibiotic self-use and importance of consultation with qualified and registered medical doctor/pharmacist before starting with antibiotics.
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Affiliation(s)
- Zikria Saleem
- Clinical Pharmacy Section, University College of Pharmacy, University of the Punjab, AllamaIqbal Campus, 54000, Lahore, Pakistan
| | - Hamid Saeed
- Clinical Pharmacy Section, University College of Pharmacy, University of the Punjab, AllamaIqbal Campus, 54000, Lahore, Pakistan
- * E-mail:
| | - Mobasher Ahmad
- Clinical Pharmacy Section, University College of Pharmacy, University of the Punjab, AllamaIqbal Campus, 54000, Lahore, Pakistan
| | - Mahrukh Yousaf
- Clinical Pharmacy Section, University College of Pharmacy, University of the Punjab, AllamaIqbal Campus, 54000, Lahore, Pakistan
| | - Hafsa Binte Hassan
- Clinical Pharmacy Section, University College of Pharmacy, University of the Punjab, AllamaIqbal Campus, 54000, Lahore, Pakistan
| | - Ayesha Javed
- Clinical Pharmacy Section, University College of Pharmacy, University of the Punjab, AllamaIqbal Campus, 54000, Lahore, Pakistan
| | - Nida Anees
- Clinical Pharmacy Section, University College of Pharmacy, University of the Punjab, AllamaIqbal Campus, 54000, Lahore, Pakistan
| | - Sonu Maharjan
- Clinical Pharmacy Section, University College of Pharmacy, University of the Punjab, AllamaIqbal Campus, 54000, Lahore, Pakistan
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Chiu YL, Kao S, Lin HC, Tsai MC, Lee CZ. Healthcare Service Utilization for Practicing Physicians: A Population-Based Study. PLoS One 2016; 11:e0130690. [PMID: 26752592 PMCID: PMC4709064 DOI: 10.1371/journal.pone.0130690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/24/2015] [Indexed: 11/29/2022] Open
Abstract
Background Physicians are considered to be the most informed consumers in the use of medical services since they have more information about diseases or medical technology. However, although plenty of researchers have suggested that different medical seeking behavior exists among physicians, very few empirical studies have been conducted to investigate differences in medical utilization between physicians and the general population. Objective We explored differences in the utilization of healthcare services between physicians and the general population using a population-based dataset. Design A cross-sectional study. Participants Data for this study were sourced from the Taiwan Longitudinal Health Insurance Database 2000. We included 1426 physicians and 1426 sex- and age-matched comparison subjects. Methods We used Wilcoxon-Mann-Whitney tests to explore differences in variables of healthcare resource utilization between physicians and comparison subjects. We further used Kruskal-Wallis tests to examine differences in variables of healthcare resource utilization between physician practice location and comparison subjects. Results We found that physicians had significantly fewer outpatient visits (13.2 vs. 15.7, p<0.001) and significantly lower outpatient costs (US$477 vs. US$680, p<0.001) than comparison subjects. Furthermore, physicians had lower total health service costs than comparison subjects (US$643 vs. US$1066, p<0.001). This indicates that the mean total health service costs in the year 2010 was 1.66-fold greater for comparison subjects than for physicians. We also found that there were significant differences in the mean number of outpatient services (p<0.001), outpatient costs (p = 0.001), inpatients costs (p = 0.018), and total costs (p = 0.001) among office-based physicians, hospital-based physicians, and comparison subjects. Specifically, Scheffe contrast tests showed that office-based physicians had significantly more outpatient visits (19.3 vs.10.7, p<0.001) and significantly higher outpatient costs (US$656 vs. US$402, p<0.001) than hospital-based physicians. Conclusions Physicians had less healthcare utilization than comparison subjects. Furthermore, hospital-based physicians had higher inpatient costs and less outpatient services and costs than office-based physicians.
