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Welles CC, Tong A, Brereton E, Steiner JF, Wynia MK, Powe NR, Chonchol M, Hasnain-Wynia R, Cervantes L. Sources of Clinician Burnout in Providing Care for Underserved Patients in a Safety-Net Healthcare System. J Gen Intern Med 2023; 38:1468-1475. [PMID: 36376633 PMCID: PMC10160271 DOI: 10.1007/s11606-022-07896-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Burnout among clinicians is common and can undermine quality of care, patient outcomes, and workforce preservation, but sources of burnout or protective factors unique to clinicians working in safety-net settings are less well understood. Understanding these clinician experiences may inform interventions to reduce burnout. OBJECTIVE To describe clinician perspectives on sources of burnout in a safety-net healthcare system. DESIGN Semi-structured interviews were conducted with clinicians from multiple disciplines who provided care at a safety-net healthcare system from October 2018 to January 2019. Transcripts were analyzed using thematic analysis. PARTICIPANTS Forty clinicians (25 female and 15 male; mean [SD] age, 41 [9.1]) participated, including physicians, social workers, advanced practice providers, nurses, psychologists, physical and occupational therapists, and other healthcare professionals. MAIN OUTCOMES AND MEASURES Themes and subthemes that reflected clinician experiences, burnout, and workload expectations. KEY RESULTS Five themes emerged: limited resources (entrenched social injustices, brokenness of the US healthcare system, precarious discharge options, and "revolving door" readmissions), barriers to building trust with patients (chasm of communication, addressing fear and mistrust, and being exposed to threats), administrative requirements (criticism hampering meaningful care, assuming extra workloads, bureaucratic burden), compassion fatigue (confronting traumatic situations, persistent worry about patient safety and welfare, witnessing mistreatment and stigmatization, overextending and overinvesting, withdrawing and shutting down, blaming self and career crisis), and advocacy as a counterbalance to burnout (solidarity when helping underserved communities, fervent advocacy, and patient gratitude). CONCLUSIONS Among clinicians who provide care in a safety-net healthcare system, sources of burnout included limited resources, barriers to building trust with patients, administrative requirements, and compassion fatigue, but clinicians remained driven by their desire to advocate for patients. Policy-level interventions which increase funding to safety-net healthcare systems to bolster existing resources and staffing, create peer-support and wellness programs, and support advocacy efforts may mitigate burnout.
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Affiliation(s)
- Christine C Welles
- Department of Medicine, University of Colorado, Leprino Building, 4th floor, 12401 East 17th Avenue, Mailstop F-782, Aurora, CO, 80045, USA.
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Elinor Brereton
- Department of Medicine, University of Colorado, Leprino Building, 4th floor, 12401 East 17th Avenue, Mailstop F-782, Aurora, CO, 80045, USA
| | - John F Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, USA
| | - Matthew K Wynia
- Department of Medicine, University of Colorado, Leprino Building, 4th floor, 12401 East 17th Avenue, Mailstop F-782, Aurora, CO, 80045, USA
- Center for Bioethics and Humanities, University of Colorado, Aurora, USA
| | - Neil R Powe
- Department of Medicine, Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Michel Chonchol
- Department of Medicine, University of Colorado, Leprino Building, 4th floor, 12401 East 17th Avenue, Mailstop F-782, Aurora, CO, 80045, USA
- Division of Renal Disease and Hypertension, University of Colorado, Aurora, USA
| | | | - Lilia Cervantes
- Department of Medicine, University of Colorado, Leprino Building, 4th floor, 12401 East 17th Avenue, Mailstop F-782, Aurora, CO, 80045, USA
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A Content Analysis of Osteopaths’ Attitudes for a More Inclusive Clinical Practice towards Transgender People. Healthcare (Basel) 2022; 10:healthcare10030562. [PMID: 35327040 PMCID: PMC8953530 DOI: 10.3390/healthcare10030562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/21/2022] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives. The aim of this qualitative study was to explore the attitudes, beliefs, and preferences of Italian osteopaths regarding the management of transgender patients through a content analysis of emergent data from semi-structured interviews. Methods. This study was a content analysis based on the Standards for Reporting Qualitative Research guidelines. Purposive sampling of 10 Italian osteopaths was applied. Data were collected through semi-structured interviews, from March to April 2021, and subsequently transcribed verbatim with the content analysis carried out as an iterative process. Results. One participant was excluded during the first interview due to them being unsuitable for this study. Data saturation was reached after two interviews with the remaining nine participants. Data analysis revealed four main themes: microaggressions, acceptance and non-judgement, person-centered treatment, and education implementation. Conclusions. This study presents cisgender Italian osteopaths’ attitudes in the care of transgender people, revealing the desire to embrace and apply osteopathic tenets regardless of the patient’s gender identity.
