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Oftung B, Tyssen R. Occupational stress among Norwegian physicians: A literature review of long-term prospective studies 2007-2019. Scand J Public Health 2024:14034948241243164. [PMID: 38600437 DOI: 10.1177/14034948241243164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
AIMS There are signs of increased stress at work among Norwegian physicians over the last decades, not least among general practitioners (GPs). In this review, we identify trends in both occupational stress and adverse work-related predictors of such stress and burnout in Norwegian physicians. METHODS We performed an extensive literature search using MEDLINE, Embase and PsycINFO. We included prospective and repeated cross-sectional studies of work stress among Norwegian physicians published in 2007-2019. RESULTS Nine studies with observation periods of 1-20 years were included. Occupational stress (global measure) among all doctors decreased gradually from medical school to 20 years later. The prevalence of an effort-reward imbalance increased fourfold among GPs during the period 2010-2019. Five studies reported higher levels of occupational stress among female physicians than among their male colleagues. Work-home conflict levels increased after graduation until 10 years after leaving medical school and plateaued thereafter. Physicians who graduated in a later cohort reported lower levels of work-home conflict and less workplace violence. Work-home conflict, low colleague support, number of work hours and workload/low autonomy were all independent predictors of occupational stress. CONCLUSIONS The reduction in occupational stress during the years after leaving medical school may result from increased competency in clinical work and decreased on-call work. The Co-ordination Act implemented in 2012 may explain the increase in occupational stress among GPs. These findings suggest that both reducing work-home conflict and increasing colleague support are important for doctors' well-being.
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Affiliation(s)
- Bendik Oftung
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Reidar Tyssen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
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2
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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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3
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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.
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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
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Sebastián-Sánchez I, Gállego-Royo A, Marco-Gómez B, Pérez-Álvarez C, Urbano Gonzalo O, Delgado-Marroquín MT, Altisent-Trota R, Astier-Peña MP. Gender analysis of Spanish National Questionnaire on behaviours and attitudes of doctors towards their own illness (CAMAPE). J Healthc Qual Res 2022; 38:165-179. [PMID: 36549947 DOI: 10.1016/j.jhqr.2022.11.006] [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: 07/20/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Physicians' health is a key element for quality healthcare. Medical professionals have difficulty accepting their role as patients and it might be different among sexes. The aim was to describe behaviours and attitudes of doctors towards their own illness. MATERIALS AND METHODS An online survey was launched through the General Council of Medical Associations webpage for all Spanish registered doctors. A bivariate analysis by sex was performed for all the questionnaire variables using parametric and non-parametric tests. The significance level was p<0.05 (95% confidence interval). RESULTS A total of 4,308 registered doctors (1,858 men and 2,450 women) answered. Women were younger, single, and worked mainly in non-surgical specialities in the public sector. Men were older, married, and worked more frequently in public-private practice. Women had less chronic conditions, except for anxiety disorders (11.52% vs 15.18%). Both sexes, especially women, primarily self-treated (94.29% vs 95.02%), went to work while ill (88.16% vs 90.29%), visited their GP (56% vs 70%), and half of them underwent annual occupational health checks (40% vs 48%). Women self-prescribed more analgesics (93.43% vs 95.63%), more presenteeism (88% vs 90%) and felt more insecure when treating sick fellows (9.96% vs 20.12%) and requested training for it. More women agreed to make deontological recommendations about doctors' health (91.55% vs 96.16%) and considered revalidation may contribute to improve doctors' health (65.29% vs 66.16%). CONCLUSIONS Male and female doctors show illness-health behaviours and attitudes at work to improve. There are differences among male and female doctors. Regarding, medical feminization, ethical recommendations may be of benefit regarding doctors' health-illness issues and considering gender perspective.
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Affiliation(s)
- I Sebastián-Sánchez
- "Universitas" Health Center, Zaragoza, Spain; Public Health Service of Aragon, Spain; University of Zaragoza, GIBA-IIS-Aragón, Spain
| | - A Gállego-Royo
- Public Health Service of Aragon, Spain; University of Zaragoza, GIBA-IIS-Aragón, Spain; "Miguel Servet" University Hospital, Zaragoza, Spain
| | - B Marco-Gómez
- University of Zaragoza, GIBA-IIS-Aragón, Spain; Department of Psychiatry "Royo Villanova" Hospital, Zaragoza, Spain
| | - C Pérez-Álvarez
- University of Zaragoza, GIBA-IIS-Aragón, Spain; Department of Psychiatry "Royo Villanova" Hospital, Zaragoza, Spain
| | - O Urbano Gonzalo
- University of Zaragoza, GIBA-IIS-Aragón, Spain; Anaesthesiology and Resuscitation, "Miguel Servet" Hospital, Zaragoza, Spain
| | - M T Delgado-Marroquín
- Public Health Service of Aragon, Spain; University of Zaragoza, GIBA-IIS-Aragón, Spain; "Delicias Norte" Health Center, Zaragoza, Spain
| | | | - M P Astier-Peña
- University of Zaragoza, GIBA-IIS-Aragón, Spain; Territorial Quality Unit, Territorial Directorate of Camp de Tarragona, Catalan Institut of Health, Generalitat de Catalunya, Spain.
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5
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Astier-Peña MP, Gallego-Royo A, Marco-Gómez B, Pérez-Alvárez C, Delgado-Marroquín MT, Altisent-Trota R. Behaviour and attitudes of Spanish physicians towards their own process of falling ill: Study protocol and validation of CAMAPE questionnaire. J Healthc Qual Res 2022; 37:349-356. [PMID: 35676170 DOI: 10.1016/j.jhqr.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/08/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Physicians have not learned their role as patients. Health programmes for doctors are focused on mental health. Nevertheless, anomalous behaviours of ill doctors exist independently of health problems. We present a study to describe behaviour and attitudes of doctors towards their own illness (CAMAPE) including the analysis of questionnaire validation. MATERIAL AND METHODS A mix methodology study based on semi-structured interviews to ill physicians and focus groups with members of medical colleges, occupational medicine services and doctors of ill doctors was performed. A survey was designed. Survey validation process included content and face validity, construct validity through exploratory and confirmatory factor analysis and reliability by Cronbach's Alpha Index. RESULTS A total of 27 interviews to ill doctors and 4 focus group were performed. Content and feasibility assessment was made by experts. Psychometric validation was performed with a sample of 4308 answers (2450 women, 56.87%). A 5-factor (F) model explained 78.08% variance. First factor (F1) "The work might worsen health". Second (F2) "Mental issues, toxic habits and the impact of a bad health on work performance"; Third (F3) presenteeism and sick leaves; Fourth (F4) the handling of an ill colleague and the role of medical colleges. Fifth (F5) the healthcare pathway and potential value of revalidation in medical profession. CONCLUSIONS A comprehensive mixed study on the process of physicians becoming ill has been launched with a reliable questionnaire in a large sample of registered doctors. The analysis will help to formulate gender-sensitive policy and ethical recommendations in relation to sick doctors given the progressive feminisation of the medical profession.
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Affiliation(s)
- M P Astier-Peña
- Médica de Familia, Centro de Salud Univérsitas, Zaragoza, Servicio Aragonés de Salud, Universidad de Zaragoza, GIBA-IIS-Aragón, Spain.
| | - A Gallego-Royo
- Medicina Preventiva y Salud Pública, Servicio Medicina Preventiva y Salud Pública, Hospital Miguel Servet, Zaragoza, Servicio Aragonés de Salud, GIBA-IIS-Aragón, Spain
| | - B Marco-Gómez
- Psiquiatra, Servicio de Psiquiatría, Hospital de Royo Villanova, Zaragoza, Servicio Aragonés de Salud, GIBA-IIS-Aragón, Spain
| | - C Pérez-Alvárez
- Psiquiatra, Servicio de Psiquiatría, Hospital de Royo Villanova, Zaragoza, Servicio Aragonés de Salud, GIBA-IIS-Aragón, Spain
| | - M T Delgado-Marroquín
- Médica de Familia, Centro de Salud de Delicias Norte, Zaragoza, Servicio Aragonés de Salud, Universidad de Zaragoza, GIBA-IIS-Aragón, Spain
| | - R Altisent-Trota
- Médico de Familia, Profesor Titular del Departamento de Medicina, Psiquiatría y Dermatología, Facultad de Medicina, Universidad de Zaragoza, GIBA-IIS-Aragón, Spain
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Bertuzzi L, El Aarbaoui T, Heron M, Gosselin A, Roy-de-Lachaise L, Fossi L, Della Corte F, Vignier N, Melchior M, Schreiber M, Vandentorren S, Vuillermoz C. Longitudinal survey on the Psychological Impact of the COVID-19 Pandemic in Healthcare Workers (PsyCOVer) in France: study protocol. BMJ Open 2022; 12:e053009. [PMID: 35058260 PMCID: PMC8783967 DOI: 10.1136/bmjopen-2021-053009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In the pandemic, healthcare professionals face even higher levels of stress. It is therefore a priority to estimate the impact of the pandemic on mental health and to propose targeted strategies to improve resilience. The aims of the study were to (1) assess the mental health of healthcare professionals working with patients with COVID-19 and identify social determinants that may increase the risk of negative outcomes; and (2) test the effectiveness of an intervention to improve the resilience of healthcare professionals in France. METHODS AND ANALYSIS To evaluate the first objective, a national longitudinal study will be carried out among healthcare professionals working with patients with COVID-19. Participants will be recruited via an internet link that will be widely disseminated on social media, mailing lists, medical boards and French medical journals. Primary outcomes are mental health distress/symptoms and resilience. Secondary outcomes are burnout, social and occupational supports and substance use. To meet the second objective, an interventional study will be conducted. The main outcome is the effectiveness of the PsySTART-Responder and the Anticipate.Plan.Deter program. Qualitative analyses will be conducted to understand the strategies used to cope with the pandemic. ETHICS AND DISSEMINATION The study protocol was approved by the Sorbonne Université Ethical Committee (No 2020-CER-2020-27) and was declared to French Commission on Information Technology and Liberties, CNIL (N°2222413, 20-05-2021). The results of this study will provide a better understanding of mental health and social inequalities in mental health among healthcare professionals working in the pandemic; data about the effectiveness of the PsySTART-Responder and the Anticipate.Plan.Deter interventional program in France.
