Health Physicians Research Articles

Burnout Among Breast Radiologists: How Can We Restore Fulfillment?

Physician burnout is increasing in prevalence and has negative implications for the quality of patient care and the health and wellbeing of physicians. Surveys before the COVID-19 pandemic showed high rates of burnout among breast radiologists, and the COVID-19 pandemic has further increased stress. This article summarizes strategies to combat burnout, including improving individual resilience by increasing mindfulness about handling stress, making goals, and noting personal accomplishments. However, more effective change is likely to occur when there is change at both a personal and an organizational level, which includes identifying the stakeholders in a workplace and determining what changes must occur to increase joy and decrease rates of burnout. Despite the increasing rates of burnout, breast radiologists report high rates of personal career satisfaction. Self-reflection and positive steps to increase joy at work are important in maintaining career fulfillment in these challenging times.

Geographic Monopolization of Physician Practices and Health Care Systems: Implications for Anesthesiology

Geographic Monopolization of Physician Practices and Health Care Systems: Implications for Anesthesiology

Multilevel influences on patient engagement and chronic care management.

Physician practices are increasingly owned by health systems, which may support or hinder adoption of innovative care processes for adults with chronic conditions. We examined health system- and physician practice-level capabilities associated with adoption of (1) patient engagement strategies and (2) chronic care management processes for adult patients with diabetes and/or cardiovascular disease. We analyzed data collected from the National Survey of Healthcare Organizations and Systems, a nationally representative survey of physician practices (n = 796) and health systems (n = 247) (2017-2018). Multivariable multilevel linear regression models estimated system- and practice-level characteristics associated with practice adoption of patient engagement strategies and chronic care management processes. Health systems with processes to assess clinical evidence (β = 6.54 points on a 0-100 scale; P = .004) and with more advanced health information technology (HIT) functionality (β = 2.77 points per SD increase on a 0-100 scale; P = .03) adopted more practice-level chronic care management processes, but not patient engagement strategies, compared with systems lacking these capabilities. Physician practices with cultures oriented to innovation, more advanced HIT functionality, and with a process to assess clinical evidence adopted more patient engagement strategies and chronic care management processes. Health systems may be better able to support the adoption of practice-level chronic care management processes, which have a strong evidence base for implementation, compared with patient engagement strategies, which have less evidence to guide effective implementation. Health systems have an opportunity to advance patient-centered care by expanding practice-level HIT functionality and developing processes to appraise clinical evidence for practices.

Exploring Individual Mental Health Issues: A Qualitative Study among Fellowship-Trained Sports Medicine Physicians

The mental health of fellowship-trained sports medicine physicians (FTSMPs) around the United States is a subject that needs additional exploration. Currently, there is little research exploring how FTSMPs address their mental health on a routine basis. Using the theory of secondary trauma stress to help navigate this study, the purpose of this expressive, all-purpose qualitative study is to improve the understanding of FTSMPs' perceptions of their mental health and the kinds of strategies used to manage these issues. This is a general qualitative study. All interviews were conducted via video communication platforms such as Zoom. The final sample included 35 FTSMPs: 25 men and 10 women. Data collection used a semi-structured interview approach. Data analysis was carried out using NVivo 12 qualitative data analysis software. Four themes emerged: mental health matters affect individual daily lives of FTSMPs; FTSMPs correlate mental health struggles with stress and anxiety; FTSMPs experience barricades when seeking support for mental health issues; and FTSMPs have poor mental health support-seeking behaviors. Results highlight openings for hospitals and private practice institutions, including producing a maintainable work-life equilibrium for FTSMPs and offering these FTSMPs access to mental health services. These recommendations may diminish exhaustion amongst several FTSMPs, a product detrimental to patients, providers, and hospitals.

Heart rate and heart rate variability during diagnostic and interventional neuroendovascular procedures.

