Category: Doctor

INTRODUCTION

Medicine is of great significance for mankind. It deals with the most fundamental aspects of the human condition: birth, life, physical functioning, vulnerability, loss, and death. Estimates show that health and medical care contribute to life expectancy over several years. Moreover, they contribute to improving people’s functional ability and quality of life. However, scientific knowledge and technical abilities are not only requirements of the medical field, but also an understanding of the human nature. As the patient is a human being with own worries and hopes, not just a group of symptoms. Therefore, an intimate patient-physician relationship is stated at true importance in medical practice. It is the medium through which data is gathered from the patient. A decent relation is necessary to provide a successful medical diagnosis and treatment.

Purpose of this report is to demonstrate physician-patient relationship with certain required aspects. The paper includes explanation of the concept and brief concision of its chronological pattern. In addition, it interprets today’s several physician-patient association types based on relative power. Moreover, unveils the concepts of illness behavior and medical jargon which interfere with the relationship, unfolding the terms and discussing their impact on the relationship. Alongside, clinical parts are included in between the whole paper.

DOCTOR-PATIENT RELATIONSHIP

A constant encounter between a patient and a healer exists in all countries at all times which is named doctor-patient relationship. The relationship among doctor and patient is a moving and meaningful experience that can be defined as a mutual relationship where one person i.e. the patient, knowingly seeks the help of another i.e. the doctor, who in return knowingly grants him as a patient and provides assistance. Basically, doctor-patient interaction reflects a kind of guardianship or trustee in which the patient’s autonomy and confidentiality is preserved by the physician, simultaneously under the oath (Fallon et al. 2015). A physician must never forget that patients are not just a group of symptoms or “cases”, but helpless human seeking for relief, help, and trust. A successful consultation with a trusted doctor will have beneficial effects irrespective of any other therapy given. In addition, it is the base of an accurate diagnosis, just as effective treatment.

The essence of doctor patient relationship has been examined in various clinical and culturally responsible settings such as breast cancer; individuals living with HIV/AIDS; and people with chronic hepatitis B virus infections; to gain insight from clinicians into the patient’s expectations throughout their therapy. Also, particularly in the case of chronic lifestyle related conditions, many people still favor a long term relationship with their relating physician, because the physician is well concerned of the whole background and record, and the patient gets fully adapted to the relaxing environment.

A number of interesting initiatives have been formulated worldwide to improve doctor-patient relationship, include the utilization of placebo; the advancement of tele-health video consultations; particularly for patient with chronic diseases, requiring substantial self-care at home. Even additional steps are suggested such as physician’s participation in funding programs. It was also proposed that the doctor-patient relationship be applied to a new form of partnership, where many doctors treat a certain patient as a team.

EVOLUTION THROUGH TIME

Throughout the course of history, the domain of doctor-patient relationship has been evolving alongside social scenario, society’s intellectual capacity, and the particular time’s ailments. The chronological overview of the interaction between doctor and patient includes five time frames of Ancient Egyptian, Greek Civilization, Medieval Europe, revolution of Europe and from 1700 onwards. It was these different time frames that resulted in the construction of various models of doctor-patient relationships at the time, and the various types we know of the present time.

Models of Doctor-Patient Relationship

1. Szasz T and Hollender M (Szasz 1956) proposed 3 basic models: a.Active-Passive model b.Guidance-Cooperation model c.Mutual participation model
2. On the contrary, Emanuel gave 4 models: a. Paternalistic model b. Informative model c. Interpretive model d. Mutual participation

Looking at the basics, these two models could be unified into a single model, which is close to the present time’s illustration, but it is beyond the scope of this paper so only the latest update of doctor-patient relationship is elucidated.

TYPES OF DOCTOR-PATIENT RELATIONSHIP

Various types of doctor-patient relationship arise from the contrast in doctor and patient relative power and control. In reality, such various models may not necessarily exist in pure form, but most consultations nevertheless tend towards a one kind.

1) Paternalistic Relationship

“Guidance-cooperation” or paternalistic relationship , with high doctor control and low patient control, where the doctor predominates and functions as a ‘parent’ figure who determines what he or she considers to be in best interest of the patient ’infant’ and the expression actually originates from Latin term of ‘father’. Such type of relationship has been identified historically in medical consultations. Nevertheless, health consultations at the present time are generally distinguished by greater supervision of the patient and mutual-based interactions.

Patients in paternalistic relationship might gain great comfort at certain stages of the illness, for being able to depend on the doctor in these lines and being soothed of the stressful concern and decision making. Furthermore, it is indeed absolutely justified in the serious emergency framework, as either the timeframe taken to acquire informed consent or involve the patient in decision-making would obviously endanger the safety of the individual. There is additional argument that this paternalistic model is not an interaction since the individual operating on is incapable dynamically participate, an appropriate answer would be that the person is considered ‘powerless’ seeking the doctors special expertise as justified in emergency cases.

2) Mutuality Relationship

A relationship of mutuality is categorized by the active patient association as more progressed, equivalent partners in the consultation and has been depicted as a ‘meeting between experts’, in which the two parties take an interest as a joint venture and collaborate in an exchange of thoughts, ideas and sharing of belief framework. The doctor brings his or her clinical abilities and knowledge to the consultation in terms of diagnostic techniques, information of the causes of malady, prognosis, and preventive strategies, and patients bring their own skill in terms of their encounters and clarification of their illness, and information of their specific social circumstances, perspectives to risk, values and inclinations. Chronic diseases such as diabetes, heart disease, cystic fibrosis, dementia, Parkinson disease reveal the effectiveness of this relationship, as these need lengthy regulations and interpretive, comprehensive interactions.

3) Consumerist Relationship

A consumerist relationship characterizes a situation in which power correlations are switched, the patient acts the active role and the doctor adopts a genuinely passive role, follows the patients’ demands for a subsequent opinion, referral to emergency department, a sick note, and so on. This type has been defined since the boosting of upper class, wealthy patients from the revolution of industry on.

