Mối quan hệ giữa việc tăng cường chất lượng cuộc sống cá nhân và sự đồng cảm giữa các bác sĩ nội trú

Journal of General Internal Medicine - Tập 20 - Trang 559-564 - 2005
Tait D. Shanafelt1,2, Colin West1, Xinghua Zhao3, Paul Novotny3, Joseph Kolars1,4, Thomas Habermann1,2, Jeff Sloan3
1Department of Internal Medicine, Mayo Clinic, Rochester, USA
2Division of Hematology, Mayo Clinic, Rochester, USA
3Cancer Center Statistics, Mayo Clinic, Rochester, USA
4Division of Gastroenterology, Mayo Clinic, Rochester, USA

Tóm tắt

CĂN CỨ: Mặc dù sự căng thẳng của bác sĩ nội trú và khả năng gây ảnh hưởng tiêu cực đến việc chăm sóc bệnh nhân đã được tài liệu hóa tốt, nhưng rất ít thông tin được biết về sự hạnh phúc của bác sĩ nội trú hoặc khả năng của nó trong việc nâng cao chất lượng chăm sóc. MỤC TIÊU: Chúng tôi đã đo lường mức độ hạnh phúc của bác sĩ nội trú và khám phá mối quan hệ của nó với sự đồng cảm. THIẾT KẾ: Khảo sát chéo, ẩn danh. THAM GIA: Các bác sĩ nội trú khoa nội tại Mayo Clinic Rochester (n=165, mùa hè năm 2003). ĐO LƯỜNG: Mức độ hạnh phúc được đo lường bằng Thang đo Kết quả Y tế 8 mục (SF-8) đã được xác thực trước đó. Độ đồng cảm được đo bằng Các phân đoạn Đánh giá quan điểm (PT) và Quan tâm đồng cảm (EC) của Chỉ số Phản ứng Interpersonal (IRI) đã được xác thực trước đó. KẾT QUẢ: Tám mươi ba (50%) bác sĩ nội trú đã trả lời khảo sát. Điểm trung bình về mức độ hạnh phúc theo SF-8 tương đương với dân số chung, và điểm số độ đồng cảm trên IRI tương tự như các mẫu bác sĩ nội trú khác. Độ đồng cảm của bác sĩ nội trú ở cả hai phân đoạn nhận thức (PT) và cảm xúc (EC) của IRI cao hơn cho những bác sĩ có mức hạnh phúc tinh thần cao hơn theo SF-8; tuy nhiên, sự khác biệt này chỉ có ý nghĩa thống kê đối với phân đoạn nhận thức. Tầm quan trọng của một số chiến lược thúc đẩy sức khỏe cá nhân khác nhau đối với những bác sĩ có sức khỏe tinh thần cao hơn theo SF-8. KẾT LUẬN: Sự hạnh phúc tinh thần cao có liên quan đến sự gia tăng độ đồng cảm của bác sĩ nội trú trong khảo sát chéo này. Cần có các nghiên cứu trong tương lai để khám phá khả năng cao về hạnh phúc của bác sĩ nội trú để nâng cao chất lượng chăm sóc y tế và năng lực bên cạnh việc khám phá những hậu quả tiêu cực của sự căng thẳng ở bác sĩ nội trú. Các nghiên cứu điều tra cách thức thúc đẩy độ hạnh phúc cho bác sĩ nội trú là cần thiết.

Từ khóa

#hạnh phúc của bác sĩ nội trú #sự đồng cảm #sức khỏe tinh thần #khảo sát chéo #Mayo Clinic #chất lượng chăm sóc y tế

