Finnish Physicians Research Articles

Content validity of the questionnaire considering opinions of the Finnish physicians on euthanasia and assisted suicide

Despite numerous surveys conducted across the world considering assisted death, content validity evaluations of the survey questionnaires are seldom published. Likewise, there is no previous research about the content validity of the survey “Finnish physicians´ attitudes and opinions on euthanasia and physician-assisted suicide” conducted by the Finnish Medical Association. The aim of this study was to assess the content validity of the survey questionnaire. To study this, a purposive sample of physicians was recruited. Firstly, the participants were interviewed to bring up their interpretations and assessments considering the relevance, comprehensibility, and measurement scale suitability of the questions. Secondly, the participants assessed the revised study questionnaire. Altogether 16 physicians participated in the study. Although the relevance and comprehensibility of the questions were assessed to be high-level, parallel interpretations of the contents were discovered. We suggest content validity research to be essential when developing a questionnaire on assisted death. Our results could be helpful when planning future surveys about this challenging topic.

Work ability meetings - Challenges and Resolutions, a survey to Finnish occupational physicians.

Work ability meetings (WAM) are an essential and common tool of disability management in occupational health services in Finland. Meetings are held between an employee, a supervisor, and an occupational physician (OP). The aim is mainly to support work ability. To describe challenges and resolutions in the meetings as described by OPs. An internet survey was emailed to the members (n = 1304) of the Finnish Society of Occupational Health Physicians in August 2014. We asked physicians to describe those WAMs they had attended, especially challenges and resolutions concerning WAM. A total of 302 (23%) OPs responded to the survey. Most severe of the challenges were personal conflicts and a lack of confidence between the parties at the workplace. Also, the participants' views may differ about the purpose and goal of the meeting. The respondents noted that the employer might be unable to organize modified work for disabled employees. As a resolution, OPs need to prepare well and maintain their professional and neutral role in WAMs in all cases. OPs also mentioned the need for training in insurance medicine and rehabilitation as well as skills as a mediator. WAM is a potential tool for return to work and disability management in collaboration between employees, employers, and occupational health when all the participants reach a common goal and become aware of their role in the process. OPs need to recognize possible conflicting interests and contact each party before WAM. Keeping confidentiality in WAMs is a crucial matter.

Health information system support for collaboration between physicians and registered nurses: National cross-sectional user experience surveys from 2010 to 2023

BackgroundIn addition to storing patient data, health information systems (HISs) should advance continuity and quality of care by supporting collaboration between physicians and registered nurses (RNs). Our aim was to study how physicians and RNs experience this support and how the situation has evolved from 2010 to 2023. MethodsNationwide usability-focused cross-sectional surveys were conducted among Finnish physicians in 2010, 2014, 2017, and 2021 and RNs in 2017, 2020, and 2023. For this study, we selected respondents (1807–2555 physicians and 1126–1950 RNs) working in public sector wards and outpatient clinics and using the six largest electronic health record (EHR) system brands. Eight statements related to collaboration were analyzed by professional group and study year. ResultsAlthough both professional groups rated HIS support for collaboration and information exchange between physicians and RNs relatively positively (42–69% agreed), their experiences had not improved much over the years. Continuity of care was considered good by 34–54% of physicians and 51–58% of RNs. Half of respondents were dissatisfied with the readability of nursing documentation (52–56% of physicians and 30–37% of RNs) and support for noticing new orders (40–46% of physicians and 26–36% of RNs). Only 7–30% of all respondents felt that patient summary views provided by EHR systems helped to form an overall picture of the patient’s situation; however, the proportion did improve over the years. ConclusionsHISs were considered to better support collaboration among their own professional group than between physicians and RNs. As reviewing patient information forms a basis for decision making and high-quality care, EHR development should not only focus on ordering and documentation tools but also on securing multiprofessional utilization of data. Indeed, the varied needs of professional groups should be recognized in the early stages of the development process.

