Norwegian Doctors Research Articles

Could UK doctors learn from Norwegian doctors’ shorter working hours?

Matthew Limb looks at what the UK might be able to learn from Norwegian doctors’ approach to medical staffing and balancing life and work

Changes in subjective well-being among Norwegian doctors from 2002 to 2012: a longitudinal study based on national samples

Background A high level of subjective well-being among doctors is important for the doctors themselves as well as for the quality of the health care systems. Therefore, assessment of subjective well-being should be performed regularly both on the individual and on the aggregate level. The aims of the study are to follow subjective well-being (SWB) among Norwegian doctors from 2002 to 2012, and to identify possible predictors of high …

Weekly working hours for Norwegian hospital doctors since 1994 with special attention to postgraduate training, work–home balance and the European Working Time Directive: a panel study

ObjectivesTo examine the weekly working hours of Norwegian hospital doctors from 1994 to 2012 with special emphasis on the quality of postgraduate training and work–home balance, and in relation to...

Differences in sickness absence between self-employed and employed doctors: a cross-sectional study on national sample of Norwegian doctors in 2010.

BackgroundDoctors have a low prevalence of sickness absence. Employment status is a determinant in the multifactorial background of sickness absence. The effect of doctors’ employment status on sickness absence is unexplored. The study compares the number of sickness absence days during the last 12 months and the impact of employment status, psychosocial work stress, self-rated health and demographics on sickness absence between self-employed practitioners and employed hospital doctors in Norway.MethodsThe study population consisted of a representative sample of 521 employed interns and consultants and 313 self-employed GPs and private practice specialists in Norway, who received postal questionnaires in 2010. The questionnaires contained items on sickness absence days during the last 12 months, employment status, demographics, self-rated health, professional autonomy and psychosocial work stress.Results84% (95% CI 80 to 88%) of self-employed and 60% (95% CI 55 to 64%) of employed doctors reported no absence at all last year. In three multivariate logistic regression models with sickness absence as response variable, employment category was a highly significant predictor for absence vs. no absence, 1 to 3 days of absence vs. no absence and 4 to 99 days of absence vs. no absence), while in a model with 100 or more days of absence vs. no absence, there was no difference between employment categories, suggesting that serious chronic disease or injury is less dependent on employment category. Average or poor self-rated health and low professional autonomy, were also significant predictors of sickness absence, while psychosocial work stress, age and gender were not.ConclusionSelf-employed GPs and private practice specialist reported lower sickness absence than employed hospital doctors. Differences in sickness compensation, and organisational and individual factors may to a certain extent explain this finding.

Offline: The league of youth

Last week was my Norwegian father's 80th birthday and a celebration was held in typically Nordic style in Oslo. Unfortunately, I missed a good deal of the night. One of my father's friends, himself a lively 85 years, slipped and fell. He cut his leg and considerable quantities of blood spilled onto the floor. I found myself in a taxi late in the evening taking him to a nearby Norwegian accident and emergency department. I don't speak Norwegian, so the task ahead seemed daunting. Fortunately, another guest came with us and we managed to negotiate our way through the triage nurse into a room where our friend could be examined. The Norwegian nurses and doctors we saw could not have been kinder. The first nurse quickly cleaned his leg. The second nurse did more of the same. A doctor came. She looked at the wound and probed to see what damage had been done. She ordered an x-ray. No fracture. She thought we might get away without stitches but called a colleague for advice. He recommended stitches. Out came the needle, stitches were sewn, and the leg bandaged. Our friend's trousers were pulled back over the wound (all this activity had been completed with his black tie dinner suit still worn). And he was moved into a wheelchair. The aim now was to stand him up, check he could walk, and then take him home (where he lived alone). Sadly, this optimistic outcome was thwarted. Our patient couldn't stand on his damaged leg, and so the doctor decided to keep him in hospital overnight (which turned out to be 3 nights).

Erratum to: changes in the lifetime prevalence of suicidal feelings and thoughts among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples

Erratum to: changes in the lifetime prevalence of suicidal feelings and thoughts among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples

Doctors' attitudes to organ donation.

