Prevalence and determinants of burnout among South African doctors during the COVID-19 pandemic

Background: Burnout, resulting from chronic workplace stress that has been unsuccessfully managed, has previously been documented in doctors. The coronavirus disease 2019 (COVID-19) pandemic has increased occupational challenges faced by doctors, potentiating their risk for burnout. Aim: This study aimed to determine the prevalence and determinants of burnout among medical doctors during the COVID-19 pandemic. Setting: Three public sector hospitals in Gqeberha, South Africa. Methods: A cross-sectional study of 260 voluntary participants was conducted. Participants completed self-administered electronic questionnaires. Logistic regression analysis was performed to explore the determinants of burnout. Results: The prevalence of burnout in this study was 78%. Burnout was significantly associated with being a medical intern or community-service medical officer (adjusted odd ratio [AOR] = 6.72, 1.71­26.40), being in the lowest income band (AOR = 10.78, 2.55­45.49), and using alcohol to manage work-related stress (AOR = 3.01, 1.12­8.04). Job-related factors associated with burnout were experiencing high conflict at work (AOR = 5.04, 1.92­13.20) and high role ambiguity and role conflict (AOR = 4.49, 1.98­10.18). Low support at work (AOR = 9.99, 3.66­27.23), medium job satisfaction (AOR = 5.38, 2.65­10.93) and medium support at work (AOR = 3.39, 1.71­6.73) were positively associated with burnout. Participants with medium (AOR = 0.28, 0.10­0.80) and high levels of resilience (AOR = 0.08, 0.03­0.25) were protected against burnout. Coronavirus disease 2019-related factors were not significantly associated with burnout. Conclusion: The burnout prevalence among South African medical doctors at public hospitals during the COVID-19 pandemic was high and strongly associated with job stress factors. Contribution: Given the increased prevalence of burnout among doctors and the strong associations with job stress factors, mitigation of burnout requires targeted organisational interventions.

The profile and causes of death among medical doctors and dental surgeons in Uganda: 1986 to 2016

Background: The loss of health workers through death is of great importance and interest to the public, media and the medical profession as it has very profound social and professional consequences on the delivery of health services. Objective: To describe the profile, causes and patterns of death among medical doctors and dental surgeons in Uganda between 1986 and 2016. Methods: We conducted a retrospective descriptive study of mortality among registered medical doctors and dental surgeons. Information on each case was collected using a standard questionnaire and analyzed. Cause of death was determined using pathology reports, and if unavailable, verbal autopsies. We summarized our findings across decades using means and standard deviations, proportions and line graphs as appropriate. Cuzick's test for trend was used to assess crude change in characteristics across the three decades. To estimate the change in deaths across decades adjusted for age and sex, we fit a logistic regression model, and used the margins command with a dy/dx option. All analyses were done in Stata version 14.0 (Stata Corp, College Station, TX). Results: There were 489 deaths registered between 1986 and 2016. Of these, 59 (12.1%) were female. The mean age at death was 48.8 years (Standard Deviation (SD) 15.1) among male and 40.1 years (SD 12.8) among females. We ascertained the cause of death for 468/489 (95.7%). The most common causes of death were HIV/AIDS (218/468, 46.6%), cancer (68/468, 14.5%), non-communicable diseases (62/48, 13.3%), alcohol related deaths (36, 7.7%), road traffic accidents (34, 7.3%), gunshots (11, 2.4%), among others. After adjusting for age and sex, HIV/AIDs attributable deaths decreased by 33 percentage points between the decade of 1986 to1995 and that of 2006 to 2016 ­0.33 (­0.44, ­0.21. During the same period, cancer attributable deaths increased by 13 percentage periods 0.13 (0.05,0.20). Conclusion: The main causes of death were HIV/AIDS, cancer, non-communicable diseases, alcohol-related diseases and road traffic accidents. There was a general downward trend in the HIV/AIDS related deaths and a general upward trend in cancer related deaths. Doctors should be targeted for preventive and support services especially for both communicable and non-communicable diseases

Virtual Hospital Tour and Observership for First and Second-year Medical Students / 医学教育

Students in all years, including those in lower years, were prohibited from coming to campus because of COVID-19, which began to spread in January 2020. However, we believed that a hospital tour and observership would be important practical training for first and second year medical students as part of the early exposure program, which aims to increase student motivation. Thus, we decided to conduct a virtual hospital tour and a virtual observation of medical doctors’ work. We used Zoom to conduct a virtual hospital tour for first-year students in June, and a virtual observation of physicians’ work for second-year students in December. Although this offered less of an opportunity to experience the reality of the clinic, there have been benefits in terms of increased learning content, fairness of learning opportunities delivered, and the promotion of independent learning. With regard to a “Hospital Tour” and the “Observation of Medical Doctors’ Work” , we believe that hybrid forms, which are able to skillfully combine the strengths of the two methods, would be effective.

