Torrens University Australia, Adelaide, South Australia, Australia
Torrens University Australia, Adelaide, South Australia, Australia.
BMJ Open. 2024 Nov 19;14(11):e088283. doi: 10.1136/bmjopen-2024-088283.
Protecting doctors' mental health has typically focused on individuals, rather than addressing organisational and structural-level factors in the work environment.
This study uses the socioecological model (SEM) to illuminate and explore how these broader factors inform the mental health of individual doctors.
Semi-structured interviews (20-25 hours) and ethnographic observations (90 hours) involving work shadowing doctors (n=14).
Doctors representing various career stages, specialty areas, genders and cultural backgrounds.
Three specialties in a public South Australian hospital. Thematic analysis revealed work-related risk factors for poor mental health.
The SEM framework was used to analyse the work environment's impact on doctors' mental health. The analysis identified how the layers interconnect to influence risk factors for individual doctors. : lack of control over career advancement, disenfranchisement due to understaffing and concerns about handling complex cases relative to experience. : negative impacts of shift work and fragmented teams, leading doctors to absorb pressure despite exhaustion to maintain professional credibility. : high patient loads with time constraints and geographical limitations hindering care delivery, compounded by administrative burdens. : the commercialisation of medicine emphasising corporatisation and bureaucratic processes, which devalues professional autonomy.
This study highlights how doctors experience layers of interconnected factors that compromise their mental health but over which they have very little control. Interventions must therefore address these issues at organisational and systemic levels, for which starting points evident within our data are identified.
保护医生的心理健康通常侧重于个人，而不是解决工作环境中的组织和结构层面的因素。
本研究使用社会生态学模型（SEM）来阐明和探讨这些更广泛的因素如何影响个体医生的心理健康。
涉及工作影子医生（n=14）的半结构式访谈（20-25 小时）和民族志观察（90 小时）。
代表不同职业阶段、专业领域、性别和文化背景的医生。
南澳大利亚州一家公立医院的三个专业。主题分析揭示了与工作相关的心理健康不良风险因素。
使用 SEM 框架分析工作环境对医生心理健康的影响。该分析确定了各层如何相互关联影响个体医生的风险因素。个体层面：职业发展缺乏控制、人手不足导致的权利丧失以及相对于经验处理复杂病例的担忧。工作层面：轮班工作和碎片化团队的负面影响，导致医生尽管疲惫不堪仍要承受压力，以维护专业信誉。组织层面：患者负荷高，时间限制和地理限制妨碍了护理的提供，加上行政负担。系统层面：医学的商业化强调企业化和官僚化进程，贬低了专业自主权。
本研究强调了医生如何体验到相互关联的因素层，这些因素损害了他们的心理健康，但他们对此几乎没有控制。因此，干预措施必须在组织和系统层面上解决这些问题，我们的数据中确定了这些问题的起点。
