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Deutsch AJ, Alvarez A, Balint S, Pappal RD, Roseen S, Sun WW, Warren J, Stanton K, Agarwal AK. #StopTheStigmaEM: Building a social media-based movement to support emergency medicine mental health. Acad Emerg Med 2024; 31:617-620. [PMID: 37897107 DOI: 10.1111/acem.14829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023]
Affiliation(s)
| | - Al'ai Alvarez
- Stanford Hospital and Clinics, Stanford, California, USA
| | | | - Ryan D Pappal
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Stacey Roseen
- Society for Academic Emergency Medicine, Des Plaines, Illinois, USA
| | - Wendy W Sun
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Kelsey Stanton
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Anish K Agarwal
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Patel P, Brown S, Guo B, Holmes EA, Iyadurai L, Kingslake J, Highfield J, Morriss R. Using a Novel Gameplay Intervention to Target Intrusive Memories After Work-Related Trauma: Iterative Qualitative Analysis of Intensive Care Unit Staff Experiences. JMIR Form Res 2024; 8:e47458. [PMID: 38421698 PMCID: PMC10940990 DOI: 10.2196/47458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/02/2023] [Accepted: 11/20/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Many intensive care unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population; however, factors such as mental health stigma and difficulty in fitting interventions into busy schedules can pose barriers. The Brief Gameplay Intervention For National Health Service Intensive Care Unit Staff Affected By COVID-19 Trauma (GAINS) study tested a brief, digital imagery-competing task intervention (including computer gameplay) with the aim of reducing the recurrence of intrusive memories, which holds promise for overcoming some of these barriers. OBJECTIVE This substudy aims to explore barriers and facilitators to the uptake and practical use of the intervention by ICU staff, along with its acceptability, and iteratively explore the impact of intervention optimizations to further refine the intervention. METHODS The GAINS study is a randomized controlled trial comparing access to a brief digital imagery-competing task intervention for 4 weeks with usual care followed by delayed access to the intervention. The participants were ICU staff who worked during the COVID-19 pandemic and experienced intrusive memories. All participants were sent a questionnaire at 4 weeks to gather data about intervention acceptability. Nested within the randomized controlled trial, a subset of 16 participants was interviewed, and data were analyzed using thematic analysis drawing from a framework approach. RESULTS Both quantitative and qualitative data indicated high acceptability of the intervention. Intervention use data show that, on average, staff were able to target approximately 73% (3.64/4.88) of their intrusive memories and engaged with the Tetris component for the full 20 minutes per session. Overall, on the acceptability questionnaire, staff found the intervention easy to use, helpful, and highly acceptable. The interviews generated four themes: approach to the intervention, positives of the intervention, negatives of the intervention, and improvements and optimizations. Findings highlighted barriers that ICU staff experienced: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, and skepticism. However, they provided suggestions on how barriers could be overcome and discussed the advantages of the intervention when compared with other treatments. Although participants described many positive aspects of the intervention, such as being easy to use, enjoyable, and leading to a reduction in the frequency or intensity of intrusive memories, they also raised practical issues for implementation. CONCLUSIONS The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events among ICU staff. Further refinement is needed to improve the adoption and reach of this intervention. A limitation is that we could not interview the National Health Service staff who were unable or unwilling to take part in the trial.
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Affiliation(s)
- Priya Patel
- NIHR ARC East Midlands, University of Nottingham, Nottingham, United Kingdom
| | - Susan Brown
- NIHR MindTech MedTech Co-operative, University of Nottingham, Nottingham, United Kingdom
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Boliang Guo
- NIHR ARC East Midlands, University of Nottingham, Nottingham, United Kingdom
| | - Emily A Holmes
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | | | - Richard Morriss
- NIHR ARC East Midlands, University of Nottingham, Nottingham, United Kingdom
- NIHR MindTech MedTech Co-operative, University of Nottingham, Nottingham, United Kingdom
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
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McAnee G, Norwood K, Leavey G. Qualitative study investigating the professional and personal effects of patient suicide on general practitioners in Northern Ireland. BMJ Open 2024; 14:e077940. [PMID: 38341208 PMCID: PMC10862281 DOI: 10.1136/bmjopen-2023-077940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE There is a dearth in suicide literature addressing the impact on general practitioners (GPs) of losing a patient. We aimed to examine the personal and professional impact as well as the availability of support and why GPs did or did not use it. DESIGN A qualitative study using one-to-one interviews with participants recruited using snowball sampling. SETTING The study was conducted in a primary care setting. PARTICIPANTS Interviews were held with 19 GPs within primary care in Northern Ireland. RESULTS GPs are impacted both personally and professionally when they lose a patient to suicide, but may not access formal help due to commonly held idealised notions of a 'good' GP who is regarded as having solid imperturbability. Fear of professional repercussions also plays a major role in deterring help-seeking. CONCLUSIONS There is a need for a systemic culture shift within general practice which allows doctors to seek support when their physical or mental health require it. This may help prevent stress, burnout and early retirement.
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Affiliation(s)
- Grainne McAnee
- School of Psychology, Ulster University School of Life and Health sciences, Coleraine, UK
| | - Kelly Norwood
- School of Psychology, Ulster University School of Life and Health sciences, Coleraine, UK
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Spiers J, Causer H, Efstathiou N, Chew-Graham CA, Gopfert A, Grayling K, Maben J, van Hove M, Riley R. Negotiating the postvention situation: A grounded theory of NHS staff experiences when supporting their coworkers following a colleague's suicide. DEATH STUDIES 2024; 48:937-947. [PMID: 38198236 PMCID: PMC11371263 DOI: 10.1080/07481187.2023.2297056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Suicide is a leading cause of death. NHS workers, especially female nurses, have heightened vulnerability. Being impacted by a colleague's suicide can lead to increased suicidality. Postvention refers to support following a suicide. We investigated current, available postvention for NHS workers following a colleague's suicide and the experiences of staff who deliver it ("supporters"). Twenty-two supporters were interviewed, and data were analyzed using classic grounded theory. The theory of negotiating postvention situations was developed. Supporters must negotiate enabling and disabling elements that form a "postvention situation" and impact behaviors and postvention efficacy. Postvention delivery is emotionally burdensome. Supporters need support, which they do not always receive. Postvention can lead to learning, which can better inform future postvention. The extent to which NHS workers can effectively support colleagues will depend on their postvention situation. As such, work must be done to enable supporters to offer effective postvention in the future.Suicide; postvention; healthcare workers; grounded theory.
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Affiliation(s)
- Johanna Spiers
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Hilary Causer
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Nikos Efstathiou
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Anya Gopfert
- Department of Health Life Sciences, University of Exeter, Exeter, UK
| | | | - Jill Maben
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Maria van Hove
- Department of Health Life Sciences, The University of Exeter- Saint Lukes Campus, Exeter, UK
| | - Ruth Riley
- School of Health Sciences, University of Surrey, Guildford, UK
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Huang R, Peng X, Yu S, Tian Y, Gao C. Attitudes and intentions toward seeking professional psychological help among Chinese healthcare workers during the COVID-19 pandemic. Front Psychiatry 2023; 14:1223895. [PMID: 37779617 PMCID: PMC10539927 DOI: 10.3389/fpsyt.2023.1223895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background It has been suggested that healthcare workers (HCWs) are experiencing massive stressors that threaten their mental health during the COVID-19 pandemic, but little is known about their attitudes and intentions toward seeking professional psychological help. This study aimed to investigate the attitudes and intentions of Chinese HCWs toward seeking professional psychological help during the COVID-19 pandemic and the associated factors. Methods A total of 1,224 Chinese HCWs working in hospitals were recruited online from 12 hospitals in Hunan province in China for a survey conducted in November 2022. The Chinese version of the attitudes toward seeking professional psychological help scale-short form (ATSPPH-SF) and the general help-seeking questionnaire (GHSQ) were separately used to assess the attitudes and intentions of the respondents toward seeking professional psychological help. Demographic and socio-psychological data were collected using a self-developed questionnaire, the perceived social support scale, the self-stigma of seeking help scale, and the patient health questionnaire-9 scale. Results The 1,208 HCWs in the final analysis showed relatively negative attitudes and low intentions toward seeking professional psychological help during the COVID-19 pandemic. Results of the multiple linear regression analysis showed that female sex (p = 0.031), experience of psychological learning (p < 0.001), and social support (p < 0.001) had a positive predictive effect on the attitudes of these HCWs toward seeking professional psychological help, whereas self-stigma of seeking help (p < 0.001) and depressive symptoms (p < 0.001) exerted negative effects. Moreover, experience of psychological learning (p = 0.004) and social support (p < 0.001) had a positive predictive effect on the intentions of these HCWs toward seeking professional psychological help, whereas divorced marital status (p = 0.011) and self-stigma of seeking help (p < 0.001) exerted negative effects. Conclusion The overall attitudes and intentions of HCWs toward seeking professional psychological help were not optimistic. Effective interventions targeted at influencing factors should be formulated to promote the professional psychological help-seeking attitudes and intentions of HCWs who are at risk of developing mental health problems.
