Healthy Doctors – Sick Medicine

Doctors are among the healthiest segments of the population in western countries. Nevertheless, they complain strongly of stress and burnout. Their own explanation is deprofessionalisation: The honourable art of doctoring has been replaced by standardised interventions and production lines; professional autonomy has withered. This view is shared by many medical sociologists who have identified a “golden age of medicine,” or “golden age of doctoring,” starting after World War II and declining around 1970. This article looks at some of the central sociological literature on deprofessionalisation, particularly in a perspective of countervailing powers. It also looks into another rise-and-fall model, proposed by the medical profession itself, where the fall in professional power was generated by the notion that there are no more white spots to explore on the map of medicine. Contemporary doctoring is a case of cognitive dissonance, where the traditional doctor role seems incompatible with modern health care. Keywords: deprofessionalisation, professional autonomy, cognitive dissonance, golden age of doctorin

Healthy Doctors – Sick Medicine

Doctors are among the healthiest segments of the population in western countries. Nevertheless, they complain strongly of stress and burnout. Their own explanation is deprofessionalisation: The honourable art of doctoring has been replaced by standardised interventions and production lines; professional autonomy has withered. This view is shared by many medical sociologists who have identified a “golden age of medicine,” or “golden age of doctoring,” starting after World War II and declining around 1970. This article looks at some of the central sociological literature on deprofessionalisation, particularly in a perspective of countervailing powers. It also looks into another rise-and-fall model, proposed by the medical profession itself, where the fall in professional power was generated by the notion that there are no more white spots to explore on the map of medicine. Contemporary doctoring is a case of cognitive dissonance, where the traditional doctor role seems incompatible with modern health care. Keywords: deprofessionalisation, professional autonomy, cognitive dissonance, golden age of doctorin

Is imperfection becoming easier to live with for doctors?

Objective Being involved in serious patient injury is devastating for most doctors. During the last two decades, several efforts have been launched to improve Norwegian doctors’ coping with adverse events and complaints. Methods The method involved survey to a representative sample of 1792 Norwegian doctors in 2012. The questions on adverse events and its effects were previously asked in 2000. Results Response rate was 71%. More doctors reported to have been involved in episodes with serious patient harm in 2012 (35%) than in 2000 (28%), and more of the episodes were reported as required by law. Doctors below age 50 report better support from colleagues, more collegial retrospective discussion on the event and less patient/family blame. In all, 27% of the doctors had been reported to the Norwegian Board of Health Supervision; 79% of these complaints were rejected; 73% of the doctors who had received a reaction from the health authorities found the reaction reasonable, but almost one out of five practiced more testing and referrals after a complaint and 25% claimed that the complaint had made them into a more fearful doctor. Conclusion Our results indicate that adverse events are being met more openly in 2012 than in 2000, and that coping with imperfection and patient complaints is less devastating for new generations of doctors

Resultados del tratamiento quirúrgico de la Hernia Inguinal Hospital Regional Ixtapan de la Sal, ISEM 2011 - 2012

To assess job satisfaction for different categories of Norwegian doctors from 2010 to 2016–2017.Cross-sectional surveys in 2010, 2012, 2014 and 2016–2017 of partly overlapping samples.Norway from 2010 to 2016–2017.Doctors working in different job positions (hospital doctors, general practitioners (GPs), private practice specialists, doctors in academia). Response rates were 67% (1014/1520) in 2010, 71% (1279/1792) in 2012, 75% (1158/1545) in 2014 and 73% (1604/2195) in 2016–2017. The same 548 doctors responded at all four points in time.Main outcome measureJob Satisfaction Scale (JSS), a 10-item widely used instrument, with scores ranging from 1 (low satisfaction) to 7 (high satisfaction) for each item, and an unweighted mean total sum score.General Linear Modelling, controlling for gender and age, and paired t-tests.For all doctors, the mean scores of JSS decreased significantly from 5.52 (95% CI 5.42 to 5.61) in 2010 to 5.30 (5.22 to 5.38) in 2016–2017. The decrease was significant for GPs (5.54, 5.43 to 5.65 vs 5.17, 5.07 to 5.28) and hospital doctors (5.14, 5.07 to 5.21 vs 5.00, 4.94 to 5.06). Private practice specialists were most satisfied, followed by GPs and hospital doctors. The difference between the GPs and the private practice specialists increased over time.From 2010 to 2016–2017 job satisfaction for Norwegian doctors decreased, but it was still at a relatively high level. Several healthcare reforms and regulations over the last decade and changes in the professional culture may explain some of the reduced satisfaction

The HPV vaccine: knowledge and attitudes among public health nurses and general practitioners in Northern Norway after introduction of the vaccine in the school-based vaccination programme

