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Abstract
IMPORTANCE Addressing physician suicide requires understanding its association with possible risk factors such as burnout and depression. OBJECTIVE To assess the association between burnout and suicidal ideation after adjusting for depression and the association of burnout and depression with self-reported medical errors. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted from November 12, 2018, to February 15, 2019. Attending and postgraduate trainee physicians randomly sampled from the American Medical Association Physician Masterfile were emailed invitations to complete an online survey in waves until a convenience sample of more than 1200 practicing physicians agreed to participate. MAIN OUTCOMES AND MEASURES The primary outcome was the association of burnout with suicidal ideation after adjustment for depression. The secondary outcome was the association of burnout and depression with self-reported medical errors. Burnout, depression, suicidal ideation, and medical errors were measured using subscales of the Stanford Professional Fulfillment Index, Maslach Burnout Inventory-Human Services Survey for Medical Personnel, and Mini-Z burnout survey and the Patient-Reported Outcomes Measurement Information System depression Short Form. Associations were evaluated using multivariable regression models. RESULTS Of the 1354 respondents, 893 (66.0%) were White, 1268 (93.6%) were non-Hispanic, 762 (56.3%) were men, 912 (67.4%) were non-primary care physicians, 934 (69.0%) were attending physicians, and 824 (60.9%) were younger than 45 years. Each SD-unit increase in burnout was associated with 85% increased odds of suicidal ideation (odds ratio [OR], 1.85; 95% CI, 1.47-2.31). After adjusting for depression, there was no longer an association (OR, 0.85; 95% CI, 0.63-1.17). In the adjusted model, each SD-unit increase in depression was associated with 202% increased odds of suicidal ideation (OR, 3.02; 95% CI, 2.30-3.95). In the adjusted model for self-reported medical errors, each SD-unit increase in burnout was associated with an increase in self-reported medical errors (OR, 1.48; 95% CI, 1.28-1.71), whereas depression was not associated with self-reported medical errors (OR, 1.01; 95% CI, 0.88-1.16). CONCLUSIONS AND RELEVANCE The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.
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Affiliation(s)
- Nikitha K. Menon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Tait D. Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Christine A. Sinsky
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, Illinois
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota
| | - Lindsey Carlasare
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, Illinois
| | - Keri J. S. Brady
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | | | - Mickey T. Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Welle D, Trockel MT, Hamidi MS, Hickson GB, Menon NK, Shanafelt TD, Cooper WO. Association of Occupational Distress and Sleep-Related Impairment in Physicians With Unsolicited Patient Complaints. Mayo Clin Proc 2020; 95:719-726. [PMID: 32247345 DOI: 10.1016/j.mayocp.2019.09.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/03/2019] [Accepted: 09/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To study the relationship between occupational distress and sleep-related impairment in physicians and unsolicited patient complaints. PARTICIPANTS AND METHODS We used deidentified data from an academic medical center's physician survey administered in April and May of 2013 to perform a retrospective cohort study. Third-party stewards of the identifiable information regarding unsolicited patient complaints from January 1, 2013, through December 31, 2016, matched these data with corresponding physicians' occupational distress data. Unsolicited patient complaints were used to calculate the Patient Advocacy Reporting System (PARS) score, a validated predictor of malpractice litigation risk and clinical outcomes. Physicians were grouped into 1 of 3 PARS risk categories based on previously defined thresholds: low risk (score of 0), intermediate risk (score of 1-12), or high risk (score ≥13). RESULTS Each 1-point increase in burnout and sleep-related impairment, on a 5-point scale, was associated with a 69% (odds ratio [OR], 1.69; 95% CI, 1.12-2.54) and 49% (OR, 1.49; 95% CI, 1.08-2.05) increased odds of being in the next higher PARS risk category, respectively, averaged across all 4 years. Professional fulfillment was a protective factor, associated with fewer unsolicited patient complaints. Each 1-point decrease in professional fulfillment was associated with a 68% (OR, 1.68; 95% CI, 1.16-2.44) increased odds of being in the next higher PARS risk category. The effect of depression on PARS risk category was not significant (OR, 1.33; 95% CI, 0.84-2.10). CONCLUSION Findings from this research suggest that occupational distress and sleep-related impairment in physicians are associated with unsolicited patient complaints.