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Affiliation(s)
- Ruirui Huang
- School of Nursing, Hunan University of Medicine, Huaihua, China
| | - Xiaoyan Peng
- School of Nursing, Hunan University of Medicine, Huaihua, China
| | - Shuai Yu
- School of Nursing, Hunan University of Medicine, Huaihua, China
| | - Yumei Tian
- School of Nursing, Hunan University of Medicine, Huaihua, China
| | - Chuanying Gao
- Department of Nursing, The First Affiliated Hospital of Hunan University of Medicine, Huaihua, China
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Dheensa S, McLindon E, Spencer C, Pereira S, Shrestha S, Emsley E, Gregory A. Healthcare Professionals' Own Experiences of Domestic Violence and Abuse: A Meta-Analysis of Prevalence and Systematic Review of Risk Markers and Consequences. TRAUMA, VIOLENCE & ABUSE 2023; 24:1282-1299. [PMID: 34978481 DOI: 10.1177/15248380211061771] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Background: Globally, healthcare professionals (HCPs) are increasingly asked to identify and respond to domestic violence and abuse (DVA) among patients. However, their own experiences of DVA have been largely ignored.Aim: To determine the prevalence of current and lifetime DVA victimisation among HCPs globally, and identify risk markers, consequences and support-seeking for DVA.Method: PubMed, EMBASE, PsycINFO, CINAHL ASSIA and ProQuest were searched. Studies about HCPs' personal experience of any type of DVA from any health service/country were included. Meta-analysis and narrative synthesis were adopted.Results: Fifty-one reports were included. Pooled lifetime prevalence was 31.3% (95% CI [24.7%, 38.7%] p < .001)) and past-year prevalence was 10.4% (95% CI [5.8%, 17.9%] p <.001). Pooled lifetime prevalence significantly differed (Qb=6.96, p < .01) between men (14.8%) and women (41.8%), and between HCPs in low-middle income (64.0%) and high-income countries (20.7%) (Qb = 31.41, p <.001). Risk markers were similar to those in the general population, but aspects of the HCP role posed additional and unique risks/vulnerabilities. Direct and indirect consequences of DVA meant HCP-survivors were less able to work to their best ability. While HCP-survivors were more likely than other HCPs to identify and respond to DVA among patients, doing so could be distressing. HCP-survivors faced unique barriers to seeking support. Being unable to access support - which is crucial for leaving or ending relationships with abusive people - leaves HCP-survivors entrapped.Conclusion: Specialised DVA interventions for HCPs are urgently needed, with adaptations for different groups and country settings. Future research should focus on developing interventions with HCP-survivors.
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Affiliation(s)
- Sandi Dheensa
- Domestic Violence and Abuse Health Research Group, Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Elizabeth McLindon
- The Royal Women's Hospital, University of Melbourne, Melbourne, VIC, Australia
- Department of General Practice, University of Melbourne, Melbourne. VIC, Australia
| | | | - Stephanie Pereira
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Satya Shrestha
- Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Dhulikhel Hospital, Kathmandu University, Dhulikhel, Nepal
| | - Elizabeth Emsley
- Domestic Violence and Abuse Health Research Group, Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Gregory
- Domestic Violence and Abuse Health Research Group, Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
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Evans GF, Brooks J, Collins L, Farrington R, Danquah A. General Practitioner Educators on Clinical Debrief: A Qualitative Investigation into the Experience of Teaching Third-Year Medical Students to Care. TEACHING AND LEARNING IN MEDICINE 2023:1-10. [PMID: 37392155 DOI: 10.1080/10401334.2023.2222314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 04/01/2023] [Accepted: 05/02/2023] [Indexed: 07/03/2023]
Abstract
Phenomenon: There is a paucity of research reporting the experiences of general practitioner clinical educators. Providing education for students could lead to better clinical skills and greater job satisfaction for the educator. However, it could also result in increased stress and mental fatigue, adding to what is an already pressured situation in the current primary care climate. Clinical Debrief is a model of case-based learning with integrated supervision developed to prepare medical students for clinical practice. This study aimed to explore the experiences of general practitioners who facilitate Clinical Debrief. Approach: Eight general practitioner educators with experience of facilitating Clinical Debrief participated in semi-structured qualitative interviews. Results were analyzed using Reflexive Thematic Analysis, and four main themes were developed. Findings: Themes included: Personal enrichment: psychological "respite" and wellbeing; Professional enrichment: Clinical Debrief as a "two-way" door; Becoming a facilitator: a journey; and, Relationships in teaching: blurred boundaries and multiple roles. Insights: Being a Clinical Debrief facilitator had a transformative impact on the personal and professional lives of the GPs who participated in this study. The implications of these findings for individual GPs, their patients, and the wider healthcare system, are discussed.
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Affiliation(s)
- Georgia F Evans
- Division of Psychology and Mental Health School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Joanna Brooks
- Division of Psychology and Mental Health School of Health Sciences, University of Manchester, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lisa Collins
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rebecca Farrington
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Adam Danquah
- Division of Psychology and Mental Health School of Health Sciences, University of Manchester, Manchester, UK
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Ryan E, Hore K, Power J, Jackson T. The relationship between physician burnout and depression, anxiety, suicidality and substance abuse: A mixed methods systematic review. Front Public Health 2023; 11:1133484. [PMID: 37064688 PMCID: PMC10098100 DOI: 10.3389/fpubh.2023.1133484] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/09/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction The World Health Organization defines burnout as a problem associated with employment, a category distinct from psychological disorders such as depression, anxiety, suicidality and disorders of substance abuse. Evaluating the association between burnout as an occupational exposure and psychological morbidity may indicate that burnout can act as an occupational risk factor for mental ill-health. The systematic review explores this relationship in physicians due to the increased risk in this population and the implications for healthcare delivery. Methods A mixed methods systematic review of the literature was conducted across Medline, Cinahl Plus, PsycInfo, Web of Science and The Cochrane Library. Databases were systematically searched using keywords relating to physician burnout and depression, anxiety, suicidality and substance abuse. Identified articles were screened for eligibility by two independent researchers. Data extraction was performed and studies assessed for risk of bias. Quantitative and qualitative results were integrated using a convergent segregated approach and results portrayed as a narrative synthesis. Results Sixty-one articles were included in the review. There was notable heterogeneity in the measurement and criteria used to define burnout limiting the assimilation of results. Despite this, all studies that measured the association between depression and burnout reported a significant association. Studies that reported association between burnout and anxiety were similarly uniformly consistent. Most studies that reported the association between burnout and suicidality indicated that a significant association exists however difficulty in measurement of suicidality may have influenced variability of results. The reported association between substance abuse and burnout was more variable, suggesting that any association is likely to be weak or influenced by other variables. Qualitative studies described the manifestations of chronic workplace stress as well as perceived links with psychological morbidity. These included lack of time for work-life balance, the contribution of professional relationships and a culture of invulnerability that exists among physicians. Conclusion The systematic review cannot conclude causality but suggests that physician burnout is associated with depression, anxiety and suicidality. Qualitative data provides insight into the nature of this association. The review indicates the need for longitudinal research and provides considerations for intervention strategies to prevent the development and progression of burnout. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172938, identifier: CRD42020172938.
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Affiliation(s)
- Emer Ryan
- Department of Cardiothoracic Anaesthesia, Auckland City Hospital, Auckland, New Zealand
- Usher Institute, University of Edinburgh, Scotland, United Kingdom
- College of Anaesthesiologists of Ireland, Dublin, Ireland
| | - Kevin Hore
- College of Anaesthesiologists of Ireland, Dublin, Ireland
- Department of Anaesthesia, Great Ormonde Street Children's Hospital, London, United Kingdom
| | - Jessica Power
- Centre for Global Health, Trinity College, Dublin, Ireland
| | - Tracy Jackson
- Usher Institute, University of Edinburgh, Scotland, United Kingdom
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Teoh K, Singh J, Medisauskaite A, Hassard J. Doctors' perceived working conditions, psychological health and patient care: a meta-analysis of longitudinal studies. Occup Environ Med 2023; 80:61-69. [PMID: 36635099 DOI: 10.1136/oemed-2022-108486] [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: 05/20/2022] [Accepted: 11/17/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Studies have demonstrated an association between doctors' perceived working conditions, and their psychological well-being and patient care. However, few have examined inter-relationships among these three domains, and even fewer using longitudinal designs. Using meta-analytical structural equation modelling, we tested longitudinal relationships among doctors' perceived working conditions, their psychological well-being and patient care. We further tested if doctors' psychological well-being mediates the relationship between perceived working conditions and patient care. METHODS We carried out a systematic review using Academic Search Premier, Business Source Premier, PsycInfo, PsycArticles and Medline for the 20-year period between January 2000 and the start of the pandemic (January 2020). We included studies with practising doctors as participants, and that reported a quantifiable bivariate effect size between at least two of the three constructs of interest-perceived working conditions (ie, job demands, job resource), psychological well-being (ie, emotional exhaustion, work engagement) and patient care (ie, clinical care, patient safety). We pooled relationship effect sizes using random-effects meta-analysis, before testing for indirect effects using two-stage structural equation modelling. RESULTS Twenty-three samples from 11 countries representing 7275 doctors were meta-analysed. The results indicated that job resources predicted work engagement (ρ=0.18; 95% CI 0.11 to 0.24) and emotional exhaustion (ρ=-0.21; 95% CI -0.31 to -0.11), while job demands predicted emotional exhaustion (ρ=0.27; 95% CI 0.17 to 0.36). Better clinical care was also associated with higher levels of job resources (ρ=0.16; 95% CI 0.04 to 0.29), and lower levels of emotional exhaustion (ρ=-0.21; 95% CI -0.37 to -0.12) and job demands (ρ=-0.27; 95% CI -0.43 to -0.10). Both factors of the work environment were associated with clinical care through doctors' emotional exhaustion, but there were insufficient studies to test the indirect effects for work engagement or patient safety. CONCLUSION Our results demonstrate the need for a systems perspective to address working conditions to support both doctors' psychological well-being and patient care. Interventions should target doctors' job resources as they are more strongly associated with psychological well-being. However, given that job demands were strongly associated with emotional exhaustion, and in turn, clinical care, there is a need to better manage doctors' workload, conflict and pressure to support the current psychological well-being crises among this occupational group. PROSPERO REGISTRATION NUMBER CRD42020189070.
