Library guides: Wellbeing: Articles

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ANZCA Bulletin articles

Roberts L, Jenkins K. Peer support: practical approaches. ANZCA Bulletin; 2020; 29(3); 34-35.

Roberts L. Doctors' health and wellbeing and our trainees... where are we up to? ANZCA Bulletin; 2019; 28(4); 70.

Andrew A, Scott DA. Fatigue - a cultural and systemic issue. ANZCA Bulletin; 2018; 27(3); 41-44.

Harding K. Learning from Richard's death. ANZCA Bulletin; 2018; 27(2); 22-24.

Have your say...Doctors' health and wellbeing draft interim framework. ANZCA Bulletin; 2018; 27(2); 25.

Handley C. Doctors' health and wellbeing - new strategies. ANZCA Bulletin; 2018; 27(1); 12.

Scott DA. ANZCA accepts doctors' wellbeing challenge. ANZCA Bulletin; 2017; 26(3); 17.

Pham P. The search for a new horizon. ANZCA Bulletin; 2017; 26(3); 18-19.

Flynn J. Taking care: don't let mandatory reporting get in the way. ANZCA Bulletin; 2017; 26(3); 20.

Coates J. Mandatory reporting - the New Zealand position. ANZCA Bulletin; 2017; 26(3); 21.

Jones C. Welfare advocates critical to doctor wellbeing. ANZCA Bulletin; 2017; 26(3); 21-23.

Khursandi D, Andrew M. Caring for anaesthetists for more than 20 years. ANZCA Bulletin; 2015; 24(4); 38-39.

Hallett A. Welfare advocates - should every department have one? ANZCA Bulletin; 2015; 24(4); 40-41.

A compassionate festive season. ANZCA Bulletin; 2015; 24(4); 41.

Reilly J, Tay T, Armstrong-Brown A. Peer-review groups add value in the hunter. ANZCA Bulletin; 2015; 24(4); 42.

Tay T, McDonald J, Shrivastava P. Report triggers concern about doctors' mental health. ANZCA Bulletin; 2014; 23(1); 26-29.

Warhaft, Naham. The Victorian doctors' health program. ANZCA Bulletin; 2001; 10(4); 31.

Khursandi DCS. Welfare. ANZCA Bulletin; 1999; 8(4); 24-25.

Gibbs J, Khursandi DS. Anaesthetists' wellbeing and welfare. ANZCA Bulletin; 1996; 5(4); 4.

Recent articles of interest

Added: 25 June 2021

Afonso AM, Cadwell JB, Staffa SJ, Zurakowski D, Vinson AE. Burnout Rate and Risk Factors among Anesthesiologists in the United States. Anesthesiology. 2021;134(5):683-696.
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Abstract
Background: Physician burnout, widespread across medicine, is linked to poorer physician quality of life and reduced quality of care. Data on prevalence of and risk factors for burnout among anesthesiologists are limited. The objective of the current study was to improve understanding of burnout in anesthesiologists, identify workplace and personal factors associated with burnout among anesthesiologists, and quantify their strength of association.

Methods: During March 2020, the authors surveyed member anesthesiologists of the American Society of Anesthesiologists. Burnout was assessed using the Maslach Burnout Inventory Human Services Survey. Additional survey questions queried workplace and personal factors. The primary research question was to assess rates of high risk for burnout (scores of at least 27 on the emotional exhaustion subscale and/or at least 10 on the depersonalization subscale of the Maslach Burnout Inventory Human Services Survey) and burnout syndrome (demonstrating all three burnout dimensions, consistent with the World Health Organization definition). The secondary research question was to identify associated risk factors.

Results: Of 28,677 anesthesiologists contacted, 13.6% (3,898) completed the survey; 59.2% (2,307 of 3,898) were at high risk of burnout, and 13.8% (539 of 3,898) met criteria for burnout syndrome. On multivariable analysis, perceived lack of support at work (odds ratio, 6.7; 95% CI, 5.3 to 8.5); working greater than or equal to 40 h/week (odds ratio, 2.22; 95% CI, 1.80 to 2.75); lesbian, gay, bisexual, transgender/transsexual, queer/questioning, intersex, and asexual status (odds ratio, 2.21; 95% CI, 1.35 to 3.63); and perceived staffing shortages (odds ratio, 2.06; 95% CI, 1.76 to 2.42) were independently associated with high risk for burnout. Perceived lack of support at work (odds ratio, 10.0; 95% CI, 5.4 to 18.3) and home (odds ratio, 2.13; 95% CI, 1.69 to 2.69) were most strongly associated with burnout syndrome.