Decision support systems as supporters of clinical work: perspectives from physicians in Finland

Abstract Background The digitalisation of healthcare has changed physicians’ clinical and administrative work. For example, decision support systems (DSSs) are expected to support physicians’ daily work. The present study examined physicians’ experiences of DSSs’ support for their work analysed by age, gender, employment sector and leadership position. Methods Altogether 4630 physicians (64% women) from Finland responded to the online survey. Logistic regression analyses were conducted to examine the associations of age, gender, employment sector, and leadership position with experiences of DSSs’ support for their work. Results Of the respondents, 21.3 % agreed that DSSs supported their work, whereas 43.5 % were neutral and 35.2 % disagreed with the statement. Age (Wald’s F = 15.5, p = 0.001), employment sector (Wald’s F = 84.6, p < 0.001), and leadership position (Wald’s F = 16.3, p < 0.001) were significantly associated with the assesment, whereas gender was not. Those aged between 45 and 54 (OR 0.65, 95% CI 0.51-0.81) and between 55 and 64 (OR 0.74, 95% CI 0.59-0.93) had lower odds for agreeing compared to those aged 35 or under. Compared to physicians in hospitals, primary care physicians had 2.18 times (95%CI=1.84-2.59) greater odds for agreeing that DSSs support their work. Those who were in leadership positions had 1.50 times (95%CI=1.23-1.82) greater odds for agreeing compared to those not in leadership positions. Conclusions Finnish physicians did not experience DSSs supporting their work. Especially older physicians, hospital physicians and those not in leadership positions gave negative assessments. DSSs should be better integrated to physician workflow, it is also possible that usability problems of DSSs such as alert fatigue affected user experiences. More attention should be paid to developing DSSs in a way that they support physicians work better. Key messages • Finnish physicians did not experience that decision support systems would actually support their work. • Especially older physicians, hospital physicians and those not in leadership positions did not agree that decision support systems would support their work.

Physicians' Experiences of EHR Technical Quality: Results from Four Large Cross-Sectional Surveys in 2010-2021.

Unexpected downtime and long response times of electronic health record (EHR) systems not only impact user satisfaction and clinicians' work efficiency but also bring about potential harm for patients. Despite improvements in the performance of EHR systems' architecture, hardware, and networks, technical challenges continue to cause problems. We explored the end-user experiences of EHR technical functionality and quality from four large national cross-sectional surveys conducted among Finnish physicians in 2010-21. The results were analyzed by healthcare sector/specialty groups. In most groups, the experiences of stability and reaction speed became worse in 2010-17, which is readily explained by the implementation of the national patient data repository services, but improvements were seen in 2021, suggesting that EHR vendors have solved at least some of the slowness problems. The proportion of physicians reporting having experienced faulty system function with potential or actualized harm for the patient had decreased in operative and medical specialties and in the private sector but remained stable in other groups. Our findings underline the importance of continuing to develop technical qualities - including the implementations of national integrations.

Facing a request for assisted death - views of Finnish physicians, a mixed method study

BackgroundAssisted death, including euthanasia and physician-assisted suicide (PAS), is under debate worldwide, and these practices are adopted in many Western countries. Physicians’ attitudes toward assisted death vary across the globe, but little is known about physicians’ actual reactions when facing a request for assisted death. There is a clear gap in evidence on how physicians act and respond to patients’ requests for assisted death in countries where these actions are not legal.MethodsA survey including statements concerning euthanasia and PAS and an open question about their actions when facing a request for assisted death was sent to all Finnish physicians. Quantitative data are presented as numbers and percentages. Statistical significance was tested by using the Pearson chi-square test, when appropriate. The qualitative analysis was performed by using an inductive content analysis approach, where categories emerge from the data.ResultsAltogether, 6889 physicians or medical students answered the survey, yielding a response rate of 26%. One-third of participants agreed or partly agreed that they could assist a patient in a suicide. The majority (69%) of the participants fully or partly agreed that euthanasia should only be accepted due to difficult physical symptoms, while 12% fully or partly agreed that life turning into a burden should be an acceptable reason for euthanasia. Of the participants, 16% had faced a request for euthanasia or PAS, and 3033 answers from 2565 respondents were achieved to the open questions concerning their actions regarding the request and ethical aspects of assisted death. In the qualitative analysis, six main categories, including 22 subcategories, were formed regarding the phenomenon of how physicians act when facing this request. The six main categories were as follows: providing an alternative to the request, enabling care and support, ignoring the request, giving a reasoned refusal, complying with the request, and seeing the request as a possibility.ConclusionsFinnish physicians’ actions regarding the requests for assisted death, and attitudes toward euthanasia and PAS vary substantially. Open discussion, education, and recommendations concerning a request for assisted death and ethics around it are also highly needed in countries where euthanasia and PAS are not legal.