Heart rate variability (HRV) reflects the activity of the autonomic nervous system (ANS) and can be used as a potential predictor of stress-related cardiovascular diseases. This study aimed to assess whether physical and mental strain during the performance of cerebral endovascular procedure influence time-domain HRV parameters in operating surgeon. Heart rate (HR) and HRV metrics were measured using a HR sensor chest strap before, during, and after neuroendovascular interventions performed by a single neurosurgeon. Three consecutive data series were reported by recording time domain: before procedure, during and after performing endovascular procedures. HR and HRV parameters were recorded during diagnostic and interventional neuroendovascular procedures. HR and HRV measures were analyzed by procedure type and recording time domain. HRV measures of a single endovascular neurosurgeon were recorded during 50 procedures. The median intraprocedural HRV score was the lowest and the median HR was the highest (HRV: 52, HR: 89 bpm) compared to preprocedural (HRV: 59, HR: 70 bpm) and postprocedural cardiovascular measures (HRV: 53, HR: 79, bpm, p < 0.001). On univariate linear regression, a negative association of interventional procedures with lower intraprocedural (β = -0.905, p = 0.001) and postprocedural (β = -1.12, p < 0.001) HRV scores compared to the diagnostic procedures was noted. HRV is a reliable tool to measure cardiovascular and mental stress. Interventional neuro-endovascular procedures seem to negatively impact the cardiovascular measures of neurointerventionalists. Further longitudinal studies utilizing HRV are warranted to address their long-term effects on the mental health of physicians.

Forced Organ Harvesting

Forced Organ Harvesting

Barriers to recovery for medical professionals: Assessing financial support through a survey of Physician Health Programs.

There is increasing focus on physician burnout, psychiatric problems, and substance use disorders. Costs of recovery for physicians enrolled in Physician Health Programs (PHPs) remain unexamined with little known regarding funding resources. We sought to elucidate perceived costs of recovery from impairing conditions and highlight resources for financial strain. This survey study was distributed by the Federation of State Physician Health Organizations via e-mail to 50 PHPs in 2021. Questions assessed perceptions of costs and ability to pay for recommended evaluation, treatment, and monitoring. Questions also assessed limitation of engagement due to financial concerns, and availability of financial resources. Complete responses were received from 40 of 50 eligible PHPs. The majority (78%) of responding PHPs assessed ability to pay at initial intake evaluation. There is notable financial strain on physicians, particularly those earliest in training, to pay for services. PHPs are vital to physicians, especially physicians-in-training, as "safe haven programs."Methods to financially assist through PHPs included fee deferrals, sliding scale fees, and fee forgiveness. Health insurance, medical schools, and hospitals were able to provide additional assistance. Because burnout, mental health, and substance use disorders are high stakes amongst physicians, it is critical that access toPHPs is available, destigmatized, and affordable.Our paper focuses specifically on the financial cost of recovery, the financial burden placed on PHP participants, a topic lacking in the literature, and highlights remedies and vulnerable populations.

Health and Well-Being of Intensive Care Unit Physicians: How to Ensure the Longevity of a Critical Specialty.

A second epidemic of burnout, fatigue, anxiety, and moral distress has emerged concurrently with the coronavirus disease 2019 (COVID-19) pandemic, and critical care physicians are especially affected. This article reviews the history of burnout in health care workers, presents the signs and symptoms, discusses the specific impact of the COVID-19 pandemic on intensive care unit caregivers, and attempts to identify potential strategies to combat the Great Resignation disproportionately affecting health care workers. The article also focuses on how the specialty can amplify the voices and highlight the leadership potential of underrepresented minorities, physicians with disabilities, and the aging physician population.

The Evolving Ukrainian Refugee Health Care Crisis - A Platform for the True Meaning of the Physician's and Health Care Professional's Healing Work

The Evolving Ukrainian Refugee Health Care Crisis - A Platform for the True Meaning of the Physician's and Health Care Professional's Healing Work

Impact of work schedules of senior resident physicians on patient and resident physician safety: nationwide, prospective cohort study

ObjectiveTo determine whether long weekly work hours and shifts of extended duration (≥24 hours) are associated with adverse patient and physician safety outcomes in more senior resident physicians (postgraduate year...