There is an increasing need for organs for transplantation purposes. Knowledge and attitudes among the medical team may affect the donation process. When respiration and cardiac activity are being sustained by artificial means, Norwegian law requires angiographic evidence of cessation of cerebral circulation as well as clinical examination before an organ donation can be carried out. We wished to survey Norwegian doctors' attitudes to organ donation and how donation processes are being addressed. A questionnaire with pre-defined response alternatives was distributed to doctors in intensive-care units as well as to specialists and junior registrars in neurosurgery in Norwegian donor hospitals in 2008-2009. Altogether 435 doctors (55%) returned a completed questionnaire. A total of 315 of 420 (75%) responded that they would consider initiating organ-preserving treatment when there is no more hope for the patient, while 18% were uncertain and 7% responded that they would not consider this option. Altogether 68 of 424 (16%) maintained that if an organ donation was relevant and current legislation could be disregarded, clinical diagnostics would be sufficient to establish a diagnosis of death. Another 22% were uncertain, while 62% were of the opinion that clinical diagnostics would be insufficient. A total of 258 of 416 (62%) reported that in their opinion, the next of kin most often could understand the implications of total destruction of the brain when this was explained to them. Future teaching should emphasise the opportunity for organ-preserving treatment in cases where a fatal outcome is expected.

Changes in the lifetime prevalence of suicidal feelings and thoughts among Norwegian doctors from 2000 to 2010: a longitudinal study based on national samples

BackgroundThinking about suicide is an indicator of suicide risk. Suicide rates are higher among doctors than in the population. The main aims of this study are to describe the changes in the lifetime prevalence of suicidal feelings from 2000 to 2010 and the possible predictors of serious suicidal thoughts in 2010 among Norwegian doctors. Differences in lifetime prevalence of suicidal feelings between Norwegian doctors in 2010 and German doctors in 2006 will be also described.MethodsLongitudinal and cross-sectional study based on questionnaire data from 2000 and 2010, including approximately 1,600 Norwegian doctors. In Germany, cross-sectional study based on questionnaire data from 2006 among a sample of 3,295 doctors. The main outcome measures were the lifetime prevalence of suicidal feelings (felt life was not worth living, wished own death, had thoughts of taking own life).ResultsThe prevalences in 2000 and 2010 of ever had feelings of life not worth living were 48 (44 to 52) % and 45 (41 to 49) %, of ever wished own death 27 (23 to 30) % and 23 (20 to 26) %, and of ever had thoughts of taking own life 29 (16 to 33) % and 24 (21 to 27) %. Paired t-tests among those who responded both in 2000 and 2010 show significant reductions for felt life not worth living (t = −3.4; p = 0.001), wished own death (t = −3.1; p = 0.002) and had thoughts of taking own life (t = −3.5; p < 0.0001). In 2010, significant predictors of serious suicidal thoughts in a multivariate model were low subjective well-being (OR 0.68; 95% CI 0.52-0.90), poor or average self-rated health (2.36; 1.25-4.45) and high psychosocial work stress (1.92; 1.06-3.46), controlled for age, gender, speciality and job satisfaction. Norwegian doctors in 2010 compared with their German counterparts in 2006 reported quite similar prevalences of suicidal feelings.ConclusionsSuicidal feelings among Norwegian doctors decreased from 2000 to 2010. Individual and work-related factors may to certain explain these findings. Compared with other professionals in Norway and doctors in Germany, Norwegian doctors showed no higher risk of suicidal thoughts.

Changes in Lifetime Prevalence of Suicidal Feelings among Norwegian Doctors from 2000 to 2010: A longitudinal Study based on National Samples

Changes in Lifetime Prevalence of Suicidal Feelings among Norwegian Doctors from 2000 to 2010: A longitudinal Study based on National Samples

Prioritizing treatment of rare diseases: A survey of preferences of Norwegian doctors

Understanding doctors' preferences for prioritizing treatment of rare diseases can provide an important context for policy makers who must decide whether to exempt rare disease treatments, which are often quite expensive, from standard cost-effectiveness criteria. We surveyed a random sample of 551 Norwegian doctors in November 2011 and compared results to a similar survey of the Norwegian population. Respondents chose whether to prioritize treatment of patients with rare versus common diseases and then decided how to allocate funds between the two groups for each of two scenarios: (1) equal costs per person and (2) higher costs for the rare disease. Respondents were randomized to treatment costs for the rare disease in the second scenario that were either 8 or 25 times higher than treating the common disease. Except for different prevalence, the diseases were described identically. Doctors displayed no general preference for prioritizing treatment of rare diseases, but a large number favored the principle of reserving a small share of funds for rare disease patients. Doctors' responses differed significantly from those of the general population when the rare disease was more costly to treat. A larger share of doctors prioritized the common disease group for treatment while a smaller share expressed indifference. When dividing funds between the two patient groups, doctors allocated a smaller share of funds to the rare disease. Doctors were much less likely than the general population to divide funds equally between the groups. This study indicates that there is little support among Norwegian doctors for prioritizing the treatment of rare diseases.