Team players and helpers – describing professional identity among finnish physicians in a cross-sectional study

BackgroundEvery physician has a unique professional identity. However, little is known about the diversity of identities among physicians. This study aimed to quantitatively assess the professional identity of physicians in Finland using descriptions of professional identity.MethodsThis study was part of a larger cross-sectional Finnish Physician 2018 Study. The target population consisted of all Finnish physicians under the age of 70 (N = 24,827) in 2018. The sample was drawn from physicians born on even numbered days (N = 11,336) using the Finnish Medical Association register. A total of 5,187 (46%) physicians responded. Professional identity was examined by 27 given characterisations using a five-point Likert scale. Multivariate logistic regression was used in assessing how place of work, graduation year and gender were associated with identity descriptions.ResultsThe descriptions which most physicians identified with were “member of a working group/team” (82%), “helper” (82%), and “health expert” (79%); the majority reported these as describing them very or quite well. Identity descriptions such as “prescriber of medications” (68% vs. 45%), “prioritiser” (57% vs. 35%) and “someone issuing certificates” (52% vs. 32%) were more popular among junior than senior physicians. The biggest differences between the genders were found in the descriptions “provider of comfort” (62% vs. 40%) and “someone engaged in social work” (45% vs. 25%), with which women identified more frequently than men.ConclusionsStrong identification as a member of a team is an important finding in the increasingly multiprofessional world of health care. Importantly, most physicians shared several core professional identity descriptions (i.e., helper, health expert) that reflect the traditional image of an exemplary doctor.

Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians: a national representative sample

BackgroundPhysicians’ work is often stressful. The digitalization of healthcare aims to streamline work, but not all physicians have experienced its realization. We examined associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians. The moderating role of the length of work experience was investigated for these associations.MethodsWe used representative survey data on Finnish physicians’ (N = 4271) experiences of digitalization from 2021. The independent variables included perceptions on statements about work transformations aligned with digitalization goals, and the extent that information systems and teleconsultations were utilized. Stress related to information systems (SRIS), time pressure, and psychological stress were the dependent variables. We analyzed the associations using multivariable linear and logistic regressions.ResultsRespondents had a mean SRIS score of 3.5 and a mean time pressure score of 3.7 on a scale of 1–5. Psychological stress was experienced by 60%. Perceptions associated with higher SRIS comprised disagreements with statements asserting that digitalization accelerates clinical encounters (b = .23 [95% CI: .16–.30]), facilitates access to patient information (b = .15 [.07–.23]), and supports decision-making (b = .11 [.05–.18]). Disagreement with accelerated clinical encounters (b = .12 [.04–.20]), and agreements with patients’ more active role in care (b = .11 [.04–.19]) and interprofessional collaboration (b = .10 [.02–.18]) were opinions associated with greater time pressure. Disagreeing with supported decision-making (OR = 1.26 [1.06–1.48]) and agreeing with patients’ active role (OR = 1.19 [1.02–1.40]) were associated with greater psychological stress. However, perceiving improvements in the pace of clinical encounters and access to patient information appeared to alleviate job strain. Additionally, extensive digital work was consistently linked to higher strain. Those respondents who held teleconsultations frequently and had less than 6 years of work experience reported the greatest levels of time pressure.ConclusionsPhysicians seem to be strained by frequent teleconsultations and work that does not meet the goals of digitalization. Improving physicians’ satisfaction with digitalization through training specific to the stage of career and system development can be crucial for their well-being. Schedules for digital tasks should be planned and allocated to prevent strain related to achieving the digitalization goals.

