Arrogance among physicians.

Arrogance among physicians is, regrettably, common and violates the benevolent spirit of medicine-its very soul -as well the quality of medical care. The need for humility in the physician warrants greater emphasis in medical training, both in the classroom and, more critically, by example. Arrogance persists because of intersecting and mutually enhancing sociologic and psychological pressures. Regarding the sociologic elements, in earlier times, the great respect and prestige accorded physicians could foster arrogance in some. Today, physicians as a group are less likely to be idealized, but the health care system has depersonalized the doctor-patient relationship and created a kind of "system arrogance" in which the patient is seen not as a person but merely as a job to be done cost-effectively. As for psychological aspects, physicians are sometimes drawn to medicine by their unconscious concerns about illness and mortality-they become health experts in the hope of extending their own lives. Such physicians treat death as the enemy, and may practice unwarranted heroic measures. But the most critical variable in the development of arrogance is a physician's knowledge and thereby his or her power over the patient. This can delude some physicians into imagining that they are all-powerful. Seriously ill or injured patients tend to view the physician as an omnipotent parent and savior, and in this way unwittingly tempt physicians to be arrogant. The author concludes by reminding his fellow physicians that "we should not exaggerate our own importance. we are but an instrument of healing and not its source."     

Distress and burnout among genetic service providers

PurposeTo determine the nature, sources, prevalence, and consequences of distress and burnout among genetics professionals.MethodsMailed survey of randomly selected clinical geneticists (MDs), genetic counselors, and genetic nurses.ResultsTwo hundred and fourteen providers completed the survey (55% response rate). Eight discrete sources of distress were identified forming a valid 28-item scale (α = 0.89). The greatest sources of distress were compassion stress, the burden of professional responsibility, negative patient regard, and concerns about informational bias. Genetic counselors were significantly more likely to experience personal values conflicts, burden of professional responsibility, and concerns about informational bias than MDs or nurses. Burnout scores were lower among those practicing more than 20 years and nurses. Distress scores were positively correlated with burnout and professional dissatisfaction (P < 0.0001). Eighteen percent of respondents think about leaving patient care, and burnout was the most significant predictor. Predictors of burnout included greater distress, fewer years in practice, working in university-based settings, being a genetic counselor or an MD, and deriving less meaning from patient care.ConclusionsGenetic service providers experience various types of distress that may be risk factors for burnout and professional dissatisfaction. Interventions to reduce distress and burnout are needed for both trainees and practitioners.     

Emotion work and burnout: cross-sectional study of nurses and physicians in Hungary

Aim

To investigate predictors of occupational burnout, such as emotion work, among health care workers and compare the frequencies of burnout and emotion work in nurses and physicians.

Method

A cross-sectional survey was conducted in 2007 and 2008 among 80 physicians and 76 nurses working in a variety of health care settings in Hungary. The survey contained sociodemographic questions and work- and health-related questions from, respectively, the Maslach Burnout Inventory-Human Services Survey and the Hungarian version of the Frankfurt Emotion Work Scale. To identify the dimensions of emotion work associated with burnout, linear regression analyses were carried out. To analyze differences in burnout and emotion work between nurses and physicians, independent t tests were used.

Results

Nurses reported significantly higher emotional dissonance and fewer regulation possibilities, such as interaction and emotion control, than physicians. However, no differences were found in the level or frequency of burnout. Nurses had fewer regulation requirements regarding sensitivity and sympathy. Linear regression analyses showed that emotional dissonance for emotional exhaustion (β = 0.401) and display of negative emotions for depersonalization (β = 0.332) were the strongest predictors of burnout.

