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1.
JMIR Public Health Surveill ; 7(6): e24312, 2021 06 09.
Article in English | MEDLINE | ID: covidwho-2197877

ABSTRACT

BACKGROUND: The COVID-19 outbreak has imposed physical and psychological pressure on health care professionals, including frontline physicians. Hence, evaluating the mental health status of physicians during the current pandemic is important to define future preventive guidelines among health care stakeholders. OBJECTIVE: In this study, we intended to study alterations in the mental health status of Portuguese physicians working at the frontline during the COVID-19 pandemic and potential sociodemographic factors influencing their mental health status. METHODS: A nationwide survey was conducted during May 4-25, 2020, to infer differences in mental health status (depression, anxiety, stress, and obsessive compulsive symptoms) between Portuguese physicians working at the frontline during the COVID-19 pandemic and other nonfrontline physicians. A representative sample of 420 participants stratified by age, sex, and the geographic region was analyzed (200 frontline and 220 nonfrontline participants). Moreover, we explored the influence of several sociodemographic factors on mental health variables including age, sex, living conditions, and household composition. RESULTS: Our results show that being female (ß=1.1; t=2.5; P=.01) and working at the frontline (ß=1.4; t=2.9; P=.004) are potential risk factors for stress. In contrast, having a house with green space was a potentially beneficial factor for stress (ß=-1.5; t=-2.5; P=.01) and anxiety (ß=-1.1; t=-2.4; P=.02). CONCLUSIONS: It is important to apply protective mental health measures for physicians to avoid the long-term effects of stress, such as burnout.


Subject(s)
Burnout, Professional , COVID-19 , Mental Health , Pandemics , Physicians/psychology , Adult , Aged , Anxiety , Depression , Emergency Medical Services , Female , Health Personnel , Humans , Male , Middle Aged , Obsessive-Compulsive Disorder , Portugal , Professional Role , SARS-CoV-2 , Stress, Psychological , Surveys and Questionnaires
2.
Clin Infect Dis ; 73(7): e2243-e2250, 2021 10 05.
Article in English | MEDLINE | ID: covidwho-2188368

ABSTRACT

Infectious diseases/human immunodeficiency virus (ID/HIV) physicians and other healthcare professionals advocate within the healthcare system to ensure adults and children receive effective treatment. These advocacy skills can be used to inform domestic and global infectious diseases policies to improve healthcare systems and public health. ID/HIV physicians have a unique frontline perspective to share with federal policymakers regarding how programs and policies benefit patients and public health. Providing this input is critical to the enactment of legislation that will maximize the response to infectious diseases. This article discusses the advocacy of ID/HIV physicians and other healthcare professionals in federal health policy. Key issues include funding for ID/HIV programs; the protection of public health and access to healthcare; improving research opportunities; and advancing the field of ID/HIV, including supporting the next generation of ID/HIV clinicians. The article also describes best practices for advocacy and provides case studies illustrating the impact of ID/HIV physician advocacy.


Subject(s)
Communicable Diseases , HIV Infections , Physicians , Adult , Child , HIV , HIV Infections/epidemiology , HIV Infections/prevention & control , Health Policy , Humans
4.
Wiad Lek ; 75(5 pt 1): 1136-1139, 2022.
Article in English | MEDLINE | ID: covidwho-1905728

ABSTRACT

OBJECTIVE: The aim: Research of the ways of adequate solving of problems with understuffed healthcare system and problems with continuous professional development of doctors. PATIENTS AND METHODS: Materials and methods: We have used a official statistical data for the period from 2009-2020 years. This data was analyzed with usage of systemic approach and statistical epidemiological analysis. RESULTS: Results: According to the data from Ministry of Health of Ukraine during the first year of the pandemic (2020) the quantity of our doctors has diminished by 6.9 thousands, and quantity of nurses - by 22,5 thousands which is much bigger deficit then in period of 2018-2019 years. The insufficiency of pediatric doctors in Ukraine has reached 1000 vacancies, general physicians - 1700, family doctors - more than 3000 vacancies, surgeons - more than 950 vacancies. It is also important to involve medical experts and medical associations and unions in the process of accreditation and licensing of providers of continuous medical education. CONCLUSION: Conclusions: Existing deficit of medical personnel should be replenished by increasing of medical education of students in medical universities and colleges funded by government. Existing system of continuous professional development of doctors requires a lot of changes (additional activities, new technologies) which must be implied with the help of professional medical associations and unions.