Conclusions: The prevalence of burnout among anesthesiologists is high, with workplace factors weighing heavily. The authors identified risk factors for burnout, especially perceived support in the workplace, where focused interventions may be effective in reducing burnout.

Last updated: 24 March 2021

Janosy NR, Anderson CTM. Toward physician well-being and the mitigation of burnout. Curr Opin Anaesthesiol. 2021;34(2):176-179.
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Abstract
Purpose of review: Healthcare provider burnout is a real phenomenon. The rates of burnout are on the rise. Burnout-associated suicide amongst physicians represents a real "public health crisis." This article discusses the drivers of burnout and offers some strategies to mitigate burnout and improve well-being.

Recent findings: Measures of burnout such as stress, micro, and macro-aggression in the workplace have a psychological impact on staff. Additionally, a measurable economic price is exacted when an organization fails to address the lack of well-being burnout represents.

Summary: As healthcare providers struggle to survive and deal with the complex new set of problems and obstacles that the COVID-19 pandemic, the National economic crisis, and the increasing regulatory obligations have summoned forth, professional burnout rates have risen drastically. With good leadership, developing comprehensive programs to identify, track, and treat burnout symptoms and improve well-being in the work environment can result in greater work satisfaction and save resources.
Haque OS, et al. Physician, heal thy double stigma - doctors with mental illness and structural barriers to disclosure. N Engl J Med. 2021;384(10):888-891.
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Despite calls for greater awareness of high rates of depression and suicide among physicians, estimates suggest that only about 1% of medical students with major depressive disorder disclose it as a disability.
Lorello GR, et al. Impact of the intersection of anaesthesia and gender on burnout and mental health. Anaesthesia. 2021;76 Suppl 4:24-31.
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Abstract
Physician burnout and poor mental health are prevalent and often stigmatised. Anaesthetists may be at particular risk and this is further increased for women anaesthetists due to biases and inequities within the specialty. However, gender-related risk factors for and experiences of burnout and poor mental health remain under-researched and under-reported. This negatively impacts individual practitioners, the anaesthesia workforce and patients and carries significant financial implications. We discuss the impact of anaesthesia and gender on burnout and mental health using the COVID-19 pandemic as an example illustrating how women and men differentially experience stressors and burnout. COVID-19 has further accentuated the gendered effects of burnout and poor mental health on anaesthetists and brought further urgency to the need to address these issues. While both personal and organisational factors contribute to burnout and poor mental health, organisational changes that recognise and acknowledge inequities are pivotal to bolster physician mental health.
Johnson TJ, Millinchamp FJ, Kelly FE. Use of a team immediate debrief tool to improve staff well-being after potentially traumatic events. [epub ahead of print, 2021 Feb 16]. Anaesthesia.
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It is inevitable that anaesthetic, theatre and ICU staff will encounter critical incidents, deaths in theatre and other potentially traumatic events during their working lives. Despite introducing trauma risk management (TRiM) at our hospital, a peer support tool that helps staff prepare for and recover from potentially traumatic events, we identified four issues which we believed were negatively affecting staff well-being following such events.
Cabaniss DL, Arbuckle MR. Wellness and the 80-hour work week: an oxymoron. Acad Med. 2021;96(3):322.
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To intern means to imprison, and a resident is someone who lives somewhere. Although these terms sound archaic, young physicians, fresh from medical school, still spend anywhere from 3 to 7 years essentially living in the hospital. And although they are paid, their salaries are not adequate to pay off their often-enormous education debts. Many are miserable.
Colaianni CA, et al. Breathe. NEJM. Published 2021 Feb 13.
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A graphical perspective of a new attending surgeon. "No-one ever tells you how hard it is to be in charge."

Rasmussen JM, Najarian MM, Ties JS, Borgert AJ, Kallies KJ, Jarman BT. Career satisfaction, gender bias, and work-life balance: a contemporary assessment of general surgeons. Journal of Surgical Education. 2021 Jan-Feb;78(1):119-125. doi: 10.1016/j.jsurg.2020.06.012.

Gray RM, Evans FM. Well-being of the global anesthesiologist. Paediatric Anaesthesia. 2021 Jan;31(1):13-15. doi: 10.1111/pan.14093.

Kaur B. Burnout recognition and mitigation in the context of a global pandemic. Paediatric Anaesthesia. 2021 Jan;31(1):8-9. doi: 10.1111/pan.14065.