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Affiliation(s)
- Leticia Bertuzzi
- Social epidemiology research team, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
| | - Tarik El Aarbaoui
- Social epidemiology research team, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
| | - Mégane Heron
- Social epidemiology research team, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
| | - Anne Gosselin
- SAGESUD Team, CEPED, Paris, France
- French Collaborative Institute On Migrations/CNRS, Aubervilliers, France
| | - Laurine Roy-de-Lachaise
- Social epidemiology research team, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
| | - Larissa Fossi
- Social epidemiology research team, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
| | - Francesco Della Corte
- CRIMEDIM, Università degli Studi del Piemonte Orientale Amedeo Avogadro Scuola di Medicina, Novara, Italy
| | - Nicolas Vignier
- Social epidemiology research team, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
- Centre d'Investigation Clinique Antilles Guyane, CIC Inserm 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - Maria Melchior
- Social epidemiology research team, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
- French Collaborative Institute On Migrations/CNRS, Aubervilliers, France
| | - Merritt Schreiber
- Harbor-UCLA Medical Center/David Geffen School of Medicine at UCLA, The Lundquist Institute, Torrance, California, USA
| | | | - Cécile Vuillermoz
- Social epidemiology research team, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, Paris, F75012, France
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7
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Garcia G, Crenner C. Comparing International Experiences With Electronic Health Records Among Emergency Medicine Physicians in the United States and Norway: Semistructured Interview Study. JMIR Hum Factors 2022; 9:e28762. [PMID: 34994702 PMCID: PMC8783275 DOI: 10.2196/28762] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 08/22/2021] [Accepted: 10/11/2021] [Indexed: 02/04/2023] Open
Abstract
Background The variability in physicians’ attitudes regarding electronic health records (EHRs) is widely recognized. Both human and technological factors contribute to user satisfaction. This exploratory study considers these variables by comparing emergency medicine physician experiences with EHRs in the United States and Norway. Objective This study is unique as it aims to compare individual experiences with EHRs. It creates an opportunity to expand perspective, challenge the unknown, and explore how this technology affects clinicians globally. Research often highlights the challenge that health information technology has created for users: Are the negative consequences of this technology shared among countries? Does it affect medical practice? What determines user satisfaction? Can this be measured internationally? Do specific factors account for similarities or differences? This study begins by investigating these questions by comparing cohort experiences. Fundamental differences between nations will also be addressed. Methods We used semistructured, participant-driven, in-depth interviews (N=12) for data collection in conjunction with ethnographic observations. The conversations were recorded and transcribed. Texts were then analyzed using NVivo software (QSR International) to develop codes for direct comparison among countries. Comprehensive understanding of the data required triangulation, specifically using thematic and interpretive phenomenological analysis. Narrative analysis ensured appropriate context of the NVivo (QSR International) query results. Results Each interview resulted in mixed discussions regarding the benefits and disadvantages of EHRs. All the physicians recognized health care’s dependence on this technology. In Norway, physicians perceived more benefits compared with those based in the United States. Americans reported fewer benefits and disproportionally high disadvantages. Both cohorts believed that EHRs have increased user workload. However, this was mentioned 2.6 times more frequently by Americans (United States [n=40] vs Norway [n=15]). Financial influences regarding health information technology use were of great concern for American physicians but rarely mentioned among Norwegian physicians (United States [n=37] vs Norway [n=6]). Technology dysfunctions were the most common complaint from Norwegian physicians. Participants from each country noted increased frustration among older colleagues. Conclusions Despite differences spanning geographical, organizational, and cultural boundaries, much is to be learned by comparing individual experiences. Both cohorts experienced EHR-related frustrations, although etiology differed. The overall number of complaints was significantly higher among American physicians. This study augments the idea that policy, regulation, and administration have compelling influence on user experience. Global EHR optimization requires additional investigation, and these results help to establish a foundation for future research.
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Affiliation(s)
- Gracie Garcia
- Department of History and Philosophy of Medicine, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Christopher Crenner
- Department of History and Philosophy of Medicine, University of Kansas School of Medicine, Kansas City, KS, United States
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Geuijen PM, Pars E, Kuppens JM, Schene AH, de Haan HA, de Jong CAJ, Atsma F, Schellekens AFA. Barriers and Facilitators to Seek Help for Substance Use Disorder among Dutch Physicians: A Qualitative Study. Eur Addict Res 2022; 28:23-32. [PMID: 34192705 DOI: 10.1159/000517043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/23/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Substance use disorders (SUDs) among physicians affect their health, quality of life, but potentially also their quality of care. Despite the availability of effective specific Physician Health Programs (PHPs), physicians with SUD often experience barriers when seeking professional help. Therefore, we studied barriers and facilitators when seeking help for SUD among physicians from a multiple perspective approach. METHODS A qualitative design was adopted for 2 sub-studies. First, answers of 2 open-ended questions (about anticipated barriers and facilitators) of an existing questionnaire were analyzed. This questionnaire was filled out by 1,685 general physicians (response rate = 47%). The answers of these open-ended questions were coded inductively. Second, 21 semi-structured interviews (about experienced barriers and facilitators) were performed with physician SUD-patients, significant others, and PHP employees. Themes identified in the first sub-study were used to deductively code the interview transcripts. Results were reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS Barriers were found at the level of the individual physician (negative feelings and lack of disease awareness), whereas facilitators were found at the level of social relationships (confrontation with SUD and social support) and health services (supportive approach, good accessibility, and positive image of services). The interviews emphasized the importance of nonjudgmental confrontation by social relationships in the process of seeking help for SUD. CONCLUSION Physicians with SUD face barriers when seeking help for SUD mostly at the level of the individual physician. Health services and people around physicians with SUD could facilitate the help-seeking process by offering confidential and nonpunitive support. Future studies should explore whether the barriers and facilitators identified in this study also hold for other mental health issues.
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Affiliation(s)
- Pauline M Geuijen
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Esther Pars
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Joanneke M Kuppens
- Physician Health Program ABS-Doctors, Royal Dutch Medical Association (RDMA), Utrecht, The Netherlands
| | - Aart H Schene
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hein A de Haan
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands.,Tactus Addiction Treatment, Deventer, The Netherlands
| | - Cornelis A J de Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands.,Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Femke Atsma
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arnt F A Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
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9
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Motreff Y, Pirard P, Vuillermoz C, Rabet G, Petitclerc M, Stene LE, Baubet T, Chauvin P, Vandentorren S. Mental health care utilization by first responders after Paris attacks. Occup Med (Lond) 2021; 72:81-90. [PMID: 34729607 PMCID: PMC8863088 DOI: 10.1093/occmed/kqab150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background First responders (FRs) are frequently exposed to potentially traumatic events, including terror attacks, and may consequently be at risk of developing mental health disorders. Prior research suggests that FRs with mental health disorders often do not receive appropriate treatment. More knowledge is needed about their use of mental health care (MHC). Aims This study aimed to identify factors associated with receiving immediate support, post-immediate support and engagement in MHC among FRs of the November 2015 terror attacks in Paris. Methods A web-based study was conducted 8–12 months after the attacks on 663 FRs who were mobilized during the night and/or the aftermath of the attacks. Logistic regression was performed to analyse factors associated with MHC. Results Overall, 44 FRs sought MHC. Among FRs with post-traumatic stress disorder (PTSD), partial PTSD or depression (n = 60), 38% sought MHC (n = 23). Post-immediate support was associated with immediate support, and both were associated with knowing someone who could help regarding the potential psychological risks following a traumatic event. MHC engagement was associated with a history of MHC, post-immediate support and the presence of PTSD, partial PTSD or depression. Conclusions Among FRs with PTSD, partial PTSD or depression, few sought MHC. Improved access to MHC for FRs after terror attacks is essential. Knowing someone who could help regarding potential psychological risks may facilitate immediate and/or post-immediate support. Furthermore, post-immediate support could encourage engagement in MHC. Efforts should be made before and after potentially traumatic events to ensure mental health education for FR.
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Affiliation(s)
- Y Motreff
- Santé publique France, Direction des maladies non transmissibles et traumatismes, Saint-Maurice, France.,INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
| | - P Pirard
- Santé publique France, Direction des maladies non transmissibles et traumatismes, Saint-Maurice, France.,MOODS, INSERM U 1018, CESP, Université Paris-Saclay, Faculté de Médecine Paris-Saclay, Le Kremlin Bicêtre, France
| | - C Vuillermoz
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
| | - G Rabet
- Santé publique France, Direction appui, traitements et analyses des données, Saint-Maurice, France
| | - M Petitclerc
- Service médical d'urgence-bureau de santé et de prévention, Brigade de sapeurs-pompiers de Paris, 1, place Jules-Renard, Paris, France.,Université Sorbonne Paris Nord, Ecole doctorale Erasme, Laboratoire UTRPP, Villetaneuse, France
| | - L Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - T Baubet
- Université Sorbonne Paris Nord, Ecole doctorale Erasme, Laboratoire UTRPP, Villetaneuse, France.,APHP Hôpital Avicenne, Psychopathology Department for Children, Adolescents, General Psychiatry and Specialized Addiction, Bobigny, France.,Centre National de Ressources et de Résilience Lille-Paris (CN2R), Lille, France
| | - P Chauvin
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France
| | - S Vandentorren
- INSERM, Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, Paris, France.,Santé publique France, Direction des régions, Saint-Maurice, France
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10
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Avoidable mortality for causes amenable to medical care and suicide in physicians in Spain. Int Arch Occup Environ Health 2021; 95:1147-1155. [PMID: 34714394 DOI: 10.1007/s00420-021-01813-9] [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: 08/23/2021] [Accepted: 10/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare avoidable mortality for causes amenable to medical care and suicide in physicians versus other professionals with similar university studies and socioeconomic position in Spain. METHODS All people aged 25-64 years who were employed on 1 November 2001 (8,697,387 men and 5,282,611 women) were included. Their vital status was followed for 10 years and the cause of death of deceased was recorded. Using a Poisson regression to estimate the mortality rate ratio (MRR), we compared mortality due to causes of death amenable to medical care, all other causes, and suicide in physicians versus other professionals. Mortality in physicians was used as a reference. RESULTS The lowest MRR for causes amenable to medical care was observed in engineers/architects (men: 0.84, 95% confidence interval [CI] 0.72, 0.97; women: 0.93, 95% CI 0.64, 1.35) and healthcare professions other than physicians/pharmacists/nurses (men: 0.86, 95% CI 0.56, 1.34; women: 0.69, 95% CI 0.32, 1.46). Regarding mortality for all other causes of death, professionals from these and other occupations presented lower mortality than physicians. Other healthcare professions, entrepreneurs, and managers/executives completed suicide at a higher rate than physicians. CONCLUSION Although the accessibility to the healthcare system and to the pharmacological drugs could suggest that physicians would present low rates for causes amenable to medical care and high rates of suicide, our results show that this is not the case in Spain.