Conclusion

The factors that should be taken into account when developing prevention and intervention programs differ for nurses and physicians. In nurses, the focus should be on stressors and emotional dissonance, while in physicians it should be on work requirements and display and regulation of negative emotions.During the last decade, the topic of emotion work has gained a much greater significance in organizational and health psychology. As defined by Zapf et al, emotion work occurs when employees are required by the employer to regulate their emotions in order to display appropriate emotions to the client (1). Emotion work determines the quality of social interaction between the caregiver and client. Action theory distinguishes 3 aspects of emotion work requirements: regulation requirements, regulation possibilities, and regulation problems. Regulation requirements (display of emotions) are related to properties of the hierarchical-sequential organization of action and constitute the complexity of decision. Regulation possibilities refer to the concept of control. Regulation problems, also known as emotional dissonance, are the discord between felt and expressed emotions and occur when stressors disturb the regulation of action (1,2). Current burnout research is greatly facilitated by theories explaining work stress (3-6). Using Karasek’s job demands control model, the research group of LeBlanc and DeJonge investigated emotional job demands (3-5). It was also found that health care workers are at high risk for emotional exhaustion resulting from interaction with clients (6,7).Burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment occurring in people-oriented and service work (8). Emotional exhaustion refers to feelings of being depleted of one’s emotional resources. Depersonalization is a negative and cynical attitude and behavior toward clients. Reduced personal accomplishment is the self-perception of a decline in one’s own competence and self-efficacy. Burnout has most often been studied in caregiving professionals, such as clinicians, psychologists, social workers, and nurses (9-17). Indeed, several studies have directly measured the emotional aspects of job demands dealing either with emotion work (18-20) or burnout (21-24). However, few studies investigating the relationship between burnout and emotion work have been conducted in the nursing and health care profession, particularly in Hungary and Eastern Europe (25). The differences in burnout and emotion work between nurses and physicians have been studied in the Netherlands, Germany, and Spain (3-5,14,26). Some studies have suggested that physicians experience more burnout than nurses (14,16), while others have suggested the opposite (17).Recently, burnout has been conceptualized as a psychological syndrome that takes place in response to chronic interpersonal stressors on the job (6). According to Zapf, burnout makes individuals no longer able to adequately manage their emotions while interacting with clients (27). According to the model of emotion work by Grandey (28), antecedents of emotion regulation are the situational variables, eg, interaction between the caregiver and client.A relationship between burnout and emotion work has recently been found in the health care setting in Western European countries (3,4,29-31). Health care professionals, especially nurses, are at high risk of burnout because their job requires a high level of emotion work (18-20,32,33). Most studies have found a positive relationship between emotion work and burnout, suggesting that emotional dissonance may predict emotional exhaustion and depersonalization (25,34). Demerouti (35) argues that contribution of job demands and resources to explaining burnout may vary across occupations because these features differ across occupations. Burnout literature usually focuses on general variables that predict burnout and does not distinguish between predictors across health professions (6,8). Thus, we hypothesized that differences in emotion work can be detected between nurses and physicians, although the predictors of the syndrome do not vary.This study assesses the relationships between burnout and emotion work in a sample of Hungarian health care professionals and investigates how emotional job demands relate to the frequency of burnout.     

Erasmian influences among renaissance physicians

The fundamental aspects of Erasmus's ethic humanism consisted of ideals of universal peace and tolerance. These ideals are exposed in the great works of his maturity Colloquia and Adagia read and meditated on by renaissance physicians in England, Spain, Germany, Italy, and also in the New Spain. Erasmus's readers were learned and numerous. Among his pupils and supporters in Spain were humanist physicians of Madrid such as Doctors Suárez and Juan de Jarava. Other supporters were in the group of the Sevillian physicians and naturalists. Among the Erasmist physicians, residing in other regions was doctor Andrés Laguna, who translated into Spanish the Dioscorides treatise on medical botany. Many physicians living in New Spain owned copies of Erasmian works, such as Doctors Pedro López (the second) and Juan de la Fuente, who was in charge of the first medical chair at the University of Mexico. The protophysician Francisco Hernández, in response to a petition of Archbishop Pedro Moya de Contreras, wrote a Christian catechism of Erasmian influence, destined for humanists in NewSpain. As asserted by Johan Huizinga, Erasmus was the sole humanist who really wrote for everyone, i.e. for all cultured people.     

Personality traits, psychological adjustment, and burnout syndrome in nursing staff

The nursing staff is prone to develop Burnout because of the work environment and the stressful situations that develop among patients and their families. Burnout syndrome it's a persistent negative mental state, work related and present in non pathologic populations. Burnout has been associated to personality traits but the findings are too heterogeneous and do not allow plausible generalizations. To identify the relation between Burnout, Personality Traits and Psychological Adjustment, questionnaires were applied to 117 subjects, all members of the nursing staff from a University Hospital in Maracaibo, Venezuela. Traits in Burnout subjects were: sensibility to criticism, lack of confidence, poor social capacity and low Psychological Adjustment. The non-Burnout subjects presented traits of optimism, reality in the way they viewed events, proper social abilities and high Psychological Adjustment. Burnout Syndrome is not a personality type and the traits associated with this syndrome seems to be associated with Psychological Adjustment.     

Personality dysfunction among somatizing patients

To examine the nature and extent of personality dysfunction related to somatization, the authors administered the Structured Interview for DSM-IV Personality and the NEO Five-Factor Inventory to a series of somatizing and nonsomatizing patients in a general medicine clinic. A greater percentage of somatizers met criteria for one or more DSM-IV personality disorders, especially obsessive-compulsive disorder, than did control patients. Somatizers also differed from control patients with respect to self-defeating, depressive, and negativistic personality traits and scored higher on the dimension of neuroticism and lower on the dimension of agreeableness. In addition, initial and facultative somatizers showed more personality pathology than true somatizers. These findings suggest that certain personality disorders and traits contribute to somatization by way of increased symptom reporting and care-seeking behavior.     

