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Working as a doctor when acutely ill: comments made by doctors responding to United Kingdom surveys.

ABSTRACT: We undertook multi-purpose surveys of doctors who qualified in the United Kingdom between 1993 and 2012. Doctors were asked specific questions about their careers and were asked to comment about any aspect of their training or work. We report doctors' comments about working whilst acutely ill.Self-completed questionnaire surveys.United Kingdom.Nine cohorts of doctors, comprising all United Kingdom medical qualifiers of 1993, 1996, 1999, 2000, 2002, 2005, 2008, 2009 and 2012.Comments made by doctors about working when ill, in surveys one, five and 10 years after graduation.The response rate, overall, was 57.4% (38,613/67,224 doctors). Free-text comments were provided by 30.7% (11,859/38,613). Three-hundred and twenty one doctors (2.7% of those who wrote comments) wrote about working when feeling acutely ill. Working with Exhaustion/fatigue was the most frequent topic raised (195 doctors), followed by problems with Taking time off for illness (112), and general comments on Physical/mental health problems (66). Other topics raised included Support from others, Leaving or adapting/coping with the situation, Bullying, the Doctor's ability to care for patients and Death/bereavement. Arrangements for cover due to illness were regarded as insufficient by some respondents; some wrote that doctors were expected to work harder and longer to cover for colleagues absent because of illness.We recommend that employers ensure that it is not unduly difficult for doctors to take time off work when ill, and that employers review their strategies for covering ill doctors who are off work.

SUBMITTER: Smith F

PROVIDER: S-EPMC4820025 | biostudies-other | 2016 Apr

REPOSITORIES: biostudies-other

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Brexit and European doctors' decisions to leave the United Kingdom: a qualitative analysis of free-text questionnaire comments.

Project description:BackgroundQuantitative evidence suggests that Brexit has had a severe and negative impact on European doctors, with many medical staff leaving the UK. This study provides a detailed examination of European doctors' feelings towards Brexit, their intentions to leave the UK, and factors that may contribute to their potential decisions to migrate.MethodsAn online questionnaire which included three optional free-text questions explored self-identifying UK-based, European doctors' views of Brexit. The three questions prompted responses on how Brexit has impacted their personal lives, their professional lives, and their future migration decisions. Fifty-nine doctors participated in the questionnaire with 52 (88.1%) providing one or more responses to the three free-text questions. Twenty-seven doctors provided answers to all three free-text questions (51.9% of included sample). Thematic analysis was used to analyse this qualitative data.ResultsBrexit was reported by the majority of participants to have a profound impact, although some respondents felt it was too soon to assess the potential consequences. Five themes emerged including: feeling unwelcome in the UK, Brexit as racism, uncertainty on legal ability to work, strain on relationships, and in contrast, a current lack of concern about Brexit.ConclusionsTo mitigate the adverse personal and professional impact of Brexit, healthcare providers should provide financial and legal support to doctors applying for settlement in the UK, ensure they are addressing issues of racial and ethnic inequality in hiring, promotion, and pay, and work towards making clinical work environments inclusive for all staff and patients.

| S-EPMC7917529 | biostudies-literature

Management of hyperkalemia in the acutely ill patient.

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| S-EPMC6395464 | biostudies-literature