Becoming Whole: Kari Martinsen’s Philosophy of Care – Selected Concepts and Impact on Clinical Nursing

There seems to be a schism between philosophical descriptions of care ethics and nurses’ concrete experiences with nurse-patient collaboration. The article uses the Norwegian doctor of philosophy Kari Martinsen’s phenomenological philosophy of care as a framework to reflect on and connect to the impact on nursing. Nursing as a relationship-based moral practice is understood in the light of the philosophy of connected relations, the source of morality, and the concrete practical situation. Love, trust and power reflect the ethical demand in the concrete and asymmetrical nurse-patient relationship. Becoming whole; nursing practice and a philosophy of care are to be understood as intertwined.

Moralsk stress og faglig ytringsfrihet blant leger

Previous studies indicate that Norwegian doctors experience distress in their encounter with differing and partly contradictory ideals, such as the obligation to criticise unethical and inappropriate practices. The objective of this study was to investigate the perception of moral distress and professional freedom of speech among Norwegian doctors as of today, as well as identify changes that have occurred since the previous study undertaken in 2004. A total of 1,522 economically active doctors received a questionnaire listing various statements describing the perception of moral distress and professional freedom of speech. The responses were compared to responses to the 2004 study. Altogether 67% of the doctors responded to the questionnaire. The proportion who reported «fairly strong» or «strong» moral distress varied from 24% to 70% among the different statements. On the whole, the «rank and file» hospital doctors reported the highest degree of moral distress. Nevertheless, a decrease in the scores for moral distress could be observed from 2004 to 2010. During the same period, the perception of professional freedom of speech increased slightly. A reduced level of distress associated with ethical conflicts in working life may be due to improved methods for handling distressing situations, or because the consequences of the health services reorganisations are perceived as less threatening now than in 2004, immediately after the introduction of the hospital reform. However, the perceived lower distress level may also be due to professional and ethical resignation. These findings should be followed up by a qualitative study.

Kulturell og musikalsk aktivitet blant norske leger

The cultural and musical activity of Norwegian doctors was studied in 1993. We wished to re-examine their cultural and musical activity, analyse the development and study the correlation with satisfaction, health and other leisure activities. In the autumn of 2010, a survey was undertaken among a representative sample of economically active Norwegian doctors. The survey asked the same questions as in 1993, and the responses were also compared to the population studies conducted by Statistics Norway. We also used a cultural index that we have developed ourselves. Altogether 1,019 doctors (70%) responded to the survey. They reported a higher level of cultural activity in 2010 than in 1993, measured in terms of reading of non-medical literature and visits to the cinema, theatre and concerts. The doctors engaged in musical activity of their own especially frequently: 58% reported to be able to play an instrument, and 21% reported to play on a regular basis, which is more than among other academic professions. We found a significant correlation between the doctors' level of cultural activity and their job satisfaction, general satisfaction, self-reported health and physical activity. The doctors who engage most frequently in cultural activities are thus most satisfied with their work and with life in general. Furthermore, they also have better self-reported health. Norwegian doctors give priority to cultural and musical activities. The assertion that doctors are particularly fond of music is more than just a myth.

Risk factors at medical school for later severe depression: A 15-year longitudinal, nationwide study (NORDOC)

BackgroundDoctors have an increased risk of suicide, and depressive symptoms are prominent among young doctors. We lack prospective studies that identify risk factors to be targeted in medical schools. MethodsFrom 1993 to 2008, graduating medical students (n=631) from all four Norwegian universities participated in the Longitudinal Study of Norwegian Medical Students and Doctors (NORDOC). After their graduating term (T1), they were followed up 1 (T2), 4 (T3), 10 (T4), and 15 (T5) years later with postal surveys. Severe depressive symptoms were measured by the General Health Questionnaire-28 (T1, T2, T3, T4, and T5) and analyzed by generalized estimating equations. ResultsAt T1 and T5, 13.7% and 7.2%, respectively, of the doctors reported severe depressive symptoms; a significant reduction over time (p=0.001) in both genders (response rates 56–83%). Independent risk factors for future depressive symptoms were: young age (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.04–1.2, p=0.003); high neuroticism (OR 3.4, 95% CI 1.5–7.6, p=0.003); high reality weakness (OR 2.3, 95% CI 1.2–4.2, p=0.008); and severe depressive symptoms at T1 (OR 3.6, 95% CI 2.1–6.1, p<0.001). LimitationsSelection bias and concurrent life and work stress may have influenced the results. ConclusionsIn addition to low age, high neuroticism yielded a threefold increased risk over the 15-year follow-up, whereas high reality weakness, which is linked to personality pathology, doubled the risk. These factors are clinically relevant for identification of students at risk.

