Medical-legal concerns among Canadian anaesthetists

This paper reports the results of a national survey of anaesthetists which was undertaken to determine the effect of liability concerns on the practice of anaesthesia. Four hundred seventy-six anaesthetists from four regions (East, Quebec, Ontario and the West) (overall usable response rate of 73.3 per cent) responded to a series of questions on sources of liability information, changes in practice patterns over the past five years, changes in style of practice and attitudes towards the physician-patient relationship and to medical-legal concerns. The major findings were that the respondents rated liability concerns as the first or second most important reason for making major changes in their practice. Some of the changes in practice were related to increased use of monitoring, more time spent with patients discussing the risks of anaesthesia and increased documentation. On the negative side, respondents had decreased the administration of obstetrical and paediatric anaesthesia and were ordering more laboratory tests and x-rays. The majority of respondents agreed that the physician-patient relationship has suffered in recent years and physicians who had been in practice for longer periods of time were more likely to be dissatisfied and to consider leaving the field of medicine. However, the survey could not show a cause-and-effect relationship between claimed practice changes and fear of litigation.     

Acute and chronic stress in cardiothoracic anaesthetists

A distinction is made between acute and chronic stress in the workplace. The distinction leads on to two types of question: (1) How does the one relate to the other? (2) Is it possible to distinguish between acute and chronic stress physiologically? Preliminary attempts to tackle the latter question are reported. The subjects were anaesthetists on a cardiothoracic unit and the physiological measures taken were urinary cortisol and salivary flowrate. Perceived stress and arousal were monitored using self-report techniques. Among the results obtained were the following:

• 1 Self-reported arousal was higher in the morning than the afternoon.
• 2 The level of arousal was associated with salivary flow, flow being weaker when arousal was higher and vice versa.
• 3 Self-reports of stress were associated with higher than average urinary cortisol levels.
• 4 The mean level of urinary cortisol over 24 hours was significantly higher for the group than that found in the general population.

     

Gender issues among South African anaesthetists.

OBJECTIVE: To study gender issues among South African anaesthetists. SUBJECTS AND DESIGN: A postal survey of all registered anaesthetists in South Africa in December 1999. RESULTS: There were 385 respondents out of a potential 960, giving a response rate of 40%; 77 respondents (20%) were female and 308 (80%) were male. The largest group of males was over 50 years old whereas most females were under 50 years. Most respondents chose anaesthesia because of academic appeal or career opportunities. More females reported experiencing sexual harassment and felt discriminated against in terms of job selection during the training period and with regard to referral practices. Most respondents felt that their colleagues did not treat them differently on account of gender but more females felt that both patients and female nurses treated them less favourably than their male colleagues. More males felt supported in their career by their life partners. More females felt that having children adversely affected academic and promotional aspects of their careers. Despite this, females were more likely to have experienced positive benefits from combining parenting with a career and were also more likely to have worked part time, mainly because of domestic commitments. Most respondents were satisfied with their careers, and would choose both medicine and anaesthesia again. CONCLUSIONS: Our study suggests that female anaesthetists are generally satisfied with their career choice. However, they are exposed to significant gender-related stresses in the workplace, which are exacerbated by time conflicts for those with children. Allowing part-time employment options and creating a less discriminating environment would enable female doctors to achieve their potential.     

Suicidality among Finnish anaesthesiologists

Background: Suicide rates among physicians have constantly been reported to be higher than in the general population and anaesthesiologists appear to lead the suicide statistics among physicians.
Methods: A cross-sectional questionnaire study was sent to all working Finnish anaesthesiologists ( n =550) investigating their suicidality (ideation and/or planning and/or attempt). The response rate was 60%.
Results: One in four had at some time seriously been thinking about suicide. Respondents with poor health (crude odds ratios 11.2 and 95% confidence interval 3.8–33.0), low social support (10.5, 4.0–27.9), and family problems (6.5, 3.4–12.5) had the highest risk of suicidality. The highest risks at work were conflicts with co-workers (4.1, 2.3–7.1) and superiors (2.1, 1.2–3.6), on-call-related stress symptoms (3.9, 1.9–8.3) and low organizational justice (1.9, 1.1–3.2). If a respondent had several risk factors, the risk of suicidality doubled with each cumulating factor.
Conclusions: The reported level of suicidal ideation among Finnish anaesthesiologists is worth concern. It should be of utmost importance to screen the risk factors and recognize suicidal physicians in order to help them. Interpersonal relationships, decision-making procedures, and on-call-burden should be focused on when aiming to prevent suicidality among physicians.     

