1
|
Lyu X, Zhang S, Fu C, Yang M, Yang T, Xie F. We are all ordinary: the shared visual narratives of daily life promote the patients' positive attitudes toward doctors. BMC Psychol 2024; 12:311. [PMID: 38812042 PMCID: PMC11137884 DOI: 10.1186/s40359-024-01820-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 05/27/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Current research on the doctor-patient relationship primarily focuses on the responsibilities of doctors, with relatively less emphasis on examining the contributions patients can make. As a result, there is an urgent demand for exploring innovative approaches that highlight the active role patients play in cultivating a robust doctor-patient relationship. The purpose of this study was to devise an intervention strategy centered around patients to enhance the doctor-patient relationship. Comics were developed to depict shared narratives encompassing challenging daily life experiences between doctors and ordinary individuals. The study aimed to assess the efficacy of this approach in cultivating positive attitudes toward doctors. METHOD A 3-group design trial was conducted in Shanghai, China. A total of 152 participants were randomly assigned to one of three conditions: the parallel presenting group (n = 51), where narratives about a doctor and an ordinary employee were presented side by side in comics; the single presenting group (n = 50), where only narratives about a doctor were presented; and the control group (n = 51). The outcomes assessed in this study encompassed changes in identification with the doctor portrayed in the comics, perceived intimacy between doctors and patients in reality, and appraisal of the doctor in a prepared doctor-patient interaction situation. RESULTS The parallel presenting group exhibited significantly larger increases in identification with the doctor portrayed in the comics, perceived intimacy between doctors and patients in reality, and appraisal of the doctor in a prepared doctor-patient interaction scenario compared to the single presenting group. The observed enhancements in the appraisal of the doctor in a prepared doctor-patient interaction scenario can be attributed to the changes in identification with the doctor portrayed in the comics experienced by the participants. CONCLUSION Our study responds to the doctor-centric focus in existing research by exploring patients' contributions to the doctor-patient relationship. Using comics to depict shared narratives, the parallel presenting group demonstrated significantly increased identification with the depicted doctor, perceived intimacy, and positive appraisal in prepared scenarios compared to the single presenting group. This underscores the effectiveness of patient-centered interventions in shaping positive attitudes toward doctors, highlighting the pivotal role patients play in fostering a resilient doctor-patient relationship. TRIAL REGISTRATION Chinese Clinical Trail Registry: ChiCTR2400080999 (registered 20 February 2024; retrospectively registered).
Collapse
Affiliation(s)
- Xiaokang Lyu
- Department of Social Psychology, School of Sociology, Nankai University, Tianjin, 300350, China
- Computational Social Science Laboratory, Nankai University, Tianjin, China
| | | | - Chunye Fu
- Department of Social Psychology, School of Sociology, Nankai University, Tianjin, 300350, China.
| | - Min Yang
- Department of Social Psychology, School of Sociology, Nankai University, Tianjin, 300350, China
| | - Tingting Yang
- Department of Social Psychology, School of Sociology, Nankai University, Tianjin, 300350, China
| | - Fandi Xie
- Shanghai Hongkou District Jiangwan Hospital, Shanghai, China
| |
Collapse
|
2
|
Pearson A, Carrieri D, Melvin A, Bramwell C, Scott J, Hancock J, Papoutsi C, Pearson M, Wong G, Mattick K. Developing a typology of interventions to support doctors' mental health and wellbeing. BMC Health Serv Res 2024; 24:573. [PMID: 38702774 PMCID: PMC11067176 DOI: 10.1186/s12913-024-10884-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/20/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The problem of mental ill-health in doctors is complex, accentuated by the COVID-19 pandemic, and impacts on healthcare provision and broader organisational performance. There are many interventions to address the problem but currently no systematic way to categorise them, which makes it hard to describe and compare interventions. As a result, implementation tends to be unfocussed and fall short of the standards developed for implementing complex healthcare interventions. This study aims to develop: 1) a conceptual typology of workplace mental health and wellbeing interventions and 2) a mapping tool to apply the typology within research and practice. METHODS Typology development was based on iterative cycles of analysis of published and in-practice interventions, incorporation of relevant theories and frameworks, and team and stakeholder group discussions. RESULTS The newly developed typology and mapping tool enable interventions to be conceptualised and/or mapped into different categories, for example whether they are designed to be largely preventative (by either improving the workplace or increasing personal resources) or to resolve problems after they have arisen. Interventions may be mapped across more than one category to reflect the nuance and complexity in many mental health and wellbeing interventions. Mapping of interventions indicated that most publications have not clarified their underlying assumptions about what causes outcomes or the theoretical basis for the intervention. CONCLUSION The conceptual typology and mapping tool aims to raise the quality of future research and promote clear thinking about the nature and purpose of interventions, In doing so it aims to support future research and practice in planning interventions to improve the mental health and wellbeing of doctors.