4) Default Relationship

A default relationship can occur if patients keep on adopting a passive role even if the doctor lessens a portion of his or her control, thus lacking adequate and sufficient direction for the consultation. This may emerge if patients are not aware of alternatives to a passive role for the patient or are reluctant to pursue an increasingly collaborative relationship.

Distinct types of relationships, and primarily those marked by paternalism and mutuality, can be considered ideal for specific situations and stages of ailment. For instance, it is commonly necessary for the doctor to be authoritative in emergency cases, while in other circumstances patients should be more actively engaged with their own treatment choices.

MODERN PATIENT-CENTERED MEDICINE

A massive debate has emerged over the last decades which asserted a patient-centered approach to healthcare. Patient-centered medicine is the latest addition to the physician patient interaction, as a fresh concept of medical system in the 21st century. Doctors in this model, each with own skill and strategy collection construct a conceptual framework wherein the patient contributes as a companion while making choices about his or her own care.

Being a Muslim is actually one of the best gifts and nikmah that a person got from his Creator. As a Muslim physician who are practicing Islamic basis in the daily life, we are basically practicing the same practice and share the same knowledge with the other doctor or physician in this field. The only thing that makes us differ is our religion and faith. This one thing is the most valuable criteria of a Muslim doctor that brings us to become closer to Allah SWT. The basis of Islam is to believe that there is no God but Allah, and Muhammad (PBUH) is the messenger of Allah. The life of a human being on earth is just a preparation or examination for the eternal life after death. The good or bad consequence of eternal life depends on how much a Muslim believes in and obey Allah. The Qur’an says that saving a life is like saving all of humanity. Medical practice is considered as a sacred duty in Islam, and the physician is rewarded by Allah to have this sacred job. Islamic scholars have agreed that the study and practice of medicine is an obligation that falls upon Muslims to have sufficient numbers of followers to practice, that’s we call them Fard Kifayah. Among a doctor and patient, both can be Muslim, or either can be Muslim. The doctor-patient relationship is an intricate concept in which patients voluntarily approach a doctor and become part of a contract by which they tend to abide by doctor’s instructions.

A good Muslim doctor should be able to make their carrier as a way to gain good deeds. By applying Islamic values in treating the patients they actually are helping the patients to relief the pain and at the same time brings them closer to Allah by showing the good values of a Muslim. Being able to take care of the patients and do what is medically best for them are the objectives of being a physician, but being able to open the heart of the patients to see the beautiful of Islam is more sacred and loved by Allah, and that’s the purpose of a person being a good Muslim. Faith is the first pillar of Islam and as we understand belief in Allah (SWT) and his Prophet (PBUH) are fundamentals of the Islamic faith. All of us who declare ourselves as Muslims vouch and declare this faith. How is this applicable to a physician? Physicians must realize that irrespective of knowledge and expertise the final common pathway that determines the success or failure of any modality of treatment is not scientific logic or deduction but with the will of Allah (SWT). If one can accept this fact, in spite of being a physician, it augurs towards reiteration of Faith. With this comes the realization of the limit of one’s own resources. When we prescribe a medication or perform surgery we attribute the success or failure to our expertise or lack of it, when in essence it is the result of divine intervention. If any physician has doubts about this statement, perhaps they can give an explanation for the cases in which he expects to see a particular result and an exact opposite result ensues.

To help understand the role of a Muslim doctor, let us have a look at the texts in the Quran and Hadith relating to the subject. Allah says in the Quran about moral disease and cure in several surahs (chapters): ‘O mankind! There hath come to you a direction from you Lord and a healing for the (disease) in your hearts, – and for those who believe, a guidance and a mercy’ (Quran 10:57).

The ‘direction’ in this verse is to the Quran itself: it is considered a sure cure to any moral or psychological disease that may afflict true believers. ‘It (Quran) is a guide and a healing to those who believe’ (Quran 41:44).

There is no doubt that genuine belief in God can be the best cure for most of our psychological disturbances. It brings peace to our hearts as we beckon to our Creator and resign in Him. ‘But He guideth to Himself those who turn to Him in patience. Those who believe, and whose hearts find peace and satisfaction in the remembrance of God: for without doubt in the remembrance of God do hearts find satisfaction and peace’ (Quran 13: 27-28).

The Hadith, as usual, gives us striking revealing facts concerning disease and cure. Our Prophet informed us that the general rule is that there is a cure to every disease, whether we are aware of it or not. We know at present that our cells produce antibodies to fend against the agents of disease: the viruses and virulent bacteria. Homeopathic philosophy is based on helping the body to overcome the disease by giving the sick very small doses of drugs that would stimulate the same symptoms in a healthy person if given in a large doses. In simple words, the well-established Hadith narrated on the authority of Ibn Maso’ud ‘God has not inflicted a disease without prescribing a cure to it, known to whoever knows it, and unknown to whoever does not know it.’ (cited by Ahmad. cf Nayl-al-Awtar, V.9, p.89) is a confirmation of the natural law of auto-resistance or self-defense. It indicates as well the necessity for discovering cures to our diseases. He said – on the authority us Usama Ibn Shuraik – when a Bedouin asked him whether he should seek treatment: ‘Yes, servants of God seek treatment; God has not set a disease without setting a cure to it, known to whoever knows it and unknown to whoever does not know it ‘ (cited by Ibn Mujah, Tirmidhi and Abu-Dawood). And again, on the authority of Abu-Huraira, the Prophet said, ‘God has not sent any disease without sending a cure to it’ (cited by Ahmad, Bukhari and Ibn Majah).

From the Quranic verses and hadith that were narrated by Prophet Muhammad, we can see the power of Allah’s creation and understand the basis of relaying on Allah’s will. Most importantly, when the Lord blesses a person with being a physician, He gives them the opportunity to do His work on heart, help relieve the suffering of His people. Each and every day, physicians are given the honor and privilege to help people feel better, breathe better, feel less pain, and through the Lord’s healing power, treat and even cure disease. If smiling to one another, as the Prophet Muhammad (PBUH) once said, is a charity, then we can understand that by helping someone’s asthma attack or helping someone overcome a cancer diagnosis or relieving the pain and suffering of someone afflicted with a terrible infection is actually a bigger charity to the Ummah. For me, as a Muslim, being a doctor goes hand in hand with my mission in life which is to help the Ummah to be better.