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Affiliation(s)
- Dana Welle
- Stanford Medicine, Stanford, CA; The Risk Authority, Columbia, SC.
| | | | | | - Gerald B Hickson
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN; Quality Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - William O Cooper
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN; Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN; Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN
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Affiliation(s)
- Justin L Bullock
- From the Department of Internal Medicine, University of California, San Francisco, School of Medicine, San Francisco
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Sun J, Sun R, Jiang Y, Chen X, Li Z, Ma Z, Wei J, He C, Zhang L. The relationship between psychological health and social support: Evidence from physicians in China. PLoS One 2020; 15:e0228152. [PMID: 31995601 PMCID: PMC6988930 DOI: 10.1371/journal.pone.0228152] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/09/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The psychological health (PH) of doctors affects the quality of medical service and is related to the safety of patients. The serious problems with the doctor-patient relationship in China can lead to long-term imbalances in doctor PH, and the poor PH status of doctors has raised scholars' concern. Current research mainly focuses on how factors such as social support and the impact of the residential environment correlate with individual PH. We continue this direction of research to see how the mechanism of social support impacts physician PH, also investigating the moderating effect of demographic indicators on physician PH. METHODS Based on a survey of 399 physicians, a descriptive analysis of measured data was done using SPSS 19.0. Pearson correlation coefficient analysis was used to examine the correlations between PH and the social support rating scale (SSRS) and the demographic variables. KMO and Bartlett methods were used to examine the correlations between PH and SDS (a scale to measure depression) and between PH and SAS (a scale to measure anxiety). The method of factor analysis was used for multicollinearity tests, and multiple stepwise regression analysis was used to explore the demographic factors correlated with PH and SSRS. Two-way interactions in moderated multiple regression were used to test the moderating effect of education level and title on SSRS, SDS, and SAS. RESULTS Our results indicate that the level of PH is influenced by the age, education, and title of a doctor. A physician's title is significantly and positively correlated with PH, but age and education are significantly negatively related. Age, education, and title also affect the level of SSRS in physicians. SSRS is positively correlated with age, education, and title, and SSRS positively influences PH. Education and title had significant effects on the moderating influences of SSRS, SDS, SAS, and PH. CONCLUSION The factors directly affecting PH include SSRS, age, and title, while education was found to be an indirect influencing factor. To meet goals expressed in Chinese government policy related to these issues, we suggest strengthening the guidance of the media, introducing laws and regulations on doctor-patient risk management and control, reforming the review mechanism of hospital job titles, improving the education level of doctors, building a comprehensive evaluation system of "practice performance + doctor-patient satisfaction", and strengthening doctor-patient empathy. Through such measures, the level of PH in physicians will improve.
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Affiliation(s)
- Jiangjie Sun
- Health Management College, Anhui Medical University, Hefei, Anhui, China
- Center for Data Science in Health, Anhui Medical University, Hefei, Anhui, China
| | - Ruochuan Sun
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yuanyuan Jiang
- Clinical Medical College, Anhui Medical University, Hefei, Anhui, China
| | - Xiuyun Chen
- College of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Zhi Li
- College of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Zuqing Ma
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jiuchang Wei
- School of Management, University of Science and Technology of China, Hefei, Anhui, China
- Center for Crisis Management Research (Sponsored by Beijing Planning Office of Philosophy & Social Science), School of Public Policy & Management, Tsinghua University, Beijing, PR China
| | - Chengsen He
- Department of Psychology, Anhui Medical University, Hefei, Anhui, China
| | - Liping Zhang
- Clinical Medical College, Anhui Medical University, Hefei, Anhui, China
- Department of Psychology, Anhui Medical University, Hefei, Anhui, China
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Pereira-Lima K, Mata DA, Loureiro SR, Crippa JA, Bolsoni LM, Sen S. Association Between Physician Depressive Symptoms and Medical Errors: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e1916097. [PMID: 31774520 PMCID: PMC6902829 DOI: 10.1001/jamanetworkopen.2019.16097] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Depression is highly prevalent among physicians and has been associated with increased risk of medical errors. However, questions regarding the magnitude and temporal direction of these associations remain open in recent literature. OBJECTIVE To provide summary relative risk (RR) estimates for the associations between physician depressive symptoms and medical errors. DATA SOURCES A systematic search of Embase, ERIC, PubMed, PsycINFO, Scopus, and Web of Science was performed from database inception to December 31, 2018. STUDY SELECTION Peer-reviewed empirical studies that reported on a valid measure of physician depressive symptoms associated with perceived or observed medical errors were included. No language restrictions were applied. DATA EXTRACTION AND SYNTHESIS Study characteristics and RR estimates were extracted from each article. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using subgroup meta-analysis and metaregression. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. MAIN OUTCOMES AND MEASURES Relative risk estimates for the associations between physician depressive symptoms and medical errors. RESULTS In total, 11 studies involving 21 517 physicians were included. Data were extracted from 7 longitudinal studies (64%; with 5595 individuals) and 4 cross-sectional studies (36%; with 15 922 individuals). The overall RR for medical errors among physicians with a positive screening for depression was 1.95 (95% CI, 1.63-2.33), with high heterogeneity across the studies (χ2 = 49.91; P < .001; I2 = 82%; τ2 = 0.06). Among the variables assessed, study design explained the most heterogeneity across studies, with lower RR estimates associated with medical errors in longitudinal studies (RR, 1.62; 95% CI, 1.43-1.84; χ2 = 5.77; P = .33; I2 = 13%; τ2 < 0.01) and higher RR estimates in cross-sectional studies (RR, 2.51; 95% CI, 2.20-2.83; χ2 = 5.44; P = .14; I2 = 45%; τ2 < 0.01). Similar to the results for the meta-analysis of physician depressive symptoms associated with subsequent medical errors, the meta-analysis of 4 longitudinal studies (involving 4462 individuals) found that medical errors associated with subsequent depressive symptoms had a pooled RR of 1.67 (95% CI, 1.48-1.87; χ2 = 1.85; P = .60; I2 = 0%; τ2 = 0), suggesting that the association between physician depressive symptoms and medical errors is bidirectional. CONCLUSIONS AND RELEVANCE Results of this study suggest that physicians with a positive screening for depressive symptoms are at higher risk for medical errors. Further research is needed to evaluate whether interventions to reduce physician depressive symptoms could play a role in mitigating medical errors and thus improving physician well-being and patient care.
