A survey of job satisfaction, sources of stress and psychological symptoms among New Zealand health professionals.

AIM: To assess job satisfaction, job-related stress and psychological morbidity among New Zealand physicians, surgeons and community pharmacists and provide a comparison with New Zealand general practitioners (GPs). METHODS: 411 physicians, 330 surgeons and 400 randomly sampled community pharmacists, were surveyed. Psychological morbidity was assessed by the General Health Questionnaire (GHQ-12) and job satisfaction by the Warr Cook Wall scale. RESULTS: Response rates were 70.5% for physicians, 69% for surgeons and 76% for community pharmacists. Job satisfaction scores for surgeons were similar to scores for GPs. Pharmacist and physicians scores were lower. Job satisfaction varied according to gender, the relative amount of time spent in public practice and the perceived ill effects of work on health. Pharmacists had the highest number of cases with significant scores on the GHQ-12 scale, with physicians and surgeons scoring similar to GPs. In each of these health professional groups approximately 10% described a level of symptoms that is associated with more severe psychological disturbance. CONCLUSIONS: All three groups were generally satisfied with their jobs. Pharmacists were significantly less so. Physicians and surgeons reported similar levels of psychological morbidity to GPs, which have been previously reported as a cause for concern.

Job satisfaction, psychological morbidity and job stress among New Zealand general practitioners.

AIM: To assess levels of psychological distress and job satisfaction among New Zealand general practitioners. METHODS: A random sample of general practitioners (GPs) in the central region of the North Island were surveyed using a postal questionnaire. Job satisfaction and psychological distress (twelve-item General Health Questionnaire, GHQ-12) were assessed and compared with personal, practice and workload characteristics. Qualitative statements about work conditions sources of stress and ill health were also collected. RESULTS: The response rate was 391/480 (81.5%). Job satisfaction scores were generally high. Rural GPs were less satisfied than urban practitioners and solo practitioners less satisfied than those in group practice. Work was perceived as affecting the physical health of 177 GPs (46%) and 220 (57%) often contemplated leaving general practice. 121 GPs (31.4%) scored >3 on the GHQ-12 showing high levels of psychological symptoms and 39 (9.9%) scored greater than eight, indicating significant psychological distress. Major causes of stress and lack of job satisfaction were: excessive paperwork, health reforms and bureaucratic interference, excessive hours and on-call work. CONCLUSIONS: Overall, GPs were satisfied with their jobs. Levels of psychological symptoms were of concern, particularly in the 10% showing very high levels of psychological distress, and in rural and solo practitioners.

Issues relating to early detection and diagnosis of breast cancer in New Zealand general practice.

AIM: This study describes current practice in New Zealand general practice with emphasis on identifying problem areas in the early detection of breast cancer. The study is focused on women outside the age group for the New Zealand breast screening programme (50-64 years). METHOD: Thirty selected general practitioners throughout New Zealand were interviewed in depth to identify the key issues relating to the early detection and diagnosis of breast cancer in the primary care setting. Attitudes to key issues were quantified in a later postal survey of 656 general practitioners randomly sampled from the RNZCGP database. RESULTS: The response rate to the quantitative study was 82%. General practitioners were generally well informed about risk factors for breast cancer and the relative sensitivity and specificity of screening and diagnostic tools. Diagnosis and management were influenced by the limitations of screening and diagnostic tools, as well as access to, and confidence in, services. The appropriate level of investigation and follow-up for young women was an area of uncertainty. CONCLUSION: The study provided data to inform guideline development and a baseline measure of current practice against which the impact of the implementation of guidelines could be measured.

Use of diagnostic imaging services in the Central Region by general practitioners.

AIM: To record general practitioners use of diagnostic imaging facilities in areas with different levels of access. METHOD: A random sample of general practitioners from three different areas kept a prospective record for one month of all patients referred to diagnostic imaging facilities, the outcomes of these investigations and the total number of patients seen. RESULTS: Referrals for diagnostic imaging services were significantly different between the localities (p = 0.014). The area with the least restrictions on access and the highest referral rate showed the greatest variation between doctors. There was a significant difference (p = 0.047) between the localities for patients who could not be referred because of restricted access and the cost of the services. The majority (68%) of patients who were unable to access these services were referred to the hospital for admission, for an outpatient appointment or to the accident and emergency department. There was little difference between the localities in either the presence or absence of pathology, or in the proportion of patients where the diagnosis was changed as a result of the diagnostic imaging investigation. CONCLUSION: Improved access to diagnostic imaging services for patients of general practitioners would result in better patient management and prevent unnecessary hospital referrals.

A qualitative study of general practitioner access to diagnostic imaging services in the Central Region.

