Medical Professionals and Healthcare Providers
Overview
Physicians
Why people chose a career in medicine
Medical school
Physician’s emotional involvement in their work
Physician’s and stress
Gender Issues in medical practice
The “femininisation” of medicine
Male and female physician’s perceptions of themselves, their work & careers
Nursing
The nature of modern nursing
Stress in Nursing
Other Health Care Professionals
Physical Rehabilitation and Physiotherapists
Technologists
Medico Familia
Medical Professionals and Healthcare Providers
Goals: to
know: what are the main training and workplace challenges and stressors for
doctors and nurses.
...possible consequences of excessive stress on doctors
and nurses.
... what are the significant gender issues in healthcare providing.
... what issues are at place for healthcare providers from other fields.
Physicians
During the period of time
between 1993 and 2001 there was a 5% decline in the number of practicing
physicians. In 2003 nearly 30% of residency
positions went unfilled!
In the same year 4.5 million Canadians said
they did not have a regular family doctor. more doctors are going into specialized training, fewer into GP. Why?
Why people chose a career in medicine
Many report that they
want to work with and help people, make use of interpersonal skills
and be
involved in science. What about the money, prestige, & power?
Stilwell et al. (2000) report that on the Myers-Briggs indicator those who are
more introverted and
feeling were likely to specialise in
GP,
while those who were more extroverted
and and thinking were likely to specialise in
surgery.
Males
were also more
likely to select surgery while females GP.
They also tend to score high on perfectionism and conscientiousness.
Medical school
Pre-med syndrome:
highly competitive attitudes sometimes lead people to sabotage
of other students
and their efforts.
Tend to work for GPA and also tend to have romanticized
notions of medical school.
Four years of student
training, gradual movement toward applied practice.
As a closed group
often get insulated and insider - outsider sentiments may develop.
One of the biggest challenges is to go from textbook to everyday real-life experience in diagnosis and treatment.
Also have challenge of what they can actually achieve in a real sense vs. their expectations and perfectionism. Medicine is best as is possible.
May develop compassion fatigue, or exhaustion from seemingly endless care.
Internship - one year
period of time post graduate where experience is garnered.
Work like slaves
80-120 hours per week in hospital (factories) and gradually earn full rights.
Residency is second
year post graduate where the slogging continues before finally becoming
certified.
Held at a greater degree of responsibility and often getting
less sleep.
Stress and burnout are common. Medical associations working to
reduce the maximum hours and minimum rest periods.
Physician’s emotional involvement in their work
In spite of sometimes appearances, physicians can place a great deal of emotional attachment to their patients and experience extreme stress when having to issue bad news about diagnosis or treatment.
Physicians and stress
Work overload and emotionally stressful patients or health care may lead
physicians to burnout.
Always caring about others and forgetting about oneself
(physician health thy self).
This appears to
particularly true for female doctors, who may also
face sexual discrimination
as well as strain between family and professional
roles.
Biggest stressors : uncertainty in diagnosis and prognosis, or prediction of outcome.
Clinical tests are not perfect and symptoms are sometimes vague.
Tests vary with respect to sensitivity,
ability to detect something when present
and specificity
ability to reject a false symptom.
While patients tend to over estimate the accuracy of diagnosis, doctors may be highly stressed by it.
With high faith in medical science, yet the possibility of misdiagnosis a lack of control is present and those who strive for perfection may be disturbed when unable to reach their goals and the high expectation they have for themselves.
Physician impairment or inability to work may occur as a result of these stressors or in combination with drug or alcohol abuse and family stresses.
Gender Issues in medical practice
Clearly, as elsewhere in science and the professional world, issues of gender or sexual discrimination .
In spite of this the gender balance in medicine is tipping towards women.
The “femininisation” of medicine
In 1991 there were 26% female physicians practicing in Canada, today almost 50%!
Not only is there a
change in the numbers of women going into medicine,
but the nature of the field
is becoming more feminine in focus and process (i.e., caring vs. curing)
Male and female physician’s perceptions
British study reveals that
males are more likely to cite:
leadership potential, spirit of curiosity, tolerance of ambiguity as personal
attributes.
Women in this study were more likely to cite:
inspire
confidence in others and ability to listen along with being caring and
compassionate. Women also cite friendship, having a good job and respect as
important.
Male and female issues arise around sexual health as well. Men and women prefer to have physicians of the same gender for such examinations.
Nursing
The nature of modern nursing
While physicians focus on curing, Nurses tend to focus more on caring.
With apparent
declined in caring Nurses have moved in two directions to combat it:
1) raise awareness about the importance of caring in health
2) job re-definition to include cure-related practices.
Advanced Practice Nursing is being advocated by the CNA where Nurses provide a specialty role using their clinical skills and judgment to include teaching, consultation, and research.
Clinical Nurse Specialist hold Master's or doctoral degrees in Nursing and have clinical expertise in one or another specialty area.
Nurse Practitioner will take on a number of the areas covered by a physician in a smaller community where little access to physicians is possible. Caring and curing are combined here.
All across the field of nursing are shortages of qualified professionals. Currently in BC and Canada the average age of nurses is over 50. Such severe shortages, and those expected, have led to burnout and compassion fatigue.
Stress in Nursing
Compassion fatigue involves a form of burnout for those who provide a large amount of compassion in their professional lives. After a period of time it is too difficult to maintain and the stress of it can lead to other issues and challenges.
Sources vary, but include the reality shock that comes when changing from student to professional nurse. as with the physician added responsibility and heavy workload may be quite far from the fantasized expectations.
The ongoing culture of nursing has also become devalued by government as seen through inadequate funding, when combined with staffing shortages leads to faster burnout and a toxic workplace.
According to Poole et al, the Job Strain model suggests that high demands and low control, as in the case of nursing, may lead to high stress and poorer health for these healthcare providers. Again helping others and placing own needs behind those of others further exacerbates the situation.
Other Health Care Professionals
Several other
healthcare professionals can be examined, the text goes into some detail on two:
Physical Rehabilitation and Physiotherapists as well as Technologists.
Physical Rehabilitation and Physiotherapists
While there is only sparse literature on this field as part of health psychology, Poole et al, identify several issues that are important to these professions.
1) Goal setting is important for establishing rehabilitation or recovery
2) Adherence also plays a big role as to whether or not people will maintain their activity diet and medication regimens.
3) Behavioural interventions are used through external reinforcement as well as self-reinforcement.
4) Cognitive interventions - working on self-efficacy beliefs as well as attributions of success and failure.
5) Pain Management is also an area of health psychology that arises in these professions
Technologists
Such individuals often combine their desire to help others with their interest in technology. Skilled training over a relatively short period of time enables working in the field after one or two years of training. Provide important link in the diagnostic - treatment chain and require personal skills for interacting with anxious or afraid people.
Medico Familia (see healthcare in Cuba, last topic)
The family doctor in Cuba, blend skills from various other areas of North American healthcare into a personal and familiar, informative and educational, knowledgeable and accessible professional.
May blend worldviews from Santeria or Chinese medicine with traditional biomedical training, in a context where there is some high-tech and advanced medicine, but it is not always available.
Preventative medicine plays a big role through educational programmes.