Awareness and Acceptance of Nicotine-free Smoking Intervention Methods (Acetium® Lozenge) Increased Among Health Care Professionals by Targeted E-training as Confirmed by Post-training Surveys.

To increase the awareness and acceptance of the new nicotine-free smoking intervention method (Acetium® lozenge; Biohit Oyj, Finland), targeted E-Training with accompanying surveys were conducted in 2018, 2020 and 2023. The target groups were derived from the General Data Protection Regulation (GDPR)-compliant registers of Finnish physicians, pharmacy staff and nurses owned by Success Clinic Oy. The post-training surveys recorded 1) awareness of the responders on Acetium® lozenge, 2) their attitude to nicotine-free smoking intervention methods in general as well as 3) their readiness for recommending this new tool to their patients. The three surveys accumulated a total of 1.892 responders. There was a constantly increasing awareness on Acetium® lozenge, increased interest in nicotine-free smoking intervention methods in general and a substantially increased readiness to recommend Acetium® acceptance to the smoking patients. The impact of E-Training, as measured by the increased interest in nicotine-free methods (56%) and readiness to endorse Acetium® acceptance (58%), was most marked among nurses who had the least awareness on Acetium® lozenge beforehand, exceeding the respective increase among medical doctors by 20% and 10% and among pharmacy staff by 30% and 20%, respectively. This E-Training had a favorable effect 1) on the responders' interest in nicotine-free smoking intervention method in general, 2) on increasing the awareness of Acetium® lozenge as a novel innovative method to quit smoking, as well as 3) on increasing the responders' readiness to introduce the new device to their smoking patients who are motivated to stop smoking nicotine-free.

Effects of digitalisation on preventive care and time pressure of primary care physicians

Abstract Background Excessive workload and waiting times in primary care, along with problems in information flow, can hamper the achievement of the public health benefits of preventive care. Digitalisation aims to promote prevention by expediting access to care and advancing self-care and seamless care, which might also streamline work. This study examined whether perceived changes in patient care due to digitalisation (teleconsultations, patient activity, and interprofessional collaboration) were associated with perceived a) improvement in preventive care and b) reduction in time pressure among primary care physicians. Methods We used national survey data on Finnish primary care physicians (N = 1538) from spring 2021. We conducted multivariable logistic and linear regression analyses, adjusted for gender, sector, and technology-related stress. We present odds ratios (OR), unstandardised b values, and their confidence intervals (CI) for statistical significance. Results Physicians who reported performing many teleconsultations (OR = 1.56, 95% CI 1.16-2.12) and perceived improvements in patient activity (OR = 5.02, 95% CI 3.73-6.75) or interprofessional collaboration (OR = 4.33, 95% CI 3.31-5.66) had greater odds of perceiving enhanced preventive care compared to their counterparts. Many teleconsultations (b=.26, 95% CI .14-.37) and perceived improvements in patient activity (b=.11, 95% CI .01-.21) or interprofessional collaboration (b=.12, 95% CI .02-.23) were also associated with higher time pressure (scale 1-5) among physicians. Conclusions Physicians may perceive that digitalisation improves preventive care when teleconsultations are frequently used, patients are encouraged to digital self-care, and practices for interprofessional collaboration are developed. Despite the patient benefits, the new tasks seem to increase physicians’ time pressure. Allocation of physicians’ working time to digital encounters and training of new tasks could help improve working conditions in primary care. Key messages • Primary care physicians who frequently utilise teleconsultations and see progress in patient activity or interprofessional collaboration due to digitalisation may find improvements in preventive care. • Digital tasks that promote preventive care may increase physicians’ constant rush and pressure to perform their duties, which should be recognised in work planning to ensure high-quality patient care.