Abstract

Today’s Indian peoples are smart. So they required less paper work and perfect solution of problem. So here consider medical industry. At traditional way Doctor and Patient communicate directly with prescription on paper but when patient going to Medical shop so pharmacists not aware about Doctor Handwriting as well as Medicine. Our research project connects three different peoples like Doctor, Patient and Medical Shops. Digital Health is being launched because a need for a destination that is beneficial for Doctors, Medicals and Patients. The aim of Research project is to developing a Digital Medical prescription for patient, and also maintains their medical history at Doctor and also Medical Shop. It is also useful for generating bill of given prescription in specific medical shops. Doctor and Patient Connect with Web Application and Android Application. This system also notifies Doctor and Patient through apps. Doctor and Patient maintain their Medical History. the main objectives of the research paper is that less paper work and avoid bad handwriting, easily understand patient and medical shop requirement.

Introduction

Digital Health is being launched because a need for a destination that is beneficial for both Doctors, Medicals and Patients. This project aims is to developing a Digital Medical prescription for patient, and also maintain their medical history. It is also useful for generating bill of given prescription in a specific medical shops. When User Registers, System Generates One UID for User. When User go to hospital they have to give their UID to Doctor, Doctor will create prescription on web application, Prescription automatically upload on system database, Now user can see their prescription on their android phone. When user go to Medical shop for medicine which is given in prescription, they have to submit their UID to Medical, Medical will create bill. Digital Prescription System is a portal that establishes a network between the user, doctor and the medical. This System Produce Digital Data which is easy to Record and Not have chance to misplace or lost. The user can view their prescription in android application.

LIMITATIONS OF PRESENT SYSTEM

• Time Consuming: As the records are to be manually maintained it consumes a lot of time
• Paper Work: Paper work is involved as the records are maintained in the files and registers
• Fear of Lost Prescription: As files are used we always have fear to lost, Once lost we have to again go to hospital and pay fees.
• Less Reliable: Use of papers for storing valuable data information is not at all reliable.
• Accuracy: As the system is in manual form, there are lot of chances of human errors.

Difficulty in accessing Data and making bills:

The Prescription in paper form, patient has to carry this prescription to medical shop, a chemist has to read that prescription and make bill by using some etc. application which is time consuming.

Difficulty in keeping new record: It is difficult to maintain and store all prescriptions and entire medical history of each patient.

PROPOSED SYSTEM

To solve these problems they required a computerized system to handle all the works. They required a web based application that will provide a working environment that will be flexible and will provide ease of work and will reduce the time for report generation and other paper works.

Aims and Objective

The Project Focuses on Digital Database for Medicine and medical history of patient .The main Objectives is to reduce the Hand writing Problem between Doctor, Patient and Pharma Distributor. Pharmacist can easily understand the doctor’s prescription and appropriate medicine will be provided to patient .It is also useful for generating bill of given prescription in a specific medical shops, and generating bill of Doctor. Patient can book Doctors appointments. It is also providing reminder facility for intake of medicines.

ADVANTAGE OF PROPOSED SYSTEM

Benefits to patients

• The benefit most evident to patients is increased convenience
• Prescription orders on SMART App or electronically to pharmacies make it possible for patients to arrive at the pharmacy and have their prescription orders waiting for them.
• Refill orders will also be streamlined and processed faster.
• Book Appointment which will save time, instead of waiting in Que.

Benefits to pharmacies

• Prescriptions that are transmitted on App to medical & Patient are more legible and can improve work flow
• Reduce work time.
• Only have to submit values of medicines bill will automatically create.

Secured

• Maintain confidentiality and avoid loss of prescription.
• No data loss even in situation of power and failure internet.

User Convenience:

• Users can view prescription as per their convenience.
• Users can view prescription immediately after the prescription created.

User can only view prescription cannot create or destroy any prescription

Go Green:

You will be saving a substantial amount of paper by using online mode of prescription. Prevent the use of paper and save the planet

Conclusion

Smart doctor & smart patient is the next step of digital India, it work with without any paper work so Go green follow to make India Clean. After successfully installing App on Doctor mobile and patient Mobile, patient also book order from at home, solved the problem of doctor handwriting to the medical shops.

References

1. https://videotron.tmtx.ca/en/topic/lg_g5/using_smart_doctor.html#step=1
2. https://www.apkmirror.com/apk/lgelectronics/smart-doctor/smart-doctor-5-30-11-release/smart-doctor-5-30-11-android-apk-download/
3. https://ejournal.manipal.edu/mjms/docs/Vol1_Issue1/full/6-Doctors%20Handwriting.pdf
4. https://www.researchgate.net/publication/14217223_The_truth_about_doctors%27_handwriting_A_prospective_study
5. Deepti Ameta, Kalpana Mudaliar and Palak Patel “Medication Reminder And Healthcare – An Android Application”, International Journal of Managing Public Sector Information and Communication Technologies (IJMPICT) Vol. 6, June 2015, pp. 39-48

The physician William Osler once said, “the good physician treats the disease; the great physician treats the patient who has the disease.” The patient-doctor relationship plays an important role in the treatment process. Each patient represents a story that includes their disease, their social situation and their beliefs, which need to be considered during check-ups and diagnosis. A good relationship is not only important for social factors, it is also essential for their treatment process. For instance, a good patient-doctor relationship can influence the frequency of doctor visits and also the patient’s self-care habits. There are many factors that make up a good relationship such as, communication, trust and confidentiality. Nevertheless, there are also some factors that affect the patient-doctor relationship, Like modern technology, and sociodemographic characters of doctors.

