Ahmad Waqas, Ashraf Huma, Talat Afnan, Khan Aleena Ahmad, Baig Ammad Anwar, Zia Iqra, Sarfraz Zohak, Sajid Hifsa, Tahir Marium, Sadiq Usman, Imtiaz Hira
CMH Lahore Medical College, Lahore, Pakistan.
PeerJ. 2018 Sep 10;6:e5519. doi: 10.7717/peerj.5519. eCollection 2018.
Burnout is defined as a prolonged state of physical and psychological exhaustion. Doctors, due to the demanding nature of their job, are susceptible to facing burnout, which has far reaching implications on their productivity and motivation. It affects the quality of care they provide to patients, thus eroding the doctor-patient relationship which embodies patient centeredness and autonomy. The study aims at addressing the stressors leading to burnout and its effect on the doctor-patient relationship.
A descriptive, cross-sectional study design with convenience (non-probability) sampling technique was employed in six major hospitals of Lahore, Pakistan. A total of 600 doctors were approached for the study which included house officers or "HOs" (recent graduates doing their 1 year long internship) and post-graduate trainees or "PGRs" (residents for 4-5 years in their specialties). Burnout was measured using the Copenhagen Burnout Inventor (CBI) while attitudes towards the doctor-patient relationship was measured using the Patient Practitioner Orientation Scale (PPOS), which measures two components of the relationship: power sharing and patient caring. Pearson correlation and linear regression analysis were used to analyze the data via SPSS v.21.
A total of 515 doctors consented to take part in the study (response rate 85.83%). The final sample consisted of 487 doctors. The burnout score was not associated with the total and caring domain scores of PPOS ( > 0.05). However, it was associated with the power sharing sub-scale of PPOS. Multiple linear regression analysis yielded a significant model, by virtue of which CBI scores were positively associated with factors such as female gender, feeling of burn out, scoring high on sharing domain of PPOS and a lack of personal control while CBI scores were negatively associated with private medical college education, having a significant other, accommodation away from home and a sense of never ending competition. Burnout levels varied significantly between house officers and post graduate trainees. Twenty-three percent of the participants (mostly house officers) had high/very high burnout levels on the CBI (Kristenson's burnout scoring). Both groups showed significant differences with respect to working hours, smoking status and income.
Although burnout showed no significant association with total and caring domain scores of PPOS (scale used to assess doctor-patient relationship), it showed a significant association with the power sharing domain of PPOS suggesting some impact on the overall delivery of patient care. Thus, it necessitates the monitoring of stressors in order to provide an atmosphere where patient autonomy can be practiced.
职业倦怠被定义为一种长期的身心疲惫状态。由于工作要求苛刻，医生容易面临职业倦怠，这对他们的工作效率和积极性有着深远影响。它影响着他们为患者提供的护理质量，从而侵蚀了体现以患者为中心和自主性的医患关系。本研究旨在探讨导致职业倦怠的压力源及其对医患关系的影响。
采用描述性横断面研究设计，运用便利（非概率）抽样技术，在巴基斯坦拉合尔的六家主要医院进行研究。共有600名医生参与该研究，其中包括住院医师（“HOs”，即刚毕业正在进行为期一年实习的医生）和研究生实习生（“PGRs”，即各专业4至5年的住院医生）。使用哥本哈根职业倦怠量表（CBI）测量职业倦怠，同时使用患者从业者导向量表（PPOS）测量对医患关系的态度，该量表测量关系的两个组成部分：权力分享和患者关怀。通过SPSS v.21软件，使用Pearson相关性分析和线性回归分析来分析数据。
共有515名医生同意参与研究（回复率85.83%）。最终样本包括487名医生。职业倦怠得分与PPOS的总分及关怀领域得分无关（P>0.05）。然而，它与PPOS的权力分享子量表相关。多元线性回归分析得出一个显著模型，据此CBI得分与女性性别、职业倦怠感、在PPOS分享领域得分高以及缺乏个人掌控等因素呈正相关，而CBI得分与私立医学院教育、有重要他人、离家居住和无休止竞争感呈负相关。住院医师和研究生实习生的职业倦怠水平差异显著。23%的参与者（大多是住院医师）在CBI（克里斯滕森职业倦怠评分）上处于高/非常高的职业倦怠水平。两组在工作时间、吸烟状况和收入方面存在显著差异。
尽管职业倦怠与用于评估医患关系的PPOS的总分及关怀领域得分无显著关联，但它与PPOS的权力分享领域有显著关联，这表明对患者护理的整体提供有一定影响。因此，有必要监测压力源，以营造一个能践行患者自主性的氛围。