End-of-life Decision-making Differs Between a Cancer and a Dementia Patient: Influences of the Physician's Background Factors.

Appropriate decision-making is essential for end-of-life (EOL) care without futile therapies. However, these decisions might vary in cases of cancer and other advanced diseases according to physicians' experience, education, and values. This study aimed to compare the decisions in EOL care of advanced cancer and dementia and the factors that influence them in medical students, general practitioners (GPs), and physicians with special competence in palliative medicine (cPM). A questionnaire presenting patient scenarios concerning different decisions and ethical aspects of EOL care with additional questions on attitudes and background factors was delivered to 500 Finnish GPs, all Finnish physicians with cPM (n=82), and all graduating medical students (n=639) in 2015-2016. Altogether 601 responses were obtained (53%). Palliative care was chosen more often for a patient with advanced prostate cancer (83%) than for a patient with advanced dementia (41%) (both patients males, same age). A suspicion of iatrogenic bleeding in the prostate cancer patient decreased the willingness to choose palliative care, especially among the students. Patient benefit was regarded as an important background factor in decision making by all respondent groups, but physicians' legal protection was not considered as important among the physicians with cPM as it was among the other respondent groups. Finnish doctors and students were more likely to choose palliative care options for an advanced prostate cancer patient than for an advanced dementia patient. Decision-making was influenced by respondents' background factors and attitudes. Education on EOL care for different types of advanced and incurable diseases is highly needed.

Physicians' Perspectives on EHR Usability: Results from Four Large Cross-Sectional Surveys from 2010 to 2021.

Usability and user experience are central quality attributes of electronic health record (EHR) systems. Usability evaluation studies typically focus on short-term use and situational usability, although feedback collected during operational use provides input for future information systems development. An abundance of studies report on physicians' dissatisfaction with the usability of their EHR systems and many show an association between poor usability and physician burnout. However, there is a scarcity of large long-term monitoring studies assessing end users' experiences with EHRs. We report on the results from four large (n=3,929-4,628) national cross-sectional usability surveys conducted among Finnish physicians in 2010, 2014, 2017, and 2021. The main finding was that the perceptions of physicians working in public health centres had changed for the better but those working in public hospitals reported similar or even more negative experiences in 2021 than in 2010-17; they rated only system responsiveness to inputs as having improved. Based on this finding, systematic research-based monitoring of EHR development from the end users' perspectives should be continued.

Self-reported skills and self-confidence in point-of-care ultrasound: a cross-sectional nationwide survey amongst Finnish emergency physicians

BackgroundThe use of point-of-care ultrasound (POCUS) is increasing. Numerous investigators have evaluated the learning curves in POCUS, but there are no published studies on how emergency physicians perceive their own competence level with this skill.MethodsA nationwide survey amongst Finnish emergency physicians was conducted. The respondents reported their use of POCUS and how it has affected their clinical decision-making. The number of POCUS examinations performed was compared to the self-assessed skill level with different applications. Cut-off values were determined for the number of examinations required to acquire a good self-assessed skill level in each POCUS application. The correlation between self-confidence and the self-estimated skill level was analyzed. Several different statistical methods were used, such as Student’s t-test, Pearson’s correlation test, Loess method and ROC curve analysis.ResultsA total of 134 out of 253 Finnish emergency medicine specialists and residents (52%) responded to the survey. The most commonly used POCUS applications were POCUS-assisted procedures, pleural effusion and pneumothorax, inferior vena cava and lower extremity deep venous thrombosis. The initial rate of perceived skill acquisition was very steep with the curve flattening with greater skill and more experience. The number of examinations performed to reach a self-assessed good competence varied from seven to 75 with different applications. The lowest cut-off point for self-assessed good competence was obtained for rapid ultrasound for the shock and hypotension-protocol and the highest for focused cardiac examinations. There was an excellent correlation between self-confidence and the self-assessed skill level.ConclusionsThe Finnish emergency practitioners’ self-assessed development of POCUS skills parallels the previously published learning curves of POCUS. The correlation of self-confidence and the self-assessed skill level was found to be excellent. These findings add information on the development of perceived POCUS skills amongst emergency physicians and could complement a formal performance assessment.