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Affiliation(s)
- Karina Pereira-Lima
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Douglas A. Mata
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sonia R. Loureiro
- Department of Neuroscience and Behavior, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - José A. Crippa
- Department of Neuroscience and Behavior, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lívia M. Bolsoni
- Department of Neuroscience and Behavior, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Srijan Sen
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor
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Affiliation(s)
- Amy M Yule
- The Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, and the Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Yule); New York State Psychiatric Institute, Division of Substance Abuse, and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (Levin)
| | - Frances R Levin
- The Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, and the Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Yule); New York State Psychiatric Institute, Division of Substance Abuse, and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (Levin)
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Bérastégui P, Jaspar M, Ghuysen A, Nyssen AS. Fatigue-related risk management in the emergency department: a focus-group study. Intern Emerg Med 2018; 13:1273-1281. [PMID: 29777436 DOI: 10.1007/s11739-018-1873-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/06/2018] [Indexed: 11/30/2022]
Abstract
Fatigue has major implications on both patient safety and healthcare practitioner's well-being. Traditionally, two approaches can be used to reduce fatigue-related risk: reducing the likelihood of a fatigued operator working (i.e. fatigue reduction), or reducing the likelihood that a fatigued operator will make an error (i.e. fatigue proofing). Recent progress mainly focussed on fatigue reduction strategies such as reducing work hours. Yet it has to be recognized that such approach has not wholly overcome the experience of fatigue. Our purpose is to investigate individual proofing and reduction strategies used by emergency physicians to manage fatigue-related risk. 25 emergency physicians were recruited for the study. Four focus groups were formed which consisted of an average of six individuals. Qualitative data were collected using a semi-structured discussion guide unfolding in two parts. First, the participants were asked to describe how on-the-job fatigue affected their efficiency at work. A mind map was progressively drawn based upon the participants' perceived effects of fatigue. Second, participants were asked to describe any strategies they personally used to cope with these effects. We used inductive qualitative content analysis to reveal content themes for both fatigue effects and strategies. Emergency physicians reported 28 fatigue effects, 12 reduction strategies and 21 proofing strategies. Content analysis yielded a further classification of proofing strategies into self-regulation, task re-allocation and error monitoring strategies. There is significant potential for the development of more formal processes based on physicians' informal strategies.
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Affiliation(s)
- Pierre Bérastégui
- Cognitive Ergonomics Laboratory (LECIT), Department of Work Psychology, University of Liège, Sart-Tilman B31, 4000, Liege, Belgium.
| | - Mathieu Jaspar
- Cognitive Ergonomics Laboratory (LECIT), Department of Work Psychology, University of Liège, Sart-Tilman B31, 4000, Liege, Belgium
| | - Alexandre Ghuysen
- Emergency Department, University Hospital Centre of Liège, Liege, Belgium
| | - Anne-Sophie Nyssen
- Cognitive Ergonomics Laboratory (LECIT), Department of Work Psychology, University of Liège, Sart-Tilman B31, 4000, Liege, Belgium
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Carrieri D, Briscoe S, Jackson M, Mattick K, Papoutsi C, Pearson M, Wong G. 'Care Under Pressure': a realist review of interventions to tackle doctors' mental ill-health and its impacts on the clinical workforce and patient care. BMJ Open 2018; 8:e021273. [PMID: 29420234 PMCID: PMC5829880 DOI: 10.1136/bmjopen-2017-021273] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/05/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Mental ill-health is prevalent across all groups of health professionals and this is of great concern in many countries. In the UK, the mental health of the National Health Service (NHS) workforce is a major healthcare issue, leading to presenteeism, absenteeism and loss of staff from the workforce. Most interventions targeting doctors aim to increase their 'productivity' and 'resilience', placing responsibility for good mental health with doctors themselves and neglecting the organisational and structural contexts that may have a detrimental effect on doctors' well-being. There is a need for approaches that are sensitive to the contextual complexities of mental ill-health in doctors, and that do not treat doctors as a uniform body, but allow distinctions to account for particular characteristics, such as specialty, career stage and different working environments. METHODS AND ANALYSIS Our project aims to understand how, why and in what contexts support interventions can be designed to minimise the incidence of doctors' mental ill-health. We will conduct a realist review-a form of theory-driven interpretative systematic review-of interventions, drawing on diverse literature sources. The review will iteratively progress through five steps: (1) locate existing theories; (2) search for evidence; (3) select articles; (4) extract and organise data and (5) synthesise evidence and draw conclusions. The analysis will summarise how, why and in what circumstances doctors' mental ill-health is likely to develop and what can remediate the situation. Throughout the project, we will also engage iteratively with diverse stakeholders in order to produce actionable theory. ETHICS AND DISSEMINATION Ethical approval is not required for our review. Our dissemination strategy will be participatory. Tailored outputs will be targeted to: policy makers; NHS employers and healthcare leaders; team leaders; support organisations; doctors experiencing mental ill-health, their families and colleagues. PROSPERO REGISTRATION NUMBER CRD42017069870.