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Burnout prevalence among European physicians: a systematic review and meta-analysis. Int Arch Occup Environ Health 2021; 95:259-273. [PMID: 34628517 DOI: 10.1007/s00420-021-01782-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Our objective was to assess burnout prevalence rates among physicians practicing in Europe (regardless of their specialty) taking into account the main approaches used to define burnout with the Maslach Burnout Inventory (MBI) tool. METHODS A systematic review was carried out from 2006 to 2018. A keyword request was obtained using the PubMed/Medline, Web of Science and Banque de Données en Santé Publique search engine. Studies written in English measuring burnout with the MBI tool among a population of practicing European physicians were selected. Data were extracted and classified according to burnout's definition provided by the authors. Three definitions using the MBI dimensions were considered: tri-, bi- and unidimensional definition. A meta-analysis was then performed on burnout prevalence rates according to the dimensional definition of burnout. RESULTS From 2378 search results, we selected 56 studies including from up to 41 European countries. Depending upon the study, physicians' burnout prevalence rates ranged from 2.5% to 72.0%. The pooled prevalence rate of burnout was estimated at 7.7% [5.3-10.4%] with the tridimensional definition, 19.7% [13.5-26.3%] with the bidimensional definition and 43.2% [29.0-57.6%] with the unidimensional definition. CONCLUSION Burnout pooled prevalence among physicians varies from single to fivefold depending on the method employed to assess burnout with the MBI tool. Medical community should determine a standardized method to assess burnout prevalence rates to best evaluate this phenomenon.
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Iloh GU, Ikwudinma AO, Emeka EA, Obi IV. Preventive Health Evaluation in Underserved Occupational Environment: A Cross-Sectional Study of its Practice, Facilitators, Barriers, and Benefits among Medical Practitioners in Nigeria. Indian J Occup Environ Med 2021; 25:101-105. [PMID: 34421246 PMCID: PMC8341407 DOI: 10.4103/ijoem.ijoem_149_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/13/2020] [Accepted: 06/30/2020] [Indexed: 11/04/2022] Open
Abstract
Background The health of medical doctors (MDs) has been the focus of global concern in addition to the recently modified physician oath now called "The Modern Physician Pledge." As a member of human family, MDs are also prone to diseases they manage in healthcare environment. Objectives The study was aimed at describing the practice, facilitators, barriers, and benefits of preventive health evaluation (PHE) in a cross-section of medical practitioners in Nigeria. Methodology A cross-sectional study done on 178 MDs in Nigeria. Data collection was done using pretested, self-administered questionnaire that elicited information on practice, facilitators, barriers, and benefits of PHE. Self-rated health status was also studied. Practice of PHE was inquired in previous one year. Results The age of the respondents ranged from 25 to 72 (36 ± 10.2) years. There were 161 (90.5%) males. All the respondents were aware of PHE. One hundred and fifty-five (87.1%) respondents rated their overall health then as excellent; 142 (79.8%) rated their overall health compared to 6 months ago as excellent, while 169 (94.9%) rated their overall health compared to others of their age as excellent. Generally, in all ages and both sexes, the most common PHE was blood pressure (BP) measurements (100%). The commonest female sex-specific PHE was self-breast examinations (100%). Among the males, the most common male-specific PHE was testicular self-examinations (87.0%). The commonest facilitator and barrier were family history of hereditary diseases (100%) and financial restraints (82.0%), respectively. The most common benefit was early detection of diseases (100%). Conclusion Awareness of PHE was 100% but didn't translate to comparative practice orientation. The most common general PHE was BP checks. The commonest female and male sex-specific PHE was self-breast and testicular examinations respectively. The predominant facilitator and barrier were family history of hereditary diseases and financial restraints. The most common benefit was early detection of diseases.
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Affiliation(s)
- Gabriel Uche Iloh
- Department of Family Medicine, Federal Medical Centre, Umuahia, Abia State, Aba, Nigeria.,Department of Medicine, College of Medicine and Health Sciences, Rhema University, Aba, Nigeria
| | - Augustine O Ikwudinma
- Department of Family Medicine, Alex Ekwueme Federal Teaching Hospital Abakiliki, Ebonyi State, Nigeria.,Department of Family Medicine, Alex Ekwueme University, Ndifu Alike, Ebonyi State, Nigeria
| | - Ekene A Emeka
- Department of Family Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.,Department of Family Medicine, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ikechukwu V Obi
- Department of Health Administraion and Management, University of Nigeria, Enugu, Nigeria.,Department of Health Services, AIICO Multishield Ltd, Enugu, Nigeria
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Alcaraz-Mor R, Urcun A, Vigouroux A, Boyer L, Villa A, Lehucher-Michel MP. Contraintes psychosociales et organisationnelles : analyse qualitative auprès de 52 médecins hospitaliers. ARCH MAL PROF ENVIRO 2021. [DOI: 10.1016/j.admp.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Bentz L, Vandentorren S, Fabre R, Bride J, Pirard P, Doulet N, Baubet T, Motreff Y, Pradier C. Mental health impact among hospital staff in the aftermath of the Nice 2016 terror attack: the ECHOS de Nice study. BMC Public Health 2021; 21:1372. [PMID: 34246247 PMCID: PMC8272451 DOI: 10.1186/s12889-021-11438-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Nice terror attack of July 14, 2016 resulted in 84 deaths and 434 injured, with many hospital staff exposed to the attack, either as bystanders on site at the time of the attack ('bystander exposure') who may or may not have provided care to attack victims subsequently, or as care providers to victims only ('professional exposure only'). The objective of this study is to describe the impact on mental health among hospital staff by category of exposure with a particular focus on those with 'professional exposure only', and to assess their use of psychological support resources. METHOD An observational, cross-sectional, multicenter study conducted from 06/20/2017 to 10/31/2017 among all staff of two healthcare institutions in Nice, using a web questionnaire. Collected data included social, demographic and professional characteristics; trauma exposure category ('bystanders to the attack'; 'professional exposure only'; 'unexposed'); indicators of psychological impact (Hospital Anxiety and Depression Scale); PTSD (PCL-5) level; support sought. Responders could enter open comments in each section of the questionnaire, which were processed by inductive analysis. RESULTS 804 staff members' questionnaires were analysed. Among responding staff, 488 were exposed (61%): 203 were 'bystanders to the attack', 285 had 'professional exposure only'. The staff with 'professional exposure only' reported anxiety (13.2%), depression (4.6%), suicidal thoughts (5.5%); rates of full PTSD was 9.4% and of partial PTSD, 17.7%. Multivariate analysis in the 'professional exposure only' category showed that the following characteristics were associated with full or partial PTSD: female gender (OR = 2.79; 95% CI = 1.19-6.56, p = 0.019); social isolation (OR = 3.80; 95% CI = 1.30-11.16, p = 0.015); having been confronted with an unfamiliar task (OR = 3.04; 95% CI = 1.18-7.85; p = 0.022). Lastly, 70.6% of the staff with 'professional exposure only' with full PTSD did not seek psychological support. CONCLUSION Despite a significant impact on mental health, few staff with 'professional exposure only' sought psychological support. Robust prevention and follow-up programs must be developed for hospital staff, in order to manage the health hazards they face when exposed to exceptional health-related events such as mass terror attacks. STUDY REGISTRATION Ethical approval for the trial was obtained from the National Ethics Committee for Human Research (RCBID N° 2017-A00812-51).
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Affiliation(s)
- Laurence Bentz
- Côte d’Azur University, Nice University Hospital, Public Health Department, Nice, France
| | - Stéphanie Vandentorren
- Santé publique France, French national public health agency, Direction scientifique et internationale, F-94415 Saint-Maurice, France
- Université Bordeaux, INSERM UMR 1219, Vintage team, F-33000 Bordeaux, France
| | - Roxane Fabre
- Côte d’Azur University, Nice University Hospital, Public Health Department, Nice, France
- Côte d’Azur University, CoBTeK lab, Nice University Hospital, CMRR, Nice, France
| | - Jeremy Bride
- Côte d’Azur University, Nice University Hospital, Public Health Department, Nice, France
- Côte d’Azur University, Nice University Hospital, Policlinique, Medical and psychological emergency unit (CUMP 06), Nice, France
- Paris 13 Sorbonne University - Paris Cité, Laboratoire UTRPP (EA 4403), Villetaneuse, France
| | - Philippe Pirard
- Santé publique France, French national public health agency, Non-Communicable Diseases and Trauma Division, F-94415 Saint-Maurice, France
- Team MOODS, CESP, Inserm 1178, Paris-Saclay University, UVSQ, Villejuif, France
| | - Nadège Doulet
- Côte d’Azur University, Nice University Hospital, Public Health Department, Nice, France
| | - Thierry Baubet
- Centre National de Ressources et de Résilience (CN2R), Lille/Paris, France
- UTRPP ER 4403, Sorbonne Paris Nord University, Villetaneuse, France
- Assistance Publique - Hôpitaux de Paris, Avicenne Hospital, Child and adolescent psychopathology, psychiatry and addiction, Bobigny, France
| | - Yvon Motreff
- Santé publique France, French national public health agency, Non-Communicable Diseases and Trauma Division, F-94415 Saint-Maurice, France
- Sorbonne Université, Inserm, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F-75012 Paris, France
| | - Christian Pradier
- Côte d’Azur University, Nice University Hospital, Public Health Department, Nice, France
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Crowther LL, Robertson N, Anderson ES. Mindfulness for undergraduate health and social care professional students: Findings from a qualitative scoping review using the 3P model. MEDICAL EDUCATION 2020; 54:796-810. [PMID: 32163615 DOI: 10.1111/medu.14150] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/28/2020] [Accepted: 03/09/2020] [Indexed: 06/10/2023]
Abstract
CONTEXT With many health and social care schools offering mindfulness training (MT) there is a need for deeper understanding about pedagogical issues. Despite encouraging findings showing relationships between MT and student stress reduction, there is little qualitative synthesis of the literature about best principles for teaching and learning. METHODS We report on a qualitative scoping review using the stages of Arksey and O'Malley's framework. The search identified papers from MEDLINE, PsychINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and SCOPUS over 15 years. The included papers were synthesised using the 3P model of teaching and learning to explore current MT for presage (teaching set-up), process (teaching delivery) and product (outcomes) factors. RESULTS A total of 16 articles were included in the review. There was a lack of consensus on definition of MT, facilitator training and the intervention used. The majority of studies involved small self-selected, mainly female cohorts. For the set-up (presage factors), the majority of curricula included MT for stress management and well-being, delivered in the early years. Providing appropriate facilitators was a concern, whereas process factors revealed enormous variability in delivery. Few studies had formal assessment, although many had outcome evaluation measures (product factors). CONCLUSIONS The qualitative review has highlighted additional benefits from MT aside from stress reduction; most noticeably, student self-awareness, peer cohesion and group support, ability to attend to patients, and student insights into health and social education culture. Seeking presage, process and product factors has illuminated variability in how MT is being adapted within health and social care curricula. This review highlights the next steps and recommendations for the future.