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Affiliation(s)
- Yu-Lung Chiu
- Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Senyong Kao
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Herng-Ching Lin
- Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Ming-Chieh Tsai
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
- Division of Gastroenterology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan
| | - Cha-Ze Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
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Alam N, Saffoon N, Uddin R. Self-medication among medical and pharmacy students in Bangladesh. BMC Res Notes 2015; 8:763. [PMID: 26652176 PMCID: PMC4675016 DOI: 10.1186/s13104-015-1737-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/24/2015] [Indexed: 11/17/2022] Open
Abstract
Background This cross-sectional survey examined the pattern of self-medication and factors associated with this practice among medical and pharmacy students in context to Bangladesh. Methods The study used a self-administered questionnaire. A total of 500; 250 medical and 250 pharmacy, students participated in the study. As it is a comparative analysis between the medical and pharmacy students, we used independent t test and Chi square test. Results The findings indicated that the impact of self-medication is almost similar in medical and pharmacy students. It was found that medical students were more careful about getting advice from a physician or seeking professional help from some healthcare personnel. About the safety of self-medication pharmacy students were more aware than medical students were. The study also showed that female and younger medical or pharmacy students were more aware about self-medication. Conclusions The current study presents a comprehensive picture of self-medication in medical and pharmacy students in Bangladesh. It is clear from the findings that practice of self-medication is highly prevalent in medical and pharmacy students in the country. This may potentially increase misuse or irrational use of medicines.
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Affiliation(s)
- Naznin Alam
- Department of Business Administration (Statistics), Stamford University Bangladesh, Dhaka-1217, Bangladesh.
| | - Nadia Saffoon
- Marketing Division, Renata Limited, Dhaka-1216, Bangladesh.
| | - Riaz Uddin
- Department of Pharmacy, Stamford University Bangladesh, Dhaka-1217, Bangladesh.
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Tischler V. Dr Junkie. The Doctor Addict in Bulgakov's Morphine: What are the Lessons for Contemporary Medical Practice? THE JOURNAL OF MEDICAL HUMANITIES 2015; 36:359-68. [PMID: 24221860 PMCID: PMC4642586 DOI: 10.1007/s10912-013-9259-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Historical, cultural and professional factors have contributed to stigma and secrecy regarding addiction in the medical profession and there are calls to improve education in this area. This paper argues that physician-penned literature plays an important role in raising awareness of substance misuse in the medical profession. Bulgakov's short story Morphine documents the decline of Dr Polyakov and illustrates a number of salient professional issues such as self-medication, abuse of authority and risks to patients. Physician-penned literature such as Morphine is of value in medical education as it offers a route into sensitive topics and an authoritative and insider perspective that is attractive to students and physicians alike.
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Affiliation(s)
- Victoria Tischler
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK.
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MacDonald K, Sciolla AF, Folsom D, Bazzo D, Searles C, Moutier C, Thomas ML, Borton K, Norcross B. Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs. Gen Hosp Psychiatry 2015; 37:489-96. [PMID: 26554082 DOI: 10.1016/j.genhosppsych.2015.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The assessment and remediation of boundary-challenged healthcare professionals is enhanced through examination of individual risk factors. We assessed three such factors--attachment style, childhood trauma and maladaptive beliefs--in 100 attendees (mostly physicians) of a CME professional boundaries course. We propose a theoretical model which draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. METHODS We administered the Experiences in Close Relationship Questionnaire (ECR-R), Childhood Trauma Questionnaire (CTQ), and Young Schema Questionnaire (YSQ) to 100 healthcare professionals (mostly physicians) attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships among self- and expert ratings and between different risk factors were examined. RESULTS Five percent of participants reported CTQ total scores in the moderate to severe range; eleven percent reported moderate to severe emotional neglect or emotional abuse. Average attachment anxiety and attachment avoidance were low, and more than half of participants were rated “secure” by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. CONCLUSION Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.