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Affiliation(s)
- Daniele Carrieri
- University of Exeter Medical School, University of Exeter, Exeter, UK
- Wellcome Centre for Cultures and Enviroments of Health, University of Exeter, Exeter, UK
| | - Simon Briscoe
- Exeter HS&DR Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Mark Jackson
- Wellcome Centre for Cultures and Enviroments of Health, University of Exeter, Exeter, UK
| | - Karen Mattick
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Geoffrey Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Clarfield AM. My Medicine, My body: The Serious Physician becomes a Serious Patient. Isr Med Assoc J 2018; 20:66. [PMID: 29658214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- A M Clarfield
- Dept. of Geriatrics, Soroka University Medical Center and the Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410101, Israel
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Bondurant R. A Legacy for the Missouri Physicians Health Program. Mo Med 2017; 114:430-431. [PMID: 30228656 PMCID: PMC6139981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Robert Bondurant
- Robert Bondurant, RN, LCSW, is Executive Director of the Missouri Physicians Health Program
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Minter B, Besdine RW. Cognitive Decline in Physicians and their Patients. R I Med J (2013) 2017; 100:21-22. [PMID: 28873479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Bradley Minter
- Geriatric Medicine, Division of Geriatrics and Palliative Medicine, Department of Medicine, Alpert Medical School of Brown University
| | - Richard W Besdine
- Professor of Medicine and Director, Division of Geriatrics and Palliative Medicine (Medicine), Alpert Medical School of Brown University;
Professor of Health Services Policy and Practice, Director, Center for Gerontology and Health Care Research, Brown University School of Public Health
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Affiliation(s)
- Jane B Lemaire
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jean E Wallace
- Department of Sociology, Faculty of Arts, University of Calgary
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Louie AK, Trockel MT, Balon R, Coverdale JH, Beresin EV, Brenner AM, Guerrero APS, Roberts LW. "Physician Wellness" as Published in Academic Psychiatry. Acad Psychiatry 2017; 41:155-158. [PMID: 28213884 DOI: 10.1007/s40596-017-0677-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Affiliation(s)
| | | | | | | | | | - Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Bismark MM, Mathews B, Morris JM, Thomas LA, Studdert DM. Views on mandatory reporting of impaired health practitioners by their treating practitioners: a qualitative study from Australia. BMJ Open 2016; 6:e011988. [PMID: 27993902 PMCID: PMC5168668 DOI: 10.1136/bmjopen-2016-011988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the views and experiences of health sector professionals in Australia regarding a new national law requiring treating practitioners to report impaired health practitioners whose impairments came to their attention in the course of providing treatment. METHOD We conducted a thematic analysis of in-depth, semistructured interviews with 18 health practitioners and 4 medicolegal advisors from Australia's 6 states, each of whom had experience with applying the new mandatory reporting law in practice. RESULTS Interviewees perceived the introduction of a mandatory reporting law as a response to failures of the profession to adequately protect the public from impaired practitioners. Mandatory reporting of impaired practitioners was reported to have several benefits: it provides treating practitioners with a 'lever' to influence behaviour, offers protections to those who make reports and underscores the duty to protect the public from harm. However, many viewed it as a blunt instrument that did not sufficiently take account of the realities of clinical practice. In deciding whether or not to make a report, interviewees reported exercising clinical discretion, and being influenced by three competing considerations: protection of the public, confidentiality of patient information and loyalty to their profession. CONCLUSIONS Competing ethical considerations limit the willingness of Australian health practitioners to report impaired practitioner-patients under a mandatory reporting law. Improved understanding and implementation of the law may bolster the public protection offered by mandatory reports, reduce the need to breach practitioner-patient confidentiality and help align the law with the loyalty that practitioners feel to support, rather than punish, their impaired colleagues.