Collapse
Affiliation(s)
- Alison Pearson
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
| | - Daniele Carrieri
- Department of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Anna Melvin
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Charlotte Bramwell
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Jessica Scott
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Pearson
- Institute of Clinical & Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Karen Mattick
- Department of Health & Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| |
Collapse
|
3
|
Khan S, Ntatamala I, Baatjies R, Adams S. Prevalence and determinants of burnout among South African doctors during the COVID-19 pandemic. S Afr J Psychiatr 2024; 30:2225. [PMID: 38726336 PMCID: PMC11079362 DOI: 10.4102/sajpsychiatry.v30i0.2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/07/2024] [Indexed: 05/12/2024] Open
Abstract
Background Burnout, resulting from chronic workplace stress that has been unsuccessfully managed, has previously been documented in doctors. The coronavirus disease 2019 (COVID-19) pandemic has increased occupational challenges faced by doctors, potentiating their risk for burnout. Aim This study aimed to determine the prevalence and determinants of burnout among medical doctors during the COVID-19 pandemic. Setting Three public sector hospitals in Gqeberha, South Africa. Methods A cross-sectional study of 260 voluntary participants was conducted. Participants completed self-administered electronic questionnaires. Logistic regression analysis was performed to explore the determinants of burnout. Results The prevalence of burnout in this study was 78%. Burnout was significantly associated with being a medical intern or community-service medical officer (adjusted odd ratio [AOR] = 6.72, 1.71-26.40), being in the lowest income band (AOR = 10.78, 2.55-45.49), and using alcohol to manage work-related stress (AOR = 3.01, 1.12-8.04). Job-related factors associated with burnout were experiencing high conflict at work (AOR = 5.04, 1.92-13.20) and high role ambiguity and role conflict (AOR = 4.49, 1.98-10.18). Low support at work (AOR = 9.99, 3.66-27.23), medium job satisfaction (AOR = 5.38, 2.65-10.93) and medium support at work (AOR = 3.39, 1.71-6.73) were positively associated with burnout. Participants with medium (AOR = 0.28, 0.10-0.80) and high levels of resilience (AOR = 0.08, 0.03-0.25) were protected against burnout. Coronavirus disease 2019-related factors were not significantly associated with burnout. Conclusion The burnout prevalence among South African medical doctors at public hospitals during the COVID-19 pandemic was high and strongly associated with job stress factors. Contribution Given the increased prevalence of burnout among doctors and the strong associations with job stress factors, mitigation of burnout requires targeted organisational interventions.
Collapse
Affiliation(s)
- Saajida Khan
- Division of Occupational Medicine and Centre for Environmental and Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Itumeleng Ntatamala
- Division of Occupational Medicine and Centre for Environmental and Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Roslynn Baatjies
- Department of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Shahieda Adams
- Division of Occupational Medicine and Centre for Environmental and Occupational Health Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
4
|
Dumesnil H, Lutaud R, Bellon-Curutchet J, Deffontaines A, Verger P. Dealing with the doctor shortage: a qualitative study exploring French general practitioners' lived experiences, difficulties, and adaptive behaviours. Fam Pract 2024:cmae017. [PMID: 38521970 DOI: 10.1093/fampra/cmae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
CONTEXT The shortage of general practitioners (GPs) is a growing concern in Europe, especially in France. This problem is likely to continue until the end of the 2020s. OBJECTIVES To study the GPs' perceptions of access to care in medically underserved areas (i.e. with low physician density), its consequences on their working conditions, and how they cope with the resulting difficulties. METHODS Semi-structured individual interviews were conducted between May and August 2021 of 29 GPs practising in areas of southeastern France with a low physician density or at risk of a doctor shortage. Purposive sampling was used to include profiles of diverse physicians and diverse rural and urban areas. The interviews, conducted with an interview guide, were transcribed and analysed thematically. RESULTS The participants described a serious degradation of access to care in their areas. These issues also concerned urban areas, where they were, according to the participants, underrecognized. The participants' workloads were rising, at a rate often perceived as unsustainable: many participants, including the youngest group, reported they were exhausted. Their principal source of dissatisfaction was their impression that they could not do their work correctly. Participants reported that these difficulties required them to improvise and adapt without any official or formal method to keep their practice manageable. CONCLUSION These GPs were worried about the future of their profession and their patients. They expected strong measures by public policymakers and officials, but paradoxically seemed to have little interest in the solutions these officials are promoting.