Subject(s)
Delivery of Health Care , Education, Medical, Continuing , Medical Staff , Career Mobility , Child , Humans , Medical Staff/education , Medical Staff/supply & distribution , Pandemics , Physicians , Ukraine/epidemiology
7.
J Eval Clin Pract ; 28(6): 941-942, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2152757
8.
Anesthesiol Clin ; 40(2): 359-372, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-2149301

ABSTRACT

Poetry and medicine are related in multiple ways, including historical interests in healing, defined broadly, through words. More contemporary scholarship explores how poems, which include insights into the human condition, can enlarge our understanding of health, illness, mortality, and health care, including issues of diversity. Anesthesiology and poetry have particular affinities due to their structures, timeframes, and rhythms. Patients, physicians, and health care workers can benefit in terms of well-being by access to reading, reflecting on, and writing poetry.


Subject(s)
Medicine , Physicians , Humans , Writing
9.
BMJ Open ; 12(11): e060575, 2022 11 22.
Article in English | MEDLINE | ID: covidwho-2137705

ABSTRACT

OBJECTIVES: The impact of a coronavirus disease (COVID-19)-specific professional development programme on the well-being of obstetrics and gynaecology (O&G) doctors in training (DiT) working during the pandemic. DESIGN: A mixed-method evaluation of a single group pre-post test design study. SETTING: Melbourne, Australia between September 2020 and April 2021. PARTICIPANTS: 55 O&G DiT working across four healthcare sites of a major tertiary hospital in Victoria, Australia, were included in the programme. INTERVENTIONS: The delivery of a codesigned peer-to-peer programme, which identified and addressed the well-being goals of O&G DiT. Seven interactive workshops were run alongside the implementation of a number of participant-led wellness initiatives. MAIN OUTCOME MEASURES: Repeated-measures analysis of WHO Well-being Index (WHO-5) and Copenhagen Burnout Innovatory (CBI) scores across three time points during the programme. Multilevel generalised linear mixed-effects models with random intercept were fit to the data, both in the entire population (intention-to-treat) and restricted to those who attended the workshop ('per-protocol' analysis). Participatory experiences and programme learning were captured using the Most Significant Change (MSC) technique, which included inductive thematic analysis. RESULTS: We demonstrated an overall 31.9% improvement in well-being scores (p=0.006). The MSC evaluation captured a shift in workplace culture as a result of the programme, with improvement across the domains of connection, caring, communication, confidence and cooperation. CONCLUSIONS: We have successfully used a mixed-method approach to contextualise a productive programme to improve the well-being of COVID-19 front-line healthcare workers.


Subject(s)
COVID-19 , Medicine , Physicians , Female , Pregnancy , Humans , COVID-19/epidemiology , Pandemics , Victoria
11.
Healthc Q ; 25(3): 11-13, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2145328

ABSTRACT

To reduce the spread of COVID-19 in Canada, patients receiving physician services experienced a significant shift to virtual appointments by telephone, video conference and online messaging as many physician visits moved from in-person to virtual delivery. The Canadian Institute for Health Information's analysis of the physician billing data in five provinces (Ontario, Manitoba, Saskatchewan, Alberta and British Columbia) shows that during the first year of the pandemic in 2020, up to twice as many physicians provided care virtually compared to 2019. At the same time, the rate at which patients received virtual services quadrupled. Furthermore, data from the 2021 Commonwealth Fund (CMWF) survey of older adults show that almost twice as many Canadian seniors (71%) had a virtual appointment with a doctor or healthcare provider compared to seniors in other CMWF countries (39%). Going forward, virtual care remains a significant mode of delivery and has important implications for the future of patient care and the relationships between patients and providers.