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Mahmood JI, Grotmol KS, Tesli M, Vaglum P, Tyssen R. Risk Factors Measured During Medical School for Later Hazardous Drinking: A 10-year, Longitudinal, Nationwide Study (NORDOC). Alcohol Alcohol 2015; 51:71-6. [DOI: 10.1093/alcalc/agv059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/19/2015] [Indexed: 11/12/2022] Open
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Roberts LW, Kim JP. Informal health care practices of residents: "curbside" consultation and self-diagnosis and treatment. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:22-30. [PMID: 24923781 DOI: 10.1007/s40596-014-0170-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/12/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The authors explore the experiences of residents with respect to informal care related to personal health, including "curbside consultation," self-diagnosis, and self-prescription-self-care practices that run counter to ethical guidelines in medicine. METHODS Residents at one medical school completed a written survey regarding their personal health care practices, including their experiences in seeking or providing informal consultation, self-diagnosis, and self-prescribing. The authors obtained frequency data and analyzed responses via cross-tabulation. They used logistic regression models to assess the association of reported informal care practices and potential confounders, such as age, gender, and training program. RESULTS One hundred and fifty-five residents volunteered (71 % response rate). Most respondents had sought health care formally (70 %), and more had sought informal care in the previous 12 months (80 %). Of those who had pursued informal care, 90 % endorsed having requested a physical exam, a laboratory test, or a medication prescription from an attending, resident, or medical student. Respondents (28 %) commonly endorsed prescribing medication for themselves. Most respondents (90 %) reported being approached for informal care at least once in the previous year, including 84 % who were approached for prescriptions and 22 % who were approached by attending physicians. Main reasons endorsed for informal care seeking related to busy schedules and to cost and confidentiality advantages. Psychiatry residents reported using both formal and informal channels for personal health care, and 31 % acknowledged prescribing medications for themselves. CONCLUSIONS Informal care was a common practice among the residents in this study. Residents reported time constraints as the greatest influence on informal care seeking, rather than reasons found in previous studies related to cost and quality of care, protection of confidentiality, or prevention of embarrassment. The effects of informal care practices involving resident physicians warrant additional study.
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Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs. Gen Hosp Psychiatry 2015; 37:81-8. [PMID: 25440724 DOI: 10.1016/j.genhosppsych.2014.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 08/20/2014] [Accepted: 09/01/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The assessment and remediation of boundary-challenged health care professionals is enhanced through examination of individual risk factors. We assessed three such factors - attachment style, childhood trauma and maladaptive beliefs - in 100 attendees (mostly physicians) of a continuing medical education (CME) professional boundaries course. We propose a theoretical model that draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. METHODS We administered the Experiences in Close Relationships Questionnaire Revised (ECR-R), Childhood Trauma Questionnaire (CTQ) and Young Schema Questionnaire (YSQ) to 100 health care professionals attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships between self-ratings and expert ratings and among different risk factors were examined. RESULTS One fifth of participants reported moderate to severe childhood abuse; sixty percent reported moderate to severe emotional neglect. Despite this, average attachment anxiety and attachment avoidance were low, and more than half of participants were rated "secure" by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. CONCLUSIONS Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.
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Chiou SJ, Kung PT, Naessens JM, Huang KH, Chang YC, Wang YH, Tsai WC. Do physicians with diabetes have differences in dialysis use and survival than other patients with diabetes. Diabetes Res Clin Pract 2014; 105:382-90. [PMID: 25088403 DOI: 10.1016/j.diabres.2014.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/10/2014] [Accepted: 07/05/2014] [Indexed: 11/24/2022]
Abstract
AIMS To assess whether the increased knowledge and resources available to physicians led to differences in dialysis and survival rates between physicians and non-physician patients with diabetes. METHODS All newly diagnosed (1997-2009) type 2 diabetes patients aged ≥35 years from the National Health Insurance Program of Taiwan database were included. After propensity score matching (1:10), we estimated the relative risk of dialysis and death using Cox proportional hazards model adjusted for demographic characteristics and comorbidities. RESULTS Physicians with diabetes were more likely to start dialysis than general patients, with a 48% increased hazard risk (HR) (P=0.006). Physicians with diabetes had significantly lower risk of death (HR: 0.88; P=0.025). However, those requiring dialysis had a non-significant increased risk of death (HR: 1.19). There was an increased HR for death in older physicians (HR: 1.81; P<0.001) and those with cancer or catastrophic illness. The HR of dialysis (7.89; P<0.0001) increased dramatically with increasing Charlson Comorbidity Index scores. CONCLUSIONS Physicians with DM survived longer than other patients with diabetes, likely benefiting from their professional resources in disease control and prevention. Nonetheless, they displayed no advantage from their medical backgrounds compared with the general patients if they developed end stage renal disease.
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Affiliation(s)
- Shang-Jyh Chiou
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, No. 89, Nei-Chiang Street, Taipei 10845, Taiwan, ROC; Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung 41354, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung 41354, Taiwan, ROC
| | - James M Naessens
- Division of Health Care Policy and Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC
| | - Yu-Chia Chang
- Department of Healthcare Administration, Asia University, 500, Lioufeng Road, Wufeng, Taichung 41354, Taiwan, ROC
| | - Yueh-Hsin Wang
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, ROC.