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Affiliation(s)
- Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - Jasmeet Singh
- Psychology Department, Nottingham Trent University, Nottingham, UK
| | | | - Juliet Hassard
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
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Spiers J, Kokab F, Buszewicz M, Chew-Graham CA, Dunning A, Taylor AK, Gopfert A, van Hove M, Teoh KRH, Appleby L, Martin J, Riley R. Recommendations for improving the working conditions and cultures of distressed junior doctors, based on a qualitative study and stakeholder perspectives. BMC Health Serv Res 2022; 22:1333. [PMCID: PMC9647238 DOI: 10.1186/s12913-022-08728-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 10/07/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Doctors, including junior doctors, are vulnerable to greater levels of distress and mental health difficulties than the public. This is exacerbated by their working conditions and cultures. While this vulnerability has been known for many years, little action has been taken to protect and support junior doctors working in the NHS. As such, we present a series of recommendations from the perspective of junior doctors and other relevant stakeholders, designed to improve junior doctors’ working conditions and, thus, their mental health.
Methods
We interviewed 36 junior doctors, asking them for recommendations for improving their working conditions and culture. Additionally, we held an online stakeholder meeting with a variety of healthcare professionals (including junior doctors), undergraduate medical school leads, postgraduate speciality school leads and NHS policymakers where we asked what could be done to improve junior doctors’ working conditions. We combined interview data with notes from the stakeholder discussions to produce this set of recommendations.
Results
Junior doctor participants and stakeholders made organisational and interpersonal recommendations. Organisational recommendations include the need for more environmental, staff and educational resources as well as changes to rotas. Interpersonal recommendations include changes to communication and recommendations for better support and teamwork.
Conclusion
We suggest that NHS policymakers, employers and managers consider and hopefully implement the recommendations set out by the study participants and stakeholders as reported in this paper and that the gold standards of practice which are reported here (such as examples of positive learning environments and supportive supervision) are showcased so that others can learn from them.
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Zaman N, Mujahid K, Ahmed F, Mahmud S, Naeem H, Riaz U, Ullah U, Cox B. What are the barriers and facilitators to seeking help for mental health in NHS doctors: a systematic review and qualitative study. BMC Psychiatry 2022; 22:595. [PMID: 36071392 PMCID: PMC9450826 DOI: 10.1186/s12888-022-04202-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The mental health of healthcare professionals is reaching a breaking point, and the COVID-19 pandemic has exacerbated current mental health issues to unprecedented levels. Whilst some research has been carried out on the barriers that doctors face when seeking mental health help, there is little research into factors which may facilitate seeking help. We aimed to expand the research base on factors which act as barriers to seeking help, as well as gain insight into facilitators of help-seeking behaviour for mental health in NHS doctors. METHODS We conducted a systematic literature review which identified the barriers and facilitators to seeking help for mental health in healthcare professionals. Following this, we conducted semi-structured interviews with 31 NHS doctors about their experiences with mental health services. Finally, through thematic analysis, key themes were synthesised from the data. RESULTS Our systematic literature review uncovered barriers and facilitators from pre-existing literature, of which the barriers were: preventing actions, self-stigma, perceived stigma, costs of seeking treatment, lack of awareness and availability of support, negative career implications, confidentiality concerns and a lack of time to seek help. Only two facilitators were found in the pre-existing literature, a positive work environment and availability of support services. Our qualitative study uncovered additional barriers and facilitators, of which the identified barriers include: a negative workplace culture, lack of openness, expectations of doctors and generational differences. The facilitators include positive views about mental health, external confidential service, better patient outcomes, protected time, greater awareness and accessibility, open culture and supportive supervisors. CONCLUSION Our study began by identifying barriers and facilitators to seeking mental health help in healthcare workers, through our systematic literature review. We contributed to these findings by identifying themes in qualitative data.. Our findings are crucial to identify factors preventing NHS doctors from seeking help for their mental health so that more can be done on a national, trust-wide and personal level to overcome these barriers. Likewise, further research into facilitators is key to encourage doctors to reach out and seek help for their mental health.
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Affiliation(s)
- Nadia Zaman
- Imperial College Business School, Exhibition Road, London, SW7 2AZ, UK.
| | - Khadeejah Mujahid
- Imperial College Business School, Exhibition Road, London, SW7 2AZ, UK
| | - Fahmid Ahmed
- Imperial College Business School, Exhibition Road, London, SW7 2AZ, UK
| | - Simran Mahmud
- Imperial College Business School, Exhibition Road, London, SW7 2AZ, UK
| | - Hamza Naeem
- Imperial College Business School, Exhibition Road, London, SW7 2AZ, UK
| | - Umar Riaz
- Imperial College Business School, Exhibition Road, London, SW7 2AZ, UK
| | - Umayair Ullah
- Imperial College Business School, Exhibition Road, London, SW7 2AZ, UK
| | - Benita Cox
- Imperial College Business School, Exhibition Road, London, SW7 2AZ, UK
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Naehrig D, Glozier N, Klinner C, Acland L, Goodger B, Hickie IB, Milton A. Determinants of well-being and their interconnections in Australian general practitioners: a qualitative study. BMJ Open 2022; 12:e058616. [PMID: 35851015 PMCID: PMC9258487 DOI: 10.1136/bmjopen-2021-058616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 06/14/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The well-being of doctors is recognised as a major priority in healthcare, yet there is little research on how general practitioners (GPs) keep well. We aimed to address this gap by applying a positive psychology lens, and exploring what determines GPs' well-being, as opposed to burnout and mental ill health, in Australia. DESIGN Semi-structured qualitative interviews. From March to September 2021, we interviewed GPs working in numerous settings, using snowball and purposive sampling to expand recruitment across Australia. 20 GPs participated individually via Zoom. A semi-structured interview-guide provided a framework to explore well-being from a personal, organisational and systemic perspective. Recordings were transcribed verbatim, and inductive thematic analysis was performed. RESULTS Eleven female and nine male GPs with diverse experience, from urban and rural settings were interviewed (mean 32 min). Determinants of well-being were underpinned by GPs' sense of identity. This was strongly influenced by GPs seeing themselves as a distinct but often undervalued profession working in small organisations within a broader health system. Both personal finances, and funding structures emerged as important moderators of the interconnections between these themes. Enablers of well-being were mainly identified at a personal and practice level, whereas systemic determinants were consistently seen as barriers to well-being. A complex balancing act between all determinants of well-being was evidenced. CONCLUSIONS GPs were able to identify targets for individual and practice level interventions to improve well-being, many of which have not been evaluated. However, few systemic aspects were suggested as being able to promote well-being, but rather seen as barriers, limiting how to develop systemic interventions to enhance well-being. Finances need to be a major consideration to prioritise, promote and support GP well-being, and a sustainable primary care workforce.
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Affiliation(s)
- Diana Naehrig
- Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Nick Glozier
- Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Christiane Klinner
- Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Louise Acland
- ForHealth, Charlestown Medical & Dental Centre, Charlestown, New South Wales, Australia
- Expert committee - Standards for General Practices, RACGP, East Melbourne, Victoria, Australia
| | - Brendan Goodger
- Central and Eastern Sydney PHN, Mascot, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Alyssa Milton
- Central Clinical School, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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13
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Raiff EM, D’Antonio KM, Mai C, Monk C. Mental Health in Obstetric Patients and Providers During the COVID-19 Pandemic. Clin Obstet Gynecol 2022; 65:203-215. [PMID: 34857681 PMCID: PMC8767924 DOI: 10.1097/grf.0000000000000668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Psychiatric morbidity is the most common childbirth complication with 1 in 5 women experiencing a perinatal mood or anxiety disorder. The cost of this psychiatric morbidity is pervasive, contributing to devastating maternal health, child developmental, and economic consequences. The coronavirus disease 2019 (COVID-19) pandemic, and associated changes to perinatal experiences, resulted in profound psychological reactions including increased anxiety, depression, stress disorders, and sleep disturbance, further impacting obstetric patients. Providers' mental health has been challenged by moral injury and shared trauma. This article reviews mental health outcomes in regard to the COVID-19 pandemic for obstetric patients and their providers.
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Affiliation(s)
| | | | - Christine Mai
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Catherine Monk
- Departments of Obstetrics and Gynecology
- Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York
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14
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Cohidon C, Mahler L, Broers B, Favrod-Coune T, Moussa A, Sebo P. Primary Care Physicians’ Personal and Professional Attributes Associated With Forgoing Own Care and Presenteeism: A Cross Sectional Study. Int J Public Health 2022; 66:1604442. [PMID: 35242001 PMCID: PMC8886613 DOI: 10.3389/ijph.2021.1604442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this study was to describe the prevalence of forgoing care and forgoing sick leave among primary care physicians (PCPs) in Switzerland and to investigate associated factors.Methods: A random sample of 1,000 PCPs in French-speaking regions of Switzerland (participation rate: 50%) was asked whether they had forgone care and sick leave during the last year. Sociodemographic, personal and occupational characteristics were recorded. Logistic regressions were performed to study these behaviours.Results: 37% of respondents reported at least one episode of forgoing care and 29% reported an episode of forgoing sick leave. No associations were found between individual characteristics and forgoing care. A heavy workload was the most common reason evoked for forgoing care. Coming to work when sick (presenteeism) was associated with female sex, younger age, having a chronic illness, working in a suburban area and working full-time.Conclusion: A high proportion of PCPs in Switzerland is forgoing own care and continues to work despite sickness. New generations of PCPs should require careful monitoring, and specific solutions should be sought to reduce these harmful behaviours.