Collapse
Affiliation(s)
- Hélène Dumesnil
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Romain Lutaud
- Faculté des Sciences Médicales et Paramédicales, Département Universitaire de Médecine Générale (DUMG), Aix Marseille Université, Marseille, France
| | - Julien Bellon-Curutchet
- Faculté des Sciences Médicales et Paramédicales, Département Universitaire de Médecine Générale (DUMG), Aix Marseille Université, Marseille, France
| | - Aliénor Deffontaines
- Faculté des Sciences Médicales et Paramédicales, Département Universitaire de Médecine Générale (DUMG), Aix Marseille Université, Marseille, France
| | - Pierre Verger
- ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| |
Collapse
|
5
|
Aljuwaiser S, Brazzelli M, Arain I, Poobalan A. Common mental health problems in medical students and junior doctors - an overview of systematic reviews. J Ment Health 2023:1-37. [PMID: 37933550 DOI: 10.1080/09638237.2023.2278095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 09/24/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Common mental health problems (CMHP) are prevalent among junior doctors and medical students, and the COVID-19 pandemic has brought challenging situations with education disruptions, early graduations, and front-line work. CMHPs can have detrimental consequences on clinical safety and healthcare colleagues; thus, it is vital to assess the overall prevalence and available interventions to provide institutional-level support. AIMS This overview summarises the prevalence of CMHPs from existing published systematic reviews and informs public health prevention and early intervention practice. METHODS Four electronic databases were searched from 2012 to identify systematic reviews on the prevalence of CMHPs and/or interventions to tackle them. RESULTS Thirty-six reviews were included: 25 assessing prevalence and 11 assessing interventions. Across systematic reviews, the prevalence of anxiety ranged from 7.04 to 88.30%, burnout from 7.0 to 86.0%, depression from 11.0 to 66.5%, stress from 29.6 to 49.9%, suicidal ideation from 3.0 to 53.9% and one obsessive-compulsive disorder review reported a prevalence of 3.8%. Mindfulness-based interventions were included in all reviews, with mixed findings for each CMHP. CONCLUSIONS The prevalence of CMHPs is high among junior doctors and medical students, with anxiety remaining relatively stable and depression slightly increasing during the COVID-19 pandemic. Future research on mindfulness-based interventions is required for a resilient and healthy future workforce. PRISMA/PROSPERO the researchers have followed PRISMA guidance. This overview was not registered with PROSPERO as it was conducted as part of an MSc research project.
Collapse
Affiliation(s)
- Sameera Aljuwaiser
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Miriam Brazzelli
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Imran Arain
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Amudha Poobalan
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
6
|
Durand-Moreau Q, Jackson T, Deibert D, Els C, Kung JY, Straube S. Mindfulness-based Practices in Workers to Address Mental Health Conditions: A Systematic Review. Saf Health Work 2023; 14:250-258. [PMID: 37818218 PMCID: PMC10562101 DOI: 10.1016/j.shaw.2023.07.006] [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: 06/07/2023] [Revised: 07/06/2023] [Accepted: 07/25/2023] [Indexed: 10/12/2023] Open
Abstract
The effectiveness of mindfulness techniques in addressing mental health conditions in workers is uncertain. However, it could represent a therapeutic tool for workers presenting with such conditions. Our objective was to assess the effects of mindfulness-based practices for workers diagnosed with mental health conditions. We conducted a systematic review of randomized controlled trials. Participants included were workers with a mental health condition. Interventions included any mindfulness technique, compared to any nonmindfulness interventions. Outcomes were scores on validated psychiatric rating scales. A total of 4,407 records were screened; 202 were included for full-text analysis; 2 studies were included. The first study (Finnes et al., 2017) used Acceptance and Commitment Therapy (ACT) associated or not with Workplace Dialogue Intervention (WDI), compared to treatment as usual. At 9 months follow-up, for the ACT group, depression scores improved marginally (standardized mean difference [SMD]: -0.06, p = 0.021), but anxiety scores were worse (SMD: 0.15, p = 0.036). Changes in mental health outcomes were not statistically significant for the ACT + WDI group. In the second study (Grensman et al., 2018), no statistically significant change in mental health scales has been observed after completion of mindfulness-based cognitive therapy compared to cognitive behavioral therapy. Substantial heterogeneity precluded meta-analysis. This systematic review did not find evidence that mindfulness-based practices provide a durable and substantial improvement of mental health outcomes in workers diagnosed with mental health conditions.
