Norwegian Centre for E-Health Research (NSE), Tromsø, Norway.
Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), General Practice, Research Unit, Trondheim, Norway.
BMC Prim Care. 2022 Aug 27;23(1):216. doi: 10.1186/s12875-022-01810-y.
General practice is a generalist discipline fraught with complexity. For inexperienced physicians, it may be demanding to get to grips with the clinical challenges. The purpose of this article is to describe possible differences in the range of tasks between inexperienced and experienced general practitioners (GPs), and the extent to which clinical experience affects the way in which GPs perceive their daily work.
An online questionnaire was sent to all regular GPs in Norway (N = 4784) in 2018. The study sought to document the tasks performed during a typical working day and how the GPs perceived their working situation. In this study, we compare the tasks, working situation and occurrence of potentially conflictual consultations among 'less experienced physicians' (≤ 5 years of experience in general practice) versus 'more experienced physicians' (> 5 years of experience). The findings are discussed in light of theories on development of expertise.
We received responses from 1032 GPs; 296 (29%) were less experienced and 735 (71%) more experienced. The two groups reported virtually the same number of consultations (19.2 vs. 20.5) and clinical problems handled (40.4 vs. 44.2) during the study day. The less experienced physicians reported a higher proportion of challenging and/or conflictual consultations, involving prescriptions for potentially addictive medication (5.7% vs. 3.1%), sickness certification (4.1% vs. 2.4%) and referral for medical investigations on weak clinical indication (8.1% vs. 5.6%). For other clinical issues there were minor or no differences. Both GP groups reported high levels of work-related stress with negative effect on self-perceived health (61.6% vs 64.6%). GPs who felt that high job demands harmed their health tended to handle a slightly higher number of medical issues per consultation and more consultations with elements of conflict.
Inexperienced GPs in Norway handle a workload comparable to that of experienced GPs, but they perceive more conflictual consultations. These findings have relevance for training and guidance of future GP specialists. Irrespective of experience, the GPs report such high levels of negative work-related stress as to indicate an acute need for organisational changes that imply a reduced workload.
全科医学是一门充满复杂性的通科医学。对于没有经验的医生来说，掌握临床挑战可能具有挑战性。本文的目的是描述经验不足的和经验丰富的全科医生之间在任务范围上可能存在的差异，以及临床经验对全科医生感知日常工作的方式的影响程度。
2018 年，我们向挪威所有的注册全科医生（N=4784）发送了一份在线问卷。该研究旨在记录典型工作日期间执行的任务以及全科医生对其工作状况的看法。在这项研究中，我们将“经验不足的医生”（<5 年全科医学经验）与“经验丰富的医生”（>5 年全科医学经验）之间的任务、工作情况和潜在冲突性咨询的发生情况进行了比较。研究结果根据专业知识发展理论进行了讨论。
我们收到了 1032 名全科医生的回复；其中 296 名（29%）为经验不足，735 名（71%）为经验丰富。两组在研究日报告的咨询量（19.2 次与 20.5 次）和处理的临床问题（40.4 次与 44.2 次）几乎相同。经验不足的医生报告说，涉及开具潜在成瘾性药物处方（5.7%与 3.1%）、病假证明（4.1%与 2.4%）和在临床指征较弱的情况下进行医疗检查转诊（8.1%与 5.6%）的挑战性和/或冲突性咨询比例更高。对于其他临床问题，两组之间差异较小或没有差异。两组全科医生都报告称，工作相关压力水平很高，对自我感知健康有负面影响（分别为 61.6%和 64.6%）。那些认为高工作要求危害其健康的全科医生往往会在每次咨询中处理更多的医疗问题和更多带有冲突因素的咨询。
挪威经验不足的全科医生处理的工作量与经验丰富的全科医生相当，但他们认为咨询的冲突性更大。这些发现与未来全科医生专家的培训和指导有关。无论经验如何，全科医生报告的如此高的负面工作相关压力表明，迫切需要进行组织变革，以减少工作量。
