Elsevier

Social Science & Medicine

Volume 52, Issue 2, January 2001, Pages 215-222
Social Science & Medicine

Interventions to improve physicians’ well-being and patient care

https://doi.org/10.1016/S0277-9536(00)00221-5Get rights and content

Abstract

Concerns about the quality of medical care provided by health services appear to be increasing. Deficits in care are frequently found to be associated with stress and with the apparent lack of recognition of psychological problems when they occur in doctors. This paper looks briefly at the levels and sources of stress, depression and alcoholism in doctors, and the relationship of these to the care they provide. It goes on to use the research findings on causation to propose a system of organisational and individual primary and secondary interventions to address these psychological problems. The paper focusses upon a longitudinal study which follows up 314 medical students over 11 years, but also uses other relevant recent literature to discuss the issues that arise.

Section snippets

Psychological problems in doctors

The principal psychological problems experienced by doctors are depression and alcoholism, and there is strong evidence that these exist in greater proportions than with other segments of the working population. There is also a considerable body of evidence that symptoms of general psychological distress are also elevated.

Levels of stress have been assessed in doctors since the mid-1980s with both longitudinal cohorts and cross-sectional studies of particular groups. In general, it has been

The negative effects upon patient care

It is difficult to know accurately just how common poor care and accidents are, and particularly those due to stress, no matter which method of assessment is used. For example, the Harvard Medical Practice Study (HMPS, 1990) found 3.7% of patient records reported unintended injuries to patients which led to “measurable disability” and this is likely to be an underestimate even of those. However, it is likely that many such incidents do not reach the notes. Moreover, beyond these more serious

The causes of impairment

There is a long-standing debate in occupational psychology about the extent to which job stress and employee wellbeing is a result of the disposition of the individual concerned or is caused by the job itself. The fact that health workers as a whole have higher stress levels than other workers might suggest that the work is intrinsically damaging, or may mean that particular types of people are attracted to caring for others, or may be a combination of both.

The doctor

There is evidence that choosing to be a doctor or a health worker in general is at least partly a reflection of your early experience (Elliott & Guy, 1993; Paris & Frank, 1983; Vaillant, Sobowale & McArthur, 1972). Furthermore, there is considerable evidence from longitudinal studies that their early experience also has an effect upon doctors’ well being (Thomas & Duszynski, 1974; Vaillant, Sobowale & McArthur, 1972; Firth-Cozens, 1992; Brewin & Firth-Cozens, 1997).

Although it may seem that

Systems models for considering risk

The size of the problem of medical accidents and the proportion of these which may be due to stress and other psychological disorders, make interventions in this area an increasingly important part of any general system of risk management. The development of such organisational systems models have been described elsewhere; for example, by Reason (1995) who looks at the team and organisational factors, task factors and human factors involved in error, and Vincent, Taylor-Adams, and Stanhope

Conclusions

This paper has reviewed the evidence for high levels of stress, depression and alcohol abuse in doctors and made links to the effects of this on patient care. By reviewing the causes of these elevated rates of disorder, a model has been described which allows us to begin to tackle the causes and symptoms of stress both organisationally and within the individual. The area is such a growing and major concern for the profession, health providers and purchasers, insurance companies and governments

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