Patient-doctor relationship plays a significant role in the medical treatment process, because it helps enhancing the accuracy of the diagnosis and increasing the patient’s knowledge about the disease all come with good relationship between the doctor and the patient. Despite that, some people make valid claims that having a solid patient-doctor relationship has no effect on a patient’s overall health. Some also think that there is no need to the relationship in the doctor’s office since the patient’s goal is to get treated without caring about personal attachments. Of course, a good patient-doctor relationship is not as important as the doctor’s level of knowledge, or the quality of health care. Katherine Hall, a general practitioner, argues that relationships between doctors and their former patients are almost always unethical. One of the reasons for this, she says, is the persistence of the unequal power distribution in the original doctor-patient relationship, which has implications for the patient’s autonomy and ability to consent (188). However, there is overwhelming evidence that weak relationships between patients and doctors result in lower standards of care, which negatively affects the overall experience of patients and staff in the medical system. Mariusz Jaworski, a psychologist at the Medical University of Warsaw, suggests that the level of support from doctors has a direct impact on the patients’ attitude towards the disease, including attitudes towards the treatment and medical personnel (11). Good patient-doctor relationships should therefore be present in every doctor’s office to ensure the best quality of treatment. Otherwise, a weak relationship effects the accuracy of information the patient provides the doctor with which leads to a fragile healthcare system.

Communication is an important part of any relationship, especially the patient-doctor relationship because it leads to the decision-making process of the treatment. The diagnosing process has improved because of a better understanding of the patient’s problem. Akihito Hagihara, a professor at Kyushu University School of Medicine, suggests that the “doctor’s explanation transmits information, which leads to decisions on treatment, and establishes trust and supportiveness” (31). Thus, good communication gives the patient a full image of the diagnosis likewise the treatment process which helps the patient to make a fully informed consent about the treatment. However, the lack of communication skills results in poor understanding of the diagnosis because “patients often either do not understand or misunderstand their doctor’s explanations” (Hagihara 39). For example, problems may develop related to drugs prescribed for the treatment for elderly patients, who may not fully understand how to take the medication prescribed or what are the side effects of it. Moreover, the effective doctor-patient communication is an essential part of building a therapeutic doctor-patient relationship, which leads to high-quality healthcare. In brief, the practice of good communication skills benefits both patients and doctors because it provides meaningful and trustworthy relationship, which leads to an improved healthcare system.

Even though, communication is so important for the patient-doctor relationship, it is almost impossible to have beneficial communication without trust. Thus, trust is a defining element in the patient-doctor relationship. In medicine, trust results from a number of interactions between patients and doctors which results in assured reliance on the character, ability, and knowledge of the doctor. For doctors to fulfill their commitment to trust, they must meet the expectations of their patients by providing the best treatment possible and by protecting their privacy under any costs. Dr. Carlos A. Pellegrini, Chief Medical Officer for UW Medicine, says that intrinsic trust in the physician is expressed in the discretionary latitude that patients give their physicians to do what is necessary to, hopefully, benefit their well-being (21). Pellegrini suggests that the final treatment goal will not be successfully achieved without the patient’s trust in their doctors.

Trust was never a major problem between patients and doctors except for the past few decades where technology entered the healthcare system (Evans 43). Since then, Patients have expressed their concerns of having their personal information and medical records exposed to technology which might not be secured enough. In 2015, the largest healthcare-related date theft took place. Hackers stole records for almost 80 million patients (“the impact of technology” 15). Recording to the article the hacking impacted the patient’s trust in the health care system even more. On the side of social networking technology, which includes the personal interaction through social media and direct emails, studies show that patient actually lost trust in some doctors that they developed a good trusting relationship with over time due to political or critical posts on their Facebook personal page. Technology in these two cases has affected the relationship and is considered as one of the trust issues in the 21st century’s healthcare system. Moreover, a group of researchers from Kyushu University’s Graduate School of Medicine, admit the negative sides of technology and how it impacts the relationship indirectly. They suggest that:

Although the level of trust in the one-to-one relationship between doctor and patient seems to be important for the use of new communication technology, the reverse also seems to apply: Communicating electronically affects the aspect of trust. This is due to the technology’s creating the potential for changes in social practices. (Andreassen et al. 155)

The interpretation is that a trusting relationship between doctors and patients appears fundamental when the patients construe the new technology as an issue of doctor-patient communication. Nevertheless, some people do think that technology has impacted the health care system in a good way through providing a platform for patients to have access to doctors form different fields all over the world. Technology can help health care systems to deliver accurately and effectively massages through social media platforms. For example, they can send public alerts about contagious diseases, vaccinations reminders and general health advices. Brenda Wiederhold, President of the Virtual Reality Medical Center, thinks that digital medicine stands at the forefront of healthcare evaluation by combining advanced biometric monitoring with more meaningful patient interaction (21). Technology helps in providing the best healthcare possible to patients. Over time, the need of technology in healthcare grows. Technology might be followed by some complications, but it indeed helps in providing the best healthcare experience to patients. One of the best aspects that technology helps improving in medicine is Telemedicine which has been able to compensate by offering better care, greater access to specialists and reducing costs, by eliminating unnecessary emergency room visits or by cutting down patient readmissions. Melissa Powell, COO of The Allure Group, says that “if telemedicine hasn’t revolutionized healthcare, it has certainly revamped it (46). Telemedicine has extended provider’s reach to areas where care might not be readily available.

As indicated, communication and trust are very important elements to the patient-doctor relationship. Yet, they mean nothing without solid confidentiality rules between both parties. this is why there is a rule known as (doctor-patient privilege), which being used broadly to refer to the concept that communication between patients and their doctors is protected from disclosure to third parties and can’t be used against the patient in court or other legal proceedings (“physician-patient privilege” 25). For instance, if the doctor asks about how the patient got the bullet in their shoulder, the patient can be fully comfortable telling the doctor without being afraid of the doctor providing the legal authority with this information. The reason behind the rule is to ensure that patients feel comfortable sharing openly and honestly with their doctors. If the patient feels afraid of sharing the entire truth it might affects the diagnose, which impacts the treatment process in a negative way. Nonetheless, in recent years, many courts have held that doctors also owe duties to protect non-patient who may be harmed by patients. (“doctor-patient confidentiality” 132). For example, courts ask doctors to worn others or the police if the patient is potentially violent or has expressed harmful thoughts. Yet, in many cases a written consent is needed before a doctor can release any information about the patient.