Fibreoptic intubation skills among anaesthetists in New Zealand

The aim of this study was to investigate methods of practice, assess skill level, and evaluate attitudes towards fibreoptic intubation in the anaesthetic community of New Zealand. A postal survey questionnaire was sent to all vocationally registered anaesthetists in New Zealand and to all New Zealand anaesthetic trainees registered with the Australian and New Zealand College of Anaesthetists. There were 611 survey questionnaires posted and 386 (63%) respondents. Almost all respondents (98% of specialists, 100% of trainees) had access to fibreoptic equipment in public and 92% of respondents performed fibreoptic intubation. The median number of fibreoptic intubations performed per year was 3 for consultants and 4 for trainees. Respondents were either self taught or colleague taught (82%). Most learnt the technique on patients (92%). There were 14% who considered themselves experienced, 30% competent, 34% adequate and 20% novice. Skills were maintained by clinical patient mix in 73%. Fibreoptic intubation was considered a skill required by all anaesthetists in 87%, and 66% considered it the gold standard for expected difficult airways. Lack of clinical cases requiring the skill and lack of practice were identified as the primary barriers to skill development. Consultants had greater opportunity to learn fibreoptic intubation skills during daily practice than trainees. Only 18% of trainees had a formal airway management program available to them at their place of work. There appears to be a need to increase available opportunities to perform fibreoptic intubation to enable maintenance and improvement of fibreoptic skills in our community. A formalized program of teaching fibreoptic intubation may offer greater opportunity for learning and skill development.     

Morbidity and early retirement among anaesthetists and other specialists

An historically prospective study of the rates of early retirement due to permanent ill health, early retirement between 60 and 64 years of age for other reasons, and deaths while in post, among consultant anaesthetists in England was carried out. The control group comprised consultants in four other hospital specialty groups. Approximately two-thirds of all consultants employed in the five specialties at National Health Service hospitals in England during 1966-83 were included in the study. Ill-health retirements among male anaesthetists were more than twice those expected on the basis of rates in the control group (p less than 0.001). The number of other early retirements between 60 and 64 was a third higher than expected (p less than 0.005). The number of deaths in post was also raised. For the smaller group of female anaesthetists there was not a statistically significant excess of ill-health retirements, but the number of early retirements between 60 and 64 was significantly greater than expected (p less than 0.005), as was the number of deaths in post (p less than 0.001). Possible causes of these excesses are discussed.     

Job satisfaction,stress and burnout in Australian specialist anaesthetists

A postal survey was sent to specialist anaesthetists in Australia looking at aspects of job satisfaction, dissatisfaction and stress. Burnout was measured using the Maslach Burnout Inventory. The response rate was 60% (422/700) with the majority of respondents being male (83%). Stressful aspects of anaesthesia included time constraints and interference with home life. Experienced assistants and improved work organisation helped to reduce stress. The high standard of practice and practical aspects of the job were deemed satisfying, whereas poor recognition and long hours were the major dissatisfying aspects of the job. With respect to burnout, high emotional exhaustion, high levels of depersonalisation and low levels of personal achievement were seen in 20, 20 and 36% of respondents, respectively. Female anaesthetists reported higher stress levels than males (p = 0.006), but tended to prioritise home/work commitments better than males (p = 0.05). Private practitioners rated time issues of high importance compared with public hospital doctors, whereas public hospital doctors rated communication problems as being more significant than with private specialists. Although burnout levels are high in anaesthetists, they compare favourably with other medical groups. There are, however, aspects of the anaesthetist's job that warrant further attention to improve job satisfaction and stress.     

Difficult airway management patterns among attending anaesthetists practising in Israel

BACKGROUND AND OBJECTIVE: In recent years, a large number of airway devices have been introduced into clinical practice as adjuncts to the management of the difficult airway. The purpose of this study was to evaluate the practices of Israeli anaesthetists in specific clinical situations and their familiarity with the use of a variety of airway devices and techniques. METHODS: A survey developed in our institution was sent to 300 attending anaesthetists representing all board-certified anaesthetists practising in Israel. RESULTS: Of the 153 respondents, 75% belonged to university hospitals. Ninety-six percent were skilled with laryngeal mask airways and 73% with fibreoptics. Seventy percent preferred regional anaesthesia with anticipated difficult intubation, continuation of anaesthesia with a laryngeal mask with failed intubation and a laryngeal mask for impossible mask ventilation. For the airway scenarios, awake fibreoptic, awake direct laryngoscopy, intubation under inhalation anaesthesia and tracheostomy were shared equally. CONCLUSIONS: There is a high degree of adherence by Israeli anaesthetists to the American Society of Anesthesiologists' difficult airway algorithm. Current airway management practice patterns in Israel are presented.     

Addicted anaesthetists

Drug dependence of anaesthetists occurs more often than in other physicians, especially the noxious usage of common substances in anaesthesiology and pain management like opioids and anaesthetics. Opioids are the most frequent abusively taken medication followed by benzodiazepines, illegal drugs, Propofol and Ketamine. Determining for the behavioral pattern is the easy access to the drugs. Especially as some of the addictive-drugs (e. g. Propofol, Ketamine) are not underlying any release-control. Recent German surveys confirm the American figures. For the development of drug dependence many factors like biographic, social and genetic aspects as well as the substances and their potential itself are significant. Furthermore, the presence of many stimuli encourages the relapse-risk for addicted people despite earlier abstinence. At least 16% of all cases and 37% of the Propofol-addiction cases proceed deadly. American studies with structured therapy-, rehabilitation- and follow-up surveillance-programs show a positive prognosis for anaesthetists. In Germany it requires rethinking and the establishment of comparable therapy-offers and facilities.