The relationship between leadership and physician well-being: a scoping review

To date, research has established the individual and organizational factors that impair well-being. Thus, we are aware of the organizational “cogs and wheels” that drive well-being, and there is a sense that we can potentially utilize effective leadership to push and pull these in the appropriate directions. However, reviews of leadership in health care point to the lack of academic rigor and difficulty in reaching solid conclusions. Conversely, there is an accepted belief that the most important determinant of the development and maintenance of cultures is current – and future – leadership. Thus, leadership is assumed to be an important element of organizational functioning without the requisite evidence base. Medicine is a unique organizational environment in which the health of physicians may be a significant risk factor for inadequate patient safety and suboptimal care. Globally, physicians are reporting increasing levels of job burnout, especially among younger physicians in training. Not surprisingly, higher levels of physician burnout are associated with suboptimal care for patients and medical error, as well as maladaptive coping strategies among physicians that serve to exacerbate the former. This review is a scoping analysis of the existing literature to address the central question: is there a relationship between organizational leadership and physician well-being? The objectives of the review are as follows: 1) identify the degree to which physician health is under threat; 2) evaluate the evidence linking leadership with physician well-being; 3) identify alternative ways to approach the problem; and 4) outline avenues for future research. Finally, enhancing progress in the field is discussed in the contexts of theory, methodology, and impact.

The impact of visual impairments in self-esteem and locus of control

This study investigates the differences between adults with visual impairments and sighted adults with regard to locus of control (LOC) and self-esteem. One hundred and eight adults with visual impairments (blindness or low vision) and fifty-five sighted adults took part in this study. Sighted adults showed a higher score on the self-esteem scale than either the individuals with low vision or with blindness. Moreover, analysis indicated no significant differences amongst the three groups of participants regarding LOC. Significant predictors of self-esteem were vision status and age at loss of sight. Significant predictors of LOC were vision status and independent movement. Findings are discussed with regard to their implications for parents, social workers, teachers, and rehabilitation specialists.

Organizational stressors, work-family interface and the role of gender in the hospital: experiences from Turkey

OBJECTIVES

In the framework of the EU project 'Improving quality and safety in the hospital: The link between organizational culture, burnout and quality of care', focus groups (FGs) were conducted to explore hospital environment stressors and their relationship with health care professional (HP) well-being and quality of care.

METHODS

Semi-structured interviews and FGs were used. Three mixed FGs with 23 health care workers, two FGs with 12 nurses, and another one with nine physicians were conducted. Thematic analyses were performed. Data were coded into main themes and subthemes.

RESULTS

Three themes emerged from the discussions: (1) Organizational stressors associated with working conditions concerning the nature of the job, workload and working schedule, unclear role definition, lack of time for personal development, interpersonal relationships at work, changes in health policy, (2) work-family spillover and (3) the gendered nature of health care work and of patients' expectations, and the gendered character of the workplace.

CONCLUSIONS

Health care professionals are faced with numerous challenges that create stress affecting their daily life. Job stressors related to working conditions, the negative and positive spillover of work-family interference and the gendered nature of health care work emerged as important issues for Turkish HPs.

STATEMENT OF CONTRIBUTION

What is already known on this subject? In Turkey, gender has rarely been considered in the healthcare studies. Rapid changes in health reforms are making healthcare professionals more vulnerable to stress. The deteriation in the health system impacts women more than men, as higher ratios work in outsourced services. What does this study add? Despite signifcant changes in attitudes towards women, nurses are treated as "mothers" of the clinics. Women as health workers are particularly exposed to multiple stressors, that are rooted in ideals about gender. Understanding the way healthcare is organized along gendered lines is a precusor to any real organizational change.

Constructing the health care system in Greece: responsibility and powerlessness

OBJECTIVES

Based on health care professionals' (HPs) and patients' interviews about work demands and quality of care in hospitals, the study explores the way that patients and HPs constructed their identities to describe and construct the health care system in Greece.

DESIGN

This is a qualitative study using a focus group (FG) design.

METHODS

Seven FGs discussions were conducted: three FGs discussions were conducted for the assessment of job stressors (1 for doctors, 1 for nurses and 1 for residents) and four FGs discussions for the assessment of quality of care (1 for doctors, 1 for nurses, 1 for residents and 1 for patients). The sample consisted of health care professionals working in a teaching hospital in the region of Thessaloniki, Greece, and patients who had at least one experience of any kind in the same hospital. Transcripts of the FGs discussions underwent discourse analysis.

RESULTS

The results showed that both HPs and patients construct the health care system based on bipolar constructions of responsibility and powerlessness. In particular, participants use these constructions to allocate the responsibility to different levels of the health care system hierarchy or to the system per se constructing, at the same time, themselves as the 'viewers' of this system.

CONCLUSIONS

The study allowed a deeper understanding of issues related to quality of care in hospitals providing context-specific information. Identity in health care organizations was inextricably linked to power and responsibility. The need to deconstruct this responsibility/powerlessness ideology is discussed.