Comparing the effectiveness of competition as a method of reminding primary oral health care dentists to record diagnoses with two alternative methods used to enhance the recording of diagnoses in primary health care

ABSTRACT The purpose of this study was to investigate whether competition is an effective method to remind primary oral health care dentists to record diagnoses (RRD). The effectiveness of competition was examined in comparison with financial group bonuses (FGBs) and electronic reminders (ERs) of the electronic health record, together with superior-subordinate or development discussions. Putative differences in the diagnosis recording cultures of Finnish public health care physicians and dentists were studied. This was a retrospective quasi-experimental observational study in which the effects of the interventions on the rate of recording diagnoses were identified using a general linear regression model and proportions of visits with recorded diagnoses. The rate of increase in the recording of diagnoses in dentists was 0.995 ± 0.273%/month (mean ± SEM) after the implementation of RRDs and this did not differ from that obtained after starting FGBs (0.919 ± 0.130%/month) or ERs with superior-subordinate or development discussions (1.562 ± 0.277%/month) in physicians. As the rates of increase did not differ none of the applied methods seemed to be more effective than the others when trying to influence the behaviour of primary health care clinicians. Altogether, public primary health care physicians were more active than respective primary oral health care dentists to record diagnoses.

The Interplay of Work, Digital Health Usage, and the Perceived Effects of Digitalization on Physicians' Work: Network Analysis Approach.

In health care, the benefits of digitalization need to outweigh the risks, but there is limited knowledge about the factors affecting this balance in the work environment of physicians. To achieve the benefits of digitalization, a more comprehensive understanding of this complex phenomenon related to the digitalization of physicians' work is needed. The aim of this study was to examine physicians' perceptions of the effects of health care digitalization on their work and to analyze how these perceptions are associated with multiple factors related to work and digital health usage. A representative sample of 4630 (response rate 24.46%) Finnish physicians (2960/4617, 64.11% women) was used. Statements measuring the perceived effects of digitalization on work included the patients' active role, preventive work, interprofessional cooperation, decision support, access to patient information, and faster consultations. Network analysis of the perceived effects of digitalization and factors related to work and digital health usage was conducted using mixed graphical modeling. Adjusted and standardized regression coefficients are denoted by b. Centrality statistics were examined to evaluate the relative influence of each variable in terms of node strength. Nearly half of physicians considered that digitalization has promoted an active role for patients in their own care (2104/4537, 46.37%) and easier access to patient information (1986/4551, 43.64%), but only 1 in 10 (445/4529, 9.82%) felt that the impact has been positive on consultation times with patients. Almost half of the respondents estimated that digitalization has neither increased nor decreased the possibilities for preventive work (2036/4506, 45.18%) and supportiveness of clinical decision support systems (1941/4458, 43.54%). When all variables were integrated into the network, the most influential variables were purpose of using health information systems, employment sector, and specialization status. However, the grade given to the electronic health record (EHR) system that was primarily used had the strongest direct links to faster consultations (b=0.32) and facilitated access to patient information (b=0.28). At least 6 months of use of the main EHR was associated with facilitated access to patient information (b=0.18). The results highlight the complex interdependence of multiple factors associated with the perceived effects of digitalization on physicians' work. It seems that a high-quality EHR system is critical for promoting smooth clinical practice. In addition, work-related factors may influence other factors that affect digital health success. These factors should be considered when developing and implementing new digital health technologies or services for physicians' work. The adoption of digital health is not just a technological project but a project that changes existing work practices.

