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African Health Sciences
Makerere University Medical School
ISSN: 1680-6905 EISSN: 1729-0503
Vol. 8, Num. 1, 2008, pp. 6-7
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African Health Sciences, Vol. 8, No. 1, March, 2008, pp. 6-7
An overview of stress in medical practice
OB Familoni
Department of Medicine, Olabisi Onabanjo University Teaching Hospital, PMB 2001, Sagamu, Nigeria
Address for correspondence: Secretariat, Ibadan, Nigeria, Po Box 29800, E-mail: rfamiloni@justice.com
Code Number: hs08003
Stress can be generally defined as undue,
inappropriate or exaggerated response to a situation. Whereas
anxiety about a situation could be positive, stress is always
negative with attending adverse psychological and
physiological changes leading to decreased productivity, disease
and sometimes death 4.
Stress in medical practice has always been a
topical issue1. This is partly because medical service
involves taking care of other peoples' lives and mistakes or
errors could be costly and sometimes irreversible. It is
thus expected that the medical doctor himself must be in
a perfect state of mind devoid of morbid worries
and anxieties. This is however not usually the case,
because the doctor apart from being affected by the same
variables that impose stress on the general population, is
also prone to stress because of the peculiarities of his
work situation and the expectation of the society at large.
The British Medical Association (BMA) published a
treatise on stress in junior doctors5 and later in senior
doctors6. The conclusions were similar, to the effect that
stress existed to a significant proportion in both groups and
that it is inimical to the doctors' health and service delivery
to patients. The magnitude of the problem was
further emphasized in the report of the American Foundation
for Suicide Prevention7 which claimed that on the
average, death by suicide is about 70% more likely among
male physicians than among other professionals and
250-400% higher among female doctors. The major cause being
stress and depression thereof.
Specific stressors include Peer pressure-
within the profession and across professions.
Social expectation- The doctor is still perceived as a
very comfortable person in our society and expectations
are usually high financially and otherwise. Failure or
inability to `meet up' may constitute a significant stress factor
in some physicians.
Training-at both the undergraduate
and postgraduate levels are long and tedious. Getting into
the few medical schools is like passing through the
proverbial eye of the needle, yet the remunerations and the social acceptability and recognition are not commensurate.
Hostile Job Environment-
Administrative ineptitude and bureaucratic bottlenecks can make
the job situation very frustrating. Inadequate
infrastructure, unavailable and obsolete equipments make the long
years and fortune spent in training at home and abroad a
waste. Unsecured future, delays in promotion and
inappropriate capacity utilization are some of the causes of
unfulfilment and stress in the job place. Long working hours
was specifically identified in the BMA report. This could
be compounded in our environment by denied and `monetized' holidays, sometimes because of
manpower shortages and/or poverty. Inadequate personal
training and retraining, and lack of continuous education
can lead to loss of self esteem and frustration in our
profession where changes and development go on at jet
speed. Fear of mistakes and litigations are becoming
increasingly important.
Early individual behavioral reactions
may include onset or increased smoking and alcohol
use. Individuals may tend to keep late nights in
clinics/offices without accompanying increased productivity.
While others might become irritable, some will tend to
intense seclusion and individualism. There may be
intense religiosity without adequate spiritual content. There
may be a tendency to unstable jobs. Anti- social behavior
like extra-marital affair is not uncommon. In
developed economies, the risk of suicide is real.
The `burnt out phenomenon', a
terminology made popular by Felton (11) consists of a triad
of emotional exhaustion, depersonalization (treating
patients and other people as if they were objects) and
low productivity/achievements. It is particularly
common in health professionals under stress. These
invariably lead to `impairment of health, grief and suffering'.
It compromises the quality of care which may lead
to litigation and a vicious cycle. In some cases it may lead
to premature retirement due to physical and/or
mental health. Premature death, even by suicide is a
distinct possibility.
In view of the deleterious effects
of uncontrolled stress on the physician, the patient and
the public at large, definite steps are required to stem
this tide and proffer solutions.
There is need to control excess workload particularly in the junior doctor cadre. This point
was particularly noted in the BMA report.
Holidays are refreshing and should be taken at least
once a year. The tendency to `monetize' holidays or pick up
a locum job during holiday period should be discouraged.
The medical curriculum, particularly
in developing countries should be strengthened with
courses such as administration and financial
management. Investments in shares and bonds should be
encouraged early in the professional careers of doctors.
Diversification of resources into money- yielding ventures
should not be viewed as phillistinic attitude but part of
planning for old age and retirement. Health and life
insurance policies are still not popular with some of our
colleagues and they should be encouraged. Some
doctors particularly those in private medical practice still
practice without professional indemnity policies! This is
dangerous and counterproductive.
Our hospitals and clinics need to be more job-friendly. The various authorities have a responsibility
to provide the minimum implements required to
perform our duties.
References
- British Medical Association. The Morbidity and
Mortality of the Medical Profession- A literature review and
suggestions for future research. London BMA 1993
- Richards C The Health of Doctors. London. The
Kings Fund 1989
- Health Policy and Economic Research Unit. Work
related stress among junior doctors. London BMA 1998
- British Medical Association. Work related stress among
senior doctors- review of research. London BMA 2000
- American Foundation for Suicide Prevention (AFSP)
New York 2004
- Felton J Burnt Out as a clinical entity -its importance
in health care workers. Occup Med 1998; 48: 237-250
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