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Affiliation(s)
- Marie M Bismark
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne. Melbourne, Victoria, Australia
| | - Ben Mathews
- School of Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jennifer M Morris
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne. Melbourne, Victoria, Australia
| | - Laura A Thomas
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne. Melbourne, Victoria, Australia
| | - David M Studdert
- Center for Health Policy/Center for Primary Care and Outcomes Research Stanford Medical School & Stanford Law School, Stanford University, Stanford, California, USA
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Abstract
OBJECTIVE To explore the views of senior doctors on mental illness within the medical profession. BACKGROUND There has been increasing interest on the issue of doctors' mental health. However, there have been few qualitative studies on senior doctors' general attitude towards mental illness within the medical profession. SETTING Large North London teaching hospital. PARTICIPANTS 13 hospital consultants and senior academic general practitioners. METHODS A qualitative study involving semi-structured interviews and reflective work. The outcome measures were the themes derived from the thematic framework approach to analysis. RESULTS Four main themes were identified. (1) 'Doctors' attitudes to mental illness'-doctors felt that there remained a significant stigma attached to suffering from a mental illness within the profession. (2) 'Barriers to seeking help'-doctors felt that there were numerous barriers to seeking help such as negative career implications, being perceived as weak, denial and fear of prejudice. (3) 'Support'-doctors felt that the use of support depended on certainty concerning confidentiality, which for occupational health was not thought to be guaranteed. Confiding in colleagues was rare except among close friends. Supervision for all doctors was raised. (4) 'General Medical Council (GMC) involvement'-doctors felt that uneasy referring colleagues to the GMC and the appraisal and revalidation process was thought not to be thorough enough in picking up doctors with a mental illness. CONCLUSIONS Owing to the small size of this study, the conclusions are limited; however, if the findings are confirmed by larger studies, they suggest that greater efforts are needed to destigmatise mental illness in the profession and improve support for doctors. Additional research should be carried out into doctors' views on occupational health services in managing doctors with mental illness, the provision of supervision for all doctors and the effectiveness of the current appraisal and revalidation process at identifying doctors with a mental illness.
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Affiliation(s)
- Eleonora F Bianchi
- Department of Primary Care and Population Health, UCL Medical School, London, UK
| | - Mimi R Bhattacharyya
- Department of Primary Care and Population Health, UCL Medical School, London, UK
| | - Richard Meakin
- Department of Primary Care and Population Health, UCL Medical School, London, UK
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Soliman M, Jalal H. A PIECE OF MY MIND. Strolling With Recovering Addicts. JAMA 2016; 315:1949-50. [PMID: 27163982 DOI: 10.1001/jama.2016.0659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Hamza Jalal
- Department of Neurology, University of Toronto, Toronto, Canada
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Zechmann S. [Nearly a third of all assistant physicians have depression or depressive symptoms]. Praxis (Bern 1994) 2016; 105:527-528. [PMID: 27120215 DOI: 10.1024/1661-8157/a002335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Stefan Zechmann
- 1 Institut für Hausarztmedizin, Horten-Zentrum für praxisorientierte Forschung und Wissenstransfer, Universitätsspital Zürich
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Abstract
Impaired physicians are unable to manage professional activities safely. Impairment can be the result of physical or mental disorders, but impaired physicians commonly refers to those suffering from substance use disorders. These disorders are at least as common in physicians as they are in the general population, and physician health programs have been established in each state to provide expeditious and detailed evaluation, referral to treatment facilities, and post-treatment monitoring to ensure compliance. These programs protect participants against sanctions and safeguard patients. The prognosis for participants is excellent, with more than 70% able to practice medicine at 5 years.
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Affiliation(s)
- Ranjan Sudan
- Department of Surgery, Duke University Medical Center, Box 2834, Durham, NC 27710, USA.
| | - Keri Seymour
- Department of Surgery, Duke University Medical Center, Box 2834, Durham, NC 27710, USA
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Smoller BM. Introduction: Burnout or Engagement...Our Choice or Theirs? Md Med 2016; 17:10-11. [PMID: 29916652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Howe EG. What Do We Owe Medical Students and Medical Colleagues Who Are Impaired? J Clin Ethics 2016; 27:87-98. [PMID: 27333059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Physicians who are impaired, engage in unprofessional behavior, or violate laws may be barred from further practice. Likewise, medical students may be dismissed from medical school for many infractions, large and small. The welfare of patients and the general public must be our first priority, but when we assess physicians and students who have erred, we should seek to respond as caringly and fairly as possible. This piece will explore how we may do this at all stages of the proceedings physicians and students may encounter. This may include helping them to resume their medical careers if and when this would be sufficiently safe and beneficial for patients.
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Affiliation(s)
- Edmund G Howe
- Programs in Medical Ethics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814 USA.
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Johnson RS, Fowler JC, Sikes KA, Allen JG, Oldham JM. Treatment of Depression in Voluntary Versus Mandated Physicians. J Am Acad Psychiatry Law 2015; 43:476-482. [PMID: 26668225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Few if any publications discuss the effectiveness of voluntary versus mandated treatment for impaired physicians. This retrospective case-control study compared the recovery rates of physicians whose treatment was mandated or coerced by either licensure boards or employers (mandated physicians) with the rates for physicians admitted voluntarily (voluntary physicians) to the Menninger Clinic's Professionals in Crisis program from 2009 through 2012. Beck Depression Inventory (BDI)-II scores served as the primary outcome measure. At the time of admission, voluntary physicians were more depressed, but the improvement rates in the voluntary and mandated groups did not differ significantly. In addition, the two groups differed neither in rates of return to the healthy range of BDI-II scores, nor in whether BDI-II scores had decreased by at least two standard deviations by the time of discharge. These findings suggest that state physician health programs can continue to mandate physicians into treatment despite concerns that mandatory treatment may be less efficacious than voluntary treatment.
