"I had a feeling of being fogged in most of the day (a feeling difficult to describe unless you have experienced it). My blood sugar problems, which I had dealt with on a small scale in the past, was absolutely out of control. - I felt seriously terrible. I became chronically irritable, foggy-headed and shaky - not good for someone whose business depends on a demanding physical work and a cheerful, enthusiastic demeanor! But it was my erratically racing heart that scared me into trying to get help"


" And to think that I used to wake up every morning feeling nauseous and often with my heart racing. It would take several hours of eating almost non-stop to feel better but each morning the symptoms would return full force. Even after the pneumonia cleared up, I didn’t have the energy to work all day"


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61% of Doctors “significantly stressed” in New Zealand

In January 1999, 411 doctors, 330 surgeons and 400 randomly sampled community pharmacists were surveyed in New Zealand regarding their job satisfaction, psychological morbidity and stress level. All three groups were satisfied with their jobs, but pharmacists were significantly less so. There is a growing international literature about the impact of stress, job satisfaction, psychological symptoms and morale on health professionals. It is recognised that a syndrome of increasing stress and psychological symptoms is not restricted to the traditionally highly stressed groups of junior hospital doctors, but may affect senior hospital consultants, general practitioners and other health professionals. New Zealand has been faced with the changes and challenges of significant health reforms yet there remains little published literature about health professional job satisfaction and levels of psychological distress in the current working environment. A study by Richards (5) identified significant stress in 61% of a sample of New Zealand doctors and there is evidence of high levels of burnout in rural practitioners.

Results: Response rates of the study were 70.5% for physicians, 69% for surgeons and 76% for community pharmacists. Job satisfaction scores for surgeons were similar to scores for general practitioners. Pharmacist and physicians scores were lower. Job satisfaction varied according to gender, the relative amount of time spent in public practice and the perceived ill effects of work on health. Pharmacists had the highest number of cases with significant scores on the GHQ-12 scale, with physicians and surgeons scoring similar to general practitioners. In each of these health professional groups approximately 10% described a level of symptoms that is associated with more severe psychological disturbance. According to the 1999 survey, although general practitioners were satisfied with their jobs overall, work was perceived as affecting the physical health of 46% of the sample and 57% had often contemplated leaving general practice. Approximately one third (31.4%) of those general practitioners had a score higher than 4 on the GHQ-12 indicative of a significant level of psychological symptoms and 10% scored more than 8 indicating significant psychological distress.
The major causes of stress and lack of medical job satisfaction
·         Excessive paperwork
·         Excessive hours
·         Health reforms
·         Bureaucratic interference
·         Compromised family or social life
·         Public practice (more stress than private)
·         On-call practice
This survey has been repeated with specialist physicians, surgeons and pharmacists to provide a comparison with general practitioners. Pharmacists more frequently contemplated giving up their job due to work stress, than all other groups. They were also less interested in their job due to work stress, and felt less able to remain competent at work than GPs. Pharmacists also felt more overwhelmed by paperwork, reported more financial concerns and very high levels of frustration at bureaucratic interference than physicians or surgeons. Family and social life was frequently compromised among all groups, and all groups set aside time for stress-relief less often than the mid point on the likert scale. Physicians and surgeons perceived public work as more stressful than private. However, similar levels of satisfaction were reported for both public work and private work. There was a significant correlation between job satisfaction and other question responses for pharmacists, physicians, and surgeons. Low job satisfaction correlated with contemplation of giving up work due to stress. Physicians and surgeons were more likely to have lower job satisfaction scores if they felt unable to remain competent in their field of work. Lower job satisfaction for pharmacists and physicians correlated with bureaucratic interference. Increased time spent in private practice correlated with increased job satisfaction for physicians and surgeons. Respondents from all health professional groups commented about stress related to
the impact of government reforms and ‘bureaucratic interference’.
Eric Bakker ND: My concern with this amazing survey is the fact that if 61% of New Zealand doctors are significantly stressed, they may actually find it difficult to recognise stress in patients themselves. Many medical professionals in fact do not even believe that adrenal fatigue  actually exists. It must be hard to recognise stress and fatigue in your patients which you yourself may well have a degree of suffering from. I encourage all healthcare professionals to study and understand stress and the adrenal gland, and how this functional syndrome can affect not only their own health, but that of their patients as well.  I now know that over half of my patients have this syndrome, which is all too often just conveniently labeled as "depression".

Abstract NZ Medical Journal 2001, 114:540-544
This study was a Wellington School of Medicine Summer Studentship Project.
“A survey of job satisfaction, sources of stress and psychological symptoms among New Zealand
Health Professionals”
1. Caplan RP. Stress, anxiety, and depression in hospital consultants, general practitioners, and senior health service managers. BMJ 1994;309(6964):1261-3.
2. Appleton K, House A, Dowell A C. A survey of job satisfaction, sources of stress and psychological symptoms among general practitioners in Leeds. Br J Gen Pract 1998;48:1059-1063.
3. Dowell AC, McLeod DK, Hamilton S. Job Satisfaction, psychological morbidity and job stress among New Zealand general practitioners. NZ Med J 2000; 113:269-72.
4. Snelgrove SR. Occupational stress and job satisfaction: a comparative study of health visitors, district nurses and community psychiatric nurses. J Nurs Manag 1998;6:97-104.
5. Richards JG. The health and health practices of doctors and their families. NZ Med J 1999;112:96-99.
6. Jenkins D. Burnout in rural general practitioners. NZ Med J 1998;111:328.
7. Warr P, Cook J, Wall T. Scales for the measurement of some work attitudes and aspects of psychological well-being. J Occ Psych. 1979;52:11-28.
8. Goldberg DP, Williams P. Manual of the general health questionnaire. Windsor, U.K: Nfer-Nelson 1988.
9. Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. Mental health of hospital consultants: the effects of stress and satisfaction at work [see comments]. Lancet 1996;347:724-8.
10. Kapur N, Appleton K, Neal RD. Sources of job satisfaction and psychological distress in GPs and medical house officers. Fam Pract 1999;16:600-1.
11. Firth-Cozens J. Predicting stress in general practitioners: 10 year follow up postal survey. BMJ 1997;315:34-5.
12. Firth-Cozens J, Greenhalgh J. Doctors’ perceptions of the links between stress and lowered clinical care. Soc Sci Med 1997;44:1017-22.
13. Wilson NC, Russell DG, Paulin JM et al. Life in New Zealand Survey: Summary Report. Dunedin, New Zealand: University of Otago 1990.
14. MaGPIe Research Group. Psychological problems in New Zealand primary healthcare: A report on the pilot phase of the Mental Health and General Practice Investigation (MaGPIe) NZ Med J 2001;114:13-16.

admin said,

January 3, 2009 @ 8:30 am

Hi Eric,
I am a doctor and can agree with the findings of this survey. We tend to work too many hours and often under high stress conditions. Is it any wonder that doctors are burned out? I enjoyed Dr. Wilson’s presentation in Auckland and look forward to his return visit. Thanks for bringing Dr. Wilson to NZ, it is about time that stress was addresed a lot more in the clinic. Many patients see us for stress related complaints in the first place! Keep up the good work.


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