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Hartnett Y, Drakeford C, Dunne L, McLoughlin DM, Kennedy N. Physician, heal thyself: a cross-sectional survey of doctors' personal prescribing habits. JOURNAL OF MEDICAL ETHICS 2020; 46:231-235. [PMID: 31796545 DOI: 10.1136/medethics-2018-105064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/26/2019] [Accepted: 10/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Self-prescribing and prescribing to personal contacts is explicitly discouraged by General Medical Council guidelines. AIMS This study examines how widespread the practice of self-prescribing and prescribing to personal contacts is. METHODS A 16-item questionnaire was distributed via an online forum comprising 4445 young medical doctors (representing 20% of all Irish registered doctors), which asked respondents about previous prescribing to themselves, their families, friends and colleagues, including the class of medication prescribed. Demographic details were collected including medical grade and specialty. RESULTS A total of 729 responses were obtained, the majority of which were from young non-consultant hospital doctors from a range of specialties. Two-thirds of respondents had self-prescribed, over 70% had prescribed to family, and nearly 60% had prescribed to a friend or colleague. Older doctors were more likely to self-prescribe (χ2=17.51, p<0.001). Interns being less likely to self-prescribe was not unexpected (χ2=69.55, p<0.001), while general practitioners (GPs) and paediatricians were more likely to self-prescribe (χ2=13.33, p<0.001; χ2=11.35, p<0.001). GPs, paediatricians and hospital medicine specialties were more likely to prescribe to family (χ2=5.19, p<0.05; χ2=8.38, p<0.05; χ2=6.17, p<0.05) and surgeons were more likely to prescribe to friends (χ2=15.87, p<0.001). Some 3% to 7% who had self-prescribed had prescribed an opiate, benzodiazepine or psychotropic medication. Male doctors, anaesthetists and surgeons were more likely to self-prescribe opioids (χ2=7.82, p<0.01; χ2=7.31, p<0.01; χ2=4.91, p<0.05), while those in hospital medicine were more likely to self-prescribe psychotropic medications (χ2=5.47, p<0.05). CONCLUSION Prescribing outside the traditional doctor-patient relationship is widespread despite clear professional guidance advising against it.
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Affiliation(s)
- Yvonne Hartnett
- Department of Psychiatry, St Patrick's University Hospital, Dublin, Ireland
- Department of Psychiatry, University of Dublin Trinity College, Dublin, Ireland
| | - Clive Drakeford
- School of Medicine, University of Dublin Trinity College, Dublin, Ireland
| | | | - Declan M McLoughlin
- Department of Psychiatry, St Patrick's University Hospital, Dublin, Ireland
- Department of Psychiatry, University of Dublin Trinity College, Dublin, Ireland
| | - Noel Kennedy
- Department of Psychiatry, St Patrick's University Hospital, Dublin, Ireland
- Department of Psychiatry, University of Dublin Trinity College, Dublin, Ireland
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Doctors' experience of becoming patients and its influence on their medical practice: A literature review. Explore (NY) 2019; 16:145-151. [PMID: 31843394 DOI: 10.1016/j.explore.2019.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/14/2019] [Accepted: 10/20/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE Doctors' illness experiences can deeply influence not only their perceptions of illness and roles but also their medical practice. Researchers and doctors have sought to understand what happens when doctors become patients. However, currently, literature reviews focused exclusively on their illness experiences are lacking. This review examines academic literature and combines it with illness narratives (i.e., pathographies) written by doctors to elucidate the unknown about doctors' experiences and its subsequent influence on medical practice. METHODS An electronic search of the databases Academic Search Complete, Google Scholar, PubMed, ProQuest, and Ichushi-Web was conducted using relevant keywords. The literature reviewed included studies that described doctors' illness experiences or doctors' perspectives on their experiences of being patients. RESULTS Previous studies showed that doctors' disease prognoses are generally better than or similar to those of patients belonging to the general population. However, doctors' documented illness experiences are multi-dimensional and have several common themes. These include the concept of the 'medical self' (behaving as a doctor despite being a patient) and 'role reversal' (the doctor adjusting to the patient role). The other elements of their experiences include barriers to health care, self-treatment and self-doctoring, presenteeism, and 'wounded healers' (those who can heal others using the wisdom from their illness experiences). Most previous literature has omitted the sociocultural and historical dispositions of doctors and their biomedical perspectives of their own afflictions, even though these strongly impact their illness experiences. CONCLUSION Further research that re-contextualises the meaning of illness for doctors is necessary.
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Work and mental health in doctors: A short review of Norwegian studies. Porto Biomed J 2019; 4:e50. [PMID: 31893247 PMCID: PMC6924981 DOI: 10.1097/j.pbj.0000000000000050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/08/2019] [Indexed: 12/02/2022] Open
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Bentz L, Pirard P, Motreff Y, Vandentorren S, Baubet T, Fabre R, Touboul Lundgren P, Pradier C. Health outcomes of the July 14, 2016 Nice terror attack among hospital-based professionals and students: the « ECHOS de Nice » health survey protocol. BMC Public Health 2019; 19:1163. [PMID: 31443708 PMCID: PMC6708198 DOI: 10.1186/s12889-019-7489-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The terror attack of July 14, 2016, in Nice, France, resulted in 86 deaths, including children, and several hundred wounded, with a major psychological impact on the population. Hospital staff had to cope with exceptional circumstances which made them vulnerable to detrimental effects on their own health. This paper describes the method that was selected for the survey entitled "ECHOS de Nice 14 Juillet" which aimed to assess the impact of the attack on the psychological, psycho-traumatic and somatic health condition of the Nice University and Lenval hospital staff who were directly or indirectly exposed to the attack, and also to describe the support and care facilities they were offered. METHOD ECHOS de Nice 14 juillet is an observational, cross-sectional, multicentre study focusing on all the hospital staff and students of both institutions, i.e. 10,100 persons in June 2017. A web-based questionnaire based on the model developed by Santé Publique France (IMPACTS and ESPA 13 novembre 2015) was adapted to the contexts of the healthcare professionals and students employed in these healthcare institutions in Nice and published on line from June 21 to October 30, 2017. The paper describes the tools that were used to meet the aims of the study, i.e. identification of exposure categories ('civilian' exposure for those present during the attack and/or 'professional' exposure); indicators of psychological impact (anxiety, depression, burnout, compassion fatigue, suicidal states, tobacco and alcohol use, self-medications), psycho-traumatic and somatic impact; professional and social impact. Lastly, awareness of availability and use of psychological support and care-follow-up facilities by professionals were investigated. Respondents could include extensive qualitative comments on the various themes explored in the questionnaire, with text analysis complementing that of quantitative data. DISCUSSION The benefits and limitations of the selected methodology are discussed, in view of contributing useful information to help anticipate and manage health issues among hospital staff who have been victims of traumatic events.
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Affiliation(s)
- Laurence Bentz
- Public Health Department, Cote d'Azur University, Nice University Hospital, F-06200, Nice, France.
