Several factors contribute to stress among junior doctors. Among these include the transition from student to professional (Robinson et al. 2006). Sources of stress are classified into external and internal factors. External stressors that impact junior doctors include the demands of excessive work load and long working hours that consequently affect their performance at work and personal life. Other sources include lack of involvement of the supervising registrar in supporting, teaching and involving the junior doctor in patient care. Bullying and harassment of junior doctors by other staff can also contribute to an external source of stress. Critical-incident stress is far more prevalent among junior doctors who tend to be more affected by upsetting events than their senior colleagues, who may have more experience in coping with such events. Internal stressors experienced by junior doctors include lack of confidence; lack of interpersonal skills or pre-existing physical or psychiatric illnesses leading to difficulties coping with stress. Conflict in professional ethics, whereby junior doctors feel constant pressure in having to discharge patients early; have to deal with differences in interpreting “not for resuscitation” orders by nursing staff; and experience a variety of patient management by different health professionals can also become a source of internal stress for junior doctors. These have lead to a disillusionment of the health service by several junior doctors, forcing some to leave for better opportunities elsewhere (Grace 2002).
Coping with stress inevitably affects both the physical and psychological health of junior doctors. Drug and alcohol abuse are not uncommon and are often developed as part of a prevailing culture in medical school (Appleby 1997). Many doctors do not have their own general practitioner and corridor consultations are common as are self-prescriptions. High rates of mental illness including depression and increased suicide rates among doctors are also concerning and reflect the difficulties that doctors face coping with stress (Shadbolt 2002). Doctors are also surprisingly poor at managing preventative health with an estimated 30% of female doctors having never had a cervical smear test (Kay, Mitchell & Del Mar 2004).
Several studies have looked at ways of managing stress among junior doctors and the importance of certain roles within the work place in managing stress. A recent study found the role of medical education officers to be crucial to early detection and management of stress among junior doctors. This study concluded that early detection of problems through feedback by supervising registrars or consultants enables timely management and intervention strategies to be put in place. Continuous appraisal and feedback by supervisors throughout the rotation rather then at the end has also been found to be more effective in preventing stress. Other strategies suggested include adequate debriefing to be held by superiors after a critical-incident. Development of formal support systems for junior doctors and the appointment of accessible junior doctor liaison officers have been found to improve feedback and communication and hence enable prevention strategies to be in place (Grace 2002).
Access to help has been reported to be a problem among junior doctors due to issues of confidentiality and fears for being judged. A confidential support service has been found to be very effective in isolating problems and offering wider support for junior doctors without the fear of feeling judged (Luck 2001). This has already been put into place in Victoria through the Australian Medical Association (AMA) Peer Support Service and in Western Australia through Colleague of First Contact.
The implementation of stress management workshops for all junior doctors was also found to be helpful but this was found to only be well attended if scheduled into an existing program of regular meetings (Appleby 1997). A hospital in New Zealand conducted a weekly intern discussion group aiming to provide training in the management of personal and professional stress and found this to be a supportive and valuable experience for interns (Davis 1999).
Finally, developing a relationship with an independent general practitioner was found to be crucial in preserving the health of junior doctors and serves as a port of call for support for all physical and psychological health problems (Shadbolt 2002). Other lifestyle measures such as maintaining interests and relationships outside medicine and exercising and having holidays are also crucial to a junior doctor’s well being (Robinson et al. 2006).
In summary, the high levels of stress experienced by junior doctors affect their physical and psychological well being which ultimately impact on patient care. A combination of support services within the health service and education in stress management are vital to enable better coping strategies for junior doctors facing the demands placed on them within the current strained health service.
References
Appleby K 1997, ‘Setting up and running a stress management service for doctors’, British Medical Journal , vol 315, pp 2.
Bruce C, Thomas PS & Yates DH, 2003, ‘Health and stress in Australian interns’, Internal Medicine Journal, vol 33, pp 392-395.
Davis M 1999, ‘Intern discussion group: a supportive educational experience for junior doctors’, Hospital Medicine, vol 60, pp 435-439.
Grace K 2002, ‘The junior doctor in distress: the role of a medical education officer at the individual level’, Medical Journal of Australia, 1 Suppl, pp S22-24
Kay MP, Mitchell GK & Del Mar CB 2004, ‘Doctors do not adequately look after their own physical health’, Medical Journal of Australia, vol 181, pp368-370.
Luck C 2001, ‘Reducing stress among junior doctors’, Student British Medical Journal, vol 09, pp41-42.
Robinson G, Bernau S, Aldington S & Beasley R 2006, ‘From medical student to junior doctor: maintaining good health during the “baptism of fire”’, Student British Medical Journal, vol 14, pp133-176.
Shadbolt NE 2002, ‘Attitudes to healthcare and self-care among junior medical officers: a preliminary report’, Medical Journal of Australia, vol 177(1 Suppl), ppS19-20.
Stress management among Junior Doctors was authored by Miss Carnjini Yogeswaran in October 2008 as part of her AFMW Leadership Scholarship.
