The development of best practices to promote physician wellbeing at the individual and organisational levels is receiving increased attention. Few studies have documented how physicians perceive their wellbeing in these contexts. The purpose of this qualitative study is to identify and discuss the reported factors that hinder wellbeing, as well as the reported factors that would promote wellbeing among physicians. There were 165 physicians from a province of Canada who wrote their open-ended responses to two questions, as part of a larger self-report questionnaire. The questions asked what causes them stress, and what interventions should be implemented at organisational/institutional levels. The largest specialty was family medicine, followed by internal medicine, and surgical disciplines, with 58% of participants male. A general inductive approach was used to analyze the data and themes and sub-themes were discovered using the socio-ecological model as the framework. Reponses were both personal and professional which resulted in the emergence of four major themes to reflect this diversity. These themes were external constraints on the practice of medicine, issues at the professional/institutional levels, issues at the individual practice level, and work/life balance. The work/life balance theme received the highest number of responses followed by external constraints on the practice of medicine. In the major theme of work-life balance, work-life conflict received the most responses, and in the major theme of external constraints on practice of medicine, lack of resources (human and material) and restrictions to autonomy received the most responses. Ideas for interventions in the work/life balance theme were health promotion, and healthy workplace initiatives. In the second largest theme, suggested ideas for interventions were collegiality/professionalism and policy formulation at the health care system. Our findings have implications for governance and health policy, health human resources and education. In particular, the socio-ecological framework was a useful framework to analyse physician wellbeing due to its applicability for issues at the structural, organisational, and individual levels. Future research should target interventions at the organisational and institutional levels to address work-life conflict and job dissatisfaction.

/pdf/may-i-long-experience-the-joy-of-healing-professional-and-noqzvogybm.pdf

May I long experience the joy of healing: professional and personal wellbeing among physicians from a Canadian province

This study examines how physicians' emotional expression facilitated shared understanding and shared decision-making with patients A sample of 278 Canadian physicians reported how often they expressed genuine emotions, faked and withheld other emotions during patient care The results revealed that: the two communication outcomes were highly interrelated; deep acting was positively related to shared understanding; faking was negatively related to both outcomes; hiding was unrelated to either outcome Addressing patients' emotional needs enhances patient-centred care and patient safety More research on managing physician's and patient's emotions is needed, given the challenges and constraints of medical practice

Relating physician emotional expression to shared understanding and shared decision-making with patients

/pdf/following-the-path-of-involuntary-change-the-emotional-2idufohc01.pdf

Following the Path of Involuntary Change: The Emotional Effects

The opportunity to educate obese patients on healthy lifestyle practices and address habits related to chronic disease development is present among many physician office visits, though this opportunity is often overlooked (Flocke, Stange, & Goodwin, 1998). Understanding ways to improve the medical education and enhance the counseling skills of future physicians are of practical and personal relevance to current research. By improving the ways in which physicians counsel obese patients on weight management practices, the healthcare paradigm is poised to create an indelible mark on the wellbeing of our nation. Based on the need to address patient education and counseling, the purpose of this study was to investigate the relationship between physician attitudes and health behaviors on their overall communication and communication skills. The study surveyed 38 second-year medical residents at the New York University Bellevue School of Medicine using the Weight Management Survey developed by NYU researchers. Communication and counseling skills were measured using scores from Objective Structured Clinical Exams (OSCEs) administered on the same day as the Weight Management Counseling survey. Results of the survey and the OSCEs were analyzed to investigate relationships between each survey item of three categories of questions (attitudes toward weight management counseling, attitudes toward obese patients, physician health habits) and each of two sets of OSCE scores (obesity-related communication skills and overall counseling skills). Results of the data analysis suggest significant relationships between physicians’ personal health habits—specifically dietary habits—and obesity counseling–related communication skills. Results also suggest a significant relationship between physicians’ attitudes toward obesity counseling–related communication skills and overall communication skills. Although an extensive body of evidence corroborates these relationships, future investigations should administer the surveys and methods used in this study in rural as well as other urban locations in order to improve variability among medical residents surveyed and assessed. These results also highlight the need to investigate more information about the learning environment of medical residents and also the working environment of physicians, in a variety of settings, in order to provide more depth to the body of literature suggesting providers’ health habits improves patient health outcomes.

Healing by Example: The Influences of Medical Residents' Attitudes and Health Behaviors on their Communication Skills and Counseling Practices

Background Many factors influence patient satisfaction during an emergency department (ED) visit, but the perception of wait time plays a central role. A long wait time in the waiting room increases the risk of hospital-acquired infection, as well as the risk of a patient leaving before being seen by a physician, particularly those with a lower level of urgency who may have to wait for a longer time. Objective We aimed to improve the perception of wait time through the implementation of a semiautomatic SMS text message system that allows patients to wait outside the hospital and facilitates the recall of patients closer to the scheduled time of meeting with the physician. Methods We performed a cross-sectional survey to evaluate the system using a tailored questionnaire to assess the patient perspective and the Unified Theory of Acceptance and Use of Technology questionnaire for the caregiver perspective. We also monitored the frequency of system use with logs. Results A total of 110 usable responses were collected (100 patients and 10 caregivers). Findings revealed that 97 of 100 (97%) patients were satisfied, with most patients waiting outside the ED but inside the hospital. The caregiver evaluation showed that it was very easy to use, but the adoption of the system was more problematic because of the perceived additional workload associated with its use. Conclusions Although not suitable for all patients, our system allows those who have a low-severity condition to wait outside the waiting room and to be recalled according to the dedicated time defined in the Swiss Emergency Triage Scale. It not only has the potential to reduce the risk of hospital-acquired infection but also can enhance the patient experience; additionally, it was perceived as a real improvement. Further automation of the system needs to be explored to reduce caregiver workload and increase its use.

Use of a Semiautomatic Text Message System to Improve Satisfaction With Wait Time in the Adult Emergency Department: Cross-sectional Survey Study

The thesis of this paper is that patient emotions have not been sufficiently integrated into patient-centeredness, a well-established organizing principle of health care management. We first review the scientific knowledge on emotions that is of relevance to support their being a core component of patient-centeredness. We then report a field study designed to investigate the mechanisms by which emotions influence care outcomes (specifically, patient satisfaction). Structural analyses performed on self-reports by 283 minor care patients in an Emergency Department revealed that both positive and negative emotions influence satisfaction indirectly by biasing patient perceptions of quality of care in a valence-congruent direction.Negative emotions have an additional direct effect on satisfaction. Patients who were made to wait longer to see the physician not only manifested a progressive deterioration of their emotional states (i.e. decrease in positive affects and increase in negative affects) but their satisfaction judgments became more importantly formed on the basis of emotions. Implications of the research for healthcare management are discussed.

Emotions, the neglected side of patient-centered health care management: The case of emergency department patients waiting to see a physician

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Emotions, the neglected side of patient-centered health care management: The case of emergency department patients waiting to see a physician