Ambivalence toward euthanasia and physician-assisted suicide has decreased among physicians in Finland

BackgroundDebates around euthanasia and physician-assisted suicide (PAS) are ongoing around the globe. Public support has been mounting in Western countries, while some decline has been observed in the USA and Eastern Europe. Physicians’ support for euthanasia and PAS has been lower than that of the general public, but a trend toward higher acceptance among physicians has been seen in recent years. The aim of this study was to examine the current attitudes of Finnish physicians toward euthanasia and PAS and whether there have been changes in these attitudes over three decades.MethodsA questionnaire survey was conducted with all Finnish physicians of working age in 2020 and the results were compared to previous studies conducted in 1993, 2003 and 2013.ResultsThe proportions of physicians fully agreeing and fully disagreeing with the legalization of euthanasia increased from 1993 to 2020 (from 5 to 25%, p < 0.001, and from 30 to 34%, p < 0.001, respectively). The number of physicians, who expressed no opinion for or against euthanasia (cannot say) decreased from 19 to 5% (p < 0.001) during the same period. The proportion of physicians having no opinion (cannot say) of whether a physician should be punished for assisting in a suicide decreased from 20 to 10% (p < 0.001).ConclusionsThis study shows that Finnish physicians’ ambivalence toward euthanasia and PAS has decreased. The ongoing debate has probably forced physicians to form more solid opinions on these matters. Our study highlights that attitudes toward euthanasia and PAS are still divided within the medical profession.

ESG Investing: A Decision-Making Paradox?

<h3>STUDY OBJECTIVE</h3> Knowledge about changes in wellbeing during the passage from professional studies to working life is scarce and controversial. This study examined these changes among university graduates with good and poor employment prospects. <h3>DESIGN</h3> A longitudinal study with four postal questionnaire surveys of a closed cohort. <h3>SETTING</h3> Cohorts of graduating Finnish physicians and architects were followed up from 1994 to 1998. In 1994 Finland9s national economy was still struggling to break loose from a period of severe recession, and unemployment rates were high even among educated professionals. As economic growth eventually got under way the unemployment situation began to ease for physicians but not for architects. <h3>PARTICIPANTS</h3> Architecture students (n = 189) from Finland9s three technical universities and medical students (n = 638) from Finland9s five medical faculties. Both had started their studies in 1989. <h3>RESULTS</h3> In the first questionnaire survey there were no differences between the professions in strain resistance resources, as indicated by Sense of Coherence (SOC), or in psychological distress, as indicated by General Health Questionnaire (GHQ). Profession emerged as a significant between subject factor in analysis of variance for repeated measures of both SOC and GHQ. Physicians9 scores on the 13 item SOC questionnaire improved during the follow up from 62.6 to 67.5 and on the 12 item GHQ questionnaire from 24.2 to 22.2. Among architects the corresponding scores remained unchanged (62.5–62.2 and 23.1–22.6). The significance of profession remained unchanged when gender and individuals9 graduation and total work experience were introduced to the statistical models as between subject factors. <h3>CONCLUSIONS</h3> Improved SOC in physicians but not in architects supports the hypothesis that good employment prospects are important to employee wellbeing. Although less consistent, indicating fluctuations in day to day psychological distress, GHQ findings are also in line with the hypothesis. In both professions the indicators studied were independent of individuals9 graduation and career. It is concluded that rather than individually, the mechanisms that connect employment prospects with wellbeing operate collectively within the whole profession. Highly educated professionals do not complete their studies until almost 30, and if for reasons of insecure employment they are unable to develop their SOC to the optimum level at that age, their resources for resisting health endangering strain may remain permanently poor.

Off-label prescribing of antipsychotics: prescribing practices and clinical experiences of Finnish physicians

