Suicide and related deaths in Victorian doctors

Psychosocial and emotional morbidities after a diagnosis of cancer: Qualitative evidence from healthcare professional cancer patients

AIM

This inquiry aimed to; (1) examine the psychosocial and emotional sequelae associated with cancer patient-hood experience in healthcare professionals (HCPs) in Uganda, (2) generate evidence to inform clinical and nursing practice about the needs of HCP patients with cancer.

DESIGN

This was a qualitative phenomenological study.

METHODS

The study was conducted among HCP cancer patients and survivors recruited from oncology and palliative care settings in Uganda. Data were collected via audio-taped, face-to-face or telephone open-ended interviews. Interviews were transcribed verbatim. Thematic analysis was used.

RESULTS

Eight HCP cancer patients and survivors participated in the study. Their mean age was 56 years, range 29-85 years. Three major themes emerged: (1) From a healthcare provider to a patient, (2) Socioeconomic challenges, and (3) Coping and support strategies.

Lifestyle factors and quality of life among primary health care physicians in Madinah, Saudi Arabia

Background

Physicians are considered to be a high-risk population for a poor quality of life (QoL), but few studies of lifestyle factors include the QoL among them.

Objectives

This study aimed to investigate the relationship between lifestyle factors and a positive QoL among primary health care (PHC) physicians.

Methods

A cross-sectional study was conducted at 20 primary healthcare centers in Madinah, Saudi Arabia. A self-administered questionnaire was used, including sociodemographic characteristics, lifestyle data, and the short version of the World Health Organization Quality of Life questionnaire. Appropriate statistical analyses were used, including multivariate logistic regression models.

Results

The response rate was 85.7% (72/84) physicians. The mean score of the total QoL and its four studied domains (physical, psychological, social, and environmental) was relatively high, with no statistically significant difference between the consultants and general practitioners. The positive total QoL in this study was significantly lower among physicians with obesity (OR = 0.55, 95%CI = 0.25–0.97), those using butter and animal fat for cooking (OR = 0.10, 95%CI = 0.02–0.81), and those eating meals out > 3 times per week (OR = 0.30, 95%CI = 0.10–0.90). Although non-significant, vegetable consumption and a high level of physical activity were associated with a positive QoL, with adjusted ORs of 2.5 (95%CI = 0.82–7.58) and 1.5 (95%CI = 0.33–6.65), respectively.

Conclusion

The findings indicate a relatively good QoL among the participating physicians; however, a lower QoL was associated with unhealthy lifestyle factors. QoL was significantly associated with obesity, cooking practices, and eating meals from restaurants.

How mindful of their own health are healthcare professionals? perception and practice of personnel in a tertiary hospital in Nigeria

OBJECTIVES

To assess health professionals' perception and determinants of their health and practice of preventive self-care.

METHODS

An analytic cross-sectional design was employed, and 232 professionals were selected by stratified sampling from all health professional departments of Delta State University Teaching Hospital. Healthcare professionals who had worked in the hospital for at least six months were included in the sampling frame. Pregnant women and supernumerary professionals were excluded. A self-administered questionnaire was used, and data analysed using SPSS. The main outcome measures were the level of perception of self-health and level of practice of preventive selfcare.

RESULTS

More than four-fifths of doctors and 64.8% of nurses had good perception of their health, with significant association between perception and service area (X2 = 11.828, p =0.008). Screening practice was lowest amongst doctors except for HIV/HBV screening. Whereas 63.4% of all participants adjudged their BMI to be normal, only 36.2% actually had normal BMI, the difference being significant (p <0.001). Almost 20% of doctors had not had a BP check in a year or more, and the same proportion of doctors and nurses had never checked their FBS. The proportion of personnel who had never checked their serum lipid profile was high among nurses (76.1%) and doctors (58.3%).

CONCLUSION

Respondents had good perception but poor preventive behaviour, beginning management after disease onset. This may be ominous for the sector. Urgent health promotion action to safeguard productivity is needed. Comprehensive data from a multi-centre study will provide a deeper understanding of the issue.

FUNDING

None declared.

Suicide among physicians and health-care workers: A systematic review and meta-analysis

Background

Medical-related professions are at high suicide risk. However, data are contradictory and comparisons were not made between gender, occupation and specialties, epochs of times. Thus, we conducted a systematic review and meta-analysis on suicide risk among health-care workers.