Changes in Alcohol Drinking Patterns and Their Consequences among Norwegian Doctors from 2000 to 2010: A Longitudinal Study Based on National Samples

To describe changes in the patterns and consequences of alcohol use among Norwegian doctors from 2000 to 2010. Longitudinal study based on data from nation-wide postal surveys in 2000 and 2010 among a representative sample of 682 doctors in Norway. The Alcohol Use Disorder Identification Test (AUDIT) was used to measure the changes in drinking patterns (frequency of drinking, frequency of heavy drinking and quantity of drinking), symptoms of alcohol dependence and adverse consequences of drinking. A score above 8 was defined as hazardous drinking. From 2000 to 2010, the proportion of doctors who used alcohol twice a week or more significantly increased from 31.4 (27.9-34.9) % to 48.7 (44.9-48.7) %, and the proportion of those who drank to intoxication weekly or more decreased significantly from 6.6 (4.7-8.6) % to 2.5 (1.3-1.7) %. The proportion who scored above 8 on the AUDIT decreased from 10.7 (8.4-13.0) % in 2000 to 8.2 (6.2-10.3) % in 2010. There was a significant increase in the partial AUDIT-score for drinking patterns (t=2.4; P=0.016), and a significant decrease in the partial AUDIT-score for adverse consequences of drinking (t=-3.6; P<0.001). The partial AUDIT-score for symptoms of alcohol dependence did not change significantly (t=-1.6; P=0.112). There were gender differences in drinking patterns. Females had less frequent alcohol consumption and fewer episodes of heavy and hazardous drinking in 2000 and 2010. The drinking pattern of Norwegian doctors has changed over the past decade towards more moderate alcohol consumption and less negative alcohol-related consequences. Changes in the attitude towards alcohol consumption may to a certain extent explain these findings.

When you can’t have the cake and eat it too: A study of medical doctors’ priorities in complex choice situations

Available literature provides little insight into medical doctors’ prescription choices when they are required to make complex trade-offs between different concerns such as treatment effect, costs, and patient preferences simultaneously. This study investigates this issue. It is based on a Discrete Choice Experiment (DCE) conducted with 571 Norwegian doctors, where the DCE captures preferences for medications described along five dimensions important for both clinical decision-making and prioritisation in the health sector. Although effectiveness is the most important determinant of choice in our study, doctors also put considerable weight on patients’ preferences and on avoiding high total costs. The probability of choosing a particular medication increases when doctors have a positive experience with the medication. GPs value high clinical effectiveness less than hospital consultants do. They are also less concerned with patient preferences. For both groups of doctors it turns out that they are willing to make difficult trade-offs between attributes they are often assumed not to be willing to compromise on, like effectiveness or patient preferences, and cost measures – given that they have proper information about these attributes.

Medical Management in Norwegian Hospitals

Hospitals are increasing in size and complexity and hospital manage-ment is being professionalized. This paper aims to investigate how doctors engage in hospital management. Are doctors losing their influence? Based on a review of existing literature and data from a longitudinal study, we show that Norwegian doctors have seemingly lost some of their previous dominance in hospital manage-ment, as other professions have entered traditional areas of medical influence. However, we argue that doctors appear to regain an influential position in formal decision making by entering positions with higher potential for influence. We suggest an analytical approach that illustrates the changing engagement of doctors in management. Our paper contributes to the current and requested research on the relationship between medicine and management in European states.