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Affiliation(s)
- Christine Cohidon
- Family Medicine Department, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- *Correspondence: Christine Cohidon,
| | - Liv Mahler
- Primary Care Division, Geneva University Hospitals, Geneve, Switzerland
| | - Barbara Broers
- Primary Care Division, Geneva University Hospitals, Geneve, Switzerland
| | | | - Amir Moussa
- Primary Care Unit, University of Geneva, Geneva, Switzerland
| | - Paul Sebo
- Primary Care Unit, University of Geneva, Geneva, Switzerland
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15
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Abstract
Doctors have a deep-rooted sense of professional identity 'the medical self'. This allows them to do the jobs society expects from them, but also acts as a barrier when seeking care when unwell. This article discusses how the medical self is formed drawing on psychoanalytic, anthropological and psychiatric literature.
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16
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Zhou AY, Zghebi SS, Hodkinson A, Hann M, Grigoroglou C, Ashcroft DM, Esmail A, Chew-Graham CA, Payne R, Little P, de Lusignan S, Cherachi-Sohi S, Spooner S, Zhou AK, Kontopantelis E, Panagioti M. Investigating the links between diagnostic uncertainty, emotional exhaustion, and turnover intention in General Practitioners working in the United Kingdom. Front Psychiatry 2022; 13:936067. [PMID: 35958644 PMCID: PMC9360551 DOI: 10.3389/fpsyt.2022.936067] [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: 05/04/2022] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND General Practitioners (GPs) report high levels of burnout, job dissatisfaction, and turnover intention. The complexity of presenting problems to general practice makes diagnostic uncertainty a common occurrence that has been linked to burnout. The interrelationship between diagnostic uncertainty with other factors such as burnout, job satisfaction and turnover intention have not been previously examined. OBJECTIVES To examine associations between diagnostic uncertainty, emotional exhaustion (EE), depersonalization (DP), job satisfaction, and turnover intention in GPs. METHODS Seventy general practices in England were randomly selected through the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP-RSC). A total of 348 GPs within 67 these practices completed a 10-item online questionnaire which included questions on GP characteristics, work-life balance, job satisfaction, sickness presenteeism, diagnostic uncertainty, turnover intention as well as EE and DP. Associations between diagnostic uncertainty and each of EE, DP, job satisfaction, and turnover intention were evaluated in multivariate mixed-effect ordinal logistic regressions whilst adjusting for covariates, to account for the correlation in the three outcomes of interest. RESULTS Almost one-third of GPs (n = 101; 29%) reported experiencing >10% of diagnostic uncertainty in their day-to-day practice over the past year. GPs reporting greater diagnostic uncertainty had higher levels of EE [OR = 3.90; 95% CI = (2.54, 5.99)], job dissatisfaction [OR = 2.01; 95% CI = (1.30, 3.13)] and turnover intention [OR = 4.51; 95% CI = (2.86, 7.11)]. GPs with no sickness presenteeism had lower levels of EE [OR = 0.53; 95% CI = (0.35, 0.82)], job dissatisfaction [OR = 0.56; 95% CI = (0.35, 0.88)], and turnover intention [OR = 0.61; 95% CI = (0.41, 0.91)]. CONCLUSION Diagnostic uncertainty may not only negatively impact on the wellbeing of GPs, but could also have adverse implications on workforce retention in primary care.
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Affiliation(s)
- Anli Yue Zhou
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Salwa S Zghebi
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Mark Hann
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Christos Grigoroglou
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Institute for Health Policy and Organisation (IHPO), Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Darren M Ashcroft
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom
| | - Aneez Esmail
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Rupert Payne
- Centre for Academic Primary Care Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Simon de Lusignan
- Medical Sciences Division, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.,Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom
| | - Sudeh Cherachi-Sohi
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sharon Spooner
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Andrew K Zhou
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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17
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Hudson E, Arnaert A, Lavoie-Tremblay M. Healthcare professional disclosure of mental illness in the workplace: a rapid scoping review. J Ment Health 2021:1-13. [PMID: 34582294 DOI: 10.1080/09638237.2021.1979485] [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: 07/27/2020] [Revised: 07/06/2021] [Accepted: 08/19/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although mental health difficulties are common among healthcare professionals (HCP), little research exists exploring the decision to disclose these difficulties in the healthcare context. AIMS This rapid scoping review aims to explore HCP disclosure of mental health difficulties in the workplace. METHODS The methodological framework was based on rapid and scoping review guidelines. A thematic synthesis approach was used for data analysis. RESULTS Seventeen articles were included. Disclosure was found to be a process that starts with weighing its pros ("personal benefits", "personal beliefs", and "professional responsibility") and cons ("fears related to professional identity", "fears related to employment", "risk of stigmatization", and "personal experiences with mental health difficulties"). A decision-making process then occurs to help HCPs figure out how to disclose. Situations of nonconsensual disclosure can transpire through "third party disclosure" or "inadvertent disclosure". Disclosure results in outcomes including "positive experiences", "negative personal consequences" and "negative consequences related to others". CONCLUSION Disclosure in healthcare and other workplaces is a complex process with few benefits and many potential repercussions. However, there is an opportunity to improve. Recognizing the value of and educating the workforce about HCPs with mental health difficulties will help work environments become safer for disclosure.
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Affiliation(s)
- Emilie Hudson
- Ingram School of Nursing, McGill University, Montréal, Canada
| | - Antonia Arnaert
- Ingram School of Nursing, McGill University, Montréal, Canada
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18
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Riley R, Buszewicz M, Kokab F, Teoh K, Gopfert A, Taylor AK, Van Hove M, Martin J, Appleby L, Chew-Graham C. Sources of work-related psychological distress experienced by UK-wide foundation and junior doctors: a qualitative study. BMJ Open 2021; 11:e043521. [PMID: 34162634 PMCID: PMC8231022 DOI: 10.1136/bmjopen-2020-043521] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/27/2021] [Accepted: 03/17/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This paper reports findings exploring work cultures, contexts and conditions associated with psychological distress in foundation and junior doctors. DESIGN Qualitative study using in-depth interviews with 21 junior doctor participants. The interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method. SETTING NHS in England. PARTICIPANTS A purposive sample of 16 female and five male junior doctor junior doctor participants who self-identified as having stress, distress, anxiety, depression and suicidal thoughts, or having attempted to kill themselves. RESULTS Analysis reported four key themes: (1) workload and working conditions; (2) toxic work cultures-including abuse and bullying, sexism and racism, culture of blaming and shaming; (3) lack of support; (4) stigma and a perceived need to appear invulnerable. CONCLUSION This study highlights the need for future solutions and interventions targeted at improving work cultures and conditions. There needs to be greater recognition of the components and cumulative effects of potentially toxic workplaces and stressors intrinsic to the work of junior doctors, such as the stress of managing high workloads and lack of access to clinical and emotional support. A cultural shift is needed within medicine to more supportive and compassionate leadership and work environments, and a zero-tolerance approach to bullying, harassment and discrimination.
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Affiliation(s)
- Ruth Riley
- Institute of Applied Health Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Farina Kokab
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - Anya Gopfert
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Anna K Taylor
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Maria Van Hove
- London School of Hygiene & Tropical Medicine, London, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louis Appleby
- Psychiatry and Behavioral Sciences, University of Manchester, Manchester, UK
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19
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Riley R, Kokab F, Buszewicz M, Gopfert A, Van Hove M, Taylor AK, Teoh K, Martin J, Appleby L, Chew-Graham C. Protective factors and sources of support in the workplace as experienced by UK foundation and junior doctors: a qualitative study. BMJ Open 2021; 11:e045588. [PMID: 34162643 PMCID: PMC8231035 DOI: 10.1136/bmjopen-2020-045588] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This paper reports findings identifying foundation and junior doctors' experiences of occupational and psychological protective factors in the workplace and sources of effective support. DESIGN Interpretative, inductive, qualitative study involving in-depth interviews with 21 junior doctor participants. The interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method. SETTING National Health Service in the UK. PARTICIPANTS Participants were recruited from junior doctors through social media (eg, the British Medical Association (BMA) junior doctors' Facebook group, Twitter and the mental health research charity websites). A purposive sample of 16 females and 5 males, ethnically diverse, from a range of specialities, across the UK. Junior doctor participants self-identified as having stress, distress, anxiety, depression and suicidal thoughts or having attempted to kill themselves. RESULTS Analysis identified three main themes, with corresponding subthemes relating to protective work factors and facilitators of support: (1) support from work colleagues - help with managing workloads and emotional support; (2) supportive leadership strategies, including feeling valued and accepted, trust and communication, supportive learning environments, challenging stigma and normalising vulnerability; and (3) access to professional support - counselling, cognitive-behavioural therapy and medication through general practitioners, specialist support services for doctors and private therapy. CONCLUSIONS Findings show that supportive leadership, effective management practices, peer support and access to appropriate professional support can help mitigate the negative impact of working conditions and cultures experienced by junior doctors. Feeling connected, supported and valued by colleagues and consultants acts as an important buffer against emotional distress despite working under challenging working conditions.