Marking the difference in acutely responding human CD8 T cells

Project description:The CD8 T cell response features functions that are fundamental for long-lasting immune protection, including antigen-specific cytolysis and memory. Accordingly, a range of differentiation subsets have been described with diverse functionalities and corresponding profiles of expression of markers. In both mouse and human systems, a major distinction has been “memory” versus “effector” terms. On the one hand, these terms may relate to temporality within the immune response : “effector” indicates the acute phase, “memory” refers to the post-contraction, resting phase. On the other hand, the terms also assign prototypic differentiation phenotypes that may be found at the same time-point : memory or effector subsets, based on characteristic markers. In this study, we analyse the human CD8 T cell response to YF-17D vaccination as the best-known model of acute immune response in humans. We study 21 characteristic markers conventionally used in mice and in humans to analyse and describe differentiation, activation, cycling, and so-called effector functions such as cytokine production and degranulation. We find clearly distinct ‘acute traits’ at the peak of the response that are shared amongst all non-naïve antigen-specific subsets, including in memory phenotype cells. These acute traits were low BCL-2 and high Ki67, CD38, HLA- DR, as well as increased Granzyme B and Perforin, which have been previously attributed only to effector cells at the peak of the response. Altogether, we evidenced ‘acute traits’ independent of differentiation phenotypes, supporting the semantic and marker distinction between “effector” and “acute” terms in the human CD8 T cell response.

2022-05-05 | GSE148223 | GEO

Reasons for considering leaving UK medicine: questionnaire study of junior doctors' comments.

Project description:To study the reasons given by junior doctors trained in the United Kingdom for considering leaving UK medicine.Analysis of replies to postal questionnaire surveys.United Kingdom.1326 doctors who qualified in 1999.Reasons for considering leaving.Of 1047 doctors who indicated that they would stay in medicine but not necessarily in the United Kingdom, 65% (682) gave reasons for leaving that concerned lifestyle, such as a preference for living outside the United Kingdom; 41% (433) gave reasons concerning working conditions in UK medicine; and 18% (184) gave positive work related reasons, such as wanting to work in developing countries. Of 279 doctors considering leaving medicine, 75% (210) cited working conditions, 23% (63) cited lifestyle reasons, and 9% (24) cited positive interests in a different career. Of the 169 doctors who said that they would probably or definitely leave the United Kingdom but remain in medicine, 78% (132) specified lifestyle reasons. Of the 42 who said that they would probably or definitely leave medicine, 67% (28) cited working conditions.The wish to work abroad, but to stay in medicine, was more common than the wish to leave medicine. The preference for a different lifestyle, particularly to live outside the United Kingdom, is not readily amenable to policy changes to the medical working environment. The smaller numbers of doctors who gave work experience as a reason for considering leaving medicine might be influenced to stay by improvements in working lives.

| S-EPMC534439 | biostudies-other

Changes in weekly working hours, proportion of doctors with hours above the limitations of European Working Time Directive (EWTD) and time spent on direct patient care for doctors in Norway from 2016 to 2019: a study based on repeated surveys.

Project description:ObjectivesTo compare the total weekly working hours, proportions with work hours above the limitations of European working time directive (EWTD) and time spent on direct patient care in 2016 and 2019 for doctors working in different job positions in Norway.DesignRepeated postal surveys in 2016 and 2019.SettingNorway.ParticipantsRepresentative samples of doctors; the response rates were 73.1% (1604/2195) in 2016 and 72.5% (1511/2084) in 2019.Main outcome measuresSelf-reported weekly working hours, proportions with hours above the limitations of EWTD defined as >48 hours/week and time spent on direct patient care.AnalysesLinear mixed models with estimated marginal means and proportions.ResultsFrom 2016 to 2019, the weekly working hours increased significantly for male general practitioners (GPs) (48.7 hours to 50.9 hours) and male hospital doctors in leading positions (48.2 hours to 50.5 hours), and significantly decreased for female specialists in private practice (48.6 hours to 44.9 hours). The proportion of time spent on direct patient care was noted to be similar between genders and over time. In 2019, it was higher for specialists in private practice (66.4%) and GPs (65.5%) than for doctors in other positions, such as senior hospital consultants (43.5%), specialty registrars (39.8%) and hospital doctors in leading positions (34.3%). Working >48 hours/week increased significantly for both male and female GPs (m: 45.2% to 57.7%; f: 27.8% to 47.0%) and hospital doctors in leading positions (m: 34.4% to 57.1%; f: 17.4% to 46.4%), while it significantly decreased for female specialty registrars (13.2% to 6.9%).ConclusionsWorking hours increased significantly for GPs and hospital doctors in leading positions from 2016 to 2019, resulting in increased proportions of doctors with work hours above the EWTD. As work hours above the EWTD can be harmful for health personnel and for safety at work, initiatives to reduce long working weeks are needed.

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Gut decontamination of acutely poisoned patients: what do doctors really know about it?

Project description:There are consensus guidelines on the appropriate use of gut decontamination in the management of poisoned patients. This study demonstrates that few doctors have read these guidelines and that they have poor knowledge of the use of gut decontamination, which can be improved with specific clinical toxicology teaching. Future guidelines should be published in journals more widely read by those doctors treating poisoned patients.

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Venous Thromboembolism Prophylaxis in Acutely Ill Veterans With Respiratory Disease.

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| S-EPMC6363316 | biostudies-literature

Experiential Communications Curriculum to Improve Resident Preparedness When Responding to Discriminatory Comments in the Workplace.

Project description:Background?Patients and families can make discriminatory comments leading to physician distress. Residents receive little training in appropriate responses to such comments and may be ill equipped to respond to intolerance without alienating the individual(s) making the comments.Objective?We assessed whether a simulated curriculum would enhance pediatrics residents' ability to effectively respond to discriminatory comments.Methods?In the 2016-2017 academic year, we modified an existing communication skills curriculum for senior pediatrics residents. Residents engaged a simulated parent who used discriminatory speech in 4 scenarios, followed by a group debriefing. We conducted anonymous surveys to assess residents' preparedness to respond to these comments before and immediately following participation and examined their experience with discriminatory comments in the workplace.Results?The majority of residents reported prior experience with discriminatory comments (32 of 45 [71%] witnessed such comments, and 27 of 48 [56%] were targeted by such comments), most often regarding age, race, and ethnicity. Mean precourse scores ranged from 2.1 to 3.1 (on a 5-point scale) regarding ability to engage in a firm yet respectful dialogue, to reference the hospital code of conduct, to coach a learner to respond, and to facilitate a team debrief. Mean postcourse scores improved significantly for these questions (range 3.8-4.1). The greatest improvement was in referencing the code of conduct (2.1 versus 4.0, P < .001).Conclusions?Immediately after participating in simulation, pediatrics residents reported a significant improvement in self-reported readiness to respond to discriminatory comments made by a parent and reported the simulation experience was beneficial.

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UK doctors move towards general practice and flexible working

Project description: Not available

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When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship.

Project description:BackgroundPatient advocates and safety experts encourage adoption of transparent health records, but sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine. As electronic health records disseminate, such disparate views fuel policy debates about risks and benefits of sharing visit notes with patients through portals.MethodsPresurveys and postsurveys from 99 volunteer doctors at three US sites who participated in OpenNotes and postsurveys from 4592 patients who read at least one note and submitted a survey.ResultsPatients read notes to be better informed and because they were curious; about a third read them to check accuracy. In total, 7% (331) of patients reported contacting their doctor's office about their note. Of these, 29% perceived an error, and 85% were satisfied with its resolution. Nearly all patients reported feeling better (37%) or the same (62%) about their doctor. Patients who were older (>63), male, non-white, had fair/poor self-reported health or had less formal education were more likely to report feeling better about their doctor. Among doctors, 26% anticipated documentation errors, and 44% thought patients would disagree with notes. After a year, 53% believed patient satisfaction increased, and 51% thought patients trusted them more. None reported ordering more tests or referrals.ConclusionsDespite concerns about errors, offending language or defensive practice, transparent notes overall did not harm the patient-doctor relationship. Rather, doctors and patients perceived relational benefits. Traditionally more vulnerable populations-non-white, those with poorer self-reported health and those with fewer years of formal education-may be particularly likely to feel better about their doctor after reading their notes. Further informing debate about OpenNotes, the findings suggest transparent records may improve patient satisfaction, trust and safety.

| S-EPMC7255406 | biostudies-literature

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