Communication, trust and confidentiality are skills that doctors, and patient might be able to gain to improve their relationship, but what if the patient-doctor relationship is being affected by factors the healthcare system can not control like personal characteristic, including their race, ethnicity and gender or even sexual orientation. This raises an important question which is, does sociodemographic characteristics of doctors affect their relationship with their patients? It is surely does. According to a group of researchers from John Hopkins University, who suggest that doctors are more likely to be judged by their personal characteristic, including their race, ethnicity and gender or even sexual orientation (Cooper 143). These factors have proven to be important for the level of comfort the patients have toward their doctors. However, the biggest struggle that face doctors is gender. The john Hopkins’s Hospital study shows that even though male and female doctors don’t differ in how much biomedical information they have, patients were more likely to choose male doctors over female ones. Moreover, despite that female doctors spend more time with patients and more frequently using a patient-centred approach, women doctors are not evaluated as highly by patients as their male colleagues (Cooper 1870). Another study performed by Haley Nolen et al, at Yale University, shows that effective patient-doctor relationship communication, potentially affected by pre-existing patient preference and gender bias (84). Which highlight the struggle that face females in the medical work environment. Dr. William Argus, Ophthalmologist in Fort Wayne, says in his TEDx talk that women today don’t have to give up their femininity to be successful doctors like how it was a decade ago (“Medical Sexism” 00:02:04 – 00:02:18). This indicates that female doctors had to look and feel like male doctors to be as “successful” as them along with being trust worthy

How good can the patient-doctor relationship be? Which limits should be considered, and which boundaries should be present? Professional boundaries are an essential part of the doctor-patient relationship, but they are sometimes crossed by both doctors and patients. Marika Davies, medicolegal advisor, claims that a series of crossing boundaries may result in the development of sexual relationships between doctors and their patients (38). These boundary crossings may be as simple as a hug after bereavement. Even though, the hug might be beneficial to a patient, Davies considers it a boundary violation. Davies also considers a simple gift or card from a patient as an inappropriate expression of gratefulness. She also thinks that the doctor needs to take a direct action toward the gift, like politely declining the item. Davies describes the foundation of doctor-patient partnership as “patients should be able to trust that their doctor will behave professionally towards them during consolations and not see them by any meaning as potential sexual partner” (20). This indicates that patient-doctor relationship may in some cases becomes a personal and even a sexual relationship. This is the main reason of why boundaries should be present always in the doctor’s office. Pursuing a relationship in any way more than a professional one is an abuse of the doctor’s position and misuse of their power. It is not only morally impermissible, it is also legally wrong. To illustrate, Section 2256 in the state of California indicates that “the commission of any act of sexual abuse, misconduct, or relations with a patient … constitutes unprofessional conduct and grounds for disciplinary action” (“Sexual Relationships” 65). Moreover, it provides that penalty for sexual exploitation requires revocation of the doctor’s license. Hence, the duties of a doctor include terminating the patient-doctor relationship before initiating a dating, romantic, or sexual relationship with the patient.

In conclusion, having a good patient-doctor relationship that includes communication, trust and empathy leads to adherence to treatment. When better adherence to treatment is combined with patient satisfaction with care, better quality of healthcare is the expected result. Even though, some might argue that the relationship between patients and doctors will affect the relationship in negative way. It is a fact that the treatment process will be hard to follow without some personal strengths with the doctor.

Introduction

In their article, “Culture, Language, and the Doctor-Patient Relationship”, published in the May 2002 issue of Family Medicine and Community Health Publication and Presentation, Warren J. Ferguson and Lucy M. Candib present several reasons on how to determine the differences between physicians and patients in race, ethnicity, and language influence the quality of the physician-patient relationship. They cite the evidence for ethnic and racial disparities in the quality of doctor-patient communication and the doctor-patient relationship that can improve the outcome measures as the main causes of the influence of cultural difference between physician and patients on communication effectiveness. Based on this evidence, Ferguson and

Candib concludes that interviewing physicians or doctors’ perceptions of and attitudes towards patients’ personal and psychosocial characteristics, behavior, and likely role demands. They studied whether these perceptions or attitudes were affected by patient race or socioeconomic status as independent variables.

Summary

Background

For the past decades, differences in health outcomes especially in ethnic minority and racial group have become clear evident. These differences have contributed especially in building relationship within the patient and the physician. Studies on doctor-patient communication have provided evidence that effective communication with each other can improve the outcome measures. While the study on patient-physician relationship have shown that the cultural differences has no relationship on building effective communication. Ultimately, this study document and evaluates the culture, language, and the doctor-patient relationship involved in medical decision making. The research problem is that there are patients who are Limited-English speaking and on strategies to overcome the language barrier by using bilingual physician or professional interpreters. The writing on the doctor-patient relationship has not tended to the impact of social contrast between doctors and patients on communication adequacy. The quality of the physician-patient relationship requires the capacity to communicate with the people who have restricted English capability. Wellbeing status, get to obstructions, and care fulfillment appeared that dialect of meet was a more critical variable than ethnicity.

Objectives

The objective of the study was to find a literature that provides evidence regarding the patient-physician in terms of race, ethnicity, and language that influence the relationship between

the patient and the physician. Based on the study, the research goal or the review’s objective was to decide how contrasts between doctors and patients in race, ethnicity, and dialect impact the quality of the physician-patient relationship or communication strategy. The objective was to discover the evidence around the contrasts in dialect, ethnicity, and race between doctors and patients influence the quality of their relationship and communication and to decide the result measures to substantiate an impact of the relationship between the specialist and client.