Method

The PubMed, Cochrane Library, Science Direct and Embase databases were searched without language restriction on April 2019, with the following keywords: suicide* AND (« health care worker* » OR physician* OR nurse*). When possible, we stratified results by gender, countries, time, and specialties. Estimates were pooled using random-effect meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression. Suicides, suicidal attempts, and suicidal ideation were retrieved from national or local specific registers or case records. In addition, suicide attempts and suicidal ideation were also retrieved from questionnaires (paper or internet).

Results

The overall SMR for suicide in physicians was 1.44 (95CI 1.16, 1.72) with an important heterogeneity (I² = 93.9%, p<0.001). Female were at higher risk (SMR = 1.9; 95CI 1.49, 2.58; and ES = 0.67; 95CI 0.19, 1.14; p<0.001 compared to male). US physicians were at higher risk (ES = 1.34; 95CI 1.28, 1.55; p <0.001 vs Rest of the world). Suicide decreased over time, especially in Europe (ES = -0.18; 95CI -0.37, -0.01; p = 0.044). Some specialties might be at higher risk such as anesthesiologists, psychiatrists, general practitioners and general surgeons. There were 1.0% (95CI 1.0, 2.0; p<0.001) of suicide attempts and 17% (95CI 12, 21; p<0.001) of suicidal ideation in physicians. Insufficient data precluded meta-analysis on other health-care workers.

Conclusion

Physicians are an at-risk profession of suicide, with women particularly at risk. The rate of suicide in physicians decreased over time, especially in Europe. The high prevalence of physicians who committed suicide attempt as well as those with suicidal ideation should benefits for preventive strategies at the workplace. Finally, the lack of data on other health-care workers suggest to implement studies investigating those occupations.

A Call to Restore Your Calling: Self-Care of the Emergency Physician in the Face of Life-Changing Stress-Part 3 of 6: Physician Illness and Impairment

Physicians suffer from most medical conditions at the same rate as their lay peers. However, physicians' self-care is often sacrificed for patient care. This third article in our series examines physician and trainee illness and impairment. Presenteeism, physician impairment, and substance use disorder (SUD) are defined. We call attention to the potential for harm of dated cultural norms, which often fuel physicians' neglect of their own health and development of ill-advised coping skills.Although any medical condition may become a functional impairment, the primary cause of physician impairment is SUD. Alcohol and prescription opioids top the list of substances used in excess by physicians. Although SUD is less prevalent in residency, we focus on the rise of marijuana and alcohol use in emergency medicine trainees. A nonpunitive model for the prevention and treatment of SUD in residency is described.Physicians are ethically and legally mandated to report any concern for impairment to either a state physician health program or a state medical board. However, recognizing physician SUD is challenging. We describe its clinical presentation, voluntary and mandated treatment tracks, provisions for protecting reporters from civil liability, prognosis for return to practice, and prevention efforts. We underscore the need to model healthy coping strategies and assist trainees in adopting them.In closing, we offer our colleagues and trainees today's to-do list for beginning the journey of reclaiming your health. We also provide resources focused on the practical support of ill and/or impaired physicians.

Drug-caused deaths in Australian medical practitioners and health-care professionals

BACKGROUND AND AIMS

There are numerous factors putting health-care professionals (HCP) at a higher risk of substance abuse and premature death, including high-stress jobs, access to controlled substances, long hours of practice and constant contact with the critically ill. This study aimed to examine fatal drug toxicity in this high-risk cohort, in order to: (1) estimate the rate of drug-caused deaths of Australian HCPs; (2) describe the key characteristics of the cohort; and (3) examine the relationship between HCP occupation and drug type, or intent.

DESIGN

Retrospective cohort study.

SETTING

The National Coronial Information System (NCIS), a database of cases reported to an Australian coroner.

PARTICIPANTS

A total of 404 drug-caused deaths reported to an Australian coroner between 2003 and 2013 involving HCPs (including medical practitioners, paramedics, nurses, dentists, psychologists, pharmacists and veterinarians).

MEASURES

χ² tests and descriptive statistics were used to examine relationships. The primary outcome measures were drug type and intent. Covariates included occupation type, mental illness and self-harm.

FINDINGS

Females comprised nearly two-thirds of the cohort. The highest number of cases involved nurses (62.87%) and medical practitioners (18.07%). The mortality rate was highest among the veterinary group [confidence interval (CI) = 42.21-58.79]. Most were intentional self-harm deaths (50.25%), followed by unintentional deaths (37.62%) (CI = 92.15-109.85). Mental illness was common, diagnosed in almost half of cases (46.04%), with the majority involving depression (CI = 33.48-44.12). Specific drugs were associated significantly with certain professions, such as intravenous barbiturates among veterinarians (χ²₍₇₎  = 237.391). A number of cases reported additional stressors, such as relationship, work-place or financial issues, and drugs were diverted from the work-place in nearly a fifth of cases.