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Affiliation(s)
- Ruth Riley
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Farina Kokab
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Anya Gopfert
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Maria Van Hove
- London School of Hygiene & Tropical Medicine, London, UK
| | - Anna K Taylor
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, Leeds, UK
| | - Kevin Teoh
- Department of Organizational Psychology, Birkbeck University of London, London, UK
| | - James Martin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louis Appleby
- Department of Psychiatry & Behavioral Sciences, University of Manchester, Manchester, UK
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20
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Taylor AK, Kingstone T, Briggs TA, O'Donnell CA, Atherton H, Blane DN, Chew‐Graham CA. 'Reluctant pioneer': A qualitative study of doctors' experiences as patients with long COVID. Health Expect 2021; 24:833-842. [PMID: 33749957 PMCID: PMC8235894 DOI: 10.1111/hex.13223] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has had far-reaching effects upon lives, healthcare systems and society. Some who had an apparently 'mild' COVID-19 infection continue to suffer from persistent symptoms, including chest pain, breathlessness, fatigue, cognitive impairment, paraesthesia, muscle and joint pains. This has been labelled 'long COVID'. This paper reports the experiences of doctors with long COVID. METHODS A qualitative study; interviews with doctors experiencing persistent symptoms were conducted by telephone or video call. Interviews were transcribed and analysis conducted using an inductive and thematic approach. RESULTS Thirteen doctors participated. The following themes are reported: making sense of symptoms, feeling let down, using medical knowledge and connections, wanting to help and be helped, combining patient and professional identity. Experiencing long COVID can be transformative: many expressed hope that good would come of their experiences. Distress related to feelings of being 'let down' and the hard work of trying to access care. Participants highlighted that they felt better able to care for, and empathize with, patients with chronic conditions, particularly where symptoms are unexplained. CONCLUSIONS The study adds to the literature on the experiences of doctors as patients, in particular where evidence is emerging and the patient has to take the lead in finding solutions to their problems and accessing their own care. PATIENT AND PUBLIC CONTRIBUTION The study was developed with experts by experience (including co-authors HA and TAB) who contributed to the protocol and ethics application, and commented on analysis and implications. All participants were given the opportunity to comment on findings.
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Affiliation(s)
- Anna K. Taylor
- School of MedicineLeeds Institute of Health SciencesFaculty of Medicine and Health, University of LeedsLeedsUK
| | - Tom Kingstone
- School of MedicineFaculty of Medicine and Health SciencesKeele UniversityKeeleUK
- Research and Innovation DepartmentSt George's HospitalMidlands Partnership NHS Foundation TrustStaffordUK
| | - Tracy A. Briggs
- Division of Evolution and Genomic SciencesSchool of Biological SciencesManchester UniversityManchesterUK
| | - Catherine A. O'Donnell
- General Practice & Primary CareInstitute of Health & WellbeingUniversity of GlasgowGlasgowUK
| | - Helen Atherton
- Unit of Academic Primary CareWarwick Medical SchoolUniversity of WarwickCoventryUK
| | - David N. Blane
- General Practice & Primary CareInstitute of Health & WellbeingUniversity of GlasgowGlasgowUK
| | - Carolyn A. Chew‐Graham
- School of MedicineFaculty of Medicine and Health SciencesKeele UniversityKeeleUK
- Research and Innovation DepartmentSt George's HospitalMidlands Partnership NHS Foundation TrustStaffordUK
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21
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Brown T, Berman S, McDaniel K, Radford C, Mehta P, Potter J, Hirsh DA. Trauma-Informed Medical Education (TIME): Advancing Curricular Content and Educational Context. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:661-667. [PMID: 32675789 DOI: 10.1097/acm.0000000000003587] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
The majority of patients and medical students experience some form of psychological trauma or adversity across their life course. All forms of trauma can be associated with adverse health consequences and can negatively affect learning and professional development. Trauma-informed care (TIC) offers a framework to address and mitigate these consequences and promote safety and health. The Substance Abuse and Mental Health Services Administration describes 6 domains of TIC: safety; trust and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historic, and gender issues. At present, TIC is not taught routinely in undergraduate medical education (UME)-a crucial educational gap given that UME grounds the development of key perspectives and practices that students use throughout their careers. Further, given the prevalence of preexisting trauma among learners and the likelihood of new traumatic exposures during training, medical schools' processes, practices, and learning environments may risk exacerbating or even causing trauma. To address this educational need and support students and their future patients, the authors propose a trauma-informed medical education (TIME) framework. TIME informs medical schools' curricular content and educational context. In UME, curricular content should address trauma epidemiology, physiology, and effects; trauma-informed clinical skills including sensitive communication and physical exam techniques; and trauma-informed self-care techniques including education on organizational resources, how to elicit supports, and personal self-care practices. A trauma-informed educational context encompasses curricular development, including student-faculty coproduction of educational content; curricular delivery, including faculty development on TIC principles; and learning environment, including trauma-informed educational practices, medical student advising, institutional policies, and recruitment. TIME offers practical strategies to support teaching, learning, educational administration, and professional development and aims to inspire new strategies for effective learner and faculty engagement. TIME aims to foster students' development of competency in TIC and promote student engagement, learning, health, and well-being.
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Affiliation(s)
- Taylor Brown
- T. Brown is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Sarah Berman
- S. Berman is a fourth-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Katherine McDaniel
- K. McDaniel is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Caitlin Radford
- C. Radford is a third-year medical student, Harvard Medical School, Boston, Massachusetts
| | - Pooja Mehta
- P. Mehta is a first-year resident, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer Potter
- J. Potter is professor of medicine, Harvard Medical School, Boston, Massachusetts
| | - David A Hirsh
- D.A. Hirsh is the George E. Thibault Academy Associate Professor and director, HMS Academy, Harvard Medical School, Boston, Massachusetts
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22
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Understanding the impact of professional motivation on the workforce crisis in medicine: a rapid review. BJGP Open 2021; 5:BJGPO.2021.0005. [PMID: 33653705 PMCID: PMC8170605 DOI: 10.3399/bjgpo.2021.0005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background The NHS is facing a workforce crisis. Responses to date have focused on improving recruitment of staff, but less attention has been paid to retention. Aim To conduct a rapid review using Rosabeth Moss Kanter’s three Ms model of workforce motivation as a sensitising framework to examine the current medical workforce crisis. The work considers how insights from research in other professions offers new thinking for understanding what motivates doctors to continue working. Design & setting Rapid literature review with secondary analysis of existing research examining reasons for leaving medicine. Method A systematic search strategy was developed with the aid of an information specialist. The search terms used were: medical professionals, retention, and NHS. The exclusions were: commentaries, non-medical professionals, non-English language, and it was limited to post-1990. The search was applied to three electronic databases, MEDLINE, Embase, and Healthcare Management Information Consortium (HMIC). This produced a dataset describing study design, and factors related to motivation for leaving the medical profession. Comparative thematic analysis distilled core themes explaining the reasons for leaving and their relation to the three Ms model. Results Of 3389 abstracts identified, screening and assessment produced 82 articles included in the final analysis. Thematic analysis identified four key themes: low morale, disconnect, unmanageable change, and lack of personal and professional support. The themes of mastery, membership, and meaning were substantially present within the dataset. Conclusion Kanter's three Ms model of motivation can be applied to the medical workforce to understand retention issues. This work supports the development of targeted solutions to tackle the worsening workforce crisis.
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23
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Domestic abuse among female doctors: thematic analysis of qualitative interviews in the UK. Br J Gen Pract 2021; 71:e193-e200. [PMID: 33558329 DOI: 10.3399/bjgp.2020.0795] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/03/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Doctors can be victim-survivors of domestic abuse (DA), but how this impacts their work and wellbeing, and whether they face barriers to seeking help is not well understood. AIM To understand single doctor mothers' lived experience of DA, barriers to seeking help, and impact on their work. DESIGN AND SETTING Individual qualitative interviews with female doctors in the UK who had left an abusive relationship. Interviews were conducted between August 2019 and March 2020. METHOD Participants were invited via a closed online forum for female doctors who are single parents. In total, 114 females expressed interest. In-depth semi-structured telephone interviews were audiorecorded and transcribed. Transcripts were uploaded to NVivo and analysed using inductive thematic analysis. RESULTS A total of 21 participants were interviewed. The internalised stigma of DA affected participants' sense of identity and belonging as a doctor, causing social and professional isolation. Many participants felt that the acute stress of DA had an impact on their work, yet often felt unable to take time off. Barriers to seeking help included lack of confidentiality, especially where the abusive partner was also a doctor (sometimes accusing the victim-survivor of mental illness or threatening to report them to the General Medical Council). Participants found peer support helpful, as well as consulting health professionals who were empathic towards them. After they had left the abusive relationship victim-survivors felt better equipped to support patients going through DA. CONCLUSION Domestic abuse impacts on the work and wellbeing of female doctors, who face unique barriers to help seeking and reporting DA. An online peer support group can help to break the sense of isolation, but specialised confidential support services are also required to help doctors experiencing DA.