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Affiliation(s)
- R Scott Johnson
- Dr. Johnson is a forensic psychiatry fellow at Massachusetts General Hospital/Harvard Medical School in Boston, MA. Dr. Sikes is the Medical Director, Cypress Creek Hospital, Houston, TX. Dr. Allen is Professor of Psychiatry and Helen Malsin Palley Chair in Mental Health Research, Dr. Fowler is Associate Professor, and Dr. Oldham is Professor and Executive Vice Chair for Clinical Affairs and Development, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX. Dr. Fowler is also Associate Director of Clinical Research, and Dr. Oldham is also Senior Vice President and Chief of Staff, The Menninger Clinic, Houston, TX. A preliminary poster of this material was presented at the 44th annual meeting of the American Academy of Psychiatry and the Law, October 24-27, 2013, San Diego, CA.
| | - J Christopher Fowler
- Dr. Johnson is a forensic psychiatry fellow at Massachusetts General Hospital/Harvard Medical School in Boston, MA. Dr. Sikes is the Medical Director, Cypress Creek Hospital, Houston, TX. Dr. Allen is Professor of Psychiatry and Helen Malsin Palley Chair in Mental Health Research, Dr. Fowler is Associate Professor, and Dr. Oldham is Professor and Executive Vice Chair for Clinical Affairs and Development, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX. Dr. Fowler is also Associate Director of Clinical Research, and Dr. Oldham is also Senior Vice President and Chief of Staff, The Menninger Clinic, Houston, TX. A preliminary poster of this material was presented at the 44th annual meeting of the American Academy of Psychiatry and the Law, October 24-27, 2013, San Diego, CA
| | - Kristi A Sikes
- Dr. Johnson is a forensic psychiatry fellow at Massachusetts General Hospital/Harvard Medical School in Boston, MA. Dr. Sikes is the Medical Director, Cypress Creek Hospital, Houston, TX. Dr. Allen is Professor of Psychiatry and Helen Malsin Palley Chair in Mental Health Research, Dr. Fowler is Associate Professor, and Dr. Oldham is Professor and Executive Vice Chair for Clinical Affairs and Development, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX. Dr. Fowler is also Associate Director of Clinical Research, and Dr. Oldham is also Senior Vice President and Chief of Staff, The Menninger Clinic, Houston, TX. A preliminary poster of this material was presented at the 44th annual meeting of the American Academy of Psychiatry and the Law, October 24-27, 2013, San Diego, CA
| | - Jon G Allen
- Dr. Johnson is a forensic psychiatry fellow at Massachusetts General Hospital/Harvard Medical School in Boston, MA. Dr. Sikes is the Medical Director, Cypress Creek Hospital, Houston, TX. Dr. Allen is Professor of Psychiatry and Helen Malsin Palley Chair in Mental Health Research, Dr. Fowler is Associate Professor, and Dr. Oldham is Professor and Executive Vice Chair for Clinical Affairs and Development, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX. Dr. Fowler is also Associate Director of Clinical Research, and Dr. Oldham is also Senior Vice President and Chief of Staff, The Menninger Clinic, Houston, TX. A preliminary poster of this material was presented at the 44th annual meeting of the American Academy of Psychiatry and the Law, October 24-27, 2013, San Diego, CA
| | - John M Oldham
- Dr. Johnson is a forensic psychiatry fellow at Massachusetts General Hospital/Harvard Medical School in Boston, MA. Dr. Sikes is the Medical Director, Cypress Creek Hospital, Houston, TX. Dr. Allen is Professor of Psychiatry and Helen Malsin Palley Chair in Mental Health Research, Dr. Fowler is Associate Professor, and Dr. Oldham is Professor and Executive Vice Chair for Clinical Affairs and Development, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX. Dr. Fowler is also Associate Director of Clinical Research, and Dr. Oldham is also Senior Vice President and Chief of Staff, The Menninger Clinic, Houston, TX. A preliminary poster of this material was presented at the 44th annual meeting of the American Academy of Psychiatry and the Law, October 24-27, 2013, San Diego, CA
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Schencker L. Counseling impaired docs. Help programs may need retooling as hospitals expand physician employment. Mod Healthc 2015; 45:14-17. [PMID: 26638409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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27
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Wilkins T. A Family Physician Confronts Parkinson Disease. Am Fam Physician 2015; 92:568. [PMID: 26447438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Tavormina MGM, Tavormina R, Nemoianni E, Tavormina G. A questionnaire to assess social stigma. Psychiatr Danub 2015; 27 Suppl 1:S328-S331. [PMID: 26417789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Psychiatric patients often suffer for two reasons: due to the illness and due to the social stigma of mental illness, that increases the uneasiness and psychic pain of the person suffering from serious psychiatric disorder. This unwell person is often the object of stigma because he is "different" from others, and he also can be margenalised by society. In this study we intend to assess whether these margenalising attitudes might be also present among mental health professionals who have presented psychic problems in a previous period of their life, against sick persons suffering of the same illness even if he is a mental health professional. Two questionnaires have been developed, one for professionals and another for the patients, with the aim of identifying these marginalising attitudes. We intend that this study shall be a multicenter, observational and international study, promoted by the Mental Health Dept. of Naples (ASL Naples 3 South, Italy).