Petrini LA, Thottathil P, Shih G, Henderson A, Pasquariello C, Black SA. Ask the question, be the solution: fostering wellbeing through contextualized assessment and strategy development. Paediatric Anaesthesia. 2020 Nov 20. doi: 10.1111/pan.14087.

Rodrigues H, Cobucci R, Oliveira A, Cabral JV, Medeiros L, Gurgel K, Souza T, Gonçalves AK. Burnout syndrome among medical residents: A systematic review and meta-analysis. PLoS One. 2018 Nov 12;13(11):e0206840. doi: 10.1371/journal.pone.0206840.

Wainwright E, Looseley A, Mouton R, et al. Stress, burnout, depression and work satisfaction among UK anaesthetic trainees: a qualitative analysis of in-depth participant interviews in the Satisfaction and Wellbeing in Anaesthetic Training study. Anaesthesia. 2019;74(10):1240-1251. doi:10.1111/anae.14694

Wilson G, Larkin V, Redfern N, Stewart J, Steven A. Exploring the relationship between mentoring and doctors' health and wellbeing: a narrative review. Journal of the Royal Society of Medicine. 2017;110(5):188-197. doi:10.1177/0141076817700848

Unadkat S, Farquhar M. Doctors' wellbeing: self-care during the covid-19 pandemic. British Medical Journal. 2020;368:m1150. Published 2020 Mar 24. doi:10.1136/bmj.m1150

Ahola K, Väänänen A, Koskinen A, Kouvonen A, Shirom A. Burnout as a predictor of all-cause mortality among industrial employees: a 10-year prospective register-linkage study. Journal of Psychosomatic Research. 2010;69(1):51-57.

beyondblue. National mental health survey of doctors and medical students. October 2013.

Llewellyn, A. Asking difficult questions in supervision, think RUOK? On the wards; Feb 9, 2017.

Rimmer A. I've noticed a change in my colleague's behaviour. what should I do? BMJ(Online). 2019;365. Request from Library

Mufarrih SH, Naseer A, Qureshi NQ, et al. Burnout, job dissatisfaction, and mental health outcomes among medical students and health care professionals at a tertiary care hospital in pakistan: protocol for a multi-center cross-sectional study. Frontiers in Psychology. 2019;10:2552-2552.

Lawson ND. It is time to stop linking burnout, depression, and medical errors. Academic Medicine. 2020;95(1):11-11.

Physician burnout: the need to rehumanise health systems. The Lancet. 2019;394(10209):1591-1591.

Karp JF. Resident mental health: time for action. Anesthesiology. 2019;131(3):464-466.

Talbot SG. Physicians aren’t ‘burning out.’ They’re suffering from moral injury. STAT, First Opinion, July 26, 2018.

Kim DD, Kimura A Jr, Pontes DKL, Oliveira MLS, Cumino DO. Evaluation of anesthesiologists' knowledge about occupational health: pilot study. BMC Anesthesiology. 2018;18(1):193-193.

Canadian Anesthesiologists' Society.Healthy Anesthesiologist [Internet]. 2019. From: https://www.cas.ca/English/Healthy-Anesthesiologist. Accessed 6 March 2019.

Schäfer SK, Lass-Hennemann J, Groesdonk H, Volk T, Bomberg H, Staginnus M, et al. Mental health in anesthesiology and ICU staff: sense of coherence matters. Front. Psychiatry, 19 September 2018.

Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors related to physician burnout and its consequences: a review. Behavioral Sciences (Basel, Switzerland). 2018;8(11).

Dhand, S. Why doctors are unhappy in their jobs - and what to do about it. Medical Observer, Opinion, 12 June 2019. [Free registration required to access]

Prins DJ, van Vendeloo SN, Brand PLP, Van der Velpen I, de Jong K, van den Heijkant F, et al. The relationship between burnout, personality traits, and medical specialty. A national study among Dutch residents. Med Teach. 2018 Nov 3:1-7.

Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132-49.

Westbrook, J., Sunderland, N. Bullying and harassment of health workers endangers patient safety. The Conversation, Medical Observer, 5 November 2018, .

Robson, S. I was a young doctor, about to kill myself, when I heard a knock at my door. Sydney Morning Herald; 2 November 2018.

Victorian Institute of Forensic Medicine. Clinical Communique. 2018;5(3):10.

Special issue on clinician suicides.

Marr, J. 'I needed it to look like an accident. A tired doctor falls asleep at the wheel and hits a tree' [article post]. Medical observer. Posted 24 August, 2017.

In this article GP Dr Jane Marr tells how one night, during a shift on a labour ward, she came close to suicide.