Tài liệu tham khảo

Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:358–67. Bellini LM, Baime M, Shea JA. Variation of mood and empathy during internship. JAMA. 2002;287:3143–6. Lemkau JP, Purdy RR, Rafferty JP, Rudisill JR. Correlates of burnout among family practice residents. J Med Educ. 1988;63:682–91. Firth-Cozens J. Emotional distress in junior house officers. Br Med J (Clin Res Ed). 1987;295:533–6. Adler R, Werner E, Korsch B. Systematic study of four years of internship. Pediatrics. 1980;66:1000–8. Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med. 1997;44:1017–22. Collier VU, McCue JD, Markus A, Smith L. Stress in medical residency: status quo after a decade of reform? Ann Intern Med. 2002;136:384–90. Hughes PH, Conrad SE, Baldwin DC Jr., Storr CL, Sheehan DV. Resident physician substance use in the United States. JAMA. 1991;265:2069–73. Reuben DB. Depressive symptoms in medical house officers. Effects of level of training and work rotation. Arch Intern Med. 1985;145:286–8. Smith JW, Denny WF, Witzke DB. Emotional impairment in internal medicine house staff. Results of a national survey. JAMA. 1986;255:1155–8. Stress and impairment during residency training: strategies for reduction, identification, and management. Resident Services Committee, Association of Program Directors in Internal Medicine. Ann Intern Med. 1988;109:154–61. Lavery JP. The physician’s reaction to a malpractice suit. Obstet Gynecol. 1988;71:138–41. Colford JM Jr., McPhee SJ. The ravelled sleeve of care. Managing the stresses of residency training. JAMA. 1989;261:889–93. Reuben DB, Novack DH, Wachtel TJ, Wartman SA. A comprehensive support system for reducing house staff distress. Psychosomatics. 1984;25:815–20. Linzer M, Visser MR, Oort FJ, Smets EM, McMurray JE, de Haes HC. Predicting and preventing physician burnout: results from the United States and the Netherlands. Am J Med. 2001;111:170–5. McCue JD, Sachs CL. A stress management workshop improves residents’ coping skills. Arch Intern Med. 1991;151:2273–7. Shanafelt T, Sloan J, Habermann T. The well-being of physicians. Am J Med. 2003;1114:513–7. Weiner EL, Swain GR, Wolf B, Gottlieb M. A qualitative study of physicians’ own wellness-promotion practices. West J Med. 2001;174:19–23. Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan C. Calibrating the physician. Personal awareness and effective patient care. Working Group on Promoting Physician Personal Awareness, American Academy on Physician and Patient. JAMA. 1997;278:502–9. Quill TE, Williamson PR. Healthy approaches to physician stress. Arch Intern Med. 1990;150:1857–61. Novack D, Epstein R, Paulsen R. Toward creating physician-healers: fostering medical students’ self-awareness, personal growth, and well-being. Acad Med. 1999;74:516–20. Ware J, Kosinski M, Dewey J, Gandek B. How to Score and Interpret Single-Item Health Status Measures: A Manual for Users of the SF-8 Health Survey. Lincoln, RI: QualityMetric Incorporated; 2001. Turner-Bowker D, Bayliss M, Ware JE Jr., Kosinski M. Usefulness of the SSF-8 health survey for comparing the impact of migraine and other conditions. Qual Life Res. 2003;12:1003–12. ACGME ACGME Outcome Project. www.acgme.org/Outcome/. 2004. Brownell A, Cote L. Senior residents’ views on the meaning of professionalism and how they learn about it. Acad Med. 2001;76:734–7. Halpern J. What is clinical empathy. J Gen Intern Med. 2001;18:670–4. Brock C, Salinsky J. Empathy: an essential skill for understanding the physician-patient relationship in clinical practice. Educ Res Methods. 1993;25:245–48. Epstein R. Mindful practice. JAMA. 1999;282:833–9. Benbassat J, Baumal R. What is empathy, and how can it be promoted during clinical clerkships. Acad Med. 2004;79:832–9. Spiro H. What is empathy and can it be taught? Ann Intern Med. 1992;116:843–6. Branch W, Pels R, Hafler J. Medical students’ empathic understanding of their patients. Acad Med. 1998;71:360–2. Charon R. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001;286:1897–902. More E. Empathy as a hermeneutic practice. Theor Med. 1996;17:243–54. Davis M. A multidimensional approach to individual differences in empathy. JSAS Catalog Selected Documents Psychol. 1980;10:85. Davis M. Measuring individual differences in empathy: evidence for a multi-dimensional approach. J Pers Soc Psychol. 1983;44:113–26. Evans B, Stanley R, Burrows G. Measuring medical students empathy skills. Br J Med Psychol. 