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Beran RG. Author reply: To PMID 25442756. Intern Med J 2015; 45:467. [PMID: 25827520 DOI: 10.1111/imj.12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 02/09/2015] [Indexed: 02/05/2023]
Affiliation(s)
- R G Beran
- School of Medicine, Griffith University, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia; Strategic Health Evaluators, Sydney, New South Wales, Australia
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Abstract
Studies suggest that medical students and physicians have higher rates of anxiety, depression, and suicidal ideation than their peers in the general population. Some authors have suggested that medical culture perpetuates these problems by erecting "barriers to treatment," preventing students and physicians from getting the help they need. Here, the author begins a broader examination of the potential role of culture by examining the myths and symbols that form the basis for medical culture and the medical self-image. The author argues that a medical self-image based on a de-contextualized medical mythology, the Asclepius myth, results in a sense of professional identity that is unbalanced, dehumanized, and characterized by unattainable expectations. The outward expression of this medical self-image, the medical culture, is often a-relational, unhealthy, stressed, or even toxic. The author suggests some ways of re-modeling medical culture, including its rituals and symbols, and medical education in ways that incorporate what is currently kept in its shadow.
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Affiliation(s)
- Jill C Thomas
- Department of Psychiatry, State University of New York Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA,
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Abstract
Mandatory reporting of impaired doctors is compulsory in Australasia. Australian Health Practitioner Regulation Agency guidelines for notification claim high benchmark though the Royal Australasian College of Surgeons and the Royal Australasian College of Physicians suggest they still obstruct doctors seeking help. Western Australia excludes mandatory reporting of practitioner-patients. This study examines reporting, consequences and international experiences with notification. Depressed doctors avoid diagnosis and treatment, fearing consequences, yet are more prone to marital problems, substance dependence and needing psychotherapy. South African research confirms isolation of impaired doctors and delayed seeking help with definable characteristics of those at risk. New Zealand data acknowledge: errors occur; questionable contribution from mandatory reporting; issues concerning competence assessment; favouring reporting to senior colleagues or self-intervention to compliance with mandatory reporting. UK found an anaesthetist guilty of professional misconduct for not reporting and sanctioned doctors regarding Harold Shipman. Australians are reluctant to report, fearing legalistic intrusion into care. Australian research confirmed definable characteristics for doctors with psychiatric illness or alcohol abuse. Exposure to legal medicine evokes personal disenchantment for doctors involved. Medicine poses barriers for impaired doctors. Spanish and UK doctors do not use general practitioners and may have suboptimal care. US and European doctors self-medicate using samples. US drug-dependent doctors also prescribe for spouses. Junior doctors are losing empathy with the profession. UK doctors favour private care, avoiding public scrutiny. NZ and Brazil created specific services for doctors, which appear effective. Mandatory reporting may be counterproductive requiring reappraisal.
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Affiliation(s)
- R G Beran
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia; University of New South Wales, Sydney, New South Wales, Australia; Strategic Health Evaluators, Sydney, New South Wales, Australia
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Shimp W. Reluctant reflections. An oncologist's take on how physician and patient burnout might be prevented. Minn Med 2014; 97:32-34. [PMID: 25651651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Boyd K. When a physician is afflicted with addiction. R I Med J (2013) 2014; 97:14-15. [PMID: 25271653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Kathleen Boyd
- Director of the Rhode Island Medical Society's Physician Health Program
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35
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Cohen A. [A psychiatrist on the "other side of the fence"]. Soins Psychiatr 2014:6. [PMID: 25335212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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36
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Beneker C. [A physician conquers burnout and addiction]. MMW Fortschr Med 2014; 156:8-9. [PMID: 25318206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Harbin T, Baum N. Impaired physicians. J Med Pract Manage 2014; 29:304-306. [PMID: 24873127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Nearly every physician has encountered a doctor who is causing problems in the practice or at the hospital. These include physicians who are impaired because of drug or alcohol abuse. Managing these physicians and helping them get back on track can be difficult and daunting. This article will discuss impaired physicians with suggestions for interacting with them and helping them become valuable members of the team.