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Mensinger JL, Granche JL, Cox SA, Henretty JR. Sexual and gender minority individuals report higher rates of abuse and more severe eating disorder symptoms than cisgender heterosexual individuals at admission to eating disorder treatment. Int J Eat Disord 2020; 53:541-554. [PMID: 32167198 PMCID: PMC7187146 DOI: 10.1002/eat.23257] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/20/2022]
Abstract
Eating disorders (EDs) occur at higher rates among sexual/gender minorities (SGMs). We currently know little about the risk factor profile of SGMs entering ED specialty care. OBJECTIVE To (a) compare history of abuse-related risk in SGMs to cisgender heterosexuals (CHs) when entering treatment, (b) determine if SGMs enter and exit treatment with more severe ED symptoms than CHs, and (c) determine if SGMs have different rates of improvement in ED symptoms during treatment compared to CHs. METHOD We analyzed data from 2,818 individuals treated at a large, US-based, ED center, 471 (17%) of whom identified as SGM. Objective 1 was tested using logistic regression and Objectives 2 and 3 used mixed-effects models. RESULTS SGMs had higher prevalence of sexual abuse (OR = 2.10, 95% CI = 1.71, 2.58), other trauma (e.g., verbal/physical/emotional abuse; OR = 2.07, 95% CI = 1.68, 2.54), and bullying (OR = 2.13, 95% CI = 1.73, 2.62) histories. SGMs had higher global EDE-Q scores than CHs at admission (γ = 0.42, SE = 0.08, p < .001) but improved faster early in treatment (γ = 0.316, SE = 0.12, p = .008). By discharge, EDE-Q scores did not differ between SGMs and CHs. DISCUSSION Our main hypothesis of greater abuse histories among SGMs was supported and could be one explanation of their more severe ED symptoms at treatment admission compared to CHs. In addition, elevated symptom severity in SGMs at admission coincides with greater delay between ED onset and treatment initiation among SGMs-possibly a consequence of difficulties with ED recognition in SGMs by healthcare providers. We recommend increased training for providers on identifying EDs in SGMs to reduce barriers to early intervention.
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Affiliation(s)
- Janell L. Mensinger
- M. Louise Fitzpatrick College of NursingVillanova UniversityVillanovaPennsylvaniaUSA
- Department of Epidemiology and Biostatistics, Dornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Janeway L. Granche
- Department of Epidemiology and Biostatistics, Dornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Shelbi A. Cox
- Center For DiscoveryDiscovery Behavioral HealthLos AlamitosCaliforniaUSA
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Morris M, Roberto K. Information-seeking behaviour and information needs of LGBTQ health professionals: a follow-up study. Health Info Libr J 2016; 33:204-21. [DOI: 10.1111/hir.12139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 02/09/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Martin Morris
- Schulich Library of Science and Engineering; McGill University; Montréal Canada
| | - K.R. Roberto
- Graduate School of Library and Information Science; University of Illinois at Urbana-Champaign; Champaign IL USA
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Przedworski JM, Dovidio JF, Hardeman RR, Phelan SM, Burke SE, Ruben MA, Perry SP, Burgess DJ, Nelson DB, Yeazel MW, Knudsen JM, van Ryn M. A Comparison of the Mental Health and Well-Being of Sexual Minority and Heterosexual First-Year Medical Students: A Report From the Medical Student CHANGE Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:652-9. [PMID: 25674912 PMCID: PMC4414698 DOI: 10.1097/acm.0000000000000658] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE Research is lacking on psychological distress and disorder among sexual minority medical students (students who identify as nonheterosexual). If left unaddressed, distress may result in academic and professional difficulties and undermine workforce diversity goals. The authors compared depression, anxiety, and self-rated health among sexual minority and heterosexual medical students. METHOD This study included 4,673 first-year students who self-reported sexual orientation in the fall 2010 baseline survey of the Medical Student Cognitive Habits and Growth Evaluation Study, a national longitudinal cohort study. The authors used items from published scales to measure depression, anxiety, self-rated health, and social stressors. They conducted bivariate and multivariate analyses to estimate the association between sexual identity and depression, anxiety, and self-rated health. RESULTS Of 4,673 students, 232 (5.0%) identified as a sexual minority. Compared with heterosexual