A Measure of Daily Distress in Practising Medicine

Abstract

Objective: Existing measures of stress either focus on burnout or frustration and fatigue factors, often referred to as job strain. The objectives of this study were to: establish a reliable measure of distress that is sensitive enough to identify job strain at lower levels of distress and risk of burnout at higher levels of distress; and document levels of distress among the major medical specialties and across varying patterns of clinical practice. Methods:A stratified cross-sectional survey of physicians in Canada was conducted in 2004. Among the eligible population, 2810 physicians (56.7%) responded. Response bias was negligible. Responding physicians completed a 13-item measure of distress. Confirmatory factor analysis was used to establish the measure. Scheffe tests were used to document differences in the levels of distress among specializations and by clinical practice profile.Results: Factor analysis revealed reliable dimensions of: fatigue (á = 0.75) and reaction (á = 0.73). The distress measure was reliable (á = 0.82). Emergency physicians (n = 4.51), surgeons (n = 4.35), and general practitioners (n = 4.33) reported the highest levels of distress, while administrative physicians (n = 3.30), community health (n = 3.35), and clinical specialists (n = 3.46) reported the lowest levels of distress. Physicians with clinical and administrative responsibilities reported the highest levels of distress (n = 4.40), compared with purely clinical physicians (n = 3.94) and clinician-academics (n = 3.98). Conclusions:Some specializations are associated with more distress than others. Administrative duties appear to add to distress for all physicians. Counterintuitively, adding academic as well as administrative responsibilities appears to add less distress than adding administrative duties alone. Academic duties are viewed as advancing medicine. Can J Psychiatry. 2009;54(3):170-180. Clinical Implications· Mentorship by senior colleagues may prevent physicians from becoming too absorbed in career responsibilities. · Community support is important to patients and physicians to ensure proper follow-up care. · Effective organization of clinical work and recognition of accomplishments by colleagues and administrators may provide psychological protection against excessive stress. Limitations· The study was cross-sectional. · The data were self-reported. · The number of specific specialists within each practice pattern was small.

Latent gender inequalities in the well-being of physicians according to payment method for practicing medicine: a cross-sectional study

“…The distress experienced by physicians in their daily practice was measured in two dimensions: fatigue and reaction [23] . All items scored on seven-point scales, from "Never" to "Daily".…”

“…The measures of career satisfaction [17] , professional equity [18] and daily distress [23] were validated in a Canadian cross-national sample among different medical specialties.…”

Payment method as a predictor of daily distress experienced by physicians

“…The distress faced by physicians and nurses is of ultimate legal responsibility over outcomes and pressures from high workloads [5][6][7] . Medical doctors are at a higher risk for burnout in comparison to individuals in other non-medical professions [1] , and high stress among physicians affects well-being of these health professionals and quality of care provided to patients [8][9][10][11][12][13] .…”

“…The practice of medicine has repetitive and unavoidable daily distresses which are particularly evident in certain areas of care (e.g., intensive care units, emergency, and operating rooms) [1,9] . Medical errors tend to occur when practitioners face intense physical and mental exhaustion [15] , and physicians are stressed when the quality of care is not as good as it could be [16] .…”

“…In Canada, about 40% of physicians feel stressed at least once a week, emergency physicians and surgeons are specialists experiencing the highest levels of distress [9] , and burnout and stress are commonly reported among family practitioners [9,12] . Declines in clinical autonomy, increases in workloads, organizational changes, practice restrictions, and career dissatisfaction have been identified as added sources of stress in medical practice [8,13,17,18] .…”