Mayo Clinic, Rochester, Minnesota.
now with University of Colorado School of Medicine, Denver.
JAMA Netw Open. 2022 May 2;5(5):e2213080. doi: 10.1001/jamanetworkopen.2022.13080.
Burnout is common among physicians and is associated with suboptimal patient outcomes. Little is known about how experiences with patients, families, and visitors differ by physician characteristics or contribute to the risk of burnout.
To examine the occurrence of mistreatment and discrimination by patients, families, and visitors by physician characteristics and the association between such interactions and experiencing burnout.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional survey was conducted from November 20, 2020, to March 23, 2021, among US physicians.
Mistreatment and discrimination were measured using items adapted from the Association of American Medical College's Graduation Questionnaire with an additional item querying respondents about refusal of care because of the physicians' personal attributes; higher score indicated greater exposure to mistreatment and discrimination.
Burnout as measured by the Maslach Burnout Inventory.
Of 6512 responding physicians, 2450 (39.4%) were female, and 369 (7.2%) were Hispanic; 681 (13.3%) were non-Hispanic Asian, Native Hawaiian, or Pacific Islander; and 3633 (70.5%) were non-Hispanic White individuals. Being subjected to racially or ethnically offensive remarks (1849 [29.4%]), offensive sexist remarks (1810 [28.7%]), or unwanted sexual advances (1291 [20.5%]) by patients, families, or visitors at least once in the previous year were common experiences. Approximately 1 in 5 physicians (1359 [21.6%]) had experienced a patient or their family refusing to allow them to provide care because of the physician's personal attributes at least once in the previous year. On multivariable analyses, female physicians (OR, 2.33; 95% CI, 2.02-2.69) and ethnic and racial minority physicians (eg, Black or African American: OR, 1.59; 95% CI, 1.13-2.23) were more likely to report mistreatment or discrimination in the previous year. Experience of mistreatment or discrimination was independently associated with higher odds of burnout (vs score of 0 [no mistreatment], score of 1: OR, 1.27; 95% CI, 1.04-1.55; score of 2: OR, 1.70; 95% CI, 1.38-2.08; score of 3: OR, 2.20; 95% CI, 1.89-2.57). There was no difference in the odds of burnout by gender after controlling for experiencing mistreatment and discrimination score and other demographic factors, specialty, practice setting, work hours, and frequency of overnight call.
In this study, mistreatment and discrimination by patients, families, and visitors were common, especially for female and racial and ethnic minority physicians, and associated with burnout. Efforts to mitigate physician burnout should include attention to patient and visitor conduct.
倦怠在医生中很常见，并且与患者的次优结果有关。人们对患者、家属和访客的经历如何因医生的特征而有所不同，以及这些经历如何导致倦怠风险，知之甚少。
研究医生特征对患者、家属和访客的虐待和歧视的发生情况，并研究这种互动与经历倦怠之间的关系。
设计、地点和参与者：这是一项横断面调查，于 2020 年 11 月 20 日至 2021 年 3 月 23 日在全美医生中进行。
使用美国医学协会毕业问卷的改编项目来衡量虐待和歧视，外加一个询问受访者是否因医生的个人属性而拒绝提供护理的项目；分数越高表示遭受的虐待和歧视越多。
采用 Maslach 倦怠量表衡量倦怠。
在 6512 名回应的医生中，2450 名（39.4%）为女性，369 名（7.2%）为西班牙裔；681 名（13.3%）为非西班牙裔亚裔、夏威夷原住民或太平洋岛民；3633 名（70.5%）为非西班牙裔白人。在过去一年中，患者、家属或访客至少有一次受到种族或族裔侮辱性言论（1849 名[29.4%]）、冒犯性性别歧视言论（1810 名[28.7%]）或不受欢迎的性要求（1291 名[20.5%]）是常见的经历。大约 1/5 的医生（1359 名[21.6%]）在过去一年中至少有一次遇到过患者或其家属因医生的个人属性而拒绝允许他们提供护理。在多变量分析中，女性医生（OR，2.33；95%CI，2.02-2.69）和少数族裔和少数民族医生（例如，黑人或非裔美国人：OR，1.59；95%CI，1.13-2.23）更有可能在过去一年中报告受到虐待或歧视。遭受虐待或歧视与更高的倦怠几率独立相关（与得分 0[无虐待]相比，得分 1：OR，1.27；95%CI，1.04-1.55；得分 2：OR，1.70；95%CI，1.38-2.08；得分 3：OR，2.20；95%CI，1.89-2.57）。在控制了经历的虐待和歧视评分以及其他人口统计学因素、专业、实践环境、工作时间和夜间轮班频率后，性别与倦怠的几率没有差异。
在这项研究中，患者、家属和访客的虐待和歧视很常见，尤其是对女性和少数族裔医生而言，并且与倦怠有关。减轻医生倦怠的努力应关注患者和访客的行为。