Knowledge, attitude and practice of laparoscopic surgery among medical doctors in Port Harcourt, Nigeria

Background: The use of minimal access techniques to achieve similar objectives as in open surgical procedures has witnessed a steady progress in the last two decades. The efficacy and safety of this mode of surgery has long been established. Medical doctors are not only members of the society; with their level of knowledge, their opinion is a strong mirror image of the pulse of the patients they treat. Aim of the study was to ascertain the knowledge, attitude, extent of practice, and factors affecting laparoscopic surgery among medical doctors in Port Harcourt, Nigeria.Methods: A cross sectional study of four hundred and fourteen (414) practicing medical doctors was conducted. Using stratified sampling method, self-administered semi-structured questionnaires was distributed to respondents in Port Harcourt in 2018. Data obtained was analysed using the Statistical Package for the Social Sciences (SPSS) version 20.0.Results: Knowledge of laparoscopic surgery among respondents was 89.6% (371). Three hundred and twelve respondents (75.4%) were willing to pay if such surgery is necessary and offered in Port Harcourt. Only 2.4%. of respondents asserted that laparoscopic surgery services are offered regularly in their hospital. Only 1 respondent (0.2%) was willing to pay ₦151,000.00 - 200,000.00 ($430 - $570) for commonly performed laparoscopic abdominal surgical procedures.Conclusions: Willingness to accept and knowledge of laparoscopic surgery was relatively high among medical doctors, hence a high prospect for laparoscopic surgery practice in Port Harcourt is therefore likely. The practice of laparoscopic surgery seems low and willingness to pay, even among doctors seem to be a challenge.

Errors in Case No. 2012Hun-Ma551·561 relating to the use of modern medical devices by oriental medical doctors

Our country has a dual medical system and as the importance of medical devices in medical practice has grown, oriental medical doctors have sought to use modern medical devices to broaden the scope of their oriental medical practice. Case No. 2012Hun-Ma551·561, which supports the use of modern medical devices by oriental medical doctors contains 3 important errors. First, its finding that a slit lamp microscope automatically provides examination results is erroneous. Second, the Court also mistakenly finds that medical service technologists, etc. Act does not prohibit the usage of devices in the instant case; thus, there is no need for the regulation of said devices. Finally, its finding lacks the proper procedure of considering the opinions of related professional groups. Thus, Case No. 2012Hun-Ma551·561 should not be considered a precedent supporting the use of modern medical devices by the oriental medical practitioners.

The investigation and analysis on the Chinese Medicine courses for the students major in western medicine / 国际中医中药杂志

Objective To investigate the evaluation and suggestion of the courses of Chinese Medicine for clinical students majoring in medical college. Methods In January 2017, at the end of the Chinese Medicine courses, a total of 35 clinical students of Capital Medical University were investigated through a questionnaire, mainly related to students' understanding of Chinese medicine; evaluation and suggestions for Chinese Medicine education and teaching. Results The majority of students believed that Chinese medicine was safe and effective. The proportion of believing worthing learning that the Chinese medicine accounted for 94.3% (33/35), and who believed Chinese medicine helpful for the clinical work accounted for 82.9% (29/35). However, the proportion of satisfaction with the current teaching method was 60% (21/35). Conclusions Most of the clinical students in this investigation have recognized the role of Chinese medicine, and have shown great interest in studying the course, but they are not satisfied with the current teaching. To improve the teaching quality of Chinese Medicine through the reform should be the direction of teachers' efforts in the future.

Information needs, seeking behavior and work effectiveness of physicians in selected government hospitals in EDO state, Nigeria

Information behaviour and work effectiveness of physicians are vital elements in the day to day practice of physicians in selected government hospitals. This study was carried out to investigate the relationship of between information need, seeking behaviour and work effectiveness of physicians in six government hospitals in Edo State. The objectives of the study include the identification of various health information needs of physicians in government hospitals, finding out their information seeking patterns and examining the level of work effectiveness. The method adopted is the survey design. A structured questionnaire was used to gather data among the respondents. Out of the 620 questionnaire administered 516 (83.2%) were retrieved. The findings revealed that the major health information need of physicians in selected government hospitals in Edo State was information on treatment and tests of patients. The quality of work delivery in terms of commitment and individual care to patients as well as commitment to organization goals is less than satisfactory. There is a significant relationship between information needs and seeking behaviour of physicians and their work effectiveness (r =0.422; p<0.05 and r = 0.090; p<0.05), respectively. It is recommended that physicians in government hospitals in Edo State need to be more pro-active in updating themselves in general medical knowledge

Investigation and Analysis of Usage of Chinese Patent Medicine of Western Medicine ;Doctors in General Hospitals / 中国中医药信息杂志

Objective To know the usage of Chinese patent medicine of western medicine doctors in general hospitals. Methods By means of informal discussion with experts, present situation was known; By means of screening questions in questionnaire, nationwide investigation was conducted by this questionnaire about Chinese patent medicine and the results were examined by statistical analysis. Results That the abuse of Chinese patent medicine by western medical doctors was quite common. The overall quality of their prescriptions was not good. Most of the doctors have never received specialized continuing education of traditional Chinese medicine, only having preliminary knowledge or nothing on syndrome differentiation and treatment of traditional Chinese medicine. Conclusion The management department should take following measures: further enhance continuing education of TCM;formulate related policies;improve present situation.