| | - Philippe Pirard
- Non-communicable Diseases and Trauma Division, French National Public Health Agency (Santé Publique France), F-94415, Saint-Maurice, France.,Epidemiology and Population Health Research Centre (CESP), National Health and Medical Research Institute (INSERM), Unit 1178 "Santé Mentale et Santé Publique", F-94807, Villejuif Cedex, France
| | - Yvon Motreff
- Non-communicable Diseases and Trauma Division, French National Public Health Agency (Santé Publique France), F-94415, Saint-Maurice, France.,Department of Social Epidemiology, National Health and Medical Research Institute (INSERM), Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Sorbonne University,, F75012, Paris, France
| | - Stéphanie Vandentorren
- Department of Social Epidemiology, National Health and Medical Research Institute (INSERM), Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Sorbonne University,, F75012, Paris, France.,French National Public Health Agency (Santé Publique France), Regional Office of Nouvelle Aquitaine, F-94415, Saint-Maurice, France
| | - Thierry Baubet
- Epidemiology and Population Health Research Centre (CESP), National Health and Medical Research Institute (INSERM), Unit 1178 "Santé Mentale et Santé Publique", F-94807, Villejuif Cedex, France.,Paris-Seine-Saint-Denis University Hospitals (AP-HP), Hôpital Avicenne, Paris 13 University, F-93000, Bobigny, France.,National Resources and Resilience Centre (CNRR), F-93000, Bobigny, France
| | - Roxane Fabre
- Public Health Department, Cote d'Azur University, Nice University Hospital, F-06200, Nice, France.,CoBTeK lab, Nice University Hospital, CMRR, Cote d'Azur University, F-06200, Nice, France
| | - Pia Touboul Lundgren
- Public Health Department, Cote d'Azur University, Nice University Hospital, F-06200, Nice, France
| | - Christian Pradier
- Public Health Department, Cote d'Azur University, Nice University Hospital, F-06200, Nice, France
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Barriers to seeking help for physicians with substance use disorder: A review. Drug Alcohol Depend 2019; 199:116-121. [PMID: 31035230 DOI: 10.1016/j.drugalcdep.2019.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/04/2019] [Accepted: 04/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Substance use disorders (SUD) might concern as many as 8-15% of physicians. Previous studies suggest that self-diagnosis and self-medication are common practices among physicians. The aim of this review was to identify if barriers to seeking help and medical care for impaired physicians exist. We also aimed at characterizing the nature of these barriers. METHODS The review included scientific papers published on the MEDLINE and PsychINFO databases between January 2000 and September 2018. The inclusion criteria were: (i) articles that focused on SUD in physicians. The exclusion criteria were: (i) no mention of SUD; (ii) no mention of barriers to seeking help; (iii) articles focused on burn-out and work-related stress; (iv) articles focused on risk factors or treatments for SUD; (v) articles focused on psychiatric comorbidities and (vi) those focused on other professionals. RESULTS Potential barriers to seeking help that were identified for impaired physicians with SUD included denial of the disease and of loss of performance, fear of stigma, psychiatric comorbidities, fear of familial/social/professional and economic consequences and a lack of knowledge. CONCLUSIONS Different barriers to seeking help could be identified. Priority should be given to educating medical students to ameliorate this. Increased awareness should reduce the stigma, which, even nowadays, still prevents some physicians from seeking help.
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Solenova LG, Nekrasova LA. Healthcare workers: occupational carcinogenic factors and cancer risk. ADVANCES IN MOLECULAR ONCOLOGY 2018. [DOI: 10.17650/2313-805x-2018-5-3-25-39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The number of healthcare workers is over two million in Russia. Many of them are exposed to hazardous physical, chemical and biological occupational factors acting along with psychological strain. The results of large epidemiological studies carried out in various countries revealed greater cancer risk in physicians and nurses: cancer of the breast, skin, brain and other sites. Higher cancer risk of lung, breast, uterine, ovary, brain is considered to be associated with ionizing radiation. The female healthcare workers who handle antineoplastic drugs showed a greater risk of birth defects in offspring, spontaneous abortions and breast cancer. In Russia, the growing number of accidents among healthcare workers following transmission of infection by carcinogenic biological factors such as HBV and HIV is observed. Higher risk of reproductive impairments, hyperplasia of the breast and uterine tissues, breast cancer are revealed in nurses working the night shift. In Russia, there is lack of epidemiological studies of cancer risk among healthcare workers, the number of medical personal exposed to occupational carcinogens is unknown. That all does not show the actual situation in our country and does not allow setting priorities in cancer prevention among medical workers.
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Affiliation(s)
- L. G. Solenova
- Research Institute of Carcinogenesis, N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - L. A. Nekrasova
- Research Institute of Carcinogenesis, N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
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Bíró É, Veres-Balajti I, Ádány R, Kósa K. Social cognitive intervention reduces stress in Hungarian university students. Health Promot Int 2018; 32:73-78. [PMID: 28180254 DOI: 10.1093/heapro/dau006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Summary A social cognitive intervention was developed and delivered as a credit course to improve mental distress of university students, based on findings in a previous health survey showing notable mental distress among future teachers in Hungary in 2007. The intervention included increasing information on psychoactive substances used for stress reduction; skills development in stress reduction methods; improving skills in communication and problem-solving. All students who participated in the previous health survey were targeted. Mental status of the participants was assessed by a questionnaire before (n: 128, 22% male, mean age 23.21 years) and after (n: 148, 30% male, mean age 23.54 years) the intervention. Specifically, self-efficacy as outcome was approximated by a trait measure (sense of coherence); psychological distress was measured by the 12-item General Health Questionnaire (Goldberg et al., 1997. The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27, 191–197) after the intervention compared with that before. After the intervention, psychological distress was reduced among the participants (p: 0.013). Non-significant improvement occurred in the mean score for sense of coherence (from a mean 60.8 points before to 61.4 points after, p: 0.688). The intervention produced a modest but significant decrease in psychological distress in students at a cost of 54 US$ per 1 point improvement in mental distress. The intervention, a first example of the translation of the social cognitive theory into practice among students in higher education can be integrated into the curriculum as a standardized optional course.
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Affiliation(s)
- Éva Bíró
- Division of Health Promotion, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai st. 26/b., H-4028, Debrecen, Hungary
| | - Ilona Veres-Balajti
- Division of Physiotherapy, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Karolina Kósa
- Division of Health Promotion, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai st. 26/b., H-4028, Debrecen, Hungary
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The impact of witnessing other people's trauma: The resilience and coping strategies of members of the Faculty of Forensic and Legal Medicine. J Forensic Leg Med 2018; 55:99-104. [DOI: 10.1016/j.jflm.2018.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/23/2018] [Accepted: 02/11/2018] [Indexed: 11/21/2022]
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Abstract
SummaryI describe the needs for and impediments in provision of psychological support services for doctors. Morbidity and the resistance in the profession to addressing their own health needs are discussed. I also explore the principles of bespoke services for doctors, with particular emphasis on overcoming stigma and facilitating therapeutic engagement. I argue that triage is an inappropriate service model of care for doctors.
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Meerten M, Bland J, Gross SR, Garelick AI. Doctors' experience of a bespoke physician consultation service: cross-sectional investigation. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.110.031047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodOur aim was to follow-up on a cohort of self-referred doctors who attended MedNet. We used a two-point cross-sectional design. Measures included three standardised self-report questionnaires administered before and after consultation. Doctors were also asked to complete a service user questionnaire, and data regarding engagement and onward referrals were gathered through case-note review.ResultsA statistically significant improvement in scores on all three questionnaires was found after intervention; however, scores on one subscale, the risk domain of the Clinical Outcomes in Routine Evaluation – Outcome Measure, did not change significantly. Of the doctors at no risk of suicide at intake, nearly two-thirds (n = 41/70, 59%) were sufficiently helped by the consultations provided to not need further treatment. Of the doctors at some risk of suicide at intake, two-thirds (n = 34/51, 67%) did need an onward referral. Only one doctor required hospital admission, an outcome that suggests the approach used is containing and clinically responsive.Clinical implicationsThis paper highlights the efficacy, need and importance of specialist services for doctors in difficulty. We found that the bespoke consultation model provided at MedNet is valued highly by the doctors as service users.
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Ishimaru T, Hattori M, Nagata M, Kuwahara K, Watanabe S, Mori K. [Factors Associated with Stress Check Attendance: Possible Effect of Timing of Annual Health Examination]. Nihon Eiseigaku Zasshi 2018; 73:235-240. [PMID: 29848876 DOI: 10.1265/jjh.73.235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The stress check program has been part of annual employees' health screening since 2015. Employees are recommended, but not obliged, to undergo the stress check offered. This study was designed to examine the factors associated with stress check attendance. METHODS A total of 31,156 Japanese employees who underwent an annual health examination and a stress check service at an Occupational Health Service Center in 2016 participated in this study. Data from the annual health examination and stress check service included stress check attendance, date of attendance (if implemented), gender, age, workplace industry, number of employees at the workplace, and tobacco and alcohol consumption. Data were analyzed using multiple logistic regression. RESULTS The mean rate of stress check attendance was 90.8%. A higher rate of stress check attendance was associated with a lower duration from the annual health examination, age ≥30 years, construction and transport industry, and 50-999 employees at the workplace. A lower rate of stress check attendance was associated with medical and welfare industry and ≥1,000 employees at the workplace. CONCLUSIONS These findings provide insights into developing strategies for improving the rate of stress check attendance. In particular, stress check attendance may improve if the stress check service and annual health examination are conducted simultaneously.
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Affiliation(s)
- Tomohiro Ishimaru
- Department of Health Management, Nishinihon Occupational Health Service Center
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
| | - Michihiro Hattori
- Department of Health Management, Nishinihon Occupational Health Service Center
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
| | - Masako Nagata
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
| | | | - Seiji Watanabe
- Department of Health Management, Nishinihon Occupational Health Service Center
| | - Koji Mori
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
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Goulet F, Thiffault J, Ladouceur R. Remediation and rehabilitation programmes for health professionals: challenges for the future. BMJ Qual Saf 2017; 26:941-943. [DOI: 10.1136/bmjqs-2017-007187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2017] [Indexed: 11/04/2022]
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Milner A, Witt K, Spittal MJ, Bismark M, Graham M, LaMontagne AD. The relationship between working conditions and self-rated health among medical doctors: evidence from seven waves of the Medicine In Australia Balancing Employment and Life (Mabel) survey. BMC Health Serv Res 2017; 17:609. [PMID: 28851354 PMCID: PMC5576303 DOI: 10.1186/s12913-017-2554-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/16/2017] [Indexed: 11/10/2022] Open
Abstract
Background Psychosocial job stressors, such as low control and high demands, have been found to influence the health and wellbeing of doctors. However, past research in this area has relied on cross-sectional data, which limits causal inferences about the influence of psychosocial job stressors on health. In this study, we examine this relationship longitudinally while also assessing whether the relationship between psychosocial job stressors and health is modified by gender. Methods The data source was seven annual waves of the Medicine in Australia: Balancing Employment and Life (MABEL) survey. The outcome was self-rated health (measured using the SF-12), and key exposures reflected job control, job demands, work-life balance variables, employment arrangements, and aggression experienced at work. We used longitudinal fixed and random effects regression models to assess within and between-person changes in health. Results Excessive job demands, low job control, feelings of not being rewarded at work, and work-life imbalance were associated with higher within-person odds of poorer self-rated health. Gender differences were apparent. For female doctors, work arrangements and work-life imbalance were associated with poorer self-rated health whilst task-based job stressors were associated with poorer self-rated health in male doctors. Conclusions These results suggest the importance of addressing adverse working environments among doctors. Trial registration Not applicable. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2554-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allison Milner
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, 3010, Australia. .,Work, Health and Wellbeing Unit, Population Health Research Centre, School of Health & Social Development, Deakin University, Melbourne, Australia.