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Spiers J, Buszewicz M, Chew-Graham CA, Riley R. The experiences of general practitioner partners living with distress: An interpretative phenomenological analysis. J Health Psychol 2020; 25:1439-1449. [PMID: 29468904 PMCID: PMC7479991 DOI: 10.1177/1359105318758860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Doctors, including general practitioners, experience higher levels of mental illness than the general population. General practitioners who are partners in their practices may face heightened stress. In total, 10 general practitioner partners living with work-related distress were interviewed, and transcripts were analysed using interpretative phenomenological analysis. Three major themes arose: (1) extreme distress, (2) conflicted doctor identity and (3) toxic versus supportive workplace relationships. Participants detailed symptoms of depression, anxiety and burnout; reported conflicted identities; and discussed the impact of bullying partnerships. We recommend that organisational interventions tackling issues such as bullying be implemented and opportunities to debrief be offered as protected time activities to general practitioner partners.
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Affiliation(s)
- Johanna Spiers
- University of Bristol, UK,Johanna Spiers, 2 The Old Byre, East Dundry
Lane, East Dundry, Bristol BS41 8NH, UK.
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Muhamad Ramzi NSA, Deady M, Petrie K, Crawford J, Harvey SB. Help-seeking for depression among Australian doctors. Intern Med J 2020; 51:2069-2077. [PMID: 32833296 DOI: 10.1111/imj.15035] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Depression is common among doctors. However, concerns remain that doctors are unlikely to ask for help when symptoms of depression arise. AIMS To determine rates and patterns of help-seeking for depression among doctors and to identify predictors of and barriers to such behaviour. METHODS A secondary analysis was conducted on a nation-wide survey of 12 252 Australian doctors. The study sample consisted of doctors who reported having ever felt seriously depressed (n = 4154; 33.9% of total sample). Rates of help-seeking, professional help-seeking behaviours and self-reported barriers were explored. Logistic regression was used to examine the association between professional help-seeking and predetermined predictive factors. RESULTS Sixty percent (95% confidence interval (CI): 58.5-61.5) of doctors who have ever felt seriously depressed reported some form of professional help-seeking for depression. The most common barrier to help-seeking was 'privacy/confidentiality'. Females (odds ratio (OR) = 1.74; 95% CI: 1.50-2.01; P < 0.001), locally trained doctors (OR = 1.34; 95% CI: 1.12-1.59; P = 0.001) and senior doctors (OR = 1.35; 95% CI: 1.14-1.61; P = 0.001) were more likely to seek professional help than their counterparts. Compared with general practitioners, psychiatrists (OR = 1.565; 95% CI: 1.15-2.13; P = 0.004) were more likely to seek professional help while surgeons (OR = 0.518; 95% CI: 0.37-0.72; P < 0.001) and pathologists/radiologists (OR = 0.695; 95% CI: 0.49-0.99; P = 0.043) were less likely. CONCLUSION While it is reassuring that the majority of depressed doctors were able to seek professional help, many were not. Major barriers to professional help-seeking, particularly concerns about confidentiality and impact on career, remain a problem. Male, overseas-trained, junior doctors, surgeons and pathologists/radiologists were less likely to seek help for depression. Targeted interventions are required to increase appropriate help-seeking for depression in doctors.
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Affiliation(s)
| | - Mark Deady
- Department of Medicine, Black Dog Institute, Sydney, New South Wales, Australia
| | - Katherine Petrie
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Department of Medicine, Black Dog Institute, Sydney, New South Wales, Australia
| | - Joanna Crawford
- Department of Medicine, Black Dog Institute, Sydney, New South Wales, Australia
| | - Samuel B Harvey
- Department of Medicine, Black Dog Institute, Sydney, New South Wales, Australia
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Healthcare professionals' perspectives on lung cancer screening in the UK: a qualitative study. BJGP Open 2020; 4:bjgpopen20X101035. [PMID: 32522753 PMCID: PMC7465573 DOI: 10.3399/bjgpopen20x101035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/29/2019] [Indexed: 12/19/2022] Open
Abstract
Background Lung cancer screening with low-dose computed tomography (LDCT) has been shown to decrease mortality. Low lung cancer survival rates in the UK, driven primarily by late-stage presentation, provide the impetus for implementing screening. Nascent guidance on screening in the UK recommends primary care case-finding. However, the potential impact and acceptability on primary care, and the opportunistic utilisation of other case-finding routes, such as pharmacies, smoking cessation services, and respiratory clinics, have not been fully explored. Aim To explore healthcare professionals’ views and perspectives about lung cancer screening and their preparedness and willingness to be involved in its implementation. Design & setting A qualitative study was carried out with semi-structured interviews conducted with GPs, pharmacists, staff from smoking cessation services within Southwark and Lambeth in London, and staff from respiratory clinics in Guys’ and St Thomas’ NHS Foundation Trust in London between April 2018 and December 2018. Method Sixteen participants were interviewed and the interview transcripts were analysed thematically. Results Participants described lung cancer screening as an important diagnostic tool for capturing lung cancer at an earlier stage and in increasing survivorship. However, the majority expressed a lack of awareness and understanding, uncertainty and concerns about the validity of screening, and the potential impact on their patients and workload. Conclusion Study participants had mixed opinions about lung cancer screening and expressed their concerns about its implementation. Addressing these concerns by providing resources and effective and detailed guidelines for their use may lead to greater engagement and willingness to be involved in lung cancer screening.
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Manning JB, Blandford A, Edbrooke-Childs J, Marshall P. How Contextual Constraints Shape Midcareer High School Teachers' Stress Management and Use of Digital Support Tools: Qualitative Study. JMIR Ment Health 2020; 7:e15416. [PMID: 32338623 PMCID: PMC7215497 DOI: 10.2196/15416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/10/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Persistent psychosocial stress is endemic in the modern workplace, including among midcareer high school (secondary comprehensive) teachers in England. Understanding contextual influences on teachers' self-management of stress along with their use of digital health technologies could provide important insights into creating more usable and accessible stress support interventions. OBJECTIVE The aim of this study was to investigate the constraints on stress management and prevention among teachers in the school environment and how this shapes the use of digitally enabled stress management tools. METHODS Semistructured interviews were conducted with 14 teachers from southern England. The interviews were analyzed using thematic analysis. RESULTS Teachers were unanimous in their recognition of workplace stress, describing physical (such as isolation and scheduling) and cultural (such as stigma and individualism) aspects in the workplace context, which influence their ability to manage stress. A total of 12 participants engaged with technology to self-manage their physical or psychological well-being, with more than half of the participants using consumer wearables, but Web-based or smartphone apps were rarely accessed in school. However, digital well-being interventions recommended by school leaders could potentially be trusted and adopted. CONCLUSIONS The findings from this study bring together both the important cultural and physical contextual constraints on the ability of midcareer high school teachers to manage workplace stress. This study highlights correlates of stress and offers initial insight into how digital health interventions are currently being used to help with stress, both within and outside high schools. The findings add another step toward designing tailored digital stress support for teachers.
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Affiliation(s)
- Julia B Manning
- University College London Interaction Centre, London, United Kingdom
| | - Ann Blandford
- Institute of Healthcare Engineering, University College London, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence-based Practice Unit, Anna Freud Centre and University College London, London, United Kingdom
| | - Paul Marshall
- Department of Computer Science, University of Bristol, London, United Kingdom
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Carrieri D, Pearson M, Mattick K, Papoutsi C, Briscoe S, Wong G, Jackson M. Interventions to minimise doctors’ mental ill-health and its impacts on the workforce and patient care: the Care Under Pressure realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The growing incidence of mental ill-health in health professionals, including doctors, is a global concern. Although a large body of literature exists on interventions that offer support, advice and/or treatment to sick doctors, it has not yet been synthesised in a way that takes account of the complexity and heterogeneity of the interventions, and the many dimensions (e.g. individual, organisational, sociocultural) of the problem.
Objectives
Our aim was to improve understanding of how, why and in what contexts mental health services and support interventions can be designed to minimise the incidence of doctors’ mental ill-health. The objectives were to review interventions to tackle doctors’ mental ill-health and its impact on the clinical workforce and patient care, drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives to produce actionable theory; and recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts.
Design
Realist literature review consistent with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Bibliographic database searches were developed and conducted using MEDLINE (1946 to November week 4 2017), MEDLINE In-Process and Other Non-indexed Citations (1946 to 6 December 2017) and PsycINFO (1806 to November week 2 2017) (all via Ovid) and Applied Social Sciences Index and Abstracts (1987 to 6 December 2017) (via ProQuest) on 6 December 2017. Further UK-based studies were identified by forwards and author citation searches, manual backwards citation searching and hand-searching relevant journal websites.
Review methods
We included all studies that focused on mental ill-health; all study designs; all health-care settings; all studies that included medical doctors/medical students; descriptions of interventions or resources that focus on improving mental ill-health and minimising its impacts; all mental health outcome measures, including absenteeism (doctors taking short-/long-term sick leave); presenteeism (doctors working despite being unwell); and workforce retention (doctors leaving the profession temporarily/permanently). Data were extracted from included articles and the data set was subjected to realist analysis to identify context–mechanism–outcome configurations.
Results
A total of 179 out of 3069 records were included. Most were from the USA (45%) and had been published since 2009 (74%). More included articles focused on structural-level interventions (33%) than individual-level interventions (21%), but most articles (46%) considered both levels. Most interventions focused on prevention, rather than treatment/screening, and most studies referred to doctors/physicians in general, rather than to specific specialties or career stages. Nineteen per cent of the included sources provided cost information and none reported a health economic analysis. The 19 context–mechanism–outcome configurations demonstrated that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job, and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote well-being. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors needed to have confidence in an intervention for the intervention to be effective.