Conjointly to move forward making a contrast in wellbeing care and in result of care. The researchers’ goal was to answer the following questions in their study that were also related to the factors of different cultures.

Methods

Literature review was used as a method to find an evidence regarding the physician- patient communication and relationship. To easily find a related literature, researchers used a key words that are related to the topic and the researchers only limited the related articles from year 1966-2000. University of Massachusetts were used as a reference on database development.

Also, researchers included articles reporting investigator- initiated research and secondary data analyses with quantitative method however they excluded the opinion bases articles. Based from the study, the researchers used “MEDLINE” in order to perform a literature review. Their searchers were constrained to articles distributed in English. The analysts looked a database created at the College of Massachusetts that incorporates distributed articles on get to and wellbeing result obstructions. The articles gave a spoken or written account of investigator- initiated inquire about and secondary data analyses with quantitative methods that controlled for covariates. The researches did not use qualitative research methodology as their particular form of procedure for accomplishing or approaching the study.

Critical Analysis

The researchers successfully provide an evidence on the relationship between the physician and the patients. First of all, the study is effective since it speaks to the target audience, it shows that communication skills facilitate participatory in decision making with patients and the provision of culturally competent care. the study promotes having distinctive attributes of the admonition that “majority” physicians need to be more effective in developing relationships and their communication with ethnic and racial minority patients. The article shows minority patients, particularly those not capable in English, get adequate data, and be energized to take an interest in therapeutic choice making. In the end of the article, they checked on report incongruities with ethnically or language-discordant physician-patient communication. Secondly, the researchers proved the language-concordant relationship in which minority patients are more likely to choose minority physician for them to easily understand the information. In this case, the researchers provided an evidence in relation with their goal that is to determine the patient

and the physician’s relationship. Lastly, the researchers were able to provide evidences that supports to their study, findings on related studies or articles that were definitely fit to answers their questions. The tables and explanations shown in their study were acceptable because they started from the factors that means what could be the barriers or lacking to the relationship between the physician and patient that was why they into strategies or possible solution for the better communication that will build better relationship too. Also, the information has clarity because they focused only to ethnicity, race, and language that will easy to lead to the goal of their study.

Benefits and Drawbacks

There are few pros and cons on the study. First of all, using literature review as a method was efficient. Aside from giving answers to the questions needed for the study, researchers did not need to find a place and participants to answer their questions. However, this kind of method has also a disadvantage in which researchers only limits their sources in literature. Sometimes, face to face interview with the participants could help and gibe the researchers more detailed answers. The researches limit their review only to ethnicity, race, and language. In addition, the significant number of studies conducted in emergency medicine settings and involving beginners that may not generalized to a larger population of patients in relationships with professionals.

Secondly, the discussion of Culture, Language, and the Doctor-Patient Relationship have not specified its extent of the area or subject matter that the topic deals with or their scope of this review and their participants and measures were also not included because they use secondary article for the reason that it translates and analyzes essential sources and also in order to archive that relates or examines data initially displayed. Additionally, they could not find studies using reliable qualitative methods from peer-reviewed journals. As a result of the broad scope of work published in books, an accurate source of medical anthropology, was not reviewed or analyzed. Thirdly, the study outcomes have relied on self-reported patient satisfaction, which have been shown to be less reliable across language differences. However, the physicians and the patients who have demonstrated significant achievement in the study of the doctor-patient relationship and communication must take up the consequence of diversifying their populations of study.

Finally, validity and reliability testing of the instrument were not reported or formally announced. This actively illustrate that both physicians and patients were most satisfied with professional interpreters. Patients, but not physicians, were satisfied with use of a family members or with use of a bilingual physician colleague.

Recommendations

To improve this study, a few modifications are required. Based on their discoveries of their writing audit, the researchers only gave 20-minute training have been demonstrated for the patients to be more assertive when obtaining medical care which is not enough due to the fact that there are a lot of patients who are still adjusting to the issue of encountering in racially, ethnically, and linguistically discordant physician-patient relationships. The researches was not fully prepared to do or deal with conducting the study due to the fact that they are still looking for recommended strategies for improving the relationship between the doctor and the patient. They stated that the literature on the doctor-patient relationship has not addressed the influence of cultural difference between physicians and patients on communication effectiveness. In choosing method in the study, it is also better to use measurement tools like surveys, interviews, or observations because in conducting own research would give convenience basis information rather than literature review, the researchers will only depend on the information in the articles that they found. There are more significant edits need to be made before the article can be accepted. The researchers need to be more emphasize on training physicians or doctors to deal with concordant experiences for underrepresented minority patients.

Conclusion

In conclusion, this study successfully achieved its goal to determine how differences between physicians and patients in race, ethnicity and language influence the quality of the physician-patient relationship. The study also provided a clear literature that served as an evidence for the factors. While the study provided a logical and convincing beginning to support the “Doctor-Patient Relationship”, using another method can also be beneficial and provide an effective support for further research. The article supports the conclusion that professional interpreters are more likely to bridge the gaps in access experienced by non-English-speaking patients, although at least one study demonstrated persistently poor communication skills on the part of the physicians using such interpreters.

Introduction:

A career in medicine asks a lot of any person; individuals must be well-rounded and academically capable with a clear work-life balance. From day one of medical school, I believe culturing resilience and reflection is vital. The NHS (no date, para. 1) defines resilience as ‘our bounce-back ability in the face of difficulty or challenges. Resilience is the ability to adapt and grow following adversity’. This supports students with the pressures of study, their transition into a doctor, and their career development thereafter. ‘Reflection is thinking about what you’ve done, what you did well, and what you could do better next time’ (GMC, 2016, p.12). An imperative part of this is using the lessons learned from a previous experience to influence how a future action is carried out (Sandars, 2009). An error in either skill can have major implications on the individual or in extreme cases, the patient.

Resilience:

Resilience is often thought of as an intrinsic quality (NHS, no date). Most students will have encountered it through their academic background and personal hardships. It will be further developed as the very nature of the university itself shifts a student’s geographical, social, and academic environment encouraging uncertainty and self-doubt. Eley et al. (2013, para 6) importantly highlighted that ‘resilience is a dynamic process’ evolving as an individual accumulates experience and overcomes failure.