| | - Katrina Witt
- Turning Point, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Marie Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Melissa Graham
- Centre for Health through Action on Social Exclusion, School of Health and Social development, Deakin University, Melbourne, Australia
| | - Anthony D LaMontagne
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Melbourne, 3010, Australia.,Work, Health and Wellbeing Unit, Population Health Research Centre, School of Health & Social Development, Deakin University, Melbourne, Australia
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Weenink JW, Kool RB, Bartels RH, Westert GP. Getting back on track: a systematic review of the outcomes of remediation and rehabilitation programmes for healthcare professionals with performance concerns. BMJ Qual Saf 2017; 26:1004-1014. [DOI: 10.1136/bmjqs-2017-006710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/19/2017] [Accepted: 07/18/2017] [Indexed: 11/04/2022]
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Suzuki S. Exhausting Physicians Employed in Hospitals in Japan Assessed by a Health Questionnaire. SANGYŌ EISEIGAKU ZASSHI = JOURNAL OF OCCUPATIONAL HEALTH 2017; 59:107-118. [PMID: 28539538 DOI: 10.1539/sangyoeisei.16-022-e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Japanese physicians employed and working in general hospitals have become busier since 2005, as they had to teach and guide the increased number of medical residents graduated from medical schools. Working hours and chronic fatigue of employed physicians were surveyed compared with independent physicians working in their own out-patient clinics and with usual employed men in Japan, and their mental health was assessed. METHODS (1) 75 employed physicians in hospitals were surveyed of their working hours a week and compared with (2) 48 independent general practitioners (GP) who work in their own out-patient clinics. (3) 47 employed physicians aged 40s and 50s out of (1) were compared with group (4) or 277 men of the same age employed in an automobile company. A symptom check list questionnaire, the Total Health Index (THI), was used to assess their stress and mental health status. The THI has 130 questions including physical symptoms, mental complaints, lifestyle and habits. 130 items have been grouped into 12 scales: vague complaints, respiratory symptoms, depression, and 9 other scales. RESULTS The average weekly working hours of employed physicians of (1) and GPs of (2) were 55.7 h and 51.3 h, respectively, and those who worked 60 h or more a week were 44.0% and 27.0%, respectively. They had significantly higher average scale scores than GPs with respect to vague complaints, irregular daily life, mental instability, depression, neurotics and psychosomatics scales. They also had significantly higher yes response rates for question items, "envy for richer friends", "feel my life is going badly", and other items than the GPs. 47 employed physicians of group (3) and 277 men workers of group (4) worked for 57.0 h and 46.0 h a week, respectively, in average, and 51.1% and 6.2% of group (3) and (4), respectively, worked for 60 h or more a week. The average scale scores of physicians of (3) were highly significantly poorer than group (4) in many scales of THI. Physicians employed also had significantly higher yes response rates for question items "feel too heavy work load", "stressed state", "irritated", "depressed", "lack of sleep", and "low back pain". Most of the physicians of group (3) were exhausted due to the hard work, showing a sharp contrast to group (4). CONCLUSIONS Physicians employed in hospitals work for 57.0 h a week on average, although usual labors of the same age in a large farm work for 46.0 h a week. Physicians employed were exhausted or burnout and under poorer mental condition.
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Díez-Goñi N, Rodríguez-Díez MC. Why teaching empathy is important for the medical degree. Rev Clin Esp 2017; 217:332-335. [PMID: 28237408 DOI: 10.1016/j.rce.2017.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/12/2016] [Accepted: 01/08/2017] [Indexed: 12/30/2022]
Abstract
Empathy is a basic skill in the exercise of medicine and increases patient and physician satisfaction and improves clinical results. However, the teaching of empathy is poorly covered in the teaching plans. A number of studies have observed a reduction in empathy during the final training courses. The reasons for this decline include, the students' excessive academic workload, the prioritisation of acquiring medical expertise over humanistic knowledge, the patient load in hospitals and health centres and the physicians' need to distance themselves from their patients. Nevertheless, intervention studies through simulation with standardised patients have shown an increase in empathy in students, which can be evaluated through the Jefferson scales: JSE-S and JSPPPE. The teaching of empathy to medical students is an important commitment in the curricular programs of medical schools.
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Affiliation(s)
- N Díez-Goñi
- Unidad de Educación Médica, Facultad de Medicina, Universidad de Navarra, Pamplona, España.
| | - M C Rodríguez-Díez
- Unidad de Educación Médica, Facultad de Medicina, Universidad de Navarra, Pamplona, España
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Lygnugaryte-Griksiene A, Leskauskas D, Jasinskas N, Masiukiene A. Factors influencing the suicide intervention skills of emergency medical services providers. MEDICAL EDUCATION ONLINE 2017; 22:1291869. [PMID: 28235388 PMCID: PMC5345589 DOI: 10.1080/10872981.2017.1291869] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Lithuania currently has the highest suicide rate in Europe and the fifth highest worldwide. AIMS To identify the factors that influence the suicide intervention skills of emergency medical services (EMS) providers (doctors, nurses, paramedics). METHOD Two hundred and sixty-eight EMS providers participated in the research. The EMS providers were surveyed both prior to their training in suicide intervention and six months later. The questionnaire used for the survey assessed their socio-demographic characteristics, suicide intervention skills, attitudes towards suicide prevention, general mental health, strategies for coping with stress, and likelihood of burnout. RESULTS Better suicide intervention skills were more prevalent among EMS providers with a higher level of education, heavier workload, more positive attitudes towards suicide prevention, better methods of coping with stress, and those of a younger age. Six months after the non-continuous training in suicide intervention, the providers' ability to assess suicide risk factors had improved, although there was no change in their suicide intervention skills. CONCLUSIONS In order to improve the suicide intervention skills of EMS providers, particular attention should be paid to attitudes towards suicide prevention, skills for coping with stress, and continuous training in suicide intervention. ABBREVIATIONS EMS: Emergency medical services; SIRI: Suicide intervention response inventory.
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Affiliation(s)
- Aidana Lygnugaryte-Griksiene
- Psychiatric Department of Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
- CONTACT Aidana Lygnugaryte-Griksiene Psychiatry Department, Lithuanian University of Health Sciences Hospital, Kaunas Clinics, Eiveniu str. 2, KaunasLT-50161, Lithuania
| | - Darius Leskauskas
- Psychiatric Department of Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Nedas Jasinskas
- Emergency Medical Department of Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania
| | - Agne Masiukiene
- Kaunas St. Kazimieras Lower Secondary School, Kaunas, Lithuania
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Isaksson Rø K, Veggeland F, Aasland OG. Peer counselling for doctors in Norway: A qualitative study of the relationship between support and surveillance. Soc Sci Med 2016; 162:193-200. [PMID: 27371908 DOI: 10.1016/j.socscimed.2016.06.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 05/24/2016] [Accepted: 06/20/2016] [Indexed: 11/27/2022]
Abstract
RATIONALE Peer support can entail collegial responsibility for counselling and support as well as reactions to academic or ethical failure. These considerations can be complementary, but also conflicting. OBJECTIVE This article focuses on how the peer support programme in Norway addresses these considerations. METHODS Focus group interviews held with Norwegian peer counsellors from August 2011 to June 2012 were analysed by a stepwise deductive-inductive method. RESULTS Based on organisational theory, two "ideal types" of counsellors were identified from the data, and these were then used to reanalyse the text. We found that the organisational framework is associated with the peer counsellors' role conception and thereby the relationship between the counsellor and the help-seeking doctor. The relationship between informal frameworks like collegiality, confidence and discretion, and more formalized incentive-driven frameworks, appear to influence the accessibility to peer support, the mandate to provide relevant help and the understanding of what peer support represents. CONCLUSION The study showed the need for a continuous awareness of a balance between the informal and the more formalized elements in the framework for peer support. This is of importance for how the service can contribute to better health among doctors and to secure quality and safety in the treatment of patients. The analysis can also be used to demonstrate the consequences of how the peer support program is designed - such as the degree of formalisation and the balance between "hard" and "soft" ways to regulate the interaction between peer counsellors and doctors - for the ability to achieve the stated objectives of the service.
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Affiliation(s)
- Karin Isaksson Rø
- LEFO - Institute for Studies of the Medical Profession, Postboks 1152 Sentrum, 0107, Oslo, Norway.
| | - Frode Veggeland
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Postboks 1089, Blindern, 0317, Oslo, Norway.
| | - Olaf G Aasland
- LEFO - Institute for Studies of the Medical Profession, Postboks 1152 Sentrum, 0107, Oslo, Norway.
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Lheureux F, Truchot D, Borteyrou X. Suicidal tendency, physical health problems and addictive behaviours among general practitioners: their relationship with burnout. WORK AND STRESS 2016. [DOI: 10.1080/02678373.2016.1171806] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Győrffy Z, Dweik D, Girasek E. Workload, mental health and burnout indicators among female physicians. HUMAN RESOURCES FOR HEALTH 2016; 14:12. [PMID: 27039083 PMCID: PMC4818422 DOI: 10.1186/s12960-016-0108-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 03/23/2016] [Indexed: 05/06/2023]
Abstract
BACKGROUND Female doctors in Hungary have worse indicators of physical and mental health compared with other professional women. We aimed to cast light on possible indicators of mental health, workload, and burnout of female physicians. METHODS Two time-points (T) were compared, in 2003 (T1 n = 408) and 2013 (T2 n = 2414), based on two nationally representative surveys of female doctors, and comparison made with data from other professional control groups. Independent samples t test or chi-squared test was used both for the two time-point comparison and the comparison between the index and the control groups. The background factors of sleep disorders and burnout were assessed by binary logistic regression analysis. RESULTS No significant differences in the rates of depressive symptoms and suicidal thoughts and attempts were detected between the 2003 and 2013 cohorts, but the prevalence of sleep disorders increased. The workload increased, and there was less job satisfaction in 2013 than in 2003, coupled to more stressful or difficult work-related situations. The personal accomplishment component of burnout significantly decreased in line with the declining work-related satisfaction. Compared to the professional control groups, the prevalence of depressive symptoms, suicide attempts, and sleep disorders was higher among female physicians at both time-points. The number of workplaces, frequency of work-related stressful situations, and intensive role conflict was associated with sleep disorders and decreased personal accomplishment. CONCLUSIONS In comparison with the other professional groups, female doctors had worse mental health indicators with regard to depression, suicidal ideas, and sleep disorders both in 2003 and 2013 while within professional strata the changes seemed to be less. Increasing workload had a clear impact on sleep disorders and the personal accomplishment dimension of burnout.