IntroductionOff-label use of antipsychotics has increased in many countries. In adult populations antipsychotics off-label prescriptions varied from 40 to 75% of all AP users.ObjectivesTo examine the off-label prescribing practices and experiences of antipsychotic medication in Finland.MethodsAn electronic questionnaire on physicians’ prescription practices of antipsychotics, especially for off-label use, was sent in 2019 for physicians (n=1195) in different health care facilities including primary health care, occupational health care, in- and outpatient mental health services and services for substance abuse. The sample was selected by systematic and convenience sampling covering five university hospital areas in Finland.ResultsIn total, 216 physicians (18% of the target sample) participated in the study, and 94% had prescribed antipsychotics for off-label use. The most common off-label indications were insomnia and anxiety. The most common antipsychotic used was quetiapine. Off-label antipsychotics was not prescribed as a first-choice medication: 99% of the physicians reported that the patients with off-label use have previously had other medications for the corresponding symptoms. In all, 88% of clinicians monitored the patients’ clinical condition, whereas metabolic values were followed more rarely. About 68% of physicians reported more benefit than harm from the antipsychotics off-label use.ConclusionsAntipsychotics are often prescribed for off-label use, most commonly for insomnia and anxiety. Most of the physicians see more benefits than harms for the patient in off-label use. There is a need to analyse the long-term benefits and harms of off-label use of antipsychotics and create more detailed treatment algorithms and clinical recommendations for such use.DisclosureNo significant relationships.

The association between stress attributed to information systems and the experience of workplace aggression: a cross-sectional survey study among Finnish physicians

BackgroundPhysicians commonly suffer from workplace aggression and its negative consequences. Previous studies have shown that stressors such as job demands increase the risk of inappropriate treatment at workplace. Poorly functioning, and constantly changing information systems form a major work stressor for physicians. The current study examined the association between physicians’ stress attributed to information systems (SAIS) and their experiences of workplace aggression. Workplace aggression covered physical and non-physical aggression, perpetrated by coworkers, patients, patient’s relatives, or supervisors.MethodsA cross-sectional survey study was conducted. The participants included 2786 physicians (67.4% women) who were sampled randomly from the registry of Finnish Medical Association, which covers almost all of the Finnish physician population. First, bivariate associations were studied among participant characteristics, SAIS and workplace aggression. Logistic regression analysis was then used to further determine how SAIS was associated with the likelihood of experiencing different types of aggression.ResultsHigher levels of SAIS were associated with higher likelihood of aggression with regard to all types of aggression, except non-physical aggression perpetrated by patients or relatives. The demographic factors (work-sector, gender, age) did not have a noticeable influence on the association between SAIS and aggression.ConclusionsThe present results build on previous evidence on the prevalence of SAIS and its negative effects on healthcare workers. Since SAIS may increase the risk of experiencing aggression, it is possible that SAIS also endangers the wellbeing of physicians and thereby the quality of patient care. Resourcing time and training during introduction of a new IS could alleviate time pressure and thus stress attributed to managing new information systems. The role of organizational climate and general workload in arousing SAIS and aggression should be examined in future studies.

Working hours, on-call shifts, and risk of occupational injuries among hospital physicians: A case-crossover study.

ObjectiveTo investigate the association of hospital physicians’ working hours and on‐call shifts with the risk of occupational injuries.MethodsIn this nested cohort study of 556 Finnish hospital physicians, we linked electronic records from working‐hour and on‐call duty payroll data to occupational injury data obtained from the Finnish Workers’ Compensation Center for the period 2005–2019. We used a case‐crossover design with matched intervals for a 7‐day ‘case window’ immediately prior to occupational injury and a ‘control window’ 7 days prior to the beginning of the case window, and analyzed their associations using conditional logistic regression models.ResultsWe noted 556 occupational injuries, 281 at the workplace and 275 while commuting. Having three to four long (>12 h) work shifts on the preceding 7 days was associated with a higher probability of an occupational injury (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.11, 4.09), and the OR for three to four on‐call shifts was 3.54 (95%CI 2.11, 5.92) in comparison to having none of these work shift types. A higher number of several consecutive working days was associated with a higher probability of injury in a dose‐response manner. Moreover, increasing weekly working hours was associated with an increased likelihood of injury (OR 1.03, 95%CI 1.01, 1.04), whereas the number of normal (≤12 h) work shifts reduced this likelihood (OR 0.79, 95%CI 0.64, 0.98).ConclusionsOur findings suggest that accumulated working‐hour load, as opposed to single, very long (>24 h) work shifts, may increase the risk of occupational injury among hospital physicians.