Murray R, Crotty B. What needs to happen to build resilience and improve mental health among junior doctors [article post]. The Conversation. Posted May 25, 2017.

Doctors experience higher levels of suicide and mental distress than their non-medical peers. A review of studies in the area found male doctors had a 26% higher risk of suicide, while female doctors had a 146% higher risk (more than double) than the general population...

Wiedersehn, Sarah. Anaesthetists conference: Medical professionals encouraged to speak up on mental health [article post]. Brisbane Times. Posted May 14, 2017.

A healthy anaesthetist means a healthier patient, which is why the topic of mental health among this "high-risk" group of doctors is being brought out in the open...

Special wellbeing issue: Pediatric Anesthesia

Special wellbeing issue: Pediatric Anesthesia
The January 2021 issue of Pediatric Anesthesia explores multiple dimensions of physician wellbeing, combining insight with actionable strategy to promote professional fulfillment and career sustainability.

Spotlight on: Substance abuse

The topic of substance abuse amongst our colleagues has frequently been discussed by the Wellbeing SIG.

The below articles discuss the issue from an Australian and New Zealand perspective.

Baird CR. Substance use disorder in anaesthetists: a personal perspective. [epub ahead of print, 2021 Jan 25]. Anaesth Intensive Care.
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Abstract
In this article, I present a firsthand account as an anaesthetist with substance use disorder who has been through rehabilitation and returned to clinical anaesthesia, followed by an overview of substance use disorder in anaesthesia. Substance use disorder is prevalent within the anaesthesia community and can result in tragic consequences, including death in many cases. The incidence is around one to two per 1000 anaesthetist years and this appears to be rising, perhaps mirroring the population-wide increase in substance use disorder as a result of the opioid epidemic. Recognising substance use disorder in a colleague and intervening to try and help them and protect patients can be immensely challenging. Carrying out a successful intervention requires careful planning and coordination in order to protect the affected individual, their colleagues and patients. Returning to clinical anaesthesia following a diagnosis of substance use disorder is also contentious, with the high abstinence rate (relative to the wider substance use disorder population) having to be balanced against the risk of death following relapse. Any return to practice must be well planned and supported, and include appropriate toxicology screening. With such measures, rehabilitation and a return to clinical anaesthesia is possible in certain cases. For the affected individual regaining, then maintaining, their professional identity can be a powerful motivator to remain abstinent. Drug diversion and substance use disorder in anaesthesia is unlikely ever to be fully preventable, but strategies such as biometric dispensing, analysis of unused drugs, random toxicology and ongoing education may help to keep it to a minimum.
Fry RA. Substance abuse by anaesthetists in Australia and New Zealand. Anaesth Intensive Care. 2005;33(2):248-255.
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Abstract
A questionnaire investigating substance abuse was sent to 128 anaesthetic departments in Australia and New Zealand of which 100 (78%) replied. Forty-four cases of substance abuse were reported. Abusers were more likely to be male, aged between 25 and 35 years and abusing opioids. Death was the eventual outcome in 24% of cases. Only 19% of abusers made a long-term recovery within the specialty. Initial signs of abuse were most commonly abnormal conduct (63% of the cases) and observed abuse (37%). More than one precipitating cause was identified in 51% of cases, the most frequently reported were mental health and family problems. The pattern of substances abused was similar to that reported in the previous Australasian survey ten years ago. However, in keeping with an international trend, there appears to be an increased use of anaesthetic agents.

Recognising Warning Signs

Are you enthusiastic for long, difficult or complicated cases?
Do you volunteer to work extra shifts or to do extra or late cases on a list?
Are you over-anxious to give breaks to your colleagues?

Did you know that these are some of the warning signs of drug abuse, according the Association of Anaesthetists of Great Britain and Ireland (AAGBI)?

These attributes are also those which are generally valued by anaesthetists, which highlights how difficult it can be to recognise substance misuse amongst our colleagues.

Recommendations for future articles of the month are welcome. Please contact Events or Dr Suzi Nou (Suzi.Nou@nh.org.au).

For more warning signs and for strategies on what to do when you suspect someone may have a substance abuse problem, I encourage you to read the Welfare of Anaesthetists Special Interest Group resource document "RD 20 Substance Abuse 2013".

RD 20 Substance Abuse 2016

Wellbeing: Articles

ANZCA Bulletin articles

Recent articles of interest

Special wellbeing issue: Pediatric Anesthesia

Spotlight on: Substance abuse

Recognising Warning Signs

More articles of interest