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Affiliation(s)
- Zsuzsa Győrffy
- />Institute of Behavioural Sciences, Semmelweis University, Nagyvárad square 4, Budapest, H-1089 Hungary
| | - Diana Dweik
- />Department of Obstetrics and Gynecology, University of Szeged, Semmelweis st. 1, Szeged, H-6725 Hungary
| | - Edmond Girasek
- />Health Services Management Training Centre, Semmelweis University, Kútvölgyi st 2, Budapest, H-1125 Hungary
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Feeney S, O'Brien K, O'Keeffe N, Iomaire ANC, Kelly ME, McCormack J, McGuire G, Evans DS. Practise what you preach: health behaviours and stress among non-consultant hospital doctors. Clin Med (Lond) 2016; 16:12-8. [PMID: 26833509 PMCID: PMC4954324 DOI: 10.7861/clinmedicine.16-1-12] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
High rates of psychological distress, depression and suicide have been reported among doctors. Furthermore, many doctors do not access healthcare by conventional means. This study aimed to increase understanding regarding non-consultant hospital doctors' (NCHDs') response to stress and barriers to accessing supports, and identify possible solutions. Medical manpower departments in 58 hospitals distributed a 25-item questionnaire to 4,074 NCHDs; we received 707 responses (response rate, 17.4%). 60% of NCHDs were unable to take time off work when unwell; 'letting teammates down' (90.8%) and 'difficulty covering call' (85.9%) were the leading reasons. 'Being too busy' (85%), 'self-prescription' (66.6%) and 'self-management' (53.1%) were ranked highest in deterring NCHDs from visiting a general practitioner (GP). 22.9% of NCHDs would not attend a GP with anxiety or depression until they began to feel hopeless, helpless or suicidal. 12.2% would not seek help at all. 55% of respondents (n = 330) had to move away from partners or dependants due to work, negatively affecting the social supports of 82.9%. Possible practical solutions were explored. NCHDS are a vulnerable population and have a particularly challenging lifestyle. Key recommendations include improved GP and counselling access for NCHDs, and addressing the culture of self-treatment and poor health behaviours through undergraduate and postgraduate education.
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Affiliation(s)
- Sinéad Feeney
- Western Training Programme in General Practice, Galway University Hospital, Galway, Ireland
| | - Kevin O'Brien
- graduate of the Western Training Programme in General Practice
| | | | | | | | | | | | - David S Evans
- Department of Public Health, Health Service Executive West, Merlin Park Regional Hospital, Galway, Ireland
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Huang CLC, Weng SF, Wang JJ, Hsu YW, Wu MP. Risks of Treated Insomnia, Anxiety, and Depression in Health Care-Seeking Physicians: A Nationwide Population-Based Study. Medicine (Baltimore) 2015; 94:e1323. [PMID: 26334890 PMCID: PMC4616506 DOI: 10.1097/md.0000000000001323] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
High occupational stress and burnout among physicians can lead to sleep problems, anxiety, depression, and even suicide. Even so, the actual risk for these behavioral health problems in health care-seeking physicians has been seldom explored. The aim of this study was to determine whether physicians have higher odds of treated insomnia, anxiety, and depression than the normal population.This is a nationwide population-based case-control study using the National Health Insurance Research Database in Taiwan for the years 2007 to 2011. Physicians were obtained from the Registry for Medical Personnel in 2009. Hospital physicians who had at least 3 coded ambulatory care claims or 1 inpatient claim with a principal diagnosis of insomnia, anxiety, or depression were identified. A total of 15,150 physicians and 45,450 matched controls were enrolled. Odd ratios (ORs) of insomnia, anxiety, and depression between physicians and their control counterparts were measured.The adjusted ORs for treated insomnia, anxiety, and depression among all studied physicians were 2.028 (95% confidence interval [CI], 1.892-2.175), 1.103 (95% CI, 1.020-1.193), and 0.716 (95% CI, 0.630-0.813), respectively. All specialties of physicians had significantly higher ORs for treated insomnia; among the highest was the emergency specialty. The adjusted ORs for treated anxiety among male and female physicians were 1.136 (95% CI, 1.039-1.242) and 0.827 (95% CI, 0.686-0.997), respectively. Among specialties, psychiatry and "others" had significantly higher risks of anxiety. Obstetrics and gynecology and surgery specialties had significantly lower risks of anxiety. The adjusted ORs for treated depression among physicians in age groups 35 to 50 years and >50 years were 0.560 (95% CI, 0.459-0.683) and 0.770 (95% CI, 0.619-0.959), respectively. Those in the psychiatry specialty had significantly higher risks of depression; internal and surgery specialties had significant lower risks of depression.Hospital physicians have lower odds of treated depression than the general population, although they have higher odd of treated insomnia and anxiety. Undertreatment was noted in some sex, age, and specialty subgroups of physicians. Additional studies are needed to determine how to eliminate barriers to their use of psychiatry resources.
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Affiliation(s)
- Charles Lung-Cheng Huang
- From the Department of Psychiatry, Chi Mei Hospital; Department of Social Worker, Chia Nan University of Pharmacy and Science (CL-CH); Department of Medical Research, Chi Mei Hospital; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science (S-FW, J-JW, Y-WH); Division of Urogynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Hospital; and Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan (M-PW)
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Vijendren A, Yung M, Sanchez J. Occupational health issues amongst UK doctors: a literature review. Occup Med (Lond) 2015; 65:519-28. [DOI: 10.1093/occmed/kqv088] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Is there a risk profile for the vulnerable junior doctor? Ir J Med Sci 2015; 185:603-609. [PMID: 26031417 DOI: 10.1007/s11845-015-1316-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/24/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mental ill health is prevalent among doctors, especially those in the early stages of postgraduate training. However, a paucity of research has examined factors predictive of psychological distress in this population. AIMS To report the findings from a multi-centre survey of mental health among junior doctors in Ireland, and assess the extent to which moderator variables (e.g., age, academic performance, nationality, etc.) alter the levels of psychological distress caused by internship. METHOD An online, anonymous, questionnaire was distributed to all interns in the Republic of Ireland in January 2012. RESULTS A total of 270 interns responded to the survey (45.0 % response rate), with 48.5 % of the respondents having a score indicative of psychological distress. A regression model found that nationality, academic performance, intern training network, rating of work stressors, home stressors, and work-life balance were associated with differing levels of mental health as measured by the General Health Questionnaire-12. CONCLUSIONS There is a need to consider moderator variables when examining mental health in healthcare populations to avoid drawing overly simplistic conclusions. Interns in Ireland reported particularly high levels of psychological distress compared to other studies of mental health among healthcare populations.
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Steffen MW, Hagen PT, Benkhadra K, Molella RG, Newcomb RD, Murad MH. A survey of physicians' perceptions of their health care needs. Occup Med (Lond) 2014; 65:49-53. [PMID: 25336036 DOI: 10.1093/occmed/kqu145] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Physicians may face unique challenges in accessing health care and managing their own health. AIMS To evaluate physicians' perceptions of their health care needs and desired services. METHODS A written survey, distributed and collected anonymously among attendees at a large primary care continuing medical education conference. RESULTS The survey was given to 346 physicians and 141 (41%) responded. The majority of physicians (53%) reported having difficulty accessing health care and reverting to self-diagnosis and treatment (63%). Over 83% reported having or knowing a colleague who had a career-threatening illness and 42% had experienced concern about a colleague's ability to practise safely. CONCLUSIONS Physicians as an occupational group have challenges in accessing health care, very commonly suffer career-limiting illnesses and revert to self-diagnosis and treatment. Programmes tailored to providing health care to physicians are needed.
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Affiliation(s)
- M W Steffen
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - P T Hagen
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - K Benkhadra
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - R G Molella
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - R D Newcomb
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - M H Murad
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
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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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Győrffy Z, Girasek E. [The health of female physicians in Hungary. A longitudinal perspective]. Orv Hetil 2014; 155:993-9. [PMID: 24936575 DOI: 10.1556/oh.2014.29912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is a worldwide rising tendency of women who decide to become physician. One of the most remarkable fields of investigation is the well-being of female doctors. AIM To study the prevalence of somatic and reproductive morbidity in a representative sample of Hungarian female physicians and compare it with a control group of graduated women. METHOD Data for this epidemiological study were collected from 2515 female physicians in 2013. Graduated women from a representative survey (Hungarostudy 2013) served as controls. The results were compared to the previous (2003-2004) representative female physicians' survey. RESULTS We found that the prevalence of chronic somatic morbidity among female physicians was significantly higher than that in the respective control groups. A larger proportion of female medical doctors were characterized by time-to-pregnancy interval longer than one year, and undergoing infertility therapy and miscarriages, compared to the control female population, while the same prevalence of terminations of pregnancy was found. CONCLUSIONS The longitudinal perspective confirmed the existence of the "Hungarian female physicians' paradox".