Worth of Traditional Herbal System of Medicine for Curing Ailments Prevalent Across the Mountain Region of Uttarakhand, India.

The present study deals with 40 medicinal plant species used to cure a variety of ailments through traditional health care system by the local healers (Vaidyas). These plants were checked and verified from the available literature which revealed that the uses of these plants were newly recorded. Depth studies of 40 new recorded medicinal plants were documented with their different parts being used in herbal medicines. It was also found that one species or some times more species were used for curing one or many diseases together. The nature and type of symptoms of diseases reported of human beings were found varying across the region. All these different kinds of diseases were grouped in to three categories i.e. serious, moderate and common based on the risk factor and seriousness of disease in consultation with doctors practicing different streams of treatment i.e. Vaidyas, Ayurvedic and Allopathic. About more than 40% of local inhabitants were consulted, so as to reveals their perceptions on ranking of 10 common ailments prioritized by the local people based on their preference for opting herbal system of treatments. The traditional herbal system of medicine is one of the most important prevailing systems in the area where modern health care centre are rare or in very poor conditions.

Development of Modern Medical Doctors in Japan from Late Edo to Early Meiji / 의사학

Western medicine began to be introduced to Japan since late 16th century. Japanese encounter with Western medicine centered on Dejima in Nagasaki in the seventeenth and eighteenth century and the initial process of introduction was gradual and slow. In the mid-nineteenth century, facing threats from Western countries, Tokugawa bakufu asked Dutch naval surgeon, J. L. C. Pompe van Meerdervoort to teach western medicine at the Kaigun Denshujo naval academy in Nagasaki. The government also supported the western medical school in Edo. This paper deals with how modern western medical doctors were developed in Japan from late Edo to early Meiji. The publication of the New Text on Anatomy in 1774 translated by Sugita Genpaku and his colleagues stimulated Japanese doctors and scholars to study western medicine, called Rangaku. During the Edo period, western medicine spread into major cities and countryside in Japan through Rangaku doctors. In 1838, for example, Dr. Ogata Koan established the Rangaku school named Tekijuku and educated many people with western medicine. When smallpox vaccination was introduced in Japan in 1849, Rangaku doctors played an important role in practiving the vaccination in cities and in countryside. After the Edo bakufu and the feudal lords of han(han) actively pursued to introduce western medicine to their hans by sending their Samurai to Edo or Nagasaki or abroad and by establishing medical schools and hospitals until their abolition in 1871. In late Edo and early Meiii military doctors were the main focus of training to meet the urgent need of military doctors in the battle fields of civil wars. The new Meiji government initiated a series of top-down reformations concerning army recruitment, national school system, public health and medical system. In 1874, the government introduced a law on medicine to adopt western medicine only and to launch a national licence system for medical doctors. Issuing supplementary regulations in the following years, the Meiji government settled down a dual-track medical licensing system: one for the graduates from medical schools with certain quality and the other for the graduate from less qualified schools who should take the licensing examination.

Volunteer Works by Medical Doctors

The mission of medical doctors is to take care of patients and to work for well-being of each member in our community. In addition, it is our privilege for medical doctors to participate in volunteer works with our medical talent. Various motives are present for medical doctors to participate in volunteer works. There are many needed people such as the homeless or the aged living alone in our community. The sympathy for the needed people is the first step to be a medical doctor. Through volunteer works, we may have enough chance to communicate with our neighbors to establish good relationships with them. Today, the most important social value is the well-being for individuals and the social welfare for a society. Medical doctors are the best prepared group for the well-being and the welfare. There are many fields of volunteer works for medical doctors around the world; refugees in Africa, the rural people in India and China, the poor in North Korea, homeless people, and foreign workers in urban areas. We may start from emergency relief for disasters, continue one step forward with hygiene and preventive medicine, and finally participate in social welfare system to take care of the aged and handicapped people. Volunteer works by medical doctors should not be like an event but a daily life. It should be accomplished continuously throughout our life, not for only one time. Volunteer works by medical doctors should cover not only medical works but also all the fields of our society including social welfare.