Objective: To investigate knowledge of and attitudes to human papillomavirus (HPV) infection, HPV vaccination, cervical cancer, related sources of information and factors associated with will- ingness to vaccinate one ’ s own daughter among primary health care (PHC) personnel. Design: Cross-sectional study. Setting: PHC. Subjects: All public health nurses (PHNs) and general practitioners (GPs) in Northern Norway were invited to answer a structured electronic questionnaire; 31% participated ( N ¼ 220). Main outcome measures: Self-reported and actual knowledge, information sources, attitudes and willingness to vaccinate their (tentative) daughter. Results: 47% of respondents knew that HPV infection is a necessary cause of cervical cancer. PHNs had higher self-reported and actual knowledge about HPV vaccination and cervical cancer than GPs. PHNs used the Norwegian Institute of Public Health ’ s numerous information sources on HPV, while GPs had a low user rate. 88% of PHNs and 50% of GPs acquired information from the pharmaceutical industry. 93% PHNs and 68% of GPs would vaccinate their 12-year-old daughter. In a multivariate logistic regression analysis, willingness to vaccinate one ’ s daughter was positively associated with younger age, being PHN (OR ¼ 5.26, 95%CI 1.74 – 15.94), little con- cern about vaccine side effects (OR ¼ 3.61, 95%CI 1.10 – 11.81) and disagreement among experts (OR ¼ 7.31, 95%CI 2.73 – 19.60). Conclusions: Increased knowledge about HPV infection and vaccination is needed, particularly among GPs. Those least concerned about side effects and disagreements among experts were most likely to vaccinate their daughter. These findings are of interest for public health authorities responsible for the Norwegian vaccination and cervix cancer screening programmes, and pro- viders of training of PHC personnel

Suicide rates from 1960 to 1989 in Norwegian physicians compared with other educational groups

The aim of the present study is to compare suicide rates between 1960 and 1989 for Norwegian physicians with corresponding rates for other Norwegians with and without university education, by age, gender, and five-year period, based on death certificates for all Norwegians who died in the period 1960-1989. There were 82 registered physician suicides, of which 9 were female, 265 suicides by persons with other university education, and 11, 165 by persons with no university education. Suicide rate is measured in number of deaths per 100,000 person years. Crude suicide rates were 47.7 (95% CI 37.7-60.4) for male physicians, 20.1 (17.7-22.9) for other male university graduates, and 22.7 (22.2-23.2) for men with no university education. The corresponding figures for females were 32.3 (15.8-63.7), 13.0 (8.4-19.8) and 7.7 (7.5-8.0). Both for males and females, suicide rates, controlled for age and period, were significantly higher for physicians than for persons with other or no university education. Poisson modelling showed that the risk of suicide for male physicians has the same age pattern as for other males with higher education. In 1985-89 the suicide rate for male physicians increased nearly linearly from about 35 at the age 35-40 to about 100 at the age 75-79, which was almost three times higher than for the other male university graduates. For the age group 50-54 the estimated rate increases from about 50 in 1960-64 to about 90 in 1985-89. For the female physicians, the low number of cases prevents reliable estimation of trends. For male physicians, the trend from 1960 to 1989 is increasing. The estimated risk for a single physician to commit suicide was almost 5 times that of a married or co-habitant colleague. For 52% of the male and 85% of the female physicians the suicide method was poisoning. This is about twice the rates in the general population.Academics Mortality Physicians Suicide.

The ethics of euthanasia--Attitudes and practice among Norwegian physicians

The ethical guidelines of the Norwegian Medical Association strongly condemn physician participation in euthanasia and assisted suicide. A previous study on attitudes towards euthanasia in the Norwegian population, however, indicates that a substantial part of the population is quite liberal. This study explores Norwegian physicians' attitudes towards and experience with end of life dilemmas. Sixty-six percent of a representative sample of 1476 who received postal questionnaires responded. They confirmed that Norwegian physicians actually seem to hold quite restrictive attitudes towards euthanasia. Seventeen percent answered yes to a question of whether a physician should have the opportunity to actively end the life of a terminal patient in great pain who requests this help, while 4% agreed that the same could be done to a chronically ill patient with great pain and a poor quality of life who otherwise would have several more years to live. Six percent of the physicians had performed actions intended to hasten a patient's death, while 76% said that they at least once had treated patients even if they had felt that treatment should have been discontinued. A multiple logistic regression analysis showed that internal medicine specialists, surgeons and psychiatrists were significantly more restrictive than their colleagues in laboratory specialties, and that physicians educated abroad and those with negative attitudes towards patient autonomy had more liberal attitudes towards euthanasia, when gender and time since graduation from medical school were controlled for.euthanasia physicians patient autonomy