Lee F Joseph, Brown Judith Belle, Stewart Moira
Centre for Family Medicine, 25 Joseph St, Kitchener, ON N2G 4X6.
Can Fam Physician. 2009 Mar;55(3):288-289.e6.
To explore the nature of professional stress and the strategies used by family physicians to deal with this stress.
Qualitative study.
Kitchener-Waterloo, Ont.
Ten key-informant family physicians.
In-depth interviews were conducted with key informants. A total of 40 key informants were identified, based on selected criteria; 24 provided consent. The potential participants were rank-ordered for interviews to provide maximum variation in age, sex, and years in practice. Interviews were conducted, audiotaped, transcribed verbatim, and analyzed until thematic saturation was reached, as determined through an iterative process. This occurred after 10 in-depth interviews. Immersion and crystallization techniques were used.
The participants described professional stresses and strategies at the personal, occupational, and health care system levels. Personal stressors included personality traits and the need to balance family and career, which were countered by biological, psychological, social, and spiritual strategies. Occupational stressors included challenging patients, high workload, time limitations, competency issues, challenges of documentation and practice management, and changing roles within the workplace. Occupational stressors were countered by strategies such as setting limits, participating in continuing medical education, soliciting support from colleagues and staff, making use of teams, improving patient-physician relationships, exploring new forms of remuneration, and scheduling appropriately. Stressors affecting the wider health care system included limited resources, imposed rules and regulations, lack of support from specialists, feeling undervalued, and financial concerns.
Family physicians face a multitude of challenges at personal, occupational, and health care system levels. A systems approach provides a new framework in which proactive strategies can augment more than one level of a system and, in contrast, reactive strategies can have negative inputs for different system levels.
探讨职业压力的本质以及家庭医生应对这种压力所采用的策略。
定性研究。
安大略省基奇纳 - 滑铁卢。
十位关键信息提供者家庭医生。
对关键信息提供者进行深入访谈。根据选定标准共确定了40位关键信息提供者；24位提供了同意。对潜在参与者按年龄、性别和从业年限进行排序以便进行访谈，以实现最大程度的多样性。进行访谈、录音、逐字转录，并通过迭代过程进行分析，直至达到主题饱和。在进行了10次深入访谈后达到了主题饱和。采用了沉浸和结晶技术。
参与者描述了个人、职业和医疗保健系统层面的职业压力及应对策略。个人压力源包括性格特点以及平衡家庭和职业的需求，应对策略包括生理、心理、社会和精神方面的策略。职业压力源包括具有挑战性的患者、高工作量、时间限制、能力问题、记录和实践管理方面的挑战以及工作场所角色的变化。应对职业压力源的策略包括设定界限、参加继续医学教育、寻求同事和工作人员的支持、利用团队、改善医患关系、探索新的薪酬形式以及合理安排日程。影响更广泛医疗保健系统的压力源包括资源有限、强加的规章制度、缺乏专科医生的支持、感觉未得到重视以及财务问题。
家庭医生在个人、职业和医疗保健系统层面面临众多挑战。系统方法提供了一个新框架，在这个框架中，积极主动的策略可以增强系统的多个层面，相反，被动反应的策略可能会对不同系统层面产生负面影响。