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Estudo da automedicação para dor musculoesquelética entre estudantes dos cursos de enfermagem e medicina da Pontifícia Universidade Católica - São Paulo. REVISTA BRASILEIRA DE REUMATOLOGIA 2014. [DOI: 10.1016/j.rbr.2014.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Braquehais MD, Lusilla P, Bel MJ, Navarro MC, Nasillo V, Díaz A, Valero S, Padrós J, Bruguera E, Casas M. Dual diagnosis among physicians: a clinical perspective. J Dual Diagn 2014; 10:148-55. [PMID: 25392289 DOI: 10.1080/15504263.2014.929331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Co-occurrence of mental disorders and substance use disorders (dual diagnosis) among doctors is a cause of serious concern due to its negative personal, professional, and social consequences. This work provides an overview of the prevalence of dual diagnosis among physicians, suggests a clinical etiological model to explain the development of dual diagnosis in doctors, and recommends some treatment strategies specifically for doctors. The most common presentation of dual diagnosis among doctors is the combination of alcohol use disorders and affective disorders. There are also high rates of self-medication with benzodiazepines, legal opiates, and amphetamines compared to the general population, and cannabis use disorders are increasing, mainly in young doctors. The prevalence of nicotine dependence varies from one country to another depending on the nature of public health policies. Emergency medicine physicians, psychiatrists, and anaesthesiologists are at higher risk for developing a substance use disorder compared with other doctors, perhaps because of their knowledge of and access to certain legal drugs. Two main pathways may lead doctors toward dual diagnosis: (a) the use of substances (often alcohol or self-prescribed drugs) as an unhealthy strategy to cope with their emotional or mental distress and (b) the use of substances for recreational or other purposes. In both cases, doctors tend to delay seeking help once a problem has been established, often for many years. Denial, minimization, and rationalization are common defense mechanisms, maybe because of the social stigma associated with mental or substance use disorders, the risk of losing employment/medical license, and a professional culture of perfectionism and denial of emotional needs or failures. Personal vulnerability interacts with these factors to increase the risk of a dual diagnosis developing in some individuals. When doctors with substance use disorders accept treatment in programs specifically designed for them (Physicians' Health Programs), they show better outcomes than the general population. However, physicians with dual diagnosis have more psychological distress and worse clinical prognosis than those with substance use disorders only. Future studies should contribute to a better comprehension of the risk and protective factors and the evidence-based treatment strategies for doctors with dual diagnosis.
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Affiliation(s)
- María Dolores Braquehais
- a Integral Care Program for Sick Doctors, Galatea Clinic, Galatea Foundation , Col·legi Oficial de Metges de Barcelona , Barcelona , Spain
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Sedative Drug Use among King Saud University Medical Students: A Cross-Sectional Sampling Study. DEPRESSION RESEARCH AND TREATMENT 2014; 2014:378738. [PMID: 24551449 PMCID: PMC3914507 DOI: 10.1155/2014/378738] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/22/2013] [Indexed: 11/17/2022]
Abstract
Introduction. Medical students experience significant psychological stress and are therefore at higher risk of using sedatives. There are currently no studies describing the prevalence of sedative drug use among medical students in Saudi Arabia. The aim of this study was to evaluate the prevalence and factors associated with sedative drug use among medical students in Saudi Arabia. Materials and Methods. A cross-sectional convenience sampling study gathered data by anonymous questionnaire from students enrolled at the King Saud University College of Medicine in 2011. The questionnaires collected data regarding social and demographic variables, sleep patterns, and the use of stimulant and sedative drugs since enrollment. Sedatives were defined as any pharmaceutical preparations that induce sleep. Results and Discussion. Of the 729 students who returned questionnaires, 17.0% reported sedative drug use at some time since enrollment. Higher academic year, lower grade point average, regular exercise, fewer hours of sleep per day, poorer quality of sleep, and the presence of sleeping disorders were found to be significantly associated with sedative drug use. Conclusions. Further study is required to increase our understanding of sedative drug use patterns in this relatively high-risk group, as such understanding will help in the development of early intervention programs.
