Riley Ruth, Spiers Johanna, Buszewicz Marta, Taylor Anna Kathryn, Thornton Gail, Chew-Graham Carolyn Anne
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Bristol Medical School, University of Bristol, Bristol, UK.
BMJ Open. 2018 Jan 11;8(1):e017361. doi: 10.1136/bmjopen-2017-017361.
This paper reports the sources of stress and distress experienced by general practitioners (GP) as part of a wider study exploring the barriers and facilitators to help-seeking for mental illness and burnout among this medical population.
Qualitative study using in-depth interviews with 47 GP participants. The interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method.
England.
A purposive sample of GP participants who self-identified as: (1) currently living with mental distress, (2) returning to work following treatment, (3) off sick or retired early as a result of mental distress or (4) without experience of mental distress. Interviews were conducted face-to-face or over the telephone.
The key sources of stress/distress related to: (1) emotion work-the work invested and required in managing and responding to the psychosocial component of GPs' work, and dealing with abusive or confrontational patients; (2) practice culture-practice dynamics and collegial conflict, bullying, isolation and lack of support; (3) work role and demands-fear of making mistakes, complaints and inquests, revalidation, appraisal, inspections and financial worries.
In addition to addressing escalating workloads through the provision of increased resources, addressing unhealthy practice cultures is paramount. Collegial support, a willingness to talk about vulnerability and illness, and having open channels of communication enable GPs to feel less isolated and better able to cope with the emotional and clinical demands of their work. Doctors, including GPs, are not invulnerable to the clinical and emotional demands of their work nor the effects of divisive work cultures-culture change and access to informal and formal support is therefore crucial in enabling GPs to do their job effectively and to stay well.
本文报告了全科医生（GP）所经历的压力和困扰来源，这是一项更广泛研究的一部分，该研究探讨了这一医学群体在寻求针对精神疾病和职业倦怠的帮助时所面临的障碍和促进因素。
采用对47名全科医生参与者进行深入访谈的定性研究。访谈进行了录音、转录、匿名处理，并导入NVivo V.11以方便数据管理。使用恒定比较法进行主题分析来分析数据。
英格兰。
一个有目的的全科医生参与者样本，他们自我认定为：（1）目前正处于精神困扰中；（2）治疗后重返工作岗位；（3）因精神困扰而病假或提前退休；（4）没有精神困扰经历。访谈通过面对面或电话进行。
压力/困扰的主要来源与以下方面有关：（1）情感工作——管理和应对全科医生工作中的社会心理成分以及应对辱骂或对抗性患者所投入和需要的工作；（2）执业文化——执业动态、同事间冲突、欺凌、孤立和缺乏支持；（3）工作角色和要求——对犯错、投诉和调查、重新验证、评估、检查以及财务担忧的恐惧。
除了通过提供更多资源来应对不断增加的工作量外，解决不健康的执业文化至关重要。同事间的支持、愿意谈论脆弱性和疾病以及拥有开放的沟通渠道，能使全科医生感觉不那么孤立，并且更有能力应对工作中的情感和临床需求。医生，包括全科医生，并非不受工作中的临床和情感需求影响，也并非不受分裂性工作文化的影响——因此，文化变革以及获得非正式和正式支持对于使全科医生有效开展工作并保持良好状态至关重要。