Subject(s)
COVID-19 , Physicians , Humans , Aged , COVID-19/epidemiology , Pandemics , Health Personnel , Alberta/epidemiology
12.
Int J Environ Res Public Health ; 19(20)2022 Oct 18.
Article in English | MEDLINE | ID: covidwho-2142998

ABSTRACT

Doctor-patient relationships (DPRs) in China have been straining. With the emergence of the COVID-19 pandemic, the relationships and interactions between patients and doctors are changing. This study investigated how patients' attitudes toward physicians changed during the pandemic and what factors were associated with these changes, leading to insights for improving management in the healthcare sector. This paper collected 58,600 comments regarding Chinese doctors from three regions from the online health platform Good Doctors Online (haodf.com, accessed on 13 October 2022). These comments were analyzed using text mining techniques, such as sentiment and word frequency analyses. The results showed improvements in DPRs after the pandemic, and the degree of improvement was related to the extent to which a location was affected. The findings also suggest that administrative services in the healthcare sector need further improvement. Based on these results, we summarize relevant recommendations at the end of this paper.


Subject(s)
COVID-19 , Physicians , Humans , Physician-Patient Relations , COVID-19/epidemiology , Pandemics , Data Mining/methods , China/epidemiology
13.
Front Public Health ; 10: 789396, 2022.
Article in English | MEDLINE | ID: covidwho-2142306

ABSTRACT

This case study illustrates the role and value of a social needs response team during times of crisis and beyond. The COVID-19 pandemic resulted in two simultaneous crises-the infectious disease crisis and the socioeconomic crisis. Unemployment and lost wages, housing and food insecurity, and increased childcare needs are just a few examples of the socioeconomic needs that skyrocketed during the COVID-19 pandemic. At the start of the pandemic, the University of Pennsylvania Health System (UPHS) formed an interdisciplinary team of physicians, social workers, nurse practitioners and students of these professions to reimagine social needs screening in a way that could reach people during the pandemic and provide sustainable support for individual's evolving social needs. The Social Needs Response Team (SNRT) at UPHS utilized various secure platforms to keep members of the team connected with each other and their patients. Orientations for participating students included training on how to employ principles of crisis intervention theory, empathetic inquiry, and patient-led and family-centered care to best uncover and serve the needs of their patients. Alongside the illustrative case study, this piece details guiding principles and concepts that are essential to integrating social needs targeted care.


Subject(s)
COVID-19 , Physicians , Humans , COVID-19/epidemiology , Pandemics , Unemployment , Students
14.
BMC Health Serv Res ; 22(1): 1333, 2022 Nov 10.
Article in English | MEDLINE | ID: covidwho-2139275

ABSTRACT

BACKGROUND: Doctors, including junior doctors, are vulnerable to greater levels of distress and mental health difficulties than the public. This is exacerbated by their working conditions and cultures. While this vulnerability has been known for many years, little action has been taken to protect and support junior doctors working in the NHS. As such, we present a series of recommendations from the perspective of junior doctors and other relevant stakeholders, designed to improve junior doctors' working conditions and, thus, their mental health. METHODS: We interviewed 36 junior doctors, asking them for recommendations for improving their working conditions and culture. Additionally, we held an online stakeholder meeting with a variety of healthcare professionals (including junior doctors), undergraduate medical school leads, postgraduate speciality school leads and NHS policymakers where we asked what could be done to improve junior doctors' working conditions. We combined interview data with notes from the stakeholder discussions to produce this set of recommendations. RESULTS: Junior doctor participants and stakeholders made organisational and interpersonal recommendations. Organisational recommendations include the need for more environmental, staff and educational resources as well as changes to rotas. Interpersonal recommendations include changes to communication and recommendations for better support and teamwork. CONCLUSION: We suggest that NHS policymakers, employers and managers consider and hopefully implement the recommendations set out by the study participants and stakeholders as reported in this paper and that the gold standards of practice which are reported here (such as examples of positive learning environments and supportive supervision) are showcased so that others can learn from them.


