Peisah C, Latif E, Wilhelm K, Williams B
School of Psychiatry, University of New South Wales, Sydney, Australia.
Aging Ment Health. 2009 Mar;13(2):300-7. doi: 10.1080/13607860802459831.
Doctors have long been exposed to situations that can induce psychological distress. Long hours, little acknowledgement, poor sleep and high-stress work environments all contribute to making doctors prone to psychological distress and burnout, which have been much studied in younger doctors, but less so in older doctors. Little is known about whether there are differences in psychological distress among different age groups of doctors.
Doctors (n = 158) were recruited from in and around the St George Hospital, a major teaching hospital in Sydney, Australia. Participants completed a self-report questionnaire, comprising the Maslach Burnout Inventory (MBI), and Kessler 10 Psychological Distress Scale. Demographic details were collected. A subsample (n = 51) completed a semi-structured interview about issues related to burnout. These data were subjected to qualitative analysis.
Older doctors and doctors with more years of experience had significantly lower scores on MBI subscales of Depersonalization and Emotional exhaustion, and K-10 measured psychological distress. Aspects of working conditions such as being in private practice were associated with increased scores on MBI subscales of Personal accomplishment, and lower scores on MBI subscales of Emotional exhaustion and Depersonalization, and K-10 measured psychological distress. Older doctors more frequently worked in private practice. These quantitative findings were supported by the qualitative data that suggested that older doctors perceived that they experienced less psychological distress compared with earlier in their careers, which they attributed to the development of protective defences in their relationship with patients and the liberation afforded by accumulation of experience and changed work conditions.
Findings from this study suggest that older, more experienced doctors report lower psychological distress and burnout than younger doctors which the older doctors attributed to lessons learned over their years of training and practice. It may be of considerable value to find ways to more efficiently pass on these lessons to younger doctors to aid them in dealing with this challenging profession. By soliciting older doctors to aid in this transfer of knowledge, this approach may also have the added benefit of assisting older doctors in transitioning from an active clinical practice to a role of mentoring the new physician cohort.
医生长期面临可能导致心理困扰的情况。工作时间长、认可度低、睡眠不足和高压力的工作环境都使得医生容易出现心理困扰和职业倦怠，这在年轻医生中已有大量研究，但在年长医生中研究较少。对于不同年龄组的医生在心理困扰方面是否存在差异，人们知之甚少。
从澳大利亚悉尼一家主要教学医院圣乔治医院及其周边招募了158名医生。参与者完成了一份自我报告问卷，包括马氏职业倦怠量表（MBI）和凯斯勒10项心理困扰量表。收集了人口统计学细节。一个子样本（51人）完成了关于职业倦怠相关问题的半结构化访谈。这些数据进行了定性分析。
年长医生和经验更丰富的医生在MBI的去个性化和情感耗竭子量表上得分显著较低，且凯斯勒10项心理困扰量表测量的心理困扰得分也较低。诸如从事私人执业等工作条件方面与MBI个人成就感子量表得分增加、情感耗竭和去个性化子量表得分降低以及凯斯勒10项心理困扰量表测量的心理困扰得分较低相关。年长医生更频繁地从事私人执业。这些定量研究结果得到了定性数据的支持，定性数据表明年长医生认为与职业生涯早期相比，他们经历的心理困扰更少，他们将其归因于在与患者关系中形成的保护性防御机制，以及经验积累和工作条件变化带来的解脱。
本研究结果表明，年长、经验更丰富的医生报告的心理困扰和职业倦怠低于年轻医生，年长医生将其归因于多年培训和实践中学到的经验教训。找到更有效地将这些经验教训传授给年轻医生以帮助他们应对这一具有挑战性职业的方法可能具有相当大的价值。通过邀请年长医生协助这种知识传递，这种方法还可能具有额外的好处，即帮助年长医生从积极的临床实践过渡到指导新一批医生的角色。