Medical students will be exposed to many pressures as part of their study demanding the necessary resilience to adapt (Kiziela et al, 2019). Medical school alters an individual’s approach to learning and how they understand concepts by applying their existing knowledge to unfamiliar contexts. I have found that resilience contributes to my perseverance with the intense workload and taking responsibility for my learning. Consequently, the effort a student has made towards developing their resilience will be reflected in their exam results.

Thompson et al. (2016) demonstrated that medical students will have greater levels of mental stress, thus promoting the importance of emotional resilience. Distress may stem from a poor work-life balance through prioritization of study over social activities, or vice versa. This can lead to burnout which ‘includes the concepts of overwhelming emotional exhaustion, cynicism due to academic workload, and feelings of inefficacy due to excessive academic demand’ (Yu and Chae, 2020, para. 2). Speaking out and seeking help with psychological health is often seen as a weakness in the healthcare setting with a stigma around it (Thompson et al., 2016). From a student’s perspective, if self-management of a problem fails, the possibility of being a ‘good doctor’ seems impossible. Emotional resilience can be utilized to find an equilibrium, maximize a student’s happiness, and increase their capacity to move forward after a period of difficulty.

For medical students transitioning to doctors, a clinical setting can be overwhelming. Oliver (2017, para. 2) describes that ‘practicing medicine has never been straightforward Doctors carry responsibility, risk, uncertainty, and self-doubt’. A GP on my placement educated me on the importance of resilience, as factors like long hours, excessive workload, poor work-life balance, compassion burnout, and managerial and regulatory changes, are increasing the demand of the job (Oliver, 2017, para. 5).

Doctor-patient interactions require emotional resilience. A patient needs a doctor to make difficult decisions, regardless of the pressures upon them from their personal and work life (Epstein and Krasner, 2013). My cardiology work experience taught me that resilience is required to remain emotionally detached and objective when responding to a patient’s needs. This is key when delivering distressing news or dealing with agitated patients. Moreover, as every patient is unique, they will have different ideas, concerns, and expectations for their care. Resilience can help overcome the challenge of tailoring the information available to each patient and persevering when it’s not effective.

As such, the mismanagement of resilience in doctors can affect their personal performance and ultimately patient care. Similar to medical students, a deficit or absence of resilience can cause burnout (Eley et al, 2013). Doctors often disregard the first indicators of mental distress including tiredness, frustration, and feeling out of their depth. Many hold on to the idea that the situation will self-resolve and their resilience will carry them through (Quill and Williamson, 1990, cited in Epstein and Krasner, 2013). Unfortunately, this often isn’t the case as the most extreme cases of burnout, decrease resilience and cause emotional deterioration (Yu and Chae, 2020). During my placement, it was clear that sharing experiences with others helps unburden an individual and ensures the continual development of a resilient mindset.

Reflection:

Similarly to resilience, I have found that reflection is heavily emphasized at medical school. Despite the purpose of reflection differing between individuals, the general concept, as written by Sanders (2009, para.60), indicates that ‘the aim of reflection is to inform future actions so that they can be more purposive and deliberate’. A key aspect to consider is the consequences of an individual’s behavior. This could be towards peers in medical school or other healthcare professionals in the clinical setting (GMC, 2016).

In an academic environment, purposefully reflecting organizes a medical student’s previous learning, and once engaged, it’s simple to apply it to different scenarios and assimilate the new knowledge with the old (Harris et al., 2012 Schmidt et al., 1989, cited in Ribeiro et al., 2019). During my own studies, I have found that critically analyzing feedback, positive or negative, is imperative as it allowed for the identification of my strengths and weaknesses and re-evaluation of my learning techniques. By establishing reflection as a habit, Ribeiro et al. (2019, para. 4) explained that it ‘fostered medical students’ engagement in learning and increased learning outcomes’. Reflection can thus enhance performance and enjoyment in the course.

However, reflection might be a difficult task for medical students as discussing failure can cause painful emotions. Boud et al. (1985, cited in Sanders, 2009, para. 81) acknowledge that to overcome this, one must ‘recognize and release these emotions since they can block further reflection’. Without accepting the fundamental issue, an individual can withdraw from the process directly inhibiting their future progress. The absence of engagement in reflection could be an indicator that the student isn’t compatible with the healthcare sector.

Unsurprisingly, the power of reflection for doctors is huge and again can be triggered by challenging patient interactions. Watching a senior colleague diffuse a tense situation or a time a doctor themselves had to console an anxious family-member, can act as sources for reflection. A doctor should mirror the positive approaches and pinpoint why other interactions were unsuccessful. However, my work experience has taught me that reflection isn’t an excuse for dishonesty; transparency is vital. Making time to apologize and explain the consequences of an error to the patient is crucial whilst following the correct protocols to maintain the patient’s trust in the profession (GMC, no date).

Reflective techniques are seen throughout the health service, for example, evaluating the services provided by the healthcare facility and whether it meets the needs of the patients (GMC, no date). Reflection also plays a part in reviewing a doctor’s performance. The GMC states that the skill ‘plays an important part of the process of revalidation, which all registered doctors go through every five years to ensure that they can maintain their registration’ (GMC, no date). It’s been brought to my attention during my aforementioned placement that this process is paramount to avoid the degradation of standards impacting patients. Furthermore, group reflection is essential for multidisciplinary teams to review patient care. By discussing a patient’s history and current treatment, including what didn’t suit a patient, a future care plan can be created.

A lack of reflection in a doctor could potentially harm a patient. Repetition of reflective techniques needs to occur frequently, otherwise, individuals may find the task more challenging than necessary (Sandars, 2009). Mistakes are inevitable due to human error, nonetheless, through reflection the effects of them should be minimized. Patients require doctors who use the reflective process to identify possible mistakes, doctors who don’t rush into decisions, and those who have the confidence to ask for help (Epstein and Krasner, 2013). The quality of reflection thus impacts the level of care a patient receives.