Subject(s)
Medical Staff, Hospital , Physicians , Humans , Medical Staff, Hospital/psychology , Qualitative Research , Physicians/psychology
15.
BMC Med Educ ; 22(1): 786, 2022 Nov 14.
Article in English | MEDLINE | ID: covidwho-2139255

ABSTRACT

BACKGROUND: Education in ECMO starts with basic theory and physiology. For this type of training, self-assessment e-learning modules may be beneficial. The aim of this study was to generate consensus on essential ECMO skills involving various professional groups involved in caring for ECMO patients. These skills can be used for educational purposes: development of an e-learning program and fine-tuning of ECMO-simulation programs. METHODS: Experts worldwide received an e-mail inviting them to participate in the modified Delphi questionnaire. A mixture of ECMO experts was contacted. The expert list was formed based on their scientific track record mainly in adult ECMO (research, publications, and invited presentations). This survey consisted of carefully designed questionnaires, organized into three categories, namely knowledge skills, technical skills, and attitudes. Each statement considered a skill and was rated on a 5-point Likert-scale and qualitative comments were made if needed. Based on the summarized information and feedback, the next round Delphi questionnaire was developed. A statement was considered as a key competency when at least 80% of the experts agreed or strongly agreed (rating 4/5 and 5/5) with the statement. Cronbach's Alpha score tested internal consistency. Intraclass correlation coefficient was used as reliability index for interrater consistency and agreement. RESULTS: Consensus was achieved in two rounds. Response rate in the first round was 45.3% (48/106) and 60.4% (29/48) completed the second round. Experts had respectively for the first and second round: a mean age of 43.7 years (8.2) and 43.4 (8.8), a median level of experience of 11.0 years [7.0-15.0] and 12.0 years [8.3-14.8]. Consensus was achieved with 29 experts from Australia (2), Belgium (16), France (1), Germany (1), Italy (1), Russia (2), Spain (1), Sweden, (1), The Netherlands (4). The consensus achieved in the first round was 90.9% for the statements about knowledge, 54.5% about technical skills and 75.0% about attitudes. Consensus increased in the second round: 94.6% about knowledge skills, 90.9% about technical skills and 75.0% about attitudes. CONCLUSION: An expert consensus was accomplished about the content of "adult essential ECMO skills". This consensus was mainly created with participation of physicians, as the response rate for nurses and perfusion decreased in the second round.


Subject(s)
Computer-Assisted Instruction , Extracorporeal Membrane Oxygenation , Physicians , Humans , Adult , Consensus , Delphi Technique , Reproducibility of Results , Surveys and Questionnaires , Intensive Care Units
16.
Science ; 378(6622): 809, 2022 11 25.
Article in English | MEDLINE | ID: covidwho-2137368

ABSTRACT

The world needs more physicians. Increasing their numbers alone won't solve the many problems associated with improving health care. But it doesn't help to have a dearth of doctors, who were generally in short supply before COVID-19 struck. The pandemic has only exacerbated doctor shortages everywhere. This doesn't bode well for a world that must prepare for future pandemics and for populations that are both growing and aging. Better health outcomes require more physicians. So, where are the bottlenecks?


Subject(s)
Education, Premedical , Physicians , Humans , Delivery of Health Care , Education, Premedical/methods , Education, Premedical/organization & administration , Physicians/statistics & numerical data , United States
17.
J Healthc Manag ; 67(6): 425-435, 2022.
Article in English | MEDLINE | ID: covidwho-2135684