Limitations
Variable quality of included literature; limited UK-based studies.
Future work
Use this evidence synthesis to refine, implement and evaluate interventions.
Study registration
This study is registered as PROSPERO CRD42017069870.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Daniele Carrieri
- College of Medicine and Health, University of Exeter, Exeter, UK
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, UK
| | - Karen Mattick
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Briscoe
- Exeter HSDR Evidence Synthesis Centre, Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Jackson
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
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Carrieri D, Mattick K, Pearson M, Papoutsi C, Briscoe S, Wong G, Jackson M. Optimising strategies to address mental ill-health in doctors and medical students: 'Care Under Pressure' realist review and implementation guidance. BMC Med 2020; 18:76. [PMID: 32228578 PMCID: PMC7106831 DOI: 10.1186/s12916-020-01532-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/13/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Mental ill-health in health professionals, including doctors, is a global and growing concern. The existing literature on interventions that offer support, advice and/or treatment to sick doctors has not yet been synthesised in a way that considers the complexity and heterogeneity of the interventions, and the many dimensions of the problem. We (1) reviewed interventions to tackle doctors' and medical students' mental ill-health and its impacts on the clinical workforce and patient care-drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives-and (2) produced recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts. METHODS Realist literature review consistent with the RAMESES quality and reporting standards. Sources for inclusion were identified through bibliographic database searches supplemented by purposive searches-resulting also from engagement with stakeholders. Data were extracted from included articles and subjected to realist analysis to identify (i) mechanisms causing mental ill-health in doctors and medical students and relevant contexts or circumstances when these mechanisms were likely to be 'triggered' and (ii) 'guiding principles' and features underpinning the interventions and recommendations discussed mostly in policy document, reviews and commentaries. RESULTS One hundred seventy-nine records were included. Most were from the USA (45%) and were published since 2009 (74%). The analysis showed that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote wellbeing. Interventions creating a people-focussed working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors and medical students needed to have confidence in an intervention for the intervention to be effective. CONCLUSIONS Successful interventions to tackle doctors' and students' mental ill-health are likely to be multidimensional and multilevel and involve multiple stakeholders. Evaluating and improving existing interventions is likely to be more effective than developing new ones. Our evidence synthesis provides a basis on which to do this. STUDY REGISTRATION PROSPERO CRD42017069870. Research project webpage http://sites.exeter.ac.uk/cup/.
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Affiliation(s)
- Daniele Carrieri
- College of Medicine and Health, University of Exeter, Exeter, UK. .,Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK.
| | - Karen Mattick
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Briscoe
- Exeter HS&DR Evidence Synthesis Centre, Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Jackson
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
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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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Kay MP, Dawes V. Working together to ensure health care access for doctors. Med J Aust 2019; 211:497-498.e1. [DOI: 10.5694/mja2.50421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Margaret P Kay
- University of Queensland Brisbane QLD
- Queensland Doctors' Health Programme Brisbane QLD
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Shinde S, Yentis SM, Asanati K, Coetzee RH, Cole‐King A, Gerada C, Harding K, Hawton K, Hennessy A, Keats P, Kumar N, McGlennan A, Pappenheim K, Plunkett E, Prior K, Rowland A. Guidelines on suicide amongst anaesthetists 2019. Anaesthesia 2019; 75:96-108. [DOI: 10.1111/anae.14890] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 02/01/2023]
Affiliation(s)
- S. Shinde
- Department of Anaesthesia Southmead Hospital North Bristol NHS Trust Vice‐President, Association of Anaesthetists and Co‐Chair, Association of Anaesthetists Working Party Bristol UK
| | - S. M. Yentis
- Department of Anaesthesia Chelsea and Westminster Hospital NHS Foundation Trust Co‐Chair, Association of Anaesthetists Working Party London UK
| | - K. Asanati
- Occupational Health Services Epsom and St. Helier University Hospitals NHS Trust Honorary Clinical Senior Lecturer, Imperial College London London UK
| | | | - A. Cole‐King
- Department of Liaison Psychiatry Glan Clwyd Hospital Betsi Cadwaladr University Health Board Wales UK
| | | | - K. Harding
- Palliative Care Doctor and part‐time GP Hereford UK
| | - K. Hawton
- Centre for Suicide Research University Department of Psychiatry Warneford Hospital Oxford UK
| | - A. Hennessy
- Department of Anaesthesia Beaumont Hospital Honorary Secretary, College of Anaesthesiologists of Ireland Dublin Ireland
| | - P. Keats
- Association of Anaesthetists London UK
| | - N. Kumar
- Health Education England – North East Newcastle upon Tyne UK
| | - A. McGlennan
- Chase Farm Hospital Royal Free London NHS Foundation Trust London UK
| | | | - E. Plunkett
- Department of Anaesthesia University Hospitals Birmingham UK
| | - K. Prior
- Department of Anaesthesia King's College Hospital Surgeon Commander, Royal Navy; Royal College of Anaesthetists representative, London, UK, London UK
| | - A. Rowland
- Business Transformation and Safeguarding for Fitness to Practise General Medical Council London UK
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Brindley PG, Olusanya S, Wong A, Crowe L, Hawryluck L. Psychological 'burnout' in healthcare professionals: Updating our understanding, and not making it worse. J Intensive Care Soc 2019; 20:358-362. [PMID: 31695741 PMCID: PMC6820226 DOI: 10.1177/1751143719842794] [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] [Indexed: 01/17/2023] Open
Abstract
Many healthcare professionals and professional societies are demanding action to counter 'burnout', especially in the acute care medical specialties. This review is intended to empower this laudable 'call to arms', while also validating concerns that have been raised about how we typically define, measure and counter this important issue. This review aims to advance the discussion, dispel common misconceptions, add important nuance, and identify common ground. We also encourage the ideas contained within the military term 'occupational stress injury', which include a cultural shift away from blame and stigmatization, and towards shared responsibility and empathy. We also outline why mandatory testing can be troublesome and why interventions should be tailored to individuals. While the need for immediate action may seem self-evident, we wish to mitigate the real possibility that good intentions could make a perilous situation worse. 'Burnout' matters, but how individuals and organizations go forward matters even more.
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Affiliation(s)
- Peter G Brindley
- Division of Critical Care Medicine,
University
of Alberta, Edmonton, AB, Canada
| | | | - Adrian Wong
- Royal Surrey County Hospital NHS
Foundation Trust, Guildford, UK
| | - Liz Crowe
- School of Medicine, Queensland
University, Brisbane, QLD, Australia
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Lindemann F, Rozsnyai Z, Zumbrunn B, Laukenmann J, Kronenberg R, Streit S. Assessing the mental wellbeing of next generation general practitioners: a cross-sectional survey. BJGP Open 2019; 3:bjgpopen19X101671. [PMID: 31615787 PMCID: PMC6995859 DOI: 10.3399/bjgpopen19x101671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 09/02/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Future and practising GPs encounter various stressors, which can potentially impair mental wellbeing and develop into mental illnesses. AIM To assess mental wellbeing of young and future GPs by their level of training. DESIGN & SETTING A cross-sectional anonymous survey of members of the Swiss Young General Practitioners Association (JHaS) was undertaken. METHOD Basic characteristics and the current mental wellbeing were assessed using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Specific stressors that can influence wellbeing were focused on. Participants were asked for ideas on how to improve wellbeing via open questions. RESULTS Response rate was 57% (n = 503). Mean value for mental wellbeing (WEMWBS) was 52.4 (maximum 70, standard deviation [SD] 7.2). Residents had a significantly lower level of mental health (51.0, SD 7.6) compared with GPs (54.2, SD 6.2). Overall, stress level was reported as high or very high by almost half of participants (49%). Forty-five per cent indicated a lack of private time; the highest proportion was among residents. Fifteen per cent (20% among residents) were at risk of burnout. Most frequent stressors were administrative tasks, high workload, and work demands. Support requests included improvement of work-life balance and reduction of administrative workload. CONCLUSION Residents had the lowest mental wellbeing, at a stress level similarly high to that of GPs. They most often indicated not having enough time for a private life and were most at risk of burnout. Improvement suggestions should be implemented to maintain mental health of young and future GPs. Particular attention should be paid to GPs in training, as owing to their reduced mental health, they may benefit most.
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Affiliation(s)
- Fanny Lindemann
- MD Candidate, Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Zsofia Rozsnyai
- Deputy Head of Career Development, Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Brigitta Zumbrunn
- Resident, Department of General Internal Medicine, Bern, Inselspital, Bern University Hospital, Switzerland
| | | | - Regula Kronenberg
- Resident, Department of General Internal Medicine, Lucerne, Cantonal Hospital Lucerne, Switzerland
| | - Sven Streit
- Head of Career Development, Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Understanding compassion in family medicine: a qualitative study. Br J Gen Pract 2019; 69:e208-e216. [PMID: 30692087 DOI: 10.3399/bjgp19x701285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/10/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients and physicians have traditionally valued compassion; however, there is concern that physician compassion has declined with the increasing emphasis on science and technology in medicine. Although the literature on compassion is growing, very little is known about how family physicians experience compassion in their work. AIM To explore family physicians' capacity for and experiences of compassion in practice. DESIGN AND SETTING This was a qualitative study designed using a phenomenological approach in rural and urban Ontario, Canada. METHOD In-depth interviews were audiotaped and transcribed verbatim, followed by independent and team coding. An iterative and interpretive analysis was conducted using immersion and crystallisation techniques. Purposive sampling recruited 22 participants (nine males and 13 females aged 26-64 years) that included family medicine residents from Western University (n = 6), and family physicians practising <5 years (n = 7) or >10 years (n = 9) in Ontario, Canada. RESULTS From the data, the authors derived the Compassion Trichotomy as a theoretical model to describe three interrelated areas that determine the evolution or devolution of compassion experienced by family physicians: motivation (core values), capacity (energy), and connection (relationship). CONCLUSION The Compassion Trichotomy highlights the importance and interdependence in physician compassion of motivation (personal reflection and values), capacity (awareness and regulation of energy, emotion, and cognition), and connection (sustained patient-physician relationship). This model may assist practising family physicians, educators, and researchers to explore how compassion development might enhance physician effectiveness and satisfaction.