Living Witnesses and Moral Agency

This chapter focuses on how the life and work of anthropologist, physician, and global health equity activist Paul Farmer provides a model for theologically-informed moral agency that transgresses the roles established by current hierarchies of being, knowledge, and power in order to relieve suffering without reproducing the iniquitous circulation of power and resources. Latin American liberation theology’s “preferential option for the poor” is Farmer’s primary moral lens. The chapter examines how Farmer lives out this commitment in his work as a health care provider alongside communities around the world fighting to survive in the face of grievously iniquitous social and economic conditions; and also as a university professor at one of the world’s wealthiest and most elite institutions of higher education. The analysis engages womanist ethicist Marcia Riggs’ conception of a mediating ethic to characterize Farmer’s moral praxis: it is a move toward justice that generates momentum in the face of a complex moral dilemma. The chapter contends that Farmer’s moral praxis contributes to the field of theological ethics by critically engaging the fraught intersection of positionality and agency, and by framing moral responses to the extremely challenging current social, economic, and political conditions in Haiti, where Farmer’s work began in the 1980s.

Prevalence of psychosocial work factors and stress and their associations with the physical and mental health of hospital physicians: A cross-sectional study in Lithuania.

A negative psychosocial work environment causes stress to the physicians of healthcare institutions, which affect their physical and mental health. This study aimed to evaluate the prevalence of psychosocial work factors and stress and their associations with the physical and mental health of hospital physicians in the Kaunas region of Lithuania. A cross-sectional study was performed. It was based on a questionnaire survey, which contained the Job Content Questionnaire (JCQ), three scales of Copenhagen Psychosocial Questionnaire (COPSOQ), and Medical Outcomes Study Short Form-36 (SF-36) health survey. The study was carried out in 2018. A total of 647 physicians completed the survey. Multivariate logistic regression models were performed by using the stepwise method. In the models potentially, confounding factors such as age and gender were controlled. In our study, the dependent variables were stress dimensions, and the independent variables were psychosocial work factors. The analysis showed that a quarter of surveyed physicians were classified as having low job skill discretion and decision-making authority, and the support of supervisors was weak. Approximately one-third of the respondents had low decision latitude, low co-worker support, and high job demands, and felt insecure at work. Job insecurity and gender were found to be the strongest independent variables for general and cognitive stress. The support of the supervisor was found as a significant factor in the case of somatic stress. Better evaluation of mental health was related to job skill discretion and co-workers' and supervisors' support, but it did not affect physical health. The confirmed associations suggest that looking at work organization factors, reducing exposure to stress, and increasing perception of the psychosocial environment can be linked to better subjective health evaluation.

Natural Language Processing Basics.

Natural Language Processing Basics.

Development of a Digital Assistant to Support Teleconsultations Between Remote Physicians and Frontline Health Workers in India: User-Centered Design Approach

Many low- and middle-income countries have adopted telemedicine programs that connect frontline health workers (FHWs) such as nurses, midwives, or community health workers in rural and remote areas with physicians in urban areas to deliver care to patients. By leveraging technology to reduce temporal, financial, and geographical barriers, these health worker-to-physician telemedicine programs have the potential to increase health care quality, expand the specialties available to patients, and reduce the time and cost required to deliver care. We aimed to identify, validate, and prioritize unmet needs in the health care space of health worker-to-physician telemedicine programs and develop and refine a solution that addresses those needs. We collected information regarding user needs through ethnographic research, direct observation, and semistructured interviews with 37 stakeholders (n=5, 14% physicians; n=1, 3% public health program manager; n=12, 32% community health workers; and n=19, 51% patients) at 2 telemedicine clinics in rural West Bengal, India. We used the Spiral-Iterative Innovation Model to design and develop a prototype solution to meet these needs. We identified 74 unmet needs through our immersion in health worker-to-physician telemedicine programs. We identified a critical unmet need that achieving optimal teleconsultations in low- and middle-income countries often requires shifting tasks such as history taking and physical examination from high-skilled remote physicians to FHWs. To meet this need, we developed a prototype digital assistant that would allow FHWs to assume some of the tasks carried out by remote clinicians. The user needs of multiple stakeholder groups (patients, FHWs, physicians, and health organizations) were incorporated into the design and features of the task-shifting tool. The final prototype was shared with the health workers, physicians, and public health program managers who expressed that the tool would be useful and valuable. The final prototype that was developed was released as an open-source digital public good and may improve the quality and efficiency of care delivery in health worker-to-physician telemedicine programs.