ABSTRACT

GOAL: Administrative burden is one of many potential root causes of physician burnout. Scribe documentation assistance can reduce this burden. However, traditional in-person scribe services are challenged by consistent staffing because the model requires the physical presence of a scribe and limits the team to a single individual. In addition, in-person scribes cannot provide the flexible support required for virtual care encounters, which can now pivot geographically and temporally. To respond to these challenges, our health network implemented an asynchronous virtual scribe model and evaluated the program's impact on clinician perceptions of burnout across multiple outpatient specialties. METHODS: Using a mixed-methods, pre-/postdesign, this evaluation measured the impact of an asynchronous virtual scribe program on physician burnout. Physicians were given the Professional Fulfillment Index tool (to self-assess their mental state) and free-text comment surveys before virtual scribe initiation and again at 3-, 6-, and 12-month intervals after program implementation. Descriptive statistics of survey results and qualitative review of free-text entries were analyzed for themes of facilitation and barriers to virtual scribe use. PRINCIPAL FINDINGS: Of 50 physician participants in this study, 42 (84%) completed the preintervention survey and 15 (36%) completed all 4 surveys; 25 participants (50%) discontinued scribe use after 12 months. Burnout levels-as defined by dread, exhaustion, lack of enthusiasm, decrease in empathy, and decrease in colleague connection-all trended toward improvement during this study. Importantly, quality, time savings, burnout, and productivity moved in positive directions as well. PRACTICAL APPLICATION: The cost burden to physicians and the COVID-19 pandemic inhibited the continued use of asynchronous virtual medical scribes. Nevertheless, those who continued in the program have reported positive outcomes, which indicates that the service can be a viable and effective tool to reduce physician burnout.


Subject(s)
Burnout, Professional , COVID-19 , Physicians , Humans , Electronic Health Records , Pandemics , Burnout, Psychological , Burnout, Professional/prevention & control
19.
BMC Med Ethics ; 23(1): 110, 2022 11 14.
Article in English | MEDLINE | ID: covidwho-2115724

ABSTRACT

BACKGROUND: Moral dilemmas have arisen concerning whether physicians and other providers should treat patients who have declined COVID vaccination and are now sick with this disease. Several ethicists have argued that clinicians have obligations to treat such patients, yet providing care to these patients has distressed clinicians, who have at times declined to do so. Critical questions thus emerge regarding how best to proceed. MAIN BODY: Providers face moral tensions: whether to place the benefits to an unvaccinated patient over their duties to protect themselves and their families, staff and other patients, and goals of working collaboratively with patients. Clinicians' duties to treat such patients arguably outweigh claims otherwise, but these obligations are creating moral conflict and distress for providers. Moral distress has been associated with burnout, post-traumatic stress disorder, and interpersonal and work difficulties. Given ongoing vaccine refusals, these problems are unlikely to disappear in the foreseeable future. Society has obligations to address this moral distress due to principles of reciprocity, and implicit social contracts, as part of which physicians risk their lives in caring for patients for the good of society as a whole. Responses are thus urgently needed at several levels: by hospitals, medical schools, professional societies, governments, media, providers and patients. Medical training on professionalism should address these stresses, probing why doctors have duties to treat these patients, but also how moral conflicts can ensue, and how best to address these tensions. Governments and institutions should thus alter relevant policies and devote more resources to addressing clinicians' psychological strains. Institutions should also improve organizational culture. Public health organizations and the media described clinicians, earlier in the pandemic, as heroes, committed to treating COVID patients. This narrative should now be changed to highlight the strains that unvaccinated patients cause-endangering hospital staff and others. CONCLUSIONS: Unvaccinated COVID patients should receive care, but multi-level strategies, involving enhanced policies, education and practice are vital to alleviate ensuing moral distress, and thus aid these clinicians and their patients. Ethical arguments that providers must treat these patients have not considered these obligations' effects on clinicians, but should do so.


Subject(s)
Burnout, Professional , COVID-19 , Physicians , Humans , Pandemics , Morals , Burnout, Professional/prevention & control
20.
Int J Psychiatry Med ; 57(6): 554-559, 2022 11.
Article in English | MEDLINE | ID: covidwho-2113815

ABSTRACT

The Balint Method has been used worldwide since Michael and Enid Balint developed it in the 1950s. Even with the proliferation of Balint groups there were still doctors and other clinicians who did not have local access. The online format was developed to provide Balint groups to those individuals. With the pandemic the majority of clinicians were unable to get together in person. The online format provided a lifeline for Balint work. This article provides a short history of the development of Balint online, how the pandemic affected further development, and a summary of what was learned from that experience.


Subject(s)
Pandemics , Physicians , Humans
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