Conclusion:

Overall, it’s clear that without resilience and reflection, huge limitations would be placed upon an individual’s academic and professional development. These skills require constant adaptation to different scenarios so it’s unlikely they will ever be perfect. Habitual engagement is essential for progression, drawing on previous experiences before, during, and after an event, as even ‘the anticipation of challenging situations also stimulates reflection’ (Mann, Gordon, and Macleod, 2009, para. 88). To avoid the absence or shortfall of these skills, I understand that a student and doctor needs to protect their mental health. Maintenance of a robust work-life balance is key, especially as ‘higher levels of resilience were associated with lower levels of psychological distress’ (Bacchi and Licinio, 2017, para. 4). Most importantly, reflection and resilience are both imperative to keep the patient at the forefront of a student’s and doctor’s mind.

Doctors, nurses, and other healthcare professionals are the providers of our communities. They use their knowledge, skills, and technology to heal our wounded and treat our ill. Even with so much education and experience gained from their hard work, there is still the problem of some of these professionals succumbing to alcohol and/or drug dependency. Most with these substance dependencies are in dire need of fighting this addiction in order to reduce the chances of a work-related incident happening to either their patients, co-workers, or themselves.

Substance Abuse with Healthcare Professionals as a Social Problem

Doctors and nurses have been labeled as holding the highest addiction rate when relating to substance abuse (Juergens, 2019). It has been statistically averaged that around 100,000 healthcare professionals across the country are suffering from substance abuse or addiction to narcotics (Juergens, 2019). Their addictions stem from the necessity to stay alert for long shift periods or to escape from the emotional hardships experienced and upsetting outcomes (Juergens, 2019). On a positive note, the doctors and nurses who have developed addictions to narcotics have a high turnover rate to recover from such addictions (Juergens, 2019).

U.S. government surveys calculated and combined from 2003-2007 and 2008-2012 prove that around 164,600 healthcare professionals, who have used narcotics each year, had increased to 168,000 (Santiago, 2017). This statistic does not necessarily state that all individuals surveyed were addicted to narcotics, but it does bring light to the start of said addictions. Due to easily accessible addictive narcotics in the workplace, healthcare professionals are able to obtain these drugs by means of self-prescription or theft (Santiago, 2017). Within the U.S., our society is so accepting of substance abuse that it is no surprise for healthcare professionals to succumb to this controversy (Santiago, 2017).

There is a link between alcohol abuse and drug abuse, and either addiction is likely to encourage the practices of the other. With alcohol-related addictions, around one-quarter of American workers admit to ingesting alcohol during the workday at least once annually as reported by the National Council on Alcoholism and Drug Dependence (NCADD) (“Treating a Healthcare,” 2019). With the portrayal of appearing highly educated and successful, medical professionals are not commonly viewed as the stereotypical alcoholic by tradition (“Treating a Healthcare,” 2019). Prior to surveys conducted between 2008 and 2012, around 4.5% of full-time workers in the healthcare industry, aged from 18 to 64, admitted to heavy drinking (“Treating a Healthcare,” 2019). 5.5% of this same group admitted to wrestling with a substance use disorder during the year national surveys were conducted (“Treating a Healthcare,” 2019).

Aside from the healthcare professionals admitting their faults with handling their addictions, it may be difficult to identify the signs of addiction when many professionals give off the capability of being a highly functional addict (Juergens, 2019). The “functional alcoholic” subtype resides within 20% of alcoholics that fit the combined categories of middle-aged with stable jobs, high-level education, and families, which is another commonality in the healthcare profession (“Treating a Healthcare,” 2019). The common signs listed share similar behavior qualities such as the addict continuously altering their movements and habits (Juergens, 2019). The normal behaviors non-addicts enact are inappropriately overused by addicts and draw more attention to themselves even if for a brief period of time it goes unnoticed by others (Juergens, 2019). Since the healthcare industry is fast-paced and stressful, attempts to emotionally distance oneself from events that are either distressing or painful highly encourage medical professionals to engage in substance abuse (“Treating a Healthcare,” 2019).

Powerful prescription medication is usually unproperly accounted for when administered, along with the combination of a healthcare professional’s extensive knowledge of the effects, substance abuse is commonly tempting to commence (Juergens, 2019). Those in emergency medicine, psychiatry, and anesthesia are the highest rated to involve themselves with substance abuse, but alcohol is also used to assist in coping with stress (“Treating a Healthcare,” 2019). Not all addicts in the healthcare profession are capable of becoming a “functional addict”, but the inevitability of becoming an addict nonetheless is possibly caused by a lack of knowledge to effectively cope with the stresses they obtain from daily exposure to on-the-spot decision-making and stressing events (Yagoda, 2016). Since the reliance on a substance becomes more tempting, a person will lose their ability to handle stress and will turn to their alcohol or illicit drug of choice in order to continue their daily tasks at work (Yagoda, 2016).

A number of colleges with higher education do tend to show a rise in alcoholic social events (Barkan, 2016). Normally the reasons college students indulge in numerous alcohol-related social gatherings are to lower levels of anxiety, develop social relations with other students, and encourage fun (Barkan, 2016). Healthcare professionals who have gone through many years of collegiate schooling may have indulged in such drinking early on in order to begin their coping phase when handling the stress, and it may have bled over to affect their coping skills as they attempt to mature in their professional field of study. About 10%, around 3.4 million, of young adults between ages 18 and 25 had, or developed, an alcohol disorder in 2017, while those over the age of 26 were surveyed around 10.6 million (Thomas, 2019). In relation to illegal drug use, those aged between 18 and 25 averaged around 2.5 million, and adults over the age of 26 were statistically around 4.3 million or 2% (Thomas, 2019). These age groups are the premises of students who are either practicing nursing or earning their doctorates. Battling these disorders may relapse following college graduation.

When alcohol is being measured, studies show that more than half of American adults were exposed to drