Dirty clothes and doctors!

As if healthcare professionals did not already have enough to worry about, it seems as though their clothes may be working against them. In a recent study where cultures were obtained from the uniforms of nurses and physicians, up to 60% of hospital staff’s uniforms are colonized with potentially pathogenic bacteria, including drug-resistant organisms. As noted by the authors, the maximal contamination occurs in areas of greatest hand contact (ie, pockets and cuffs), allowing recontamination of already washed hands. The authors acknowledged that the scope of the research was limited and it remained to be determined whether these bacteria could be transferred to patients and cause clinically relevant infection.

Study: Am J Infect Control 2011;39:555-9.)doi:10.1016/j.ajic.2010.12.016

Are GPs better at communication?

GP observers and patient observers performed quality assessments of Dutch General Practice consultations on hypertension videotaped in 1982-1984 and 2000-2001 [Butalid L, Verhaak PFM, Tromp F, et al. BMJ Open (2011). doi:10.1136]. GPs, although more task-orientated (according to the authors) seem to be getting better. Both GPs and patients rated the 2000-2001 consultations as better, in terms of medical technical quality, psychosocial quality and the quality of interpersonal behaviour. Great study and interesting data. The authors admit that the GP ratings may have suffered from a ‘halo effect’ and they don’t have a complete answer for why the patient ratings agreed with the GPs, given one would expect patients would prefer a more affective style communication. However, the authors don’t discuss the possibility that being a patient and judging a consultation externally may prompt different evaluation needs. It would of been useful to also have data from the actual patients involved in the research.

GPs as medical leaders

The following video http://www.youtube.com/watch?v=JmQaCZufBtQ contains an excellent interview with Prof. Aidan Halligan. He talks about his views regarding medical education. Near the end of the video, his discusses an experience he had  in Afghanistan where a GP was leading a NHS field hospital team. He admits this went against the grain, but talks about how it has influenced his work in the NHS.

Is self-treatment an occupational hazard among physicians and medical students?

When it comes to their own health, doctors may behave irrationally and paradoxically. The medical profession expect patients to seek appropriate medical help when they encounter significant problems with their health and yet doctors do not behave in this way when it comes to their own health. There is a culture within medicine that doctors do not expect themselves or their colleagues to be sick. Thus, the associated complexities of self-diagnosis, self-referral and self-treatment among physicians are significant and may have repercussions for both their own health and, by implication, for the quality of care delivered to patients. In a recent review of the literature [Occupational Medicine doi:10.1093/occmed/kqr098], the authors found that self-treatment was strongly embedded within the culture of both physicians and medical students as an accepted way to enhance/buffer work performance. Although numbers are likely to be small, the implication of potentially impaired doctors treating patients is serious.

Physicians as “second victims”

Critical incidents and medical mistakes have serious psychological and health related impact on patients and their families. This is for sure. However, a recently published review of the impact of critical incidents provides interesting insights on how such incidents can also impact on healthcare professionals [Best Practice & Research Clinical Anaesthesiology 25 (2011) 169–179]. The second victim label refers to the way that healthcare professionals can be adversely affected by critical incidents.

The paper reviews lots of interesting work and provides useful directions for future research and interventions. For me, three points from the review stood out;

1.    Some health-care providers report symptoms of post-traumatic stress disorder, such as sleep disturbance, nightmares, irritability and problems concentrating that may even lead to inability to work. However, even without these symptoms (especially) physicians frequently suffer from feelings of incompetence, anxiety about future errors and professional isolation, all of which were associated with higher job-related stress making it harder to continue working clinically

2.    Long term impacts included increased burnout, symptoms of depression and reduced quality of life

3.    A major motivation for taking legal action is the lack of reliable information and a perceived lack of respect and feelings of abandonment.

So, some healthcare professionals can suffer just as much as patients from critical incidents, they may (understandably) fail to perform adequately in terms of disclosure, and not surprisingly some patients want to take legal action.

Using drama to explain medical errors and medical mistakes!

 I recently attended a conference about organisational culture and job burnout in hospitals (April 2011-Thessaloniki, Greece). I delivered a paper at the conference. However, I was very impressed by the presentation from a group of final year medical students (from Aristotle Medical School, Thessaloniki, Greece). The students used drama as a way to highlight the impact that medical mistakes have on both healthcare professionals and patients. It`s difficult to convey their approach without showing a video, but basically, they dramatised personal interviews from physicians as a series of short plays. In addition, they used clever technology to overlay the Hippocratic oath throughout the performance. Thus, we the audience, were prompted to reflect via the use of different modalities. Very innovative, very interesting and difficult to forget! Drama and medicine in Greece, very fitting!

Preventing job burnout in medical students

Treating burnout in physicians can be difficult and the evidence to date is mixed and patchy. However, a recent paper in Medical Education [Med Educ. 2010 Oct;44(10):1016-26. doi: 10.1111/j.1365-2923.2010.03754.x] provides some interesting insights on how we can try to prevent burnout in medical students. The researchers followed medical students prospectively and categorised students in three major groups; (1) no burnout (the resilient group), (2) initial burnout, but no burnout on follow-up (recovering group), (3) burnout continuously (chronic burnout group). Roughly, a third of students were classified in the resilient group. The researchers found that modifiable individual factors and learning climate characteristics including employment status, stress level and perceptions of the prioritising of student education by faculty members related to medical students’ vulnerability to burnout. The authors do not name it as such, but in my opinion, the factors identified by the authors all relate to organisational/educational climate. On the plus side, the fact that the identified factors are modifiable provides hope, and more importantly, the opportunity for us to test their hypotheses.