DISTRESS AND CAREER REGRET IN AUSTRALIAN ORTHOPAEDIC SURGICAL TRAINEES: A NATIONAL SURVEY

Physician health is a global concern, with increasing research efforts directed towards the challenge. Australia has limited published specialty-specific well-being data for trainees and consultants in medicine and surgery. We measured distress in Australian Orthopaedic trainees using the Physician Well-Being Index (PWBI, MedEd Web Solutions) using an online anonymous survey sent by the Australian Orthopaedic Association.The survey response rate was 38% (88/230). Forty-four percent of survey respondents met criteria for distress. Self-reported burnout in the 30 days prior was reported by 63% of respondents. Fifty-eight percent of females and 41% of males met criteria for distress. Of the 19% or respondents identifying as an ethnic minority, 53% were distressed compared to 42% of those identifying as non-ethnic minority. Trainees without a mentor had a 50% distress rate compared to those with a mentor (37% distress rate). Twenty-five percent of all trainees wished they had picked a career outside of medicine and 16% wished they had pursued a medical career other than Orthopaedic Surgery. Of those trainees who had already passed the fellowship exam, 17% wished they had pursued a career outside of medicine and 21% wished they had pursued a medical career in an area other than Orthopaedic Surgery.These findings suggest concerning rates of career regret and gender-related trends in distress in Australian Orthopaedic trainees. Females may be over-represented in our results as 17% of the source population was female compared to 22% of respondents. Further research is required across all Australian specialties to gain further understanding of factors contributing to distress and to assist in the development of strategy to protect against physician burnout.

Team Approach: Management of Mental Health in Orthopaedic Patients.

Mental health evaluation should be considered an essential part of the routine preoperative assessment and should be managed by a multidisciplinary team composed of the primary care physician, orthopaedic provider, and behavioral health specialist. The scientific literature indicates that patients without comorbid psychiatric symptoms and adaptive coping strategies, resilience, and well-managed expectations have improved functional outcomes and satisfaction after orthopaedic procedures. Psychological issues are multifaceted and require treatment tailored to each individual patient. Therefore, close communication between all members of the care team is required to create and execute the perioperative plan.

Prevalance of Burnout Syndrome Among Anaesthesia Residents in Tertiary Care Hospitals of Karachi

Objective: The purpose of this study is to assess the incidence of burnout syndrome among Karachi's anesthesiology residents in teaching hospitals. Methods: This cross-sectional research was undertaken at tertiary care hospitals of Karachi. Ethical committee permission, authorization from institutions, and agreement from residents were all required before data collection from 144 anesthesiology residents could begin. Participants were recruited from both public and private healthcare facilities. The demographic data from a questionnaire was used to determine the prevalence of the burnout syndrome, which is defined by feelings of emotional tiredness, depersonalization, and decreased personal accomplishment. SPSS was used to generate descriptive statistics. Results: The mean working hours of the participants in government and private hospitals were 64.21±12.40 and 90.24±25.01 hours. A significant difference (p=0.000) in the mean working hours of the participants were observed in participants at government and private hospitals. Emotional exhaustion score of the participants in government and private hospitals were 15.72±11.56 and 22.69±11.20. A significant difference (p=0.002) in the mean emotional exhaustion score of the participants were observed in participants at government and private hospitals. Depersonalization score of the participants in government and private hospitals were 8.79±6.71 and 12.82±7.59. A significant difference (p=0.004) in the mean depersonalization score of the participants were observed in participants at government and private hospitals. Reduced personal achievement score of the participants in government and private hospitals were 12.97±11.96 and 19±12.65. A significant difference (p=0.002) in the mean reduced personal achievement score of the participants were observed in participants at government and private hospitals. Conclusion: We observed the variation in burnout of private hospital versus government hospital. Residents working in private hospital work for extensive hours as compared to government hospital residents. There is an extensive need of comprehensive support groups, humane number of working hours, improved de-stressing activities for mental health of resident physicians and enhance their productivity. Keywords: Burnout, emotional exhaustion, depersonalization, Reduced personal achievement