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Kumar N, Kanchan T, Unnikrishnan B, Rekha T, Mithra P, Kulkarni V, Papanna MK, Holla R, Uppal S. Perceptions and practices of self-medication among medical students in coastal South India. PLoS One 2013; 8:e72247. [PMID: 24015223 PMCID: PMC3756058 DOI: 10.1371/journal.pone.0072247] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/06/2013] [Indexed: 11/18/2022] Open
Abstract
Self-medication is a common practice worldwide and the irrational use of drugs is a cause of concern. This study assessed the prevalence of self-medication among the medical students in South India. The data was analysed using SPSS version 11.5. A total of 440 students were included in the study. The prevalence of self-medication was 78.6%. A larger number of females were self-medicating (81.2%) than males (75.3%). The majority of the students self-medicated because of the illness being too trivial for consultation (70.5%). Antipyretics were most commonly self-medicated by the participants (74.8%). Only 47% of the participants opined that self-medication was a part of self-care and it needs to be encouraged. 39.3% of the participants perceived that the supply of medicine without prescription by the pharmacist can prevent the growing trend of self-medication. Easy availability and accessibility to health care facilities remains the cornerstone for reducing the practice of self-medication.
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Affiliation(s)
- Nithin Kumar
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
- * E-mail:
| | - Tanuj Kanchan
- Department of Forensic Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - T. Rekha
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Vaman Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Mohan Kumar Papanna
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Ramesh Holla
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Surabhi Uppal
- Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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Badiger S, Kundapur R, Jain A, Kumar A, Pattanshetty S, Thakolkaran N, Bhat N, Ullal N. Self-medication patterns among medical students in South India. Australas Med J 2012; 5:217-20. [PMID: 22848313 DOI: 10.4066/amj.2012.1007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Self-medication results in wastage of resources, increases resistance of pathogens and generally causes serious health hazards such as adverse drug reactions, prolonged suffering and drug dependence. This study was undertaken to determine the reasons for self-medication and the pattern of self-medication among medical students. METHOD This cross-sectional descriptive study was conducted at the K.S. Hegde Medical Academy, Mangalore. The participants were medical students from first to final year. Medical students were selected through convenience sampling. The data was collected using a pre-tested semi-structured questionnaire. The data was analysed using SPSS version 16 and the results expressed as proportions. RESULTS A total of 200 students, 121 (60.5%) female and 79 (39.5%) male, were included in the study. Of the medical students surveyed, self-medication was reported among 92%. The respondents who used self-medication found it to be time- saving in providing relief from minor ailments. The most common ailments for which self-medication were used were: the common cold (69%), fever (63%) and headache (60%). The students consulted their textbooks (39%) and seniors or classmates (38%) for the medications. Antipyretics (71%), analgesics (65%), antihistamines (37%) and antibiotics (34%) were the most common self- medicated drugs. Of the respondents, 33% were unaware of the adverse effects of the medication and 5% had experienced adverse reactions. The majority (64%) of students advised medications to others, more often to family and friends. CONCLUSION The prevalence of self-medication among medical students is high, facilitated by the easy availability of drugs and information from textbooks or seniors. A significant number of students are unaware of the adverse effects of the medication that they themselves take and suggest to others. Therefore, potential problems of self-medication should be emphasised to the students.
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Affiliation(s)
- Sanjeev Badiger
- Department of Community Medicine, K.S. Hegde Medical Academy, Nitte University, Mangalore, India
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Ross S, von Fragstein M, Cleland J. Medical students' illness-related cognitions. MEDICAL EDUCATION 2011; 45:1241-1250. [PMID: 21995548 DOI: 10.1111/j.1365-2923.2011.04079.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT Doctors do not follow guidance when managing their own health and illness. This behaviour may start at medical school. This study aimed to investigate whether inappropriate responses to illness are an issue for medical students and, if so, to identify the determinants of students' responses to illness. METHODS We undertook a qualitative study using framework analysis to explore the views of medical students at two UK medical schools. RESULTS Eight focus groups carried out with 35 medical students identified four main themes in students' cognitions about their intended behaviour: not using usual patient pathways; informal consultation; self-treatment, and keeping going when ill. The reasons or assumptions underlying these beliefs referred to: time and resources, including wider issues such as responsibility to colleagues; stigma and attitudes of others including regulatory bodies; beliefs about themselves in terms of taking on the patient role and issues relating to coping and self-sufficiency; the behaviour and attitudes of peers; patient safety considerations; patients' views about sick doctors; barriers to accessing care; the ease of self-care, and uncertainty about ability to self-care. CONCLUSIONS Many different factors related to medical students' beliefs about illness. Conflicts occur among student needs to be seen as competent and dedicated to medicine, to protect personal privacy, to maintain convenience, and to seek care appropriately in order to be fair on colleagues and protect the public. These conflicts were complicated by perceptions of the system, peers and doctors as unsupportive of ill health except by facilitating informal access to care. Beliefs underlying intentions are similar between doctors and medical students, but further research is needed to fully determine how and when these beliefs are formed.