A review of self-medication in physicians and medical students

BACKGROUND

There is a culture within medicine that doctors do not expect themselves or their colleagues to be sick. Thus, the associated complexities of self-diagnosis, self-referral and self-treatment among physicians are significant and may have repercussions for both their own health and, by implication, for the quality of care delivered to patients.

AIMS

To collate what is known about the self-treatment behaviour of physicians and medical students.

METHODS

The following databases were searched: PubMed, PsychInfo, EBSCO, Medline, BioMed central and Science Direct. Inclusion criteria specified research assessing self-treatment and self-medicating of prescription drugs among physicians and/or medical students. Only peer-reviewed English language empirical studies published between 1990 and 2009 were included.

RESULTS

Twenty-seven studies were identified that fitted the inclusion criteria. Self-treatment and self-medicating was found to be a significant issue for both physicians and medical students. In 76% of studies, reported self-treatment was >50% (range: 12-99%). Overall, only one of two respondents was registered with a general practitioner or primary care physician (mean = 56%, range = 21-96). Deeper analysis of studies revealed that physicians believed it was appropriate to self-treat both acute and chronic conditions and that informal care paths were common within the medical profession.

CONCLUSIONS

Self-treatment is strongly embedded within the culture of both physicians and medical students as an accepted way to enhance/buffer work performance. The authors believe that these complex self-directed care behaviours could be regarded as an occupational hazard for the medical profession.

Abnormal prefrontal activation directly related to pre-synaptic striatal dopamine dysfunction in people at clinical high risk for psychosis

Schizophrenia is characterized by altered prefrontal activity and elevated striatal dopaminergic function. To investigate the relationship between these abnormalities in the prodromal phase of the illness, we combined functional Magnetic Resonance Imaging and (18)F-Dopa Positron Emission Tomography. When performing a verbal fluency task, subjects with an At-Risk Mental State showed greater activation in the inferior frontal cortex than controls. Striatal dopamine function was greater in the At-Risk group than in controls. Within the At-Risk group, but not the control group, there was a direct correlation between the degree of left inferior frontal activation and the level of striatal dopamine function. Altered prefrontal activation in subjects with an At-Risk Mental State for psychosis is related to elevated striatal dopamine function. These changes reflect an increased vulnerability to psychosis and predate the first episode of frank psychosis.

Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study

BACKGROUND

To understand why treatment referral rates for ESRF are lower in Ireland than in other European countries, an investigation of factors influencing general practitioner referral of patients developing ESRF was conducted.

METHOD

Randomly selected general practitioners (N = 51) were interviewed using 32 standardised written patient scenarios to elicit referral strategies.

MAIN OUTCOME MEASURES

General practitioner referral levels and thresholds for patients developing end-stage renal disease; referral routes (nephrologist vs other physicians); influence of patient age, marital status and co-morbidity on referral.

RESULTS

Referral levels varied widely with the full range of cases (0-32; median = 15) referred by different doctors after consideration of first laboratory results. Less than half (44%) of cases were referred to a nephrologist. Patient age (40 vs 70 years), marital status, co-morbidity (none vs rheumatoid arthritis) and general practitioner prior specialist renal training (yes or no) did not influence referral rates. Many patients were not referred to a specialist at creatinine levels of 129 micromol/l (47% not referred) or 250 micromol/l (45%). While all patients were referred at higher levels (350 and 480 micromol/l), referral to a nephrologist decreased in likelihood as scenarios became more complex; 28% at 129 micromol/l creatinine; 28% at 250 micromol/l; 18% at 350 micromol/l and 14% at 480 micromol/l. Referral levels and routes were not influenced by general practitioner age, sex or practice location. Most general practitioners had little current contact with chronic renal patients (mean number in practice = 0.7, s.d. = 1.3).

CONCLUSION

The very divergent management patterns identified highlight the need for guidance to general practitioners on appropriate management of this serious condition.

A study of knowledge and attitudes towards the use of evidence-based medicine among primary health care physicians in Bahrain

OBJECTIVE

A study of perceptions and attitudes towards the use of evidence-based medicine (EBM) among family physicians in Bahrain.

METHODS

A systematically developed, anonymous, self administered 13 item questionnaire was mailed to 124 Bahraini family physicians in the Ministry of Health, Bahrain between January and April 2004. The response rate was 65%. Data were analyzed using the Statistical Package for Social Sciences (Windows version 11.00).

RESULTS

The respondents (n=81) were mainly female (65.4%) with a mean age of 40 (SD 7.7) years, with 12.7 (SD 8.3) years since graduation. Forty-two percent had attended EBM workshops and 61% claimed to use EBM in their practice. Those who had attended a workshop were more likely to assert that they were practicing EBM (82% versus 47%; p=0.001). Less than 10% selected patient s choice as a component of EBM. The 81.5% of respondents agreed their patients were willing to participate in decision making but 50% felt that only 10-25% of their patients were capable. No time (53.1%) and no ready access to resources (73.5%) were the most cited barriers, 32% of respondents agreed that EBM is not applicable to their culture.