Collapse
Affiliation(s)
- Quentin Durand-Moreau
- Division of Preventive Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tanya Jackson
- Division of Preventive Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Danika Deibert
- Division of Preventive Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Charl Els
- Division of Preventive Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- College of Physicians and Surgeons of Alberta, Edmonton, AB, Canada
| | - Janice Y. Kung
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - Sebastian Straube
- Division of Preventive Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
7
|
Schwill S, Bugaj TJ, Rentschler A, Nikendei C, Szecsenyi J, Krug K. Effects of an educational compact intervention in self-care - a mixed methods study with postgraduate trainees in primary care. BMC PRIMARY CARE 2023; 24:124. [PMID: 37328816 PMCID: PMC10273587 DOI: 10.1186/s12875-023-02074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Multiple studies indicate that residents in family medicine (FM) are exposed to considerable stress and are particularly affected by burnout syndrome. Aim of the study was to specify the effects of a so-called "compact intervention" (i.e., a short intervention) in self-care on FM residents. METHODS The authors performed a concurrent and independent mixed-methods study with FM residents on the KWBW VerbundweiterbildungPLUS© program. FM residents could voluntarily take part in a two-day seminar including 270 min on self-care, which can be regarded as a compact intervention. Study participants completed a questionnaire before (T1) and ten to twelve weeks after the course (T2), with subsequent recruitment to interview. The main outcomes of the quantitative part were to evaluate (I) self-rated change of cognition and (II) change in behavior. The qualitative outcomes were all possible effects of the compact intervention on participants´ competencies as well as all sorts of induced behavioral changes. RESULTS From a total of n = 307 residents, n = 287 FM residents (intervention group: n = 212; control group: n = 75) participated in the study. At T2, 111 post-intervention questionnaires were completed. 56% rated the intervention to be helpful for their well-being (n = 63/111). At T2, there was a significant increase in those willing to act in comparison to T1 (p = .01): 36% (n = 40/111) had changed their behavior and half of the study participants had passed on competencies to others (n = 56/111). From the intervention group, n = 17 participants additionally gave an interview. FM residents favored a trustful learning atmosphere, an interactive teaching concept and practical exercises. They described an encouraging stimulus to act and specified behavioral changes. CONCLUSIONS A compact intervention in self-care could increase well-being, foster competencies and induce behavioral changes, if implemented into a training program with sufficient group cohesiveness. Further studies are required to specify long-term-results.
Collapse
Affiliation(s)
- Simon Schwill
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Till Johannes Bugaj
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Annalena Rentschler
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
8
|
Huang CLC. Underrecognition and un-dertreatment of stress-related psychiatric disorders in physicians: Determinants, challenges, and the impact of the COVID-19 pandemic. World J Psychiatry 2023; 13:131-140. [PMID: 37123097 PMCID: PMC10130963 DOI: 10.5498/wjp.v13.i4.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/12/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023] Open
Abstract
Medical practitioners’ duties are highly stressful and performed in a particularly challenging and competitive work environment. Stress and burnout among physicians have emerged as a worldwide public health problem in recent years. A high level of distress and burnout can lead to clinically significant behavioral health problems, such as stress-related psychiatric disorders. Mounting evidence shows that physicians have higher risks of insomnia, anxiety, and depression than the general population, especially during the coronavirus disease 2019 pandemic. However, the behavioral health problems of these vulnerable healthcare professionals are noteworthy for being underrecognized and undertreated. In this mini-review, we summarize the current progress of studies on the prevalence and determinants of distress and stress-related psychiatric disorders among phy-sicians and their healthcare-seeking behaviors. We discuss future research directions and the clinical approach that may maximize self-awareness and promote prompt and adequate treatment for clinically significant behavioral health problems of physicians.
Collapse
Affiliation(s)
- Charles Lung-Cheng Huang
- Department of Psychiatry, Chi Mei Medical Center, Tainan 710, Taiwan
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| |
Collapse
|