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Affiliation(s)
- Sarah Ross
- Division of Medical and Dental Education, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
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Van der Veer T, Frings-Dresen MHW, Sluiter JK. Health behaviors, care needs and attitudes towards self-prescription: a cross-sectional survey among Dutch medical students. PLoS One 2011; 6:e28038. [PMID: 22132202 PMCID: PMC3221693 DOI: 10.1371/journal.pone.0028038] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 10/31/2011] [Indexed: 12/17/2022] Open
Abstract
Purpose There is a growing awareness of the potent ways in which the wellbeing of physicians impacts the health of their patients. The purpose of this study was to investigate the health behaviors, care needs and attitudes towards self-prescription of Dutch medical students, and any differences between junior preclinical and senior clinically active students. Methods All students (n = 2695) of a major Dutch medical school were invited for an online survey. Physical activity, eating habits, alcohol consumption, smoking, Body Mass Index, substance use and amount of sleep per night were inquired, as well as their need for different forms of care and their attitude towards self-prescription. Results Data of 902 students were used. Physical activity levels (90% sufficient) and smoking prevalence (94% non-smokers) were satisfying. Healthy eating habits (51% insufficient) and alcohol consumption (46% excessive) were worrying. Body Mass Indexes were acceptable (20% unhealthy). We found no significant differences in health behaviors between preclinical and clinically active students. Care needs were significantly lower among clinically active students. (p<0.05) Student acceptance of self-prescription was significantly higher among clinically active students. (p<0.001) Conclusions Unhealthy behaviors are prevalent among medical students, but are no more prevalent during the clinical study phase. The need for specific forms of care appears lower with study progression. This could be worrying as the acceptance of self-care and self-prescription is higher among senior clinical students. Medical faculties need to address students' unhealthy behaviors and meet their care needs for the benefit of both the future physicians as well as their patients.
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Affiliation(s)
- Tjeerd Van der Veer
- Coronel Institute of Occupational Health, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | | | - Judith K. Sluiter
- Coronel Institute of Occupational Health, Academic Medical Center (AMC), Amsterdam, The Netherlands
- * E-mail:
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Montgomery AJ, Bradley C, Rochfort A, Panagopoulou E. A review of self-medication in physicians and medical students. Occup Med (Lond) 2011; 61:490-7. [PMID: 21727179 DOI: 10.1093/occmed/kqr098] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is a culture within medicine that doctors do not expect themselves or their colleagues to be sick. Thus, the associated complexities of self-diagnosis, self-referral and self-treatment among physicians are significant and may have repercussions for both their own health and, by implication, for the quality of care delivered to patients. AIMS To collate what is known about the self-treatment behaviour of physicians and medical students. METHODS The following databases were searched: PubMed, PsychInfo, EBSCO, Medline, BioMed central and Science Direct. Inclusion criteria specified research assessing self-treatment and self-medicating of prescription drugs among physicians and/or medical students. Only peer-reviewed English language empirical studies published between 1990 and 2009 were included. RESULTS Twenty-seven studies were identified that fitted the inclusion criteria. Self-treatment and self-medicating was found to be a significant issue for both physicians and medical students. In 76% of studies, reported self-treatment was >50% (range: 12-99%). Overall, only one of two respondents was registered with a general practitioner or primary care physician (mean = 56%, range = 21-96). Deeper analysis of studies revealed that physicians believed it was appropriate to self-treat both acute and chronic conditions and that informal care paths were common within the medical profession. CONCLUSIONS Self-treatment is strongly embedded within the culture of both physicians and medical students as an accepted way to enhance/buffer work performance. The authors believe that these complex self-directed care behaviours could be regarded as an occupational hazard for the medical profession.