Sexual history-taking among primary care physicians

BACKGROUND: Because many people seek sexual healthcare in settings where they seek primary healthcare, the extent to which primary care physicians take sexual histories is important. We surveyed Atlanta-area primary care physicians to estimate the extent to which they take sexual histories as well as the components of those histories and the circumstances under which they are taken. METHODS: Four-hundred-sixteen physicians in four specialties (obstetrics/gynecology, internal medicine, general/family practice, pediatrics) responded to a mail survey conducted during 2003-2004. Respondents answered whether they asked about sexual activity at all, including specific components of a comprehensive sexual history such as sexual as sexual orientation, numbers of partners and types of sexual activity, during routine exams, initial exams, complaint-based visits or never. Respondents also reported their opinions on whether they felt trained and comfortable taking sexual histories. RESULTS: Respondents (51% male, 58% white) saw an average of 94 patients per week. A majority (56%) felt adequately trained, while 79% felt comfortable taking sexual histories. Almost three in five (58%) asked about sexual activity at a routine visit, but much smaller proportions (12-34%) asked about the components of a sexual history. However, 76% of physicians reported asking about sexual history (61-75% for various components) if they felt it would be relevant to the chief complaint. CONCLUSIONS: Most physicians report feeling comfortable taking sexual histories and will do so if the patient's apparent complaint is related to sexual health. But sexual histories as part of routine and preventive healthcare are less common, and many physicians miss essential components of a comprehensive sexual history. Structural changes and suggestions for training to enhance sexual history-taking are discussed.     

Collective bargaining and strikes among physicians

Unlike employees in other sectors of the economy, health care workers are directed toward one ultimate goal: making people well and keeping them healthy. The development of collective bargaining and union activities during this century has had a great impact on all industries in the United States and the western world. However, only in recent years have workers in the health care sector been affected by the organized labor movement. The history of collective bargaining and strikes among physicians, the key decision-makers in the health care sector, is even more recent. Because of their central position, physicians'' collective activity has had and will continue to have tremendous implications for the viability of the present health care system and the quality of patient care. Even though most physicians continue to function as individual, entrepreneurial service providers and “professionals,” physicians as a group are more frequently being seen as members of a utility like industry. Their importance to individuals and society as a whole, it can be argued, is second to none; if physicians refuse to work there can be no worse set of outcomes. To estimate the potential future impact of growing collective action on the part of physicians, this article explores the general historical developments.     

Continuing medical education and burnout among Danish GPs.

BACKGROUND: There has been minimal research into continuing medical education (CME) and its association with burnout among GPs. AIM: The aim of this study was to investigate the association between participating in CME and experiencing burnout in a sample of Danish GPs. DESIGN OF STUDY: Cross-sectional questionnaire study. SETTING: All 458 active GPs in 2004, in the County of Aarhus, Denmark were invited to participate. METHOD: Data on CME activities were obtained for all GPs and linked to burnout which was measured using the Maslach Burnout Inventory--Human Services Survey. The relationship between CME activity and burnout was calculated as prevalence ratios (PR) in a generalised linear model. RESULTS: In total, 379 (83.5%) GPs returned the questionnaire. The prevalence of burnout was about 25%, and almost 3% suffered from 'high burnout'. A total of 344 (92.0%) GPs were members of a CME group or a supervision group. Not being a member of either a CME group or a supervision group was statistically significantly associated with doubled likelihood of burnout (PR = 2.2). Among GPs not making use of a practice facilitator, a seven-fold higher likelihood of high burnout was found. CONCLUSION: GPs who were not members of a CME group and did not take part in outreach visits had a higher likelihood of suffering from burnout and high burnout than those who were members of a CME group or received outreach visits. Therefore, not being a member of a CME group could indicate that the GP is more likely to suffer from burnout. Although the present study does not unequivocally establish causality, it would be interesting to see whether staying active in CME may also prevent burnout among GPs.     

Universality of physicians’ burnout syndrome as a result of experiencing difficulty in relationship with patients

The aim of our work is to present the universality of burnout syndrome among physicians worldwide and to demonstrate selected aspects of the relationship between patients and doctors as a common factor predisposing to burnout. We looked up 20 original pieces of research from the Medline database published in the last 10 years to determine the prevalence of burnout among doctors in different countries. In all quoted works a remarkable percentage of doctors of interventional and non-interventional specialties suffered burnout. Because it is the relationship with patients that constitutes a key denominator for their work, in the discussion we have exposed an important aspect of it, destructive patient games, described on the basis of transactional analysis. Since universal burnout causes a deterioration of doctors’ service, for the optimal good of the patient to survive preservation of the doctor''s well-being in the patient-doctor relationship is needed everywhere.     