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Affiliation(s)
- Zsuzsa Győrffy
- Semmelweis Egyetem, Általános Orvostudományi Kar Magatartástudományi Intézet Budapest Nagyvárad tér 4. 1089
| | - Edmond Girasek
- Semmelweis Egyetem Egészségügyi Menedzserképző Központ Budapest
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Eikeland HL, Ørnes K, Finset A, Pedersen R. The physician's role and empathy - a qualitative study of third year medical students. BMC MEDICAL EDUCATION 2014; 14:165. [PMID: 25108627 PMCID: PMC4128827 DOI: 10.1186/1472-6920-14-165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 07/29/2014] [Indexed: 05/06/2023]
Abstract
BACKGROUND Empathy is important in ensuring the quality of the patient-physician relationship. Several studies have concluded that empathy declines during medical training, especially during the third year. However, there is little empirical research on what may influence a medical student's empathy. In addition, studies of empathy in medicine have generally been dominated by quantitative approaches, primarily self-assessment questionnaires. This is a paradox given the complexity and importance of empathy. In this paper we explore medical students' opinions of what may foster or inhibit empathy during medical school, with a particular emphasis on how empathy is influenced by the initiation into the physician's role. METHODS We performed semi-structured qualitative interviews with 11 third year medical students. Content analysis was used to analyse the transcribed interviews. RESULTS Five aspects of the the physician's role and the students' role acquisition emerged when the students were asked to describe what may influence their empathy: 1) Becoming and being a professional, 2) Rules concerning emotions and care, 3) Emotional control, 4) The primary importance of biomedical knowledge, and 5) Cynicism as a coping strategy. CONCLUSION This study suggest that the described inhibitors of empathy may originate in the hidden curriculum and reinforce each other, creating a greater distance between the physician and the patient, and possibly resulting in decreased empathy. Mastering biomedical knowledge is an important part of the students' ideals of the physician's role, and sometimes objective and distanced ideals may suppress empathy and the students' own emotions.
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Affiliation(s)
- Hanne-Lise Eikeland
- Department of Behavioral Sciences, Institute of Basic Medical Sciences, University of Oslo, Domus Medica, Sognsvannsveien 9, Oslo 0372, Norway
| | - Knut Ørnes
- Department of Behavioral Sciences, Institute of Basic Medical Sciences, University of Oslo, Domus Medica, Sognsvannsveien 9, Oslo 0372, Norway
| | - Arnstein Finset
- Department of Behavioral Sciences, Institute of Basic Medical Sciences, University of Oslo, Domus Medica, Sognsvannsveien 9, Oslo 0372, Norway
| | - Reidar Pedersen
- Institute of Health and Society, Centre for Medical Ethics, University of Oslo, Kirkeveien 166, Fredrik Holsts hus, Oslo 0450, Norway
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Abstract
Despite increasing research on physician well-being, factors appearing to account for individual variation in levels of optimal functioning are largely unclear. One such factor could be self-regulation, which reflects how individuals effectively manage their thoughts, emotions and behaviours, and cope with adversity in their environment. The purpose of this study was to determine if self-regulation capacity could significantly predict psychological well-being in a sample of Canadian physicians. A total of 132 physicians completed the Scales of Psychological Well-Being and the short form of the Self-Regulation Questionnaire. Regression analyses confirmed the hypothesis that a significant amount of variance in levels of psychological well-being would be explained by self-regulation capacity. There was a particularly strong relationship between self-regulation capacity and the dimensions of purpose in life and environmental mastery, which suggests that physicians who effectively self-manage may be better able to preserve a sense of purpose and an adequate work-life balance in their daily life. Physicians today face consistently growing demands stemming from increasingly challenging work environments. Results of this study mark an important step in increasing our understanding of a potentially valuable skill that may help physicians to achieve well-being.
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Affiliation(s)
- Christopher R Simon
- a Faculty of Health Sciences, School of Human Kinetics , University of Ottawa , Ottawa , Canada
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Rosta J, Aasland OG. Changes in the lifetime prevalence of suicidal feelings and thoughts among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples. BMC Psychiatry 2013; 13:322. [PMID: 24286517 PMCID: PMC4219507 DOI: 10.1186/1471-244x-13-322] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 11/22/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Thinking about suicide is an indicator of suicide risk. Suicide rates are higher among doctors than in the population. The main aims of this study are to describe the changes in the lifetime prevalence of suicidal feelings from 2000 to 2010 and the possible predictors of serious suicidal thoughts in 2010 among Norwegian doctors. Differences in lifetime prevalence of suicidal feelings between Norwegian doctors in 2010 and German doctors in 2006 will be also described. METHODS Longitudinal and cross-sectional study based on questionnaire data from 2000 and 2010, including approximately 1,600 Norwegian doctors. In Germany, cross-sectional study based on questionnaire data from 2006 among a sample of 3,295 doctors. The main outcome measures were the lifetime prevalence of suicidal feelings (felt life was not worth living, wished own death, had thoughts of taking own life). RESULTS The prevalences in 2000 and 2010 of ever had feelings of life not worth living were 48 (44 to 52) % and 45 (41 to 49) %, of ever wished own death 27 (23 to 30) % and 23 (20 to 26) %, and of ever had thoughts of taking own life 29 (16 to 33) % and 24 (21 to 27) %. Paired t-tests among those who responded both in 2000 and 2010 show significant reductions for felt life not worth living (t = -3.4; p = 0.001), wished own death (t = -3.1; p = 0.002) and had thoughts of taking own life (t = -3.5; p < 0.0001). In 2010, significant predictors of serious suicidal thoughts in a multivariate model were low subjective well-being (OR 0.68; 95% CI 0.52-0.90), poor or average self-rated health (2.36; 1.25-4.45) and high psychosocial work stress (1.92; 1.06-3.46), controlled for age, gender, speciality and job satisfaction. Norwegian doctors in 2010 compared with their German counterparts in 2006 reported quite similar prevalences of suicidal feelings. CONCLUSIONS Suicidal feelings among Norwegian doctors decreased from 2000 to 2010. Individual and work-related factors may to certain explain these findings. Compared with other professionals in Norway and doctors in Germany, Norwegian doctors showed no higher risk of suicidal thoughts.
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Affiliation(s)
- Judith Rosta
- Institute for Studies of Medical Profession (LEFO), Oslo, Norway.
| | - Olaf G Aasland
- Institute for Studies of Medical Profession (LEFO), Oslo, Norway,Institute of Health and Society, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Ansmann L, Kowalski C, Ernstmann N, Ommen O, Jung J, Visser A, Pfaff H. Do breast cancer patients receive less support from physicians in German hospitals with high physician workload? A multilevel analysis. PATIENT EDUCATION AND COUNSELING 2013; 93:327-334. [PMID: 23890726 DOI: 10.1016/j.pec.2013.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 06/20/2013] [Accepted: 06/23/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Little is known about how organizational factors influence the patient-physician interaction. This study investigates the relationship between physician workload in hospitals and breast cancer patients' perceptions of the support provided by physicians. METHODS Data from 1844 newly diagnosed breast cancer patients treated in 35 breast cancer center hospitals in the German state of North Rhine-Westphalia in 2010 were combined with data from 348 physicians from the same hospitals. Multilevel logistic regression models were calculated using 31 hospitals with complete patient and physician data. Patients' perceptions of physician support were studied in relation to physician workload in hospitals. RESULTS Breast cancer patients perceived themselves as receiving less support from physicians when treated in hospitals where physicians reported working more overtime hours and having less time for patient care. CONCLUSION This study provides preliminary evidence of the association between the hospital work environment and physicians' ability to support patients. Future studies should investigate the extent to which physicians' interaction performance can be modified through hospital-level interventions aimed at managing workload. PRACTICE IMPLICATIONS By approaching the problem of physician staffing in hospitals and investing in the hospitals' working conditions, health policy and hospital management could create conditions conducive to better patient-physician interaction.
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Affiliation(s)
- Lena Ansmann
- Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany.
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Wurst FM, Kunz I, Skipper G, Wolfersdorf M, Beine KH, Vogel R, Müller S, Petitjean S, Thon N. How therapists react to patient's suicide: findings and consequences for health care professionals' wellbeing. Gen Hosp Psychiatry 2013; 35:565-70. [PMID: 23829978 DOI: 10.1016/j.genhosppsych.2013.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/08/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To test the robustness of the findings of previous studies in a large aggregated sample regarding (a) the impact of a patient's suicide on therapist's distress; (b) identify a potential subgroup of therapists needing special postvention; (c) and assess potential differences in overall distress between professional groups and at different levels of care. METHODS A questionnaire, characterizing the therapists, their reactions and the patients, had been sent out to 201 psychiatric hospitals in Germany providing different levels of care. Aggregated data from previous studies have been used. RESULTS In 39.6% of all cases, therapists suffer from severe distress after a patients' suicide. The global item "overall distress" can be used as an indicator to identify a subgroup of therapists that might need individualized postvention. No significant difference in overall distress experienced was observed between professional groups and at different levels of care. CONCLUSION Our data suggest that identifying the severely distressed subgroup could be done using a visual analogue scale for overall distress. As a consequence, more specific, individualized and intensified help could be provided to these professionals, helping them to overcome distress and thereby ensuring delivery of high quality care to the patient.
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Affiliation(s)
- Friedrich Martin Wurst
- Department of Psychiatry and Psychotherapy II, Christian-Doppler-Hospital, Paracelsus Medical University, A-5020 Salzburg, Austria.
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Torppa MA, Toivola K, Ruskoaho J, Pitkälä KH. Clinical supervision among family physicians: prevalence, needs, and attitudes. J Prim Care Community Health 2013; 4:275-80. [PMID: 23799675 DOI: 10.1177/2150131913489031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Clinical supervision (CS) is not an established support system among physicians. Family physicians (FPs) have used Balint groups as a form of clinical supervision. In all, not much is known about the prevalence of physicians' attendance to or needs for CS. OBJECTIVE We studied what proportion of FPs compared with other physicians have attended or report they would need CS and whether having patients who request certain tests or medicines is associated with FPs' attendance to or need for CS. DESIGN A postal survey for all working-aged Finnish physicians was performed in 2008. Special questions concerning CS (eg, Balint) and patients' requests were included. RESULTS Response rate for the survey was 74% (N = 13 708). Special questions were responded by 10 559 physicians of whom 1252 were FPs. FPs had attended CS more often than other physicians (42% vs 29%, P < .001). Of FPs, 25% reported a need for CS with no availability of it. FPs experienced with or needing for CS were more often than other FPs females, had participated in continuing medical education, and reported that patients with requests have increased in recent years. CONCLUSION Both experience of CS and a need for CS with no availability are common among Finnish FPs. Experiences of patients with requests may reflect a need for CS among FPs. Studies on the content, significance and effectiveness CS among FPs are needed.
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