Health Professional Wellbeing

A Dutch study by Prins et al. (2007) of burnout in medical residents has found the greatest predictor of burnout is the the level of perceived support from supervisors. The survey of over 250 medical residents also found that the residents were significantly more dissatisfied with support received from their supervisors compared with support received from other residents and nurses.

The study recommends support strategies be taught to not only residents, but also supervisors in an attempt to minimise burnout in young doctors.

The study can be found at www.informaworld.com.

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Meditation, like relaxation and many other similar interventions, has been described as a passive intervention, directed at mitigating the symptoms of stress rather than its causes. Data and reasoning from Dr Ramesh Manocha’s thesis suggest that mental silence has a more significant role than this because it can not only reduce symptoms but may also change cognitive and perceptual patterns. Therefore there may be a role for meditation as a resilience-enhancing, preventative measure as well.

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A US study of nurses has found that better care environments were associated with significantly more positive job experiences for nurses and significantly lower risk of death for patients. The survey of more then 10,000 nurses recommended that care environments be optimised and nurses educated to maintain care environments.

The full study can be found at www.ncbi.nlm.nih.gov.

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Researchers in America have found evidence to suggest that short term stress may temporarily boost the immune system. The researchers exposed two groups of mice to cancer causing light three times a week. Both groups were  identical except that one group were restrained before being exposed to the light, which previous research has shown produces a fight-or-flight stress response.

The researches found that mice that were stressed had greater immune response and fewer and smaller tumours then the mice in the control group. The researchers concluded that the short term stress in the mice enhanced their immune system.

Lead author, Dr Firdaus Dhabhar, believes short term stress may be better for us then we commonly believe. “The key is not to let the stress response linger,” Dr Dhabhar said.

The study can be found online at Science Direct.

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Stress was first proposed by Selye to describe the subjective experience of an individual who is faced with demands and circumstances that challenge their ability to deal with them. He later revised his own definition and agreed that the term strain more closely represents the experience while stress more correctly refers to the circumstances that lead to it.

In the context of work, the stress construct (or strain as the more academically correct term) is founded on a core set of operational notions. These include Karasek’s idea of “demand-control imbalance” or “job strain”, Siegrist’s idea of “effort-reward imbalance”, and Johnson’s idea of “support”.

Dr Ramesh Manocha.

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A survey by Surgenor et al. (2009) of 180 medical consultants in New Zealand hospitals investigated burnout and its relationship with demographic characteristics.

The study found 29% of the sample had high emotional exhaustion, 24% had high depersonalisation, and 31% had low personal accomplishment. Twenty per cent of the sample was assessed as having high overall burnout.

Factors which significantly correlated with burnout were longer work hours, less experience and lower job satisfaction.

The authors recommended well researched stress management interventions to target burnt out consultants.

The study can be found at www.ncbi.nlm.nih.gov.

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Head et al. (2002) in a follow up study on the Whitehall data of more then 10,000 British civil servants, reported that high job demands, low decision latitude and effort-reward imbalance, were all related to higher rates of coronary heart disease, despite controlling for conventional risk factors such as smoking or blood pressure. Similarly, high job strain, high demands and reduced decision latitude were associated with the highest risk of coronary heart disease (Kuper et al., 2003).

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An American survey by Shanafelt et al. (2009) of almost 8,000 surgeons investigated the incidence and factors of burnout in the American surgeon population.

The study found that 40% of respondents were suffering from burnout, 30% showed symptoms of depression, and only 36% felt surgery left sufficient time for personal and family life. The study additionally found that 28% of the respondents had a mental quality of life score of less then half a standard deviation below the population average.

The study accepted a number of limitations including a low response rate, and highlighted a number of strengths including that it is the largest survey of physician burnout to date.

The study can be found here.

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In a recent survey of hospital doctors by Salaried Doctors Queensland (SDQ), 88% reported suffering dangerous levels of fatigue while working. The survey of 113 doctors also found that 60 per cent had reported making mistakes while fatigued. The study was used as evidence to support the SDQ’s latest push to the Queensland State Government to limit shift lengths to 12 hours with a minimum of 10 hours of break between shifts.

From the ABC.

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While it seems logical to deal with the causes of stress at the level at which they are generated (i.e. management and organisation), such organisation-based strategies have paradoxically, shown disappointing results. For instance, in his review of controlled work stress interventions, Van der Klink (2001) concluded that organisation-based stress reduction strategies alone yielded minimal measurable benefits, whereas interventions aimed at the individuals within organisations generated much greater and more consistent effects.

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