1993;66:121–33. Evans B, Stanley R, Coman G, Burrows G. Psychological tests to measure the effects of medical education on students’ interpersonal skills. Med Educ. 1989;23:492–7. Coman G, Evans B, Stanley R. Scores on the interpersonal reactivity index: a sample of Australian medical students. Psychol Rep. 1988;62:943–5. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287:226–35. Melville A. Job satisfaction in general practice: implications for prescribing. Soc Sci Med [Med Psychol Med Sociol]. 1980;14A:495–9. DiMatteo MR, Sherbourne CD, Hays RD, et al. Physicians’ characteristics influence patients’ adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol. 1993;12:93–102. Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med. 2000;15:122–8. Linn LS, Brook RH, Clark VA, Davies AR, Fink A, Kosecoff J. Physician and patient satisfaction as factors related to the organization of internal medicine group practices. Med Care. 1985;23:1171–8. Lichtenstein RL. The job satisfaction and retention of physicians in organized settings: a literature review. Med Care Rev. 1984;41:139–79. Winefield H, Chur-Jansen A. Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase? Med Educ. 2000;34:90–94. Shapiro J, Morrison E, Bocker J. Teaching empathy to first year medical students: evaluation of an elective literature and medicine course. Educ Health. 2004;17:73–84. Shapiro J, Rucker L. Can poetry make better doctors? Teaching the humanities and arts to medical students and residents at the University of California, Irvine, College of Medicine. Acad Med. 2003;78:953–7. Kopelman L. Values and virtures: how should they be taught? Acad Med. 1999;12:1307–10. Branch W. Supporting the moral development of medical students. J Gen Intern Med. 2000;15:503–8. DiLalla L, Hull S, Dorsey J. Effect of gender, age, and relevant course work on attitudes toward empathy, patient spirituality, and physician wellness. Teach Learn Med. 2004;16:165–70. Kopelman L. Philosophy and medical education. Acad Med. 1995;70:795–805. Roter D, Stewart M, Putnam S, Lipkin M Jr., Stiles W, Inui T. Communication patterns of primary care physicians. JAMA. 1997;277:350–6. Hornblow A, Kidson M, Jones K. Measuring medical students’ empathy: a validation study. Med Educ. 1977;11:7–12. Nightingale S, Yarnold P, Greenberg M. Sympathy, empathy, and physician resource utiliation. J Gen Intern Med. 1991;6:420–3. Hojat M, Gonnella J, Nasca T, Veloski SM, Magee M. The Jefferson scale of physician empathy: further psychometric data and differences by gender and specialty at item level. Acad Med. 2002;77:S58–60. Hojat M, Gonnella J, Mangione S, et al. Empathy in medical students as related to academic performance, clinical competence, and gender. Med Educ. 2002;36:522–27. Oswald P. Does the interpersonal reactivity index perspective-taking scale predict who will volunteer time to counsel adults entering college? Percept Motor Skills. 2003;97:1184–6. Asch D, Jedrziewski M, Christakis N. Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997;50:1129–36. Kellerman S, Herold J. Physician response to surveys A review of the literature. Am J Prev Med. 2001;20:61–71. Girard DE, Elliot DL, Hickam DH, et al. The internship—a prospective investigation of emotions and attitudes. West J Med. 1986;144:93–8. Gross E. Gender differences in physician stress: why the discrepant findings. Women Health. 1997;26:1–14. Frank E, McMurray JE, Linzer M, Elon L. Career satisfaction of US women physicians: results from the women physicians’ health study. Society of general internal medicine career satisfaction study group. Arch Intern Med. 1999;159:1417–26. McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The work lives of women physicians results from the physician work life study. The SGIM Career Satisfaction Study Group. J Gen Intern Med. 2000;15:372–80. Cooper CL, Rout U, Faragher B. Mental health, job satisfaction, and job stress among general practitioners. BMJ. 1989;298:366–70. Sekeres MA, Chernoff M, Lynch TS Jr., Kasendorf EI, Lasser DH, Greenberg DB. The impact of a physician awareness group and the first year of training on hematology-oncology fellows. J Clin Oncol. 2003;21:3676–82. Shanafelt T, Novotny P, Johnson ME, et al. The well-being and personal wellness promotion practices of medical oncologists in the north central cancer treatment group. Oncology (Karger). 2005;68:23–32. Kash KM, Holland JC, Breitbart W, et al. Stress and burnout in oncology. Oncology (Huntingt). 2000;14:1621–33; discussion 1633–4, 1636–7.