CONCLUSION

Most family physicians in Bahrain claimed to use EBM in their practice, particularly if they had attended an EBM workshop. However, most of them did not consider patients values as a component of EBM. A substantial minority considered that EBM is inapplicable to their culture.

Emotional labour at work and at home among Greek health‐care professionals

PURPOSE

The emotionally taxing nature of health-care work has been increasingly recognized. In parallel, the field of work and family has been searching for more specific antecedents of both work interference with family (WFI) and family interference with work (FWI). The current study aims to examine the relationship between surface acting and hiding negative emotions with WFI and FWI among Greek health-care professionals.

DESIGN/METHODOLOGY/APPROACH

The research is a cross-sectional study of 180 Greek doctors and 84 nurses using self-report measures.

FINDINGS

Results indicated that, for doctors, surface acting at work was positively related to WFI and, for nurses, surface acting at home was positively related to FWI.

RESEARCH LIMITATIONS/IMPLICATIONS

The respondents were sampled on a convenience basis and the non-random procedure may have introduced unmeasured selection effects. The present study is cross-sectional and thus the postulated relationships cannot be interpreted causally.

PRACTICAL IMPLICATIONS

Emotional management training and opportunities for emotional decompression for Greek health-care professionals should be explored. In terms of medical education, the need to train students to understand and cope with emotional demands is an important first step. This research highlights the need for communication-skills training courses facilitating emotional awareness and emotional management.

ORIGINALITY/VALUE

These findings position emotional labour as an important antecedent of both WFI and FWI.

PET measurement of the influence of corticosteroids on serotonin-1A receptor number

BACKGROUND

The hypothalamic-pituitary-adrenal (HPA) axis and serotonergic system interact functionally. The modulatory effect of corticosteroids on 5-HT(1A) receptor number and function has been repeatedly demonstrated in preclinical studies suggesting that raised corticosteroid levels decrease 5-HT(1A) receptor number and function in the hippocampus.

METHODS

We used positron emission tomography (PET) to quantify the number of 5-HT(1A) receptors in two studies, the first in normal subjects given a single dose of hydrocortisone using a random-order, double-blind, placebo-controlled design and second in patients treated long-term with corticosteroids.

RESULTS

We did not find that exposure to elevated levels of corticosteroids in either the short or long term alters 5-HT(1A) receptor binding in the hippocampus or other brain regions examined.

CONCLUSIONS

This study does not support the hypothesis that corticosteroids exert a major inhibitory regulatory control over the 5-HT(1A) receptor binding in the human brain.

AIDS education: knowledge, sexual attitudes and sexual behavioral responses of selected college students

The problem studied in this investigation was whether a behaviorally focused Human Immunodeficiency Virus (HIV)/Acquired Deficiency Syndrome (AIDS) Program affects the knowledge, sexual attitudes and sexual behavior of college students. Three hundred and six first- and third-year college students were included in the study from one university located in Southeastern Virginia. The sample was predominately female, African-American and between the ages of 16-22 years of age. Freshmen students were presently enrolled in the institution's HIV/AIDS education program, which was part of a required course. The class sessions consisted of a pretest prior to students completing the reading assignment and class discussion. During the regular class session, the researcher discussed the reading assignment, provided basic information about HIV/AIDS, its transmission, prevention and treatment, and at the end of the sessions administered a posttest. Junior students were administered a posttest only. No prior reading assignment or class session was provided. The data collected were analyzed in terms of significant differences, utilizing t-tests for paired and independent groups, factor analysis and an analysis of variance. The results of the study indicated that there was little effect of HIV/AIDS education programs on knowledge, sexual attitudes and sexual behavior.

Student upward mobility: utilization of an educational support model

Hampton University School of Nursing was funded by the Teagle Foundation in 1990 for four years and later expanded for an additional year to develop, implement and evaluate an innovative Individualized Educational Support Model for licensed practical nurses (LPNs) residing in Southeastern Virginia. Project staff assigned the Teagle Initiative developed a model program for LPNs seeking the Bachelor of Science degree in nursing. The Teagle model offers opportunities for advanced placement through National League for Nursing Mobility Examinations, CLEP, ACT-PEP, and challenge examinations; tutoring by faculty and peers; counseling by project staff for academic and financial aid, and other concerns as needed; socialization with other project students and generic students; monthly stipends to assist with additional expenses incurred when the adult student returns to school and an alternative admissions criteria for the LPN who may not meet all aspects of the Hampton University admissions criteria.

Previously unreported abnormalities of dermal basement membranes and collagen fibrils in a patient with X-linked spondyloepiphyseal dysplasia tarda

Electron microscopic findings of the skin biopsy of a boy with spondyloepiphyseal dysplasia tarda showed several novel features. The basement membrane of the epidermis showed focal irregular thickening and reduplication. The collagen fibres showed foci of fibrous long spacing collagen and marked variation in fibre diameter. Taken together these abnormalities have not been reported in any other condition.