AIMS: To determine general practitioners' views about access to diagnostic imaging services in the Central Region, particularly for low-income patients, and the perceived impact of limited access on patient outcomes. METHOD: A key general practitioner in each of 21 main geographical localities facilitated a discussion with a group of general practitioners using a pretested questionnaire. Each group tried to reach a consensus view and these responses were analysed to determine the common themes and ideas. RESULTS: General practitioners identified difficulties and barriers to access for all common diagnostic imaging procedures throughout the Central Region. Cost was the main barrier to access. Limited access resulted in increased risk for patients, unnecessary use of outpatient facilities and wasted time for general practitioners. Up to 40% of patients with restricted access to diagnostic imaging services were referred to outpatient departments and up to 20% went without the service. CONCLUSION: Many general practitioners in the Central Region do not have direct access to diagnostic imaging services except for patients who can afford private services. This is thought to generate significant additional costs and risks for patients. Improved access to these services would reduce hospital outpatient waiting times and provide a better service for patients.

An audit of a cervical smear screening programme.

An audit of a computer based screening and recall programme in a Wellington group general practice is reported (practice population 13,866). The records of all women aged between 20 and 59 years (4133 women) were checked to determine if they had had a cervical smear test in the previous two years. A random sample of women who had a cervical smear result recorded in the notes (107 women called "responders") showed that 71% gave "familiarity with the family doctor" and "acting in response to a recall letter" as reasons for choosing the place of their last smear. Satisfaction with the service was indicated by 95% of these women stating they would have their next smear at the medical centre. In the audit of all the records, a group of 667 women who had been sent a letter inviting them to have a smear done and who had apparently declined the procedure was identified (called "nonresponders"). A random sample of this group (168 women) was taken and an attempt made to interview them. In fact only 38 women could be identified as requiring a smear and even if those who refused to be interviewed (13) and those unable to be contacted (23) are added, then less than half of this sample were "true nonresponders". This suggests that the percentage of women in the practice who have been offered a smear and have refused to have one is less than 8%.

Automated leucocyte adherence inhibition testing in patients with colorectal cancer.

This paper details our initial experiences with a semi-automated leucocyte adherence inhibition (SALAI) assay in patients with colorectal disease. Two assay systems were used. Leucocytes from blood donors and patients with different colorectal diagnoses were tested for sensitization to colorectal tumour extracts, and leucocytes from healthy blood donors were assayed with serum from blood donors or patients to determine whether the serum itself contained factors which would react with the non-sensitized leucocytes in the test system. The sensitivity of the SALAI assay using patients' leucocytes was 64%, and the specificity was 68%. Discriminant analysis did not affect the sensitivity of the assay for colorectal cancer (64%), although the specificity was increased for all patients except those with malignant disease other than colorectal cancer. The sensitivity of the SALAI assay using patients' serum was 50% but the specificity was 74%. Discriminant analysis increased the sensitivity of this assay to 80% but specificity was reduced to 61%. Thus, the SALAI assay with patients' serum, although potentially more advantageous than the assay using patients' leucocytes in the clinical setting, was less specific. Furthermore, samples from patients with early colorectal cancers were less reactive making the serum assay unsuitable for screening asymptomatic patients. The SALAI assay using patients' leucocytes, however, has a higher sensitivity than most reported variations of the assay but a slightly lower specificity. It is suggested that the SALAI assay is preferable to other methods for leucocyte adherence inhibition (LAI) testing.

A comparison of the macrophage migration inhibition (MMI) assay and the semi-automated leucocyte adherence inhibition (SALAI) assay.

The present study was undertaken in order to compare simultaneously the semi-automated leucocyte adherence inhibition (SALAI) assay with the two-stage macrophage migration inhibition (MMI) assay in patients with colorectal disease. Eighty-six patients were assayed simultaneously in the MMI assay and the SALAI assays using patients' leucocytes and 83 patients were assayed simultaneously in the MMI assay and the SALAI assay using patients' serum. The SALAI assay using patients' leucocytes was more sensitive (70% vs 40%) and more specific (87% vs 73.3%) than the MMI assay. The SALAI assay was simple to perform, allowed many replicate samples and was more specific and sensitive in relation to the detection of colorectal cancer than other more commonly advocated tests. It may be useful as a screening test for colorectal cancer and it is suggested that further studies should be undertaken in this area.

An automated method for leucocyte adherence inhibition testing.

The detection of anti-tumour cell-mediated immunity in cancer patients by the leucocyte adherence inhibition test was reported in 1974. The test has since been variously described as capricious, non-reproducible and invalid. These criticisms may be related to the critical and difficult to reproduce washing procedure of the original test. In order to overcome this, an automated assay has been developed. The apparatus devised allows replicate samples to be tested concurrently. It consists of 30 X 100 microliter syringes whose barrels have been extended by nylon cones (1500 microliter) and whose plungers move synchronously. Suspensions of washed peripheral blood leucocytes with serum and tumour antigen are incubated in the syringes. Non-adherent cells are washed from the syringes by fully withdrawing their plungers and allowing entry of 1,000 microliter of saline from the cones. The effluent containing non-adherent cells is collected and automatically counted. A one-way analysis of variance using a statistical package for the social sciences (SPSS) programme for the syringe, wash and drainage volumes indicates that the variance between syringes is so small that sub-division of the syringes into control and test groups is justified. The crudity of the prototype, however, results in variations between volumes aspirated on successive occasions. Preliminary clinical studies show that 13/15 patients have a test result which correlates with their Mantoux status.