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Affiliation(s)
- A J Montgomery
- Department of Education and Social Policy, University of Macedonia, Egnatia Street 156, Thessaloniki 54006, Greece.
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Brooks SK, Gerada C, Chalder T. Review of literature on the mental health of doctors: are specialist services needed? J Ment Health 2011; 20:146-56. [PMID: 21275504 DOI: 10.3109/09638237.2010.541300] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Mental ill health is common among doctors. Fast, efficient diagnosis and treatment are needed as mentally ill doctors pose a safety risk to the public, yet they are often reluctant to seek help. AIMS To review literature regarding risk factors and potential barriers to help-seeking unique to doctors; to consider the success of interventions by specialist services for doctors. METHOD Key phrases regarding the 'mental health of doctors' were entered into internet searches and journal databases to identify relevant research. When key authors were identified, author-specific searches were carried out. FINDINGS There are contradictory reports about the prevalence of mental ill health in doctors but it is generally agreed that doctors face a large number of risk factors, both occupational and individual; and help-seeking is difficult due to complexities surrounding a doctor becoming a patient. Specialist services developed specifically for interventions for doctors with mental health problems tend to show promising results but further research is needed. CONCLUSIONS The unique and complex situation of a doctor becoming a patient benefits from specialist services; such services should focus on early intervention and raising awareness.
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Affiliation(s)
- Samantha K Brooks
- Academic Department of Psychological Medicine, Weston Education Centre, King's College London, London SE5 9RJ, UK
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Richer S. Should family physicians treat themselves or not?: No. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2009; 55:781-782. [PMID: 19675258 PMCID: PMC2726086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Rø KEI, Gude T, Tyssen R, Aasland OG. Counselling for burnout in Norwegian doctors: one year cohort study. BMJ 2008; 337:a2004. [PMID: 19001492 PMCID: PMC2659953 DOI: 10.1136/bmj.a2004] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2008] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate levels and predictors of change in dimensions of burnout after an intervention for stressed doctors. DESIGN Cohort study followed by self reported assessment at one year. SETTING Norwegian resource centre. PARTICIPANTS 227 doctors participating in counselling intervention, 2003-5. INTERVENTIONS Counselling (lasting one day (individual) or one week (group based)) aimed at motivating reflection on and acknowledgement of the doctors' situation and personal needs. MAIN OUTCOME MEASURES Levels of burnout (Maslach burnout inventory) and predictors of reduction in emotional exhaustion investigated by linear regression. RESULTS 185 doctors (81%, 88 men, 97 women) completed one year follow-up. The mean level of emotional exhaustion (scale 1-5) was significantly reduced from 3.00 (SD 0.94) to 2.53 (SD 0.76) (t=6.76, P<0.001), similar to the level found in a representative sample of 390 Norwegian doctors. Participants had reduced their working hours by 1.6 hours/week (SD 11.4). There was a considerable reduction in the proportion of doctors on full time sick leave, from 35% (63/182) at baseline to 6% (10/182) at follow-up and a parallel increase in the proportion who had undergone psychotherapy, from 20% (36/182) to 53% (97/182). In the whole cohort, reduction in emotional exhaustion was independently associated with reduced number of work hours/week (beta=0.17, P=0.03), adjusted for sex, age, and personality dimensions. Among men "satisfaction with the intervention" (beta=0.25, P=0.04) independently predicted reduction in emotional exhaustion. CONCLUSIONS A short term counselling intervention could contribute to reduction in emotional exhaustion in doctors. This was associated with reduced working hours for the whole cohort and, in men, was predicted by satisfaction with the intervention.