Personality patterns among correctional officer applicants

The MMPI profiles of 359 correctional officer applicants were cluster analyzed, which resulted in the identification of five relatively homogeneous subgroups. While MMPI performance was not related to later events in the correctional careers of the Ss, certain similarities were noted between the officer group and two samples of inmates previously studied in a comparable fashion. In this respect, although the officers manifested generally lower profile elevations than inmates, configural similarities were noted between the average inmate and officer profiles, and partial overlap was seen between the profile types identified in the two groups. The implications of the findings for occupationally adaptive and maladaptive correctional officer behavior were discussed.     

Personality Antecedents of Burnout among Middle-Aged Physicians

Abstract

Utilizing a prospective design, this study addressed the question of whether vulnerability to burnout among physicians is associated with certain longstanding, maladaptive personality tendencies that predate entrance into medical training and subsequent exposure to the intrinsic stresses of medical practice. Subjects were 440 practicing physicians whose personality traits and psychological adjustment had been assessed with the Minnesota Multiphasic Personality Inventory (MMPI) shortly before entering medical school who were followed up by mail questionnaire an average of 25 years later to evaluate current symptoms of burnout with the Tedium scale. Results revealed that higher burnout scores were significantly correlated with a number of standard and special MMPI scales measuring low self-esteem, feelings of inadequacy, dysphoria and obsessive worry, passivity, social anxiety, and withdrawal from others. In contrast, burnout scores exhibited no significant associations with demographic or practice characteristics, including sex, age, medical specialty, practice arrangement, hours worked per week, or percentage of work time spent in direct contact with patients. Alternative interpretations of these findings and their potential implications for reducing the risk of burnout among physicians are discussed.     

Sources and magnitude of job stress among physicians

Research has suggested that physicians' jobs are more stressful than many other types of work, but sources of job stress for physicians have rarely been measured systematically. Interview data from 204 young physicians (57 women, 147 men) were used to construct four scales of sources of job stress: patient relationships, business/financial issues, time pressures, and competence concerns. The latter is a stronger source of stress for doctors in early practice. Sources and intensity of job stressors do not vary significantly by gender, but medical practice problems are more stressful in nonprofit than in for-profit practices. Early-career doctors appeared to experience only moderate levels of stress, and stressors were not related to impaired mental health.An earlier version of the paper was presented at the 1989 American Sociological Association meeting, San Francisco, CA. The research was supported by a grant from the National Institute of Mental Health to Camille B. Wortman, Linda Grant, and Donald R. Brown entitled Stress and Coping Among Physicians.     

A 35-year follow-up study on burnout among Finnish employees

This three-wave 35-year prospective study used the Job Demands-Resources model and life course epidemiology to examine how life conditions in adolescence (1961-1963) through achieved educational level and working conditions in early adulthood (1985) may be indirectly related to job burnout 35 years later (1998). We used data (N = 511) from the Finnish Healthy Child study (1961-1963) to investigate the hypothesized relationships by employing structural equation modeling analyses. The results supported the hypothesized model in which both socioeconomic status and cognitive ability in adolescence (1961-1963) were positively associated with educational level (measured in 1985), which in turn was related to working conditions in early adulthood (1985). Furthermore, working conditions (1985) were associated with job burnout (1998) 13 years later. Moreover, adult education (1985) and skill variety (1985) mediated the associations between original socioeconomic status and cognitive ability, and burnout over a 35-year time period. The results suggest that socioeconomic, individual, and work-related resources may accumulate over the life course and may protect employees from job burnout.     

Measurement and correlates of empathy among female Japanese physicians

ABSTRACT: BACKGROUND: The measurement of empathy is important in the assessment of physician competence and patient outcomes. The prevailing view is that female physicians have higher empathy scores compared with male physicians. In Japan, the number of female physicians has increased rapidly in the past ten years. In this study, we focused on female Japanese physicians and addressed factors that were associated with their empathic engagement in patient care. METHODS: The Jefferson Scale of Empathy (JSE) was translated into Japanese by using the back-translation procedure, and was administered to 285 female Japanese physicians. We designed this study to examine the psychometrics of the JSE and group differences among female Japanese physicians. RESULTS: The item-total score correlations of the JSE were all positive and statistically significant, ranging from .20 to .54, with a median of .41. The Cronbach's coefficient alpha was .81. Female physicians who were practicing in "people-oriented" specialties obtained a significantly higher mean empathy score than their counterparts in "procedure-" or "technology-oriented" specialties. In addition, physicians who reported living with their parents in an extended family or living close to their parents, scored higher on the JSE than those who were living alone or in a nuclear family. CONCLUSIONS: Our results provide support for the measurement property and reliability of the JSE in a sample of female Japanese physicians. The observed group differences associated with specialties and living arrangement may have implications for sustaining empathy. In addition, recognizing these factors that reinforce physicians' empathy may help physicians to avoid career burnout.