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Clough BA, March S, Leane S, Ireland MJ. What prevents doctors from seeking help for stress and burnout? A mixed-methods investigation among metropolitan and regional-based australian doctors. J Clin Psychol 2018; 75:418-432. [DOI: 10.1002/jclp.22707] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/06/2018] [Accepted: 09/04/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Bonnie A. Clough
- Institute for Resilient Regions, School of Psychology and Counselling, University of Southern Queensland; Springfield Central Australia
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University; Gold Coast Australia
| | - Sonja March
- Institute for Resilient Regions, School of Psychology and Counselling, University of Southern Queensland; Springfield Central Australia
| | - Sheena Leane
- Institute for Resilient Regions, School of Psychology and Counselling, University of Southern Queensland; Springfield Central Australia
| | - Michael J. Ireland
- Institute for Resilient Regions, School of Psychology and Counselling, University of Southern Queensland; Springfield Central Australia
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Ways of Knowing. Br J Gen Pract 2018; 68:507. [DOI: 10.3399/bjgp18x699449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Chew-Graham C. RCGP Research Paper of the Year 2017: of relevance to the General Practice Forward View?. Br J Gen Pract 2018; 68:536-537. [PMID: 30361314 PMCID: PMC6193773 DOI: 10.3399/bjgp18x699641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Carolyn Chew-Graham
- Keele University, Keele, Staffordshire. Chair, Scientific Foundation Board, RCGP. Chair, Research Paper of the Year, RCGP.
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Nørøxe KB, Pedersen AF, Bro F, Vedsted P. Mental well-being and job satisfaction among general practitioners: a nationwide cross-sectional survey in Denmark. BMC FAMILY PRACTICE 2018; 19:130. [PMID: 30055571 PMCID: PMC6064618 DOI: 10.1186/s12875-018-0809-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/27/2018] [Indexed: 01/12/2023]
Abstract
Background Poor mental well-being and low job satisfaction among physicians can have significant negative implications for the physicians and their patients and may also reduce the cost efficiency in health care. Mental distress is increasingly common in physicians, including general practitioners (GPs). This study aimed to examine mental well-being and job satisfaction among Danish GPs and potential associations with age, gender and practice organisation. Methods Data was collected in a nationwide questionnaire survey among Danish GPs in 2016. Register data on GPs and their patient populations was used to explore differences between respondents and non-respondents. Associations were estimated using multivariate logistic regression analysis. Results Of 3350 eligible GPs, 1697 (50.7%) responded. Lower response rate was associated with increasing numbers of comorbid, aging or deprived patients. About half of participating GPs presented with at least one burnout symptom; 30.6% had high emotional exhaustion, 21.0% high depersonalisation and 36.6% low personal accomplishment. About a quarter (26.2%) experienced more than one of these symptoms, and 10.4% experienced all of them. Poor work-life balance was reported by 16.2%, low job satisfaction by 22.1%, high perceived stress by 20.6% and poor general well-being by 18.6%. Constructs were overlapping; 8.4% had poor overall mental health, which was characterized by poor general well-being, high stress and ≥ 2 burnout symptoms. In contrast, 24.6% had no burnout symptoms and reported high levels of general well-being and job satisfaction. Male GPs more often than female GPs reported low job satisfaction, depersonalisation, complete burnout and poor overall mental health. Middle-aged (46–59 years) GPs had higher risk of low job satisfaction, burnout and suboptimal self-rated health than GPs in other age groups. GPs in solo practices more often assessed the work-life balance as poor than GPs in group practices. Conclusion The prevalence of poor mental well-being and low job satisfaction was generally high, particularly among mid-career GPs and male GPs. Approximately 8% was substantially distressed, and approximately 25% reported positive mental well-being and job satisfaction, which shows huge variation in the mental well-being among Danish GPs. The results call for targeted interventions to improve mental well-being and job satisfaction among GPs. Electronic supplementary material The online version of this article (10.1186/s12875-018-0809-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Busk Nørøxe
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Anette Fischer Pedersen
- Research Unit for General Practice & Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Flemming Bro
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
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Riley R, Spiers J, Chew-Graham CA, Taylor AK, Thornton GA, Buszewicz M. 'Treading water but drowning slowly': what are GPs' experiences of living and working with mental illness and distress in England? A qualitative study. BMJ Open 2018; 8:e018620. [PMID: 29724736 PMCID: PMC5942433 DOI: 10.1136/bmjopen-2017-018620] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This paper provides an in-depth account of general practitioners' (GPs) experiences of living and working with mental illness and distress, as part of a wider study reporting the barriers and facilitators to help-seeking for mental illness and burn-out, and sources of stress/distress for GP participants. DESIGN Qualitative study using in-depth interviews with 47 GP participants. The interviews were audio recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method. SETTING England. PARTICIPANTS A purposive sample of GP participants who self-identified as: (1) currently living with mental distress, (2) returning to work following treatment, (3) off sick or retired early as a result of mental distress or (4) without experience of mental distress. Interviews were conducted face to face or over the telephone. RESULTS The findings report GP participants' in-depth experiences of distress and mental illness with many recollecting their distressing experiences and significant psychological and physical symptoms relating to chronic stress, anxiety, depression and/or burn-out, and a quarter articulating thoughts of suicide. Many talked about their shame, humiliation and embarrassment at their perceived inability to cope with the stresses of their job and/or their symptoms of mental illness. CONCLUSIONS These findings paint a concerning picture of the situation affecting primary care doctors, with participants' accounts suggesting there is a considerable degree of mental ill health and reduced well-being among GPs. The solutions are complex and lie in prevention and provision. There needs to be greater recognition of the components and cumulative effect of occupational stressors for doctors, such as the increasing workload and the clinical and emotional demands of the job, as well as the need for a culture shift within medicine to more supportive and compassionate work environments.
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Affiliation(s)
- Ruth Riley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Johanna Spiers
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | | | - Anna K Taylor
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Gail A Thornton
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, London, UK
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Nicholson PJ, Gration JC. Helping patients with common mental health problems return to work. Br J Gen Pract 2018; 68:164-165. [PMID: 29592920 PMCID: PMC5863649 DOI: 10.3399/bjgp18x695333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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42
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Carrieri D, Briscoe S, Jackson M, Mattick K, Papoutsi C, Pearson M, Wong G. 'Care Under Pressure': a realist review of interventions to tackle doctors' mental ill-health and its impacts on the clinical workforce and patient care. BMJ Open 2018; 8:e021273. [PMID: 29420234 PMCID: PMC5829880 DOI: 10.1136/bmjopen-2017-021273] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/05/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Mental ill-health is prevalent across all groups of health professionals and this is of great concern in many countries. In the UK, the mental health of the National Health Service (NHS) workforce is a major healthcare issue, leading to presenteeism, absenteeism and loss of staff from the workforce. Most interventions targeting doctors aim to increase their 'productivity' and 'resilience', placing responsibility for good mental health with doctors themselves and neglecting the organisational and structural contexts that may have a detrimental effect on doctors' well-being. There is a need for approaches that are sensitive to the contextual complexities of mental ill-health in doctors, and that do not treat doctors as a uniform body, but allow distinctions to account for particular characteristics, such as specialty, career stage and different working environments. METHODS AND ANALYSIS Our project aims to understand how, why and in what contexts support interventions can be designed to minimise the incidence of doctors' mental ill-health. We will conduct a realist review-a form of theory-driven interpretative systematic review-of interventions, drawing on diverse literature sources. The review will iteratively progress through five steps: (1) locate existing theories; (2) search for evidence; (3) select articles; (4) extract and organise data and (5) synthesise evidence and draw conclusions. The analysis will summarise how, why and in what circumstances doctors' mental ill-health is likely to develop and what can remediate the situation. Throughout the project, we will also engage iteratively with diverse stakeholders in order to produce actionable theory. ETHICS AND DISSEMINATION Ethical approval is not required for our review. Our dissemination strategy will be participatory. Tailored outputs will be targeted to: policy makers; NHS employers and healthcare leaders; team leaders; support organisations; doctors experiencing mental ill-health, their families and colleagues. PROSPERO REGISTRATION NUMBER CRD42017069870.
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Affiliation(s)
- Daniele Carrieri
- University of Exeter Medical School, University of Exeter, Exeter, UK
- Wellcome Centre for Cultures and Enviroments of Health, University of Exeter, Exeter, UK
| | - Simon Briscoe
- Exeter HS&DR Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Mark Jackson
- Wellcome Centre for Cultures and Enviroments of Health, University of Exeter, Exeter, UK
| | - Karen Mattick
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Geoffrey Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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