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Lusilla P, Gual A, Roncero C, Bruguera E, Marcos V, Valero S, Casas M. Dual diagnosis in inpatient physicians: prevalence and clinical characteristics. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/17523280701724189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Noble SIR, Nelson A, Finlay IG. Challenges faced by palliative care physicians when caring for doctors with advanced cancer. Palliat Med 2008; 22:71-6. [PMID: 18216079 DOI: 10.1177/0269216307084607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is possible that patients with advanced cancer, who are from the medical profession, have different or additional care needs than other patients. Previous training, professional experiences and access to information and services may influence their needs and subsequent illness behaviour. Caring for ;one of our own' may also evoke particular feelings and emotions from health professionals involved in their care and pose unique challenges in the delivery of equitable patient-centred care. AIM To explore the experiences of palliative care physicians when caring for members of the medical profession with advanced incurable cancer. PARTICIPANTS AND METHODS Semi-structured interviews exploring the experiences of senior palliative care physicians were recorded and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis (IPA) for emergent themes. Data were collected from ten senior palliative care physicians with a combined total of 107 years of palliative care career experience, caring for a reported combined estimate of 120 doctor-patients. RESULTS On the basis of their reflections, palliative care physicians reported that doctor-patients appear to find it difficult to assume a patient role, especially at a time they are likely to be truly vulnerable. This patient group will routinely attempt to maintain control of their care and environment using various strategies. These include self-referrals, accessing their own tests, directing the consultation and putting barriers up to psychosocial aspects of palliative care. Doctor-patients' general practitioners are at risk of exclusion from the management of care, and referral to palliative care services appears to occur later in the illness journey of doctor-patients compared to lay patients. Participants recalled how caring for colleagues evokes powerful emotional responses, such as a strong desire to provide the best care possible as well as feelings of anxiety. They frequently find themselves under pressure to disclose confidential information from medical colleagues not involved in the doctor-patients' care. Doctor-patients frequently receive what other healthcare professionals perceive as preferential treatment, which may unintentionally result in suboptimal care. CONCLUSION The core needs of doctors with advanced cancer could be assumed to be the same as other patients. However, the juxtaposition of role from professional to patient appears to evoke unique care needs from the patient, and behaviour responses from the professional. Forewarning and awareness of these issues may help prevent potential problems in this patient group's cancer journey as well as the experience of the professionals involved in their management.
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Affiliation(s)
- S I R Noble
- Department of Palliative Medicine, Cardiff University and Royal Gwent Hospital, Wales.
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Tyssen R. Health problems and the use of health services among physicians: a review article with particular emphasis on Norwegian studies. INDUSTRIAL HEALTH 2007; 45:599-610. [PMID: 18057803 DOI: 10.2486/indhealth.45.599] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This paper provides an overview of recent Norwegian and international research into physicians' health problems and their use of health services, with a particular focus on more recent studies relating to The Norwegian Physicians' Survey. The review suggests that physicians' physical health is similar to the general population, although female physicians tend to be in better health than other women. Some mental disorders such as depression and suicide appear to be more prevalent. Mental health problems are known to be associated with low work control (autonomy), time pressure and demanding patients. There is little difference between the genders early in their career, but more female than male physicians seem to experience problems later on. Physicians seldom take sick leave, and tend to make less use of primary health care and some screening facilities. Self-treatment is common -- even for mental problems. American impaired physician programmes have demonstrated high recovery rates (70-80%), and increasing emphasis is now being placed on psychiatric diagnoses. As certain mental disorders appear to be common among physicians, specialist psychiatric services should be made more accessible for this group. A low-threshold facility for seeking help with such problems has recently been developed in Norway (the Villa Sana Resource Centre).
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Affiliation(s)
- Reidar Tyssen
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
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Abstract
Compliance can represent a poor outcome and, as a concept places medication at the center of therapeutic action. Compliance implies submission to the authority of the prescriber and invites or reenforces an adversarial approach to the doctor-patient relationship. It is that relationship which is properly viewed as central to all therapies. The multiple meanings that medications have for everyone in our society, whether we are in the role of patient, doctor, or simply a member of the community, effects treatment adherence and outcomes. The promotion of a collaborative therapeutic relationship requires sensitivity to these meanings and roles as well as to cultural contexts in which the therapeutic relationship is embedded. Examples of some of the factors in patients, psychiatrists, and the rest of the world that militate for and against effective treatment are given.
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Mansourian A, Saifi A, Vakili M, Marjani A, Ghaemi E, Moradi A, Ahmadi A. Prescribing Antibiotics by General and Specialist Physicians:A Pharmacist Administrated Survey. JOURNAL OF MEDICAL SCIENCES 2007. [DOI: 10.3923/jms.2007.427.431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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