students, after adjusting for relevant covariates, sexual minority students had greater risk of depressive symptoms (adjusted relative risk [ARR] = 1.59 [95% confidence interval, 1.24-2.04]), anxiety symptoms (ARR = 1.64 [1.08-2.49]), and low self-rated health (ARR = 1.77 [1.15-2.60]). Sexual minority students were more likely to report social stressors, including harassment (22.7% versus 12.7%, P < .001) and isolation (53.7% versus 42.8%, P = .001). Exposure to social stressors attenuated but did not eliminate the observed associations between minority sexual identity and mental and self-reported health measures. CONCLUSIONS First-year sexual minority students experience significantly greater risk of depression, anxiety, and low self-rated health than heterosexual students. Targeted interventions are needed to improve mental health and well-being.
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Affiliation(s)
- Julia M Przedworski
- J.M. Przedworski is a doctoral student and National Cancer Institute predoctoral fellow, Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota. J.F. Dovidio is Carl Iver Hovland Professor, Department of Psychology, Yale School of Public Health, and Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut. R.R. Hardeman is an associated health postdoctoral fellow, Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota. S.M. Phelan is assistant professor, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota. S.E. Burke is a doctoral candidate, Department of Psychology, Yale University, New Haven, Connecticut. M.A. Ruben is a postdoctoral research fellow, Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Boston, Massachusetts. S.P. Perry is assistant professor, Department of Psychological Science, University of Vermont, Burlington, Vermont. D.J. Burgess is associate professor, Department of Medicine, University of Minnesota, and core investigator, Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota. D.B. Nelson is core investigator and senior statistician, Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, and associate professor, Department of Medicine, University of Minnesota, Minneapolis, Minnesota. M.W. Yeazel is associate professor, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota. J.M. Knudsen is director, Office of Health Equity and Inclusion, and assistant professor, Radiology Department, Mayo Clinic, Rochester, Minnesota. M. van Ryn is professor, Health Services Research, Mayo Clinic College of Medicine, and director, Research Program on Equity and Quality of Patient-Provider Encounters, Division of Health Care Polic
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Koh CS, Kang M, Usherwood T. 'I demand to be treated as the person I am': experiences of accessing primary health care for Australian adults who identify as gay, lesbian, bisexual, transgender or queer. Sex Health 2014; 11:258-64. [DOI: 10.1071/sh14007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/22/2014] [Indexed: 11/23/2022]
Abstract
Background
Individuals who identify as gay, lesbian, bisexual, transgender or queer (GLBTQ) suffer higher rates of illness and morbidity compared with the general population but may experience significant barriers to accessing primary health care. Method: We used an online questionnaire to explore GLBTQ adults’ experiences of accessing primary health care in Australia. We developed the questionnaire in consultation with individuals who belonged to or worked closely with the GLBTQ community. Questions were open-ended and sought information about four topic areas: sexual identity and its meaning, utilisation of primary health care services, disclosure of sexual identity to primary care providers and experiences of accessing primary health care. Data were analysed by coding free-text responses into themes. Results: Ninety-nine valid responses were received. Participants were 18–60+ years old (modal age group: 20–29 years); 70% lived in cities. Of these, 49% identified as gay, 35% as lesbian, 13% as bisexual, 8% as queer and 3% as transgender. Some participants indicated more than one identity. GLBTQ-identifying adults often divided care, seeking different primary care services for different health concerns. Themes in relation to disclosure of sexual identity were: taking a rights-based position, experiences of homophobia and clinical context. Themes about access to primary health care were: diversity and heterogeneity, real or perceived discrimination, visual symbols and respect. Conclusion: Despite diversity, GLBTQ adults experience many barriers to accessing health care due to sexual identity. General practitioners and other primary health care providers have a role in ensuring equitable access to health care.
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Dhaliwal JS, Crane LA, Valley MA, Lowenstein SR. Student perspectives on the diversity climate at a U.S. medical school: the need for a broader definition of diversity. BMC Res Notes 2013; 6:154. [PMID: 23595029 PMCID: PMC3684552 DOI: 10.1186/1756-0500-6-154] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 03/27/2013] [Indexed: 11/24/2022] Open
Abstract
Background Medical schools frequently experience challenges related to diversity and inclusiveness. The authors conducted this study to assess, from a student body’s perspective, the climate at one medical school with respect to diversity, inclusiveness and cross-cultural understanding. Methods In 2008 students in the doctor of medicine (MD), physical therapy (PT) and physician assistant programs at a public medical school were asked to complete a diversity climate survey consisting of 24 Likert-scale, short-answer and open-ended questions. Questions were designed to measure student experiences and attitudes in three domains: the general diversity environment and culture; witnessed negative speech or behaviors; and diversity and the learning environment. Students were also asked to comment on the effectiveness of strategies aimed at promoting diversity, including diversity and sensitivity training, pipeline programs, student scholarships and other interventions. Survey responses were summarized using proportions and 95 percent confidence intervals (95% CI), as well as inductive content analysis. Results Of 852 eligible students, 261 (31%) participated in the survey. Most participants agreed that the school of medicine (SOM) campus is friendly (90%, 95% CI 86 to 93) and welcoming to minority groups (82%, 95% CI 77 to 86). Ninety percent (95% CI 86 to 93) found educational value in a diverse faculty and student body. However, only 37 percent (95% CI 30 to 42) believed the medical school is diverse. Many survey participants reported they have witnessed other students or residents make disparaging remarks or exhibit offensive behaviors toward minority groups, most often targeting persons with strong religious beliefs (43%, 95% CI 37 to 49), low socioeconomic status (35%, 95% CI 28 to 40), non-English speakers (34%, 95% CI 28 to 40), women (30%, 95% CI 25 to 36), racial or ethnic minorities (28%, 95% CI 23 to 34), or gay, lesbian, bisexual or transgendered (GLBT) individuals (25%, 95% CI 20 to30). Students witnessed similar disparaging or offensive behavior by faculty members toward persons with strong religious beliefs (18%, 95% CI 14 to 24), persons of low socioeconomic status (12%, 95% CI 9 to 17), non-English speakers (10%, 95% CI 6 to 14), women (18%, 95% CI 14 to 24), racial or ethnic minorities (12%, 95% CI 8 to 16) and GLBT individuals (7%, 95% CI 4 to 11). Students’ open-ended comments reinforced the finding that persons holding strong religious beliefs or conservative values were the most common targets of disparaging or offensive behavior. Conclusions These data suggest that medical students believe that diversity and a climate of inclusiveness and respect are important to a medical school’s educational and clinical care missions. However, according to these students, the institution must embrace a broader definition of diversity, such that all minority groups are valued, including individuals with conservative viewpoints or strong religious beliefs, the poor and uninsured, GLBT individuals, women and non-English speakers.
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Lambrese JV, Hunt JI. Mental Health Needs of Sexual Minority Youth: A Student-Developed Novel Curriculum for Healthcare Providers. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2013. [DOI: 10.1080/19359705.2013.721610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jason V. Lambrese
- a Department of Psychiatry , Harvard Medical School, Cambridge Health Alliance , Cambridge , Massachusetts , USA
| | - Jeffrey I. Hunt
- b Department of Psychiatry and Human Behavior, Emma Pendelton Bradley Hospital , Alpert Medical School of Brown University , Providence , Rhode Island , USA
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