La "fisiología de la ciudad": médicos, e ingenieros en el Medellín de hace un siglo / Urban physiology: physicinans and engineers in Medellin, one century ago

Este texto explora el papel cumplido por los médicos en la regulación, el control y el planeamiento de la ciudad de Medellín entre finales del siglo XIX y principios del XX. Se plantea cómo la higiene como saber, importada de Europa por los médicos, orientó prácticas y fue otro de los parámetros del progreso y la civilización de la sociedad y la ciudad entre uno y otro siglo. De igual manera, se da cuenta del influjo que tuvieron el saber y la práctica de los médicos, desde distintas concepciones teóricas, para orientar tanto la higiene privada como la higiene pública de la ciudad. Se destaca la manera en que los médicos, como individuos u organización social, introdujeron sus percepciones, diagnósticos y propuestas sobre los problemas de la salud pública en conferencias, artículos y prácticas concretas que se expresaron en la arquitectura y el urbanismo de la ciudad; así, los médicos de Medellín lograron introducir políticas públicas para la reglamentación y el desarrollo urbano arquitectónico mucho antes que los ingenieros y los arquitectos; en este sentido fueron pioneros en la planificación de la ciudad.

This paper explores the role accomplished by medical doctors in the regulation, management and planning of the city of Medellín between the XIX and XX centuries. Hygiene as a knowledge, imported by medical doctors from Europe, was applied and used as progress and development parameter for both the society and the city. From different theoretical perspectives, medical knowledge and practice had a vital impact on the definition of hygiene as a private and public matter. It is important to emphasize the approach that medical doctors, as individuals or as members of a social organization, shared their observations, diagnoses and strategies on public health problems not only in conferences and papers but also in tangible actions which are reflected in the architecture and urbanism of the city. In this manner, medical doctors influenced public policies to regulate and help in the architectonic development even before engineers and architects; in that sense they were the pioneers of the "city planning"

A Study of Treatise on Medicine by King Sejo / 의사학

This paper explores historical backgrounds and contents of Treatise on Medicine written by King Sejo (r.1455-1468) including his views on traditional medicine and pharmacy in the early Chosen period. The Treatise declared by King Sejo in 1463 has been considered as an important and unique manual of medicine because it was the exclusive example written by the king of Chosen. It was the King Sejo's era when the medical milieu in both social and medical aspects was highly encouraged thanks to the previous achievements by King Sejong the Great (r.1418-1450). King Sejo, in particular, who was much interested in practical learning called 'Miscellaneous Studies' emphasized on court medicine. His writing can be understood in such historical frame. Another reason why he wrote the Treatise can be said that he felt necessary for establishing the medical ethic codes for inefficient court medicine-officials. In personal background, he tried to find available remedies since he had been suffered from some chronic diseases. The contents of the Treatise can be broadly fallen to the clinical and ethical aspects, In the former one, the Treatise focuses on treatment without hesitation through the sharp and exact diagnosis by medical doctors. In the latter one, eight categories of medical doctors are discussed according to their moral degrees, sim'eui, sik'eui, yak'eui, hon'eui, kwang'eui, mang'eui, sa'eui, and sal'eui. Finally, musim'ji-eui was supplemented. Among them, sal'eui, medicine-official laking both medical ability and ethical attitude, was classified as the lowest degree, sim'eui, medicine-official sincerely making his all efforts for patients, was thought to be a paragon of medical morality. In conclusion, the Treatise on Medicine by King Sejo played an important role as a manual for the principle of medical practice and for the instruction to enhance ethical attitude among medicine-officials.

Job Stress and Its Related Factors in South Korean Doctors / 예방의학회지

OBJECTIVE: To investigate the sources, extent and related factors in South Korean doctors. METHODS: The study subjects were 934 doctors in Taegu, Kyungpook Province, Korea(540 independent practitioners, 105 employed at hospitals and 289 residents in training). Information concerning job stress was obtained using a 9-item questionnaire. Information regarding related factors such as demographic characteristics(age, sex, marital status), perceptions on the socioeconomic status of doctors and working conditions(work time, on-call days per week) was also obtained by self-administered questionnaire during April and May, 2000. RESULTS: Major sources of job stress included clnical responsibility/judgement factor, patient factor and work loading factor. The job stress score of residents was the highest among three groups. The score was lower in older doctors. The score was low among those who thought doctors socioeconomic status was not good. The longer the work time, the higher the job stress score was. Multiple regression analysis was conducted to control for the mutual influence of independent variables. In regression analysis, the score of residents was higher than practitioners. Work time and socioeconomic status perception had negative effects on job stress score. CONCLUSION: The average job stress score of the doctors was high. Age, work type, working conditions and perceptions of socioeconomic status were found to besignificantly related to job stress score. Although the job stress of doctors is somewhat inevitable due to the nature of the doctor's job, control of work time, development of coping tools and other intervention methods are needed to reduce job stress of doctors. Further studies are required to understand the characteristics of job stress and reduce the job stress of doctors.