Health Professional Wellbeing

A Dutch study by Zantinge et al. exploring the impact of burnout on the quality of health care delivered by GPs found that burnt-out GPs have, contrary to expectations, longer consolations with patients.

The study explored three facets of burnout - emotional exhaustion, depersonalisation and reduced accomplishments. It found that GPs with emotional exhaustion or depersonalisation additionally show more communication in their consultations (such as increased eye contact and greater explanation of diagnoses); while GPs with feelings of reduced accomplishment or competency have reduced communication and fewer patient-centred consultations.

The study offered two explanations for the results. The study first proposed that doctors who are suffering psychological problems may be more empathetic towards patients suffering from similar problems. The study also suggested that burnt-out GPs may take longer in their consultations because they are less efficient.

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

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Biological research data elucidating the mechanisms by which stress can impact on the physical body is considerably less than the epidemiological data; however the insights it provides are relatively more robust. The main candidate mechanisms for a causal link between psychosocial factors and health include (from Mackay et al., 2004):

• Neuroendocrine and autonomic changes.
• Metabolic syndrome and insulin resistance.
• Disturbances in blood coagulation.
• Inflammatory/immunological changes that modulate susceptibility to infection.
• Homeostatic and allostatic changes in response to stress.
•    Psychological mechanisms such as anxiety, hyper-vigilance and risk-taking.

Therefore it has been suggested that simple health promotional strategies such as stress management interventions (SMIs) make a significant contribution not only to organizational function and individual wellbeing, but also to national health expenditure.

Dr Ramesh Manocha

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A systematic review by Mukherjee et al. (2009) explored burnout in paediatric oncology staff. Of the 10 studies included in the analysis none directly measured the extent of burnout in the staff, and only one measured distress, reporting a lower level of distress then the general population.

The systematic review reported a number of factors associate with increased burnout and distress in the staff including coping style, duration of relationship of patients, and care settings.

Sources of stress in paediatric oncology staff included observing patient suffering, caring for a dying patient, death, supporting parents of patients, delivery of inadequate care, workload, lack of resources, insufficient managerial support and poor relationship with colleagues.

The study highlighted a number of major limitations including an extremely limited quantity of research, poor quality of research, and a large range of staff types within the area of research. The studies examined were also reported a number of limitations including  small sample sizes and limited research sites.

The study can be found at interscience.wiley.com.

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An survey commissioned by Lifeline Australia found that over 90% of adults feel stressed in at least one facet of their lives, with almost half feeling very stressed. The survey, which was published earlier this year, found that 67% of respondents were stressed about finances, 65% about the future, 55% about health and 41% felt stressed about personal relationships.

Dawn O’Neil, head of Lifeline Australia, called the results “alarming”.

“I don’t believe that as a society we should just accept that our lives today are more stressful than in the past. We need to look at ways we can take responsibility for our stress levels before prolonged stress causes harm to our physical and mental health,” she said.

From www.lifeline.org.au.

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Selye (1974) suggested that having to live with other people is one of the most stressful aspects of life. Other research data supports the common sense reasoning that relationships can be a major source of both stress and support (Makin, 1996). Since being employed typically means significant interaction with other people, whether these be colleagues, bosses or subordinates, being at work can constitute one of the most stressful environments for the individual. However, when supervisors provide social support (defined as having good quality relationship with supervisors, co-workers, family and friends and the amount of positive consideration and task assistance received from them), this has a beneficial effect on worker performance and well-being (Ganster, 1986).

Dr Ramesh Manocha

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A study published in the MJA has found doctors who are involved in medico-legal matters are more likely to suffer from serious mental health problems including anxiety and depression.

The study of 2999 doctors also found that over 65% of doctors in Australia will be involved in medico-legal matters at some point of their career.

Dr Louise Nash, lead author of the study, emphasised that doctors need to look after themselves. “If they are feeling stressed, they should consider options for reducing their hours, and make sure they do not turn to any negative coping mechanisms, such as drinking,” she said.

Dr Nash noted that the study raised questions about the causality of the relationship between medico-legal processes and poor mental health.

From the Medical Observer.

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A Korean study by Cho et al. (2009) investigated the relationship between nurse staffing, the quality of care delivered by nurses, and nurse related job outcomes.

The survey of 1365 nurses working in intensive care units found half of the nurses were highly burned out, and a quarter were planning on leaving within a year. The survey also found perceived adequate staffing was significantly correlated with burnout in the nurses.

The study can be found at PubMed.

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In Australia, the Bettering Evaluation and Care of Health (BEACH) project was initiated 10 years ago to continuously collect information about the clinical activities in general practice in Australia. The programme is overseen by the Family Medicine Research Centre in collaboration with the Australian Institute of Health and Welfare. A sub-study from the BEACH project, supported by the Commonwealth Department of Veteran’s Affairs assessed the prevalence of stress and anxiety issues among patients of GPs. An analysis of 100 GP encounters with 3,684 patient encounters, found that 40% of respondents (i.e. 1, 470 patients) reported experiencing a period of anxiety or stress lasting 2 weeks or more in the previous 12 months. Of this group, 75% sought help from professionals and 58% from their GP. Similar results were found in a study of Australian patients by Cohen et al. (1983), clearly indicating that medical practitioners need to understand the aetiology and management of this widespread problem.

Dr Ramesh Manocha

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An Australian study by Rella et al. (2009) which explored the development of burnout in nursing students has found that 20% of nursing graduates suffer from serious maladaptive stress.

The survey of 431 Bachelor of Nursing students emphasised the need for additional support from nursing staff for nursing graduates in the form of mentoring and guidance, and provision of effective stress management.

The researchers emphasise that while nursing is an inherently stressful position, burnout in nurses occurs when there is a failure to consistent recovery from stress outside of work hours.

The full study can be found at www.ingentaconnect.com.

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An Australian study by Markwell and Wainer (2009) found 70% of junior doctors surveyed have experienced high levels of stress at work and 56% have been concerned about the wellbeing of their colleagues because of the work conditions.

The survey, published in the Medical Journal of Australia today also found over 70% of the junior doctors met the criteria for low job satisfaction, 69% met the criteria for burnout and 54% met the criteria for compassion fatigue.

The survey of 914 junior doctors recommended that stress management strategies be incorporated into continuing medical education.

From the Medical Journal of Australia.

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