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Kusy M, Holloway EL. A field guide to real-time culture change: just "rolling out" a training program won't cut it. J Med Pract Manage 2014; 29:294-303. [PMID: 24873126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Presented as a representative case of how to handle the disruptive behaviors of professionals in healthcare, this article describes the strategies of a systems approach with a five-phase model for culture change. The "large-scale, real-time" culture change process, based on our own evidence-based research on toxic behaviors and the research of others, has been demonstrated to be more effective than one-on-one feedback to change these behaviors. The real-time approach has been applied to other organizational situations--strategy formulation, change management, or service improvement--with more sustainable effects than simply training alone. This article will help your organization with four outcomes: understanding the rationale for a five-phase model for cultural change, describing the advantages of a real-time versus nonreal-time approach to change, identifying the how-to's for application within a systems approach, and articulating a clear evaluation process to sustain successful organizational culture change.
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Bernadino M. Honorary M.D. Minn Med 2013; 96:30-32. [PMID: 24494358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Haddad T. Cognitive assessment in the practice of medicine--dealing with the aging physician. Physician Exec 2013; 39:14-20. [PMID: 23923707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Wilmot C. Reflections on palliative care. J Cancer Educ 2013; 28:392-393. [PMID: 23681771 DOI: 10.1007/s13187-013-0480-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Clare Wilmot
- North Country Home Health and Hospice Agency, 536, Cottage St, Littleton, NH, 03561, USA.
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[Physician colleague, how are you dealing with your illness? (interview by Dr. med. Bernhard Mäulen)]. MMW Fortschr Med 2013; 155:6-7. [PMID: 24437115 DOI: 10.1007/s15006-013-0605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Affiliation(s)
- James W Jones
- The Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77356, USA.
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Brady WH, Lawson A, Baldwin W. Physician wellness committee: friend or foe? Physician Exec 2013; 39:38-42. [PMID: 23621065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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47
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Boden TW. Feeling powerless? J Med Pract Manage 2013; 28:257-259. [PMID: 23547504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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48
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Rode H, de Rond M, Dam I. [Addicted colleagues: a blind spot amongst physicians?]. Ned Tijdschr Geneeskd 2013; 157:A5718. [PMID: 23739599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Physician impairment due to substance abuse or dependence is at least as prevalent as amongst non-physicians and is a real challenge. Not only for the impaired physicians themselves, but also for their colleagues, family members and patients. A 68-year-old physician describes her experiences of being an alcoholic as well as a patient with concomitant psychiatric disorders, including the hurdles she had to get over to deal with her disease and remain abstinent. Although colleagues knew what was going on, some of them took no action. The initial treatment by her general practitioner proved compromised. Addressing addiction amongst fellow physicians can be challenging and for this reason the Royal Dutch Medical Association (KNMG) has started the ABS Programme. On prompt and adequate intervention, treatment in specialised facilities has proved to be highly and durably effective. Addicted physicians who have been successfully treated should be monitored and supported, thus enabling their safe return to practice.
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Affiliation(s)
- Hans Rode
- Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst, Utrecht, the Netherlands.
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Maclean L, Reiss D, Whyte S, Christopherson S, Petch E, Penny C. Psychiatrists' experiences of being stalked: a qualitative analysis. J Am Acad Psychiatry Law 2013; 41:193-199. [PMID: 23771932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Stalking is a well-recognized social phenomenon, one that particularly affects health care professionals, especially psychiatrists and other mental health workers; however, the nature and effects of stalking of psychiatrists have not been examined in detail. This study is a qualitative thematic analysis of the free-text responses of 2,585 psychiatrists in the United Kingdom (approximately 25% of all U.K. psychiatrists), almost 11 percent of whom described being stalked according to a strict research definition, and 21 percent of whom perceived themselves as having been stalked. It demonstrates that threat minimization, negative psychological impact, awareness of vulnerability, and difficulty obtaining help were major themes in how psychiatrists viewed their experiences of being stalked. It shows how some psychiatrists coped better than others and makes suggestions for appropriate professional support.
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Affiliation(s)
- Louise Maclean
- Three Bridges Regional Secure Unit, Uxbridge Road, Southall, UK.
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Abstract
Over the course of the last century, physicians have written a number of articles about suicide among their own. These articles reveal how physicians have fundamentally conceived of themselves, how they have addressed vulnerability among their own, and how their self-identification has changed over time, due, in part, to larger historical changes in the profession, psychiatry, and suicidology. The suicidal physician of the Golden Age (1900-1970), an expendable deviant, represents the antithesis of that era's image of strength and invincibility. In contrast, the suicidal physician of the modern era (1970 onwards), a vulnerable human being deserving of support, reflects that era's frustration with bearing these unattainable ideals and its growing emphasis on physician health and well-being. Despite this key transition, specifically the acknowledgment of physicians' limitations, more recent articles about physician suicide indicate that Golden Age values have endured. These persistent emphases on perfection and discomfort with vulnerability have hindered a comprehensive consideration of physician suicide, despite one hundred years of dialogue in the medical literature.
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Affiliation(s)
- Rupinder K Legha
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA.
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