Sleep in Residents: A Comparison between Anesthesiology and Occupational Medicine Interns.

Sleep deprivation is a significant risk to the health and judgment of physicians. We wanted to investigate whether anesthesiology residents (ARs) who work only one night shift per week have different physical and mental health from occupational medicine residents (OMRs) who do not work at night. A total of 21 ARs and 16 OMRs attending a university general hospital were asked to wear an actigraph to record sleep duration, heart rate and step count and to complete a questionnaire for the assessment of sleep quality, sleepiness, fatigue, occupational stress, anxiety, depression and happiness. ARs had shorter sleep duration than OMRs; on average, they slept 1 h and 20 min less (p < 0.001). ARs also had greater daytime sleepiness, a higher heart rate and lower happiness than OMRs. These results should be interpreted with caution given the cross-sectional nature of the study and the small sample size, but they are an incentive to promote sleep hygiene among residents.

The New Oncologic Diagnosis Discussion: Perspectives of Pediatric Oncologists.

We aimed to understand how new diagnosis discussions are conducted in pediatric oncology, and the training provided for their conduct. This mixed-methods study used a sequential exploratory design. Qualitative interviews (n = 20) were conducted with pediatric oncologists (n = 15) and fellows (n = 5) at a single institution, focusing on the process used to convey the diagnosis and treatment plan to the family. Accreditation Council for Graduate Medical Education-accredited pediatric oncology fellowship program directors (n = 38) and fellows (n = 70) were subsequently surveyed to confirm qualitative results and elucidate the training that fellows receive in conducting new diagnosis discussions. Our findings suggest that new diagnosis discussions in pediatric oncology are typically conducted in three stages: (1) concern for cancer; (2) confirmation of diagnosis; and (3) treatment plan/consent, and are fundamentally similar across settings; however, pediatric oncologists skillfully tailor their approach on the basis of clinical circumstances and parental needs. Decisions regarding inclusion of the child are primarily determined by parental preference, whereas inclusion of health care team members is driven by physician role (ie, trainee v program director) and health care organization-related factors. Physician preparation for discussions involves logistical, intellectual, and emotional components. Disclosure of prognosis is nuanced. There is variability across pediatric oncology fellowship programs in the provision of training for these discussions. We identified common practices of pediatric oncologists as they prepare for and lead new diagnosis discussions in pediatric oncology. We found variability in the training that pediatric oncology fellows receive regarding how to conduct these discussions, highlighting a need for standardized training curricula.

OuR Space Commentary: Wellness Perspective From SABI's Early Career Committee.

Radiologists and members-in-training are experiencing higher (and escalating) rates of burnout, resulting in a profound impact on the health of physicians, patients, and the community. Lately, the radiology community has demonstrated a growing awareness of this phenomenon, which has led to emphasis on practicing and promoting wellness. With a myriad of factors contributing to burnout in radiology, a multifaceted approach is pivotal for counteracting burnout and fostering overall well-being, including efforts driven at both organizational and individual levels. This article discusses perspectives from the members of the Early Career Committee at the Society for Advanced Body Imaging (SABI); it explores their beliefs and practical strategies for maintaining personal well-being.