Yaphe, John

Frontiers in Behavioral Neuroscience

Universidade do Minho: RepositoriUM

Rev Port Med Geral Fam 2015;31:86-786 editorialthe mental health of patients seen in primary care. Theemigration of young workers with quick minds andstrong backs to richer countries in Europe and beyondhas also affected those left behind. The search for workand the absence of work are common topics for dis-cussion with the family doctor.Illness arising in the workplace is well known. Ourpublic health colleagues teach us about the “top six”conditions affecting the health of workers: skin irritants,inhalation of toxins, posture, noise, vibration, and ra-diation. The recent outbreak of Legionnaire’s diseaseamong people exposed to discharge from a factory to-wer has heightened public awareness of the risks of ex-posure to industrial wastes.  We have a responsibility topromote awareness of these risks, to advise our patientsto take the necessary measures to prevent damage (hel-mets, goggles, masks, gloves, boots and so on), and toscreen for early signs of exposure to reduce further da-mage. While we are agents of the society in the Natio-nal Health Service, there is no ethical conflict from “dou-ble agency”. The health and safety of our working pa-tients comes before our concern for the profits of theiremployers.Psychological risks in the workplace are less discus-sed but are well known to family doctors. The problemsof burnout in health professionals have been discussedin this journal.5 Maslach’s burnout inventory has beentranslated into Portuguese and validated for use amongboth health care workers and medical students. Weneed to be aware of the signs and risks of emotional exhaustion, depersonalization, and the sense of loss ofpersonal rewards from our work. This has implicationsfor our patients as well as our own health.Other psychological risks in the workplace affectivehealth arise from two recently studied phenomena. Thefirst is the effects of shift work.6 Changes in shifts are likejet lag. They can throw off the body’s internal clock andlead to accidents, irritability, family disruption, and de-creased production. Care in managing changes in shiftsincludes providing adequate time to adjust to a newroutine, supervision in the performance of sensitivetasks at the time of a change and minimising frequent*Associate Professor, Community Health, University of Minho.John Yaphe, MD MClSc*Work and HealthWork is an important determinant ofhealth. Most of us work to live whilesome of us live to work. Our workinghours comprise a significant part of ourlives. Our identities are bound up in the work we do.Freud said in 1930 that the bases of society are love andwork. “The communal life of human beings had a two-fold foundation: the compulsion to work, which wascreated by external necessity, and the power of love.”1:48In the previous editorial, we explored the relations bet-ween sex, gender and health.2 The effects of work onhealth are the focus of this editorial.We know that our economic health is tied to our phy-sical health. Social status depends partly on the jobsthat determine our income. Our work can also be thesource of ill health through injuries, toxins and stress.Loss of work can also lead to ill health.3 Retirement canadversely affect health.4 There is a broad interface bet-ween the medical world and the world of work and itcan be helpful to family doctors to explore what weknow about work and health.During undergraduate medical education and post-graduate training in family medicine, many educatorspay little attention to the importance of work in healthand disease. The School of Health Science of the Uni-versity of Minho is attempting to remedy this by raisingawareness of medical students in the second year in amedical sociology course with a seminar on work andhealth. In the third year, our colleagues from publichealth discuss issues related to occupational health andindustrial diseases in the community health course.During the clinical rotations in family medicine clinics,students observe the mysterious process of the baixa(off-work certification by the family doctor). They alsolearn of the importance of work as a determinant of so-cial status and income, with direct influences on health.  Work is also tied up with our sense of identity andwell-being. The recent economic crisis in Portugal hasproduced an increase in unemployment, especiallyamong young adults. This has had important effects onRev Port Med Geral Fam 2015;31:86-787editorialchanges. Melatonin may also have a role to play in hel-ping workers adjust to change in shifts.A second factor is the role of bullying in the work-place.7 While this has been given attention among chil-dren in schools, it also occurs in adult populations. Mostworkplaces have a zero-tolerance policy to bullying butit can be subtle and its effects can be far-reaching. Thefamily doctor can play a role by being aware of patientsat risk of bullying. Frequent absence from work for so-called trivial illnesses may raise a warning flag. We mayask the patients questions similar to the ones we usewhen screening for domestic abuse. Has anyone at worktried to hurt, hit, insult, belittle, or threaten you? Doyou feel safe and comfortable at work? We can then re-fer to the appropriate agencies that ensure safety in theworkplace.When we talk with our patients, we need to be awa-re of their sense of fulfillment that comes from successin both love and work. When these elements are mis-sing, it can have effects on health. Simple counsellingskills are required to explore this issue. They are allwithin the capabilities of family doctors. We can ask ba-sic questions like: What kind of work do you do? Howsatisfied are you with your work? How satisfied are youwith the rewards you receive from your work? What kindof support do you receive on the job? How does yourwork affect your health? What risks do you see in yourworkplace? How can I help you to cope?Effects of work on health are becoming increasinglyimportant. We encourage our readers to explore theseissues with their patients, their students and their col-leagues. We also look forward to receiving submissionsof original research, reviews, opinions and debate onthis important topic. REFERENCES1. Freud S. Civilization and its discontents. New York: W. W. Norton; 1961.ISBN 97803930962312. Yaphe J. Sex and gender in family medicine in Portugal [Editorial]. RevPort Med Geral Fam. 2015;31(1):10-1.3. Institute for Work and Health. Unemployment and mental health.Toronto: Institute for Work and Health; 2009 [cited 2015 Mar 11].Available from: http://www.iwh.on.ca/briefings/unemployment-and-mental-health 4. Skerret PJ. Is retirement good for health or bad for it? Harvard HealthBlog; 2012 [cited 2015 Mar 11]. Available from: http://www.health.har-vard.edu/blog/is-retirement-good-for-health-or-bad-for-it-201212105625/print/#comments_controls 5. Yaphe J. On the health of doctors: why we need to look after ourselvesfirst [Editorial]. Rev Port Med Geral Fam. 2013;29(2):86-7.6. Costa G. Shift work and health: current problems and preventive ac-tions. Saf Health Work. 2010;1(2):112-23. doi:10.5491/SHAW.2010.1.2.112. 7. Carter M, Thompson N, Crampton P, Morrow G, Burford B, Gray C, etal. Workplace bullying in the UK NHS: a questionnaire and interviewstudy on prevalence, impact and barriers to reporting. BMJ Open.2013;3(6):e002628. doi:10.1136/bmjopen-2013-002628.CONFLICT OF INTERESTNone reportedENDEREÇO PARA CORRESPONDÊNCIAyonahyaphe@hotmail.com

Work and Health

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Work and Health

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Universidade do Minho: RepositoriUM

Universidade do Minho: RepositoriUM