CONCLUSIONS

Between 2003 and 2013, Australian health-care professionals averaged 37 deaths per year attributed to drug toxicity, with a mortality rate of nearly five deaths per 1000 employed HCPs. Drug-caused deaths among HCPs in Australia commonly involve females in their mid-40s, with a diagnosis of mental illness, personal and professional stress and the intent to self-harm.

Cancer incidence and cause-specifi c mortality in male and female physicians: a cohort study in Estonia

Aims: To evaluate whether the presumed knowledge of physicians about healthier lifestyle decreases their risk of cancer and mortality, a retrospective cohort study of male and female physicians was conducted in Estonia. Methods: The cancer incidence and cause-specifi c mortality of 3,673 physicians (870 M, 2,803 F ) in Estonia was compared with the rates of the general population. Information on cancer cases and deaths in the cohort between 1983 and 1998 was obtained from the Estonian Cancer Registry and the mortality database of Estonia. Results: The standardized incidence ratio (SIR) for all cancers was 1.32 (95% confi dence interval (CI) 1.15-1.48) in women and 0.92 (95% CI 0.73-1.13) in men. Female physicians had an elevated risk for breast cancer (SIR 2.03, 95% CI 1.62-2.51) and myeloid leukaemia (SIR 3.69, 95% CI 1.35-8.02). Male physicians had an excess of skin melanoma (SIR 4.88, 95% CI 1.58-11.38). A large defi cit of lung cancer was observed (SIR 0.24, 95% CI 0.11-0.48). The very low all-cause mortality in the cohort (standardized mortality ratio 0.55, 95% CI 0.50-0.61) was mainly due to large defi cits in deaths from lung cancer, cardiovascular diseases and external causes. The suicide rate in the cohort was lower than in the general population. Conclusions: No health risks were observed in the cohort that could be linked to the occupational exposures of physicians. The pattern of cancer incidence and mortality seen in physicians in Estonia is similar to the pattern seen among professional classes in other countries.

How do primary care physicians in Singapore keep healthy?

INTRODUCTION

Not much is known regarding how primary care physicians (PCPs) in Singapore keep themselves healthy and mitigate ill health. This study aims to determine the health-seeking behaviour of local PCPs and to identify the predictors of local PCPs attaining the recommended level of exercise.

METHODS

This study was a cross-sectional questionnaire survey, which included questions on the demographic characteristics, practice profiles and health-seeking behaviour of PCPs. The sampling frame was the 1,400 listed members of the College of Family Physicians Singapore. The anonymised survey was executed in two phases: a postal survey, followed by a web-based survey on the College of Family Physicians Singapore website. The two data sets were collated; the categorical variables, summarised; and the differences between subgroups (based on exercise engagement), compared using Fisher's exact test. The effect of each risk factor on exercise duration was quantified using odds ratio (OR) estimate and 95% confidence interval (CI). Multivariate logistic regression analysis was performed to identify significant predictors of exercise engagement.

RESULTS

A total of 631 PCPs participated in the survey--26% were ≤ 34 years old, 58% were male, 21% were single, 34% were singleton practitioners, and 56% were private practitioners. The percentage of PCPs who exercised ≥ 2.5 hours weekly was 29%, while 28% exercised < 0.5 hours weekly. Of the PCPs surveyed, 1% currently smoke, 0.8% drink more than 14 units of alcohol weekly, 60% undertook health screening, 65% had blood investigations done, and 64% had taken preventive measures such as getting influenza vaccination.

CONCLUSION

While local PCPs generally did not have undesirable habits such as smoking and alcohol abuse, they could further increase their exercise intensity and undertake more preventive measures such as getting vaccinated against various diseases.

Mental health first aid training for Australian medical and nursing students: an evaluation study

BACKGROUND

The role and demands of studying nursing and medicine involve specific stressors that may contribute to an increased risk for mental health problems. Stigma is a barrier to help-seeking for mental health problems in nursing and medical students, making these students vulnerable to negative outcomes including higher failure rates and discontinuation of study. Mental Health First Aid (MHFA) is a potential intervention to increase the likelihood that medical and nursing students will support their peers to seek help for mental health problems. This study aimed to evaluate the effectiveness of a tailored MHFA course for nursing and medical students.

METHODS

Nursing and medical students self-selected into either a face-to-face or online tailored MHFA course. Four hundred and thirty-four nursing and medical students completed pre- and post-course surveys measuring mental health first aid intentions, mental health literacy, confidence in providing help, stigmatising attitudes and satisfaction with the course.

RESULTS

The results of the study showed that both the online and face-to-face courses improved the quality of first aid intentions towards a person experiencing depression, and increased mental health literacy and confidence in providing help. The training also decreased stigmatizing attitudes and desire for social distance from a person with depression.

CONCLUSION

Both online and face-to-face tailored MHFA courses have the potential to improve outcomes for students with mental health problems, and may benefit the students in their future professional careers.

Factors related to health-related quality of life among Chinese psychiatrists: occupational stress and psychological capital

BACKGROUND

Psychiatry has been considered as one of the most stressful medical specialities, and psychiatrists are likely to experience impaired health-related quality of life (HRQOL). However, few studies are available in regard to related factors of HRQOL among psychiatrists in China. This study aims to evaluate the condition of HRQOL of psychiatrists and explore its predictive factors, especially the effects of occupational stress and psychological capital.

METHODS

A cross-sectional, multicenter survey was conducted among psychiatrists from different regions of Liaoning province, China, during August 2013-April 2014. Self-administrated questionnaires including the 36-item Short-Form Health Survey (SF-36), the Chinese version Psychological Capital Questionnaire, effort-reward-imbalance (ERI) scale and participants' basic characteristics were distributed to 500 psychiatrists from 10 psychiatric hospitals of 8 major cities in Liaoning province. Overall, 373 psychiatrists became our final research objects. Hierarchical multiple regression analysis (HMR) was performed to explore the predictors of psychiatrists' HRQOL.

RESULTS

The mean (SD) scores of PCS and MCS among psychiatrists were 79.78 (16.55) and 71.50 (19.24) respectively. The mean (SD) of ERR were 0.777 (0.493), and 89 (23.9%) had ERR scores above 1 (ERR > 1). Hierarchical multiple regression analysis showed that, psychiatrists' basic characteristics that significant correlated with PCS and MCS were educational level, turnover intention, and exercise; age, weekly working hours were associated with MCS; psychiatrists' experienced occupational stress (both ERR and overcommitment), and PsyCap were significant predictors for PCS and MCS.

CONCLUSIONS

Chinese psychiatrists experienced relatively good physical QOL but impaired mental QOL, and they experienced high level of occupational stress. For the sake of psychiatrists' HRQOL, the reduction of occupational stress should be implemented. The enhancement of PsyCap could be a new intervention strategy and should be paid attention to in improving HRQOL of psychiatrists. Proportionate occupational reward (money, esteem, career opportunities) to their high work demands, psychological counseling, and stress management courses should be provided to psychiatrists to improve their QOL. PsyCap, as a personal coping resource open to change, should be managed and developed among psychiatrists.

The acute surgical unit: improving emergency care

BACKGROUND

Acute care surgical teams are a new concept in the provision of emergency general surgery. Juggling emergency patients around the surgeons' and staffs' elective commitments resulted in semi-emergency procedures routinely being delayed. In an era of increasing financial pressure and the recent introduction of 'safe work hours' practices, the need for a new system which optimized available resources became apparent.

METHODS

At Fremantle Hospital we developed a new system in a concerted effort to minimize the waiting time for general surgical referrals in the Emergency Department, as well as to move semi-urgent operating from the afterhours to the daytime. To analyse the impact of the ASU, data were collected during February, March, and April 2009 and compared with data from the same period in 2008.

RESULTS

Although most referrals were received afterhours, over 85% of operations were performed during working hours compared with 72% in the 2008 period. The time from referral to review decreased from an average of 3.2 h in 2008 to 2.1 h. The mean duration of stay in 2009 was 3 days, which was a reduction from 4.2 days in 2008. An increase in weekend discharge rates was seen after the introduction of the ASU.

CONCLUSION

Despite an increased workload, more referrals were seen and more operations performed during working hours and the time from referral to review was reduced. Higher discharge rates and reduced length of stays increased the availability of beds. We have demonstrated a successful new model which continues to evolve.

Suicide by occupation: does access to means increase the risk?

OBJECTIVE

To examine suicide by identified occupational groups in New Zealand over a period of 30 years, focusing on groups predicted to have high suicide rates because of access to and familiarity with particular methods of suicide.

METHOD

Suicide data (including open verdicts) for the period 1973-2004 were examined, excluding 1996 and 1997 for which occupational data were not available. Occupational groups of interest were dentists, doctors, farmers (including farm workers), hunters and cullers, military personnel, nurses, pharmacists, police and veterinarians. Crude mortality rates were calculated based on numbers in each occupational group at each quinquennial census, 1976-2001. Standardized mortality ratios were calculated using suicide rates in all employed groups (the standard population).

RESULTS

Few of the occupations investigated had high risks of suicide as assessed by standardized mortality ratios, and some were at lower risk than the total employed population. Standardized mortality ratios were elevated for male nurses (1.7; 95% CI: 1.2-2.5), female nurses (1.3; 95% CI: 1.0-1.6), male hunters and cullers (3.0; 95% CI: 1.7-4.8), and female pharmacists (2.5; 95% CI: 0.8-5.9). Doctors, farmers and veterinarians were not at high risk, and men in the police and armed forces were at low risk. Access to means appeared to have influenced the method chosen. Nurses, doctors and pharmacists were more likely to use poisoning than were other employed people (3, 4 and 5 times respectively, compared with all others employed). Farmers and hunters and cullers were more than twice as likely as all others employed to use firearms.

CONCLUSIONS

Access to means may be less important in some circumstances than in others, perhaps because of the presence of other factors that confer protection. Nevertheless, among the groups we studied with access to lethal means were three groups whose risk of suicide has so far received little attention in New Zealand: nurses, female pharmacists, and hunters and cullers.

Survey on recent suicidal ideation among female university hospital physicians in Sweden and Italy (the HOUPE study): cross-sectional associations with work stressors

BACKGROUND

Suicide rates among physicians are higher than in the general population, and rates among female physicians are particularly high. More female than male physicians report suicidal thoughts, with suicidal ideation being a well-recognized precursor of suicide. The urgent need to find the reasons for suicide risk in female physicians is underscored by society's increasing dependence on this group of health care providers.

OBJECTIVE

The aim of this paper was to identify potential risk and protective factors associated with recent suicidal ideation in female physicians.

METHODS

A cross-sectional survey analysis of work-related health, organizational culture, career paths, and working conditions was performed among permanently employed female physicians from the HOUPE (Health and Organisation among University Physicians in four European countries) study: 385 in Sweden and 126 in Italy. The main outcome measure was recent (within the prior 12 months) suicidal thoughts.

RESULTS

Overall, 13.7% and 14.3% of the participants from Sweden and Italy, respectively, reported suicidal thoughts within the prior 12 months. Among the physicians from Sweden, the most powerful multivariate model for such thoughts included 2 independent variables related to work: degrading experiences/harassment at work (odds ratio [OR], 3.03; 95% CI, 1.48-6.23), and work meetings to discuss stressful situations (OR, 0.36; 95% CI, 0.19-0.69). The model included self-diagnosis and self-treatment as a significant factor. Work meetings to discuss stressful situations were also in the multivariate model for the Italian physicians (OR, 0.21; 95% CI, 0.05-0.86), together with being given work assignments without adequate resources (OR, 5.0; 95% CI, 1.32-18.8). Significant non-work-related factors in the Italian model were younger age and seeking professional help for depression or burnout.

CONCLUSIONS

In both Sweden and Italy, work stressors have been identified that may increase the risk for suicide for female physicians. A potential protective factor was meetings to discuss stressful work experiences. These findings suggest that such meetings should be more broadly implemented.

Substance abuse among medical practitioners

This paper reviews the literature relating to the prevalence, causes and treatment of substance abuse and psychiatric illness among doctors. Possible aetiological and pathogenic factors influencing drug-dependent doctors are discussed and some problems which arise in the management of these doctors are raised. Local studies in relation to certain personality factors in medical students, to cause of death in a medical cohort, and preliminary impressions from a study of substance-abusing doctors are reported.

Lower mortality in male physicians of Chinese medicine than male population in Taiwan

Studies on the physicians' health have paid less attention on the Chinese medicine than on the western medicine professionals. Like western medicine professionals, Chinese medicine physicians' health condition is critical to the quality of care and patients' safety. They also cared a large number of patients in many Asia societies. However, no data have been reported regarding the health problems associated with Chinese medicine physicians. The aim of this study was to examine the mortality patterns of a cohort consisting of 6109 male physicians of Chinese medicine who were followed from 1991 through 2003 in Taiwan. The analyses of female subjects were not included due to small sample size. We calculated the overall and cause-specific standardized mortality ratios (SMRs) and life expectancy of the study cohort using the death rates of some 11 millions of Taiwanese male population as reference. We found out that physicians of Chinese medicine experienced significantly lower death rate of mortality from all causes (SMR = 0.63, 95% > CI: 0.57, 0.69), from malignant neoplasms (SMR = 0.69, 95% CI: 0.57, 0.82) and from cerebrovascular disease (SMR = 0.53, 95% CI: 0.38, 0.72). Additionally, they have longer life expectancy (ranged from 3 years to approximately 15 years). Our study is crucial to evaluate potential health risks associated with Chinese medicine physicians. Although this study did not reveal elevated death rate among Chinese medicine physicians, researchers and policy makers should not overlook other heath problems that Chinese medicine physicians might have experienced.

Doctors as patients: a systematic review of doctors' health access and the barriers they experience

BACKGROUND

The need to improve doctors' access to health care by reducing the barriers they experience has been regularly described in the literature, yet the barriers experienced are not well defined, despite the volume of expert opinion in this area.

AIM

To define what is known about doctors' access to health care from the data within the current literature.

DESIGN OF STUDY

A systematic review of studies of doctors' health access.

METHOD

A systematic search of MEDLINE and CINAHL, supplemented by citation searches and searches of the grey literature, identified both quantitative and qualitative studies. Two reviewers used specific criteria for inclusion of studies and quality assessment. The data were tabulated and analysed.

RESULTS

Twenty-six articles met the inclusion criteria. The paucity of data and the overall poor quality of those data are highlighted. Despite this, many doctors appear to have a GP, but this does not ensure adequate health access. Systemic barriers to healthcare access (long hours and cultural issues) are more significant than individual barriers.

CONCLUSION

Expert opinion in this field is supported by poor-quality data. The current knowledge reveals important similarities between doctors and the general population in their healthcare access, especially with mental health issues. Understanding this may help the medical profession to respond to these issues of 'doctors' health' more effectively.

Doctors do not adequately look after their own physical health

Studies of doctors' health have emphasised psychological health, and limited data have been collected on their physical health status. Doctors often fail to follow current preventive health guidelines for their physical health. About half of doctors do not have an established relationship with an independent general practitioner. This would enhance their health and provide a means of ready access to the healthcare system should a problem arise.

Understanding the stresses and strains of being a doctor

Stress in doctors is a product of the interaction between the demanding nature of their work and their often obsessive, conscientious and committed personalities. In the face of extremely demanding work, a subjective lack of control and insufficient rewards are powerful sources of stress in doctors. If demands continue to rise and adjustments are not made, then inevitably a "correction" will occur, which may take the form of "burnout" or physical and/or mental impairment. Doctors need to reclaim control of their work environment and employers need to recognise the need for doctors to participate in decisions affecting their working lives. All doctors should be aware of predictors of risk and signals of impairment, as well as available avenues of assistance. Relevant medical organisations (eg, the Colleges, hospital administrations, and medical defence organisations) need to develop and rehearse effective response pathways for assisting impaired doctors.

Doctors' health-seeking behaviour: a questionnaire survey

OBJECTIVES

To explore doctors' perceptions of the acceptable limits to self-treatment and to identify barriers to doctors seeking appropriate healthcare.

DESIGN

Self-completion, postal survey using three hypothetical case vignettes.

SETTING AND PARTICIPANTS

896 Australian doctors randomly selected from the Health Insurance Commission database and stratified by sex, discipline (general practitioner or specialist) and location (urban or rural). Data were collected between May and July 2001.

MAIN OUTCOME MEASURES

Doctors' self-reported attitudes on illness behaviour and choice of medical care in response to case vignettes.

RESULTS

358 (40%) doctors returned questionnaires. More participants believed it was acceptable to self-treat acute conditions (315/351; 90%) than to self-treat chronic conditions (88/350; 25%). Nine per cent (30/351) of participants believed it was acceptable to self-prescribe psychotropic medication. A greater proportion of GPs (206/230; 90%) than specialists (101/121; 83%) believed doctors are reluctant to attend another doctor, especially if the problem is psychological. Women and GPs were significantly less likely to report that it was easy to find a satisfactory treating doctor (women, 58/140 [41%]; men, 128/211 [61%]; GPs, 106/231 [46%]; specialists, 80/120 [67%]). Being a specialist was predictive of seeking appropriate healthcare for all three vignettes.

CONCLUSION

Doctors have varying opinions regarding the acceptability of self-treating chronic conditions, and perceive considerable barriers to seeking appropriate medical care. Strategies are needed to challenge the culture of self-reliance.

Are anaesthetists prone to suicide? A review of rates and risk factors

Suicide represents a major source of mortality in Western countries. There is an emerging literature about suicide and the medical profession. The suicide of an anaesthetist represents a catastrophic event, with painful consequences for family, colleagues and the community at large. This review will examine the literature regarding suicide amongst anaesthetists and trainees in the field. It is presented in three sections. First, it provides an overview of existing epidemiological data, comparing rates in the general population, the medical profession, in general, and in anaesthesia, in particular. Second, risk factors that may account for differences in rates will be discussed. Finally, a series of recommendations has been formulated.

Humanistic medicine or values-based medicine. what's in a name?

"Humanistic medicine" is a term compounded, for therapeutic purposes, with the good intent of reminding clinicians of their need to be compassionate and empathic. Although the expression is arresting, and demands thought, it does not go far enough. "Values-based medicine" is a stronger term, reminding clinicians of the sustaining values that underpin the whole health endeavour. These values include an acceptance of the value of individual human life in quantity and quality, and of the importance to both individuals and communities of human security and flourishing. Values-based medicine can incorporate all the other paradigms of medicine, including scientific and evidence-based medicine, within it, because it can include anything that contributes to human security and flourishing. If we are to seek a new paradigm for a reconstructed view of healthcare, the term "values-based medicine" might have more power and relevance than "humanistic medicine".

Suicide in women

This article reviews research into suicide in women during the last 25 years. National rates vary between the extremes of 19/10(5) per year in Sri Lanka and < 1/10(5) per year in the Philippines and Egypt, but almost everywhere rates for women are much lower than male rates, with a median ratio of 2.8/1. The exceptions are in India and China, which report higher rates in young married women. The reproductive process has some influence. While menstruation, hormonal treatment, pregnancy and the puerperium have no major effect, unwanted pregnancy may still lead to suicide under certain circumstances, and severe labour can occasionally do so. Having children protects, but the relative risk is no more than 2.0 in nulliparous women. Social factors also have a limited effect. There are higher rates of suicide in divorced women, but the evidence on widowhood is equivocal. Prosperity and employment have no effect. Sexual abuse, rape and domestic violence undoubtedly lead to suicide attempts, but the evidence on completed suicide is lacking. There are many unanswered questions, especially why rates of completed suicide for women (with a greater prevalence of overt depression) are lower than for men, and why Chinese and Indian women have higher rates. More research is required, especially from developing nations.

Self-reported depression and suicide attempts among U.S. women physicians

OBJECTIVE

Studies examining suicide rates for U.S. women physicians and other U.S. women have found odds ratios as high as 4 to 1. Although such reports are controversial and are based on small groups (N = 17 to 49 suicides), they are often cited as evidence of a high prevalence of psychopathology among women physicians.

METHOD

The authors used the results of the Women Physicians' Health Study (N = 4,501), a large, nationally distributed questionnaire, to assess the lifetime prevalence of self-identified depression and suicide attempts among U.S. women physicians.

RESULTS

An estimated 1.5% (N = 61) of U.S. women physicians have attempted suicide, and 19.5% (N = 808) have a history of depression. Those who were born in the United States, were not Asian, had histories of cigarette smoking, alcohol abuse or dependence, sexual abuse, domestic violence, poor current mental health, more severe harassment, or a family history of psychiatric disorders were significantly more likely to report suicide attempts or depression. Depression was more common among those who were not partnered, were childless, had a household gun, had more stress at home, drank alcohol, had worse health, or had a history of obesity, chronic fatigue syndrome, substance abuse, an eating disorder, or another psychiatric disorder and among those who reported working too much, career dissatisfaction, less control at work, and high job stress. Strata reporting higher rates of depression tended to show higher (although usually nonsignificant) rates of suicide attempts.

CONCLUSIONS

Depression is approximately as common among U.S. women physicians as among other U.S. women, but suicide attempts may be fewer. A number of conditions may help identify women physicians at high risk for suicide attempts and depression.

Doctors detected self-administering opioids in New South Wales, 1985-1994: characteristics and outcomes

OBJECTIVE

To describe the characteristics and outcomes of doctors whose drug authorities were withdrawn as a result of self-administering opioids for non-medical purposes.

DESIGN

Retrospective review of New South Wales Health Department information relating to all doctors whose authorities to possess, supply, prescribe or administer drugs of addiction had been withdrawn in the period 1985 to 1994 as a result of confirmed self-administration of opioids.

OUTCOME MEASURES

Age, sex, geographical location and practice category at the time of intervention; drugs used; period of opioid use before authority withdrawal; means of detection; and registration status as at August 1995.

RESULTS

From 1985 to 1994, 79 doctors had their drug authorities withdrawn (0.4% of the NSW medical profession in 1994). The groups significantly over-represented were general practitioners and those aged 30-39 years. Pethidine was the main drug used (66 doctors; 84%). Drug use for more than two years before detection was reported by 34 (43%) doctors. Community pharmacists were the source of reports leading to detection of 28 (35%) doctors. As at August 1995, 27 (34%) of the study group were not practising; 10 (13%) had died.

CONCLUSION

Outcomes for these doctors were poor. There was substantial attrition from practice and a high mortality rate.

Surgeon, don't heal thyself: a study of the health of Australasian urologists

BACKGROUND

Modern surgical practice is stressful and anxiety-producing. We investigated urologists health and their attitude to their own health care.

METHODS

Two hundred and seventy-five Australasian urologists were surveyed to ascertain their attitudes to their physical and psychological health; 205 responses were received.

RESULTS

Ten per cent reported serious physical illnesses. Fewer than half had their own general practitioner (GP), and fewer than one-third had seen a doctor in the previous 12 months. A majority had, at some time, prescribed themselves medication, including antibiotics, narcotic and non-narcotic analgesia and benzodiazepams. Nearly all reported that aspects of their urological practice caused them anxiety. More felt that this anxiety was the result of pressures experienced outside the operating theatre than problems directly related to performing surgery. A small number of psychological problems were reported, and fewer than 10 per cent had ever a visited a psychiatrist. It was evident that most Australasian urologists were unwilling to discuss any psychological problems that they may have. Even when a specific problem had been identified, few sought the appropriate care.

CONCLUSIONS

It would be advantageous for Australasian urologists and doctors in general to see their GP more regularly, and be more willing to discuss any psychological difficulties that they may experience.

Occupational stress in anaesthesia

Anaesthetists, like most in the medical profession, often deny that they may be suffering from work-related stress. This article explores the sources and effects of occupational stress with suggestions for dealing with the stresses of our specialty.

A systematic review on gender-specific suicide mortality in medical doctors

BACKGROUND

So far no comprehensive systematic review has been published about epidemiologic studies on suicides among medical practitioners. The aim here is to describe the variation of published estimates of relative risk of doctors to die from suicide.

METHOD

A systematic review of published original articles on population-based studies, registered mainly in MEDLINE and fulfilling specific methodological requirements. Incidence rates and standardised mortality ratios were calculated for male and female doctors in relation to the reference groups.

RESULTS

The estimated relative risk varied from 1.1 to 3.4 in male doctors, and from 2.5 to 5.7 in female doctors, respectively, as compared with the general population, and from 1.5 to 3.8 in males and from 3.7 to 4.5 in females, respectively, as compared with other professionals. The crude suicide mortality rate was about the same in male and female doctors.

CONCLUSION

In all studies the suicide rates among doctors were higher than those in the general population and among other academic occupational groups.

Medical care of doctors

AIM

To describe doctors' attitudes towards their own medical care.

METHODS

Postal survey asking 2564 doctors about their access to, and use of, medical services. The sample, 14% of all New South Wales doctors, was randomly selected from the NSW Register of Medical Practitioners. To ensure anonymity, non-respondents were not followed up.

RESULTS

The response rate was 44%. Only 42% of respondents had a general practitioner and most had self-prescribed medication. Nineteen per cent reported marital disturbances, 18% emotional disorders, 3% alcohol problems and 1% drug abuse, but not many had discussed these problems with their doctor. Twenty-six per cent had a condition warranting a medical consultation but felt inhibited about consulting a doctor.

CONCLUSION

Many doctors lack adequate medical care.

RECOMMENDATIONS

We recommend that doctors have their own general practitioner, avoid "corridor consultations" and not self-prescribe drugs that affect mental function. Teaching of appropriate help-seeking responses should be part of medical education.