Will sick leave after a counselling intervention prevent later burnout? A 3-year follow-up study of Norwegian doctors

Burnout and mental distress in working doctors increase the risk for both suboptimal treatment of patients and negative health consequences for the doctors. Doctors have low rates of sickness absence and are reluctant to seek help, especially for mental distress. We examined whether a spell of sickness absence after a counselling intervention could predict reduction in emotional exhaustion among doctors at work 3 years later. A 3-year follow up after a counselling intervention for burnout at the Resource Centre Villa Sana in Norway in 2003-05 was completed by 184/227 doctors. Self-report assessments were administered at baseline, 1-, and 3-years. The effect of number of weeks of sickness absence on reduction in emotional exhaustion among doctors working 3 years after the intervention was assessed by linear regression. Of the 184 doctors completing assessment, 149 were working at 3-year follow up. Emotional exhaustion (scale 1-5) was significantly reduced at follow up (from 3.00±0.96 to 2.37±0.79, p<0.001). The number of weeks of sickness absence after the intervention was a significant positive predictor of this reduction (β=0.31, p<0.001), also after including sex, age, neuroticism, reduction of work hours, and other forms for treatment in the model. The number of weeks of sickness absence after a counselling intervention for burnout had a positive predictive effect on reduction in emotional exhaustion among doctors at work 3 years later. Sick leave thus seems to "prevent" later burnout, which can be of importance both for their patients and for the doctors themselves.

Law, ethics and clinical judgment in end-of-life decisions—How do Norwegian doctors think?

AimAccording to Norwegian law, an autonomous patient has the right to refuse life-prolonging treatment. If the patient is not defined as dying, however, health personnel are obliged to instigate life-saving treatment in an emergency situation even against the patient's wishes. The purpose of this study was to investigate how doctors’ attitudes and knowledge agree with these legal provisions, and how the statutory provision on emergency situations influences the principle of patient autonomy for severely ill, but not dying, patients. MethodA strategic sample of 1175 Norwegian doctors who are specialists in internal medicine, paediatrics, surgery, neurology and neurosurgery received a mail questionnaire about decisions on end-of-life care in hypothetical scenarios. The case presented concerns a 45-year-old autonomous patient diagnosed with end-stage ALS who declines ventilatory treatment. Recipients were randomly selected from the membership roster of the Norwegian Medical Association. 640 (54.5%) responded; of these, 406 had experience with end-of-life decisions. Results56.1% (221/394) stated that ALS patients in such situations can always refuse life-prolonging treatment, and 42.4% (167/394) were of the opinion that the patient can normally refuse life-prolonging treatment. 1.5% (6/394) stated that the patient cannot refuse life-prolonging treatment. ConclusionsThe answers indicate that the respondents include patients’ refusal in an overall clinical judgement, and interpret patients’ right to decline life-saving treatment in different ways. This may reflect the complex legal situation in Norway regarding patient autonomy with respect to the right of severely ill, but not dying, patients’ right to decline acute life-saving treatment.

The impact of change in a doctor's job position: a five-year cohort study of job satisfaction among Norwegian doctors

BackgroundJob satisfaction among physicians may be of importance to their individual careers and their work with patients. We lack prospective studies on whether a change in a doctor's job position influences their job satisfaction over a five-year period if we control for other workload factors.MethodsA longitudinal national cohort of all physicians who graduated in Norway in 1993 and 1994 was surveyed by postal questionnaire in 2003 (T1) and 2008 (T2). Outcomes were measured with a 10-item job satisfaction scale. Predictor variables in a multiple regression model were: change in job position, reduction in work-home interface stress, reduction in work hours, age, and gender.ResultsA total of 59% of subjects (306/522) responded at both time points. The mean value of job satisfaction in the total sample increased from 51.6 (SD = 9.0) at T1 to 53.4 (SD = 8.2) at T2 (paired t test, t = 3.8, p < 0.001). The major groups or positions at T1 were senior house officers (45%), chief specialists in hospitals (23%), and general practitioners (17%), and the latter showed the highest levels of job satisfaction. Physicians who changed position during the period (n = 176) experienced an increase in job satisfaction from 49.5 (SD = 8.4) in 2003 to 52.9 (SD = 7.5) in 2008 (paired t test, t = 5.2, p < 0.001). Job satisfaction remained unchanged for physicians who stayed in the same position. There was also an increase in satisfaction among those who changed from positions other than senior house officer at T1 (p < 0.01). The significant adjusted predictor variables in the multiple regression model were the change in position from senior house officer at T1 to any other position (β = 2.83, p < 0.001), any change in job position (from any position except SHO at T1) (β = 4.18, p < 0.01) and reduction in work-home interface stress (β = 1.04, p < 0.001).ConclusionsThe physicians experienced an increase in job satisfaction over a five-year period, which was predicted by a change in job position and a reduction in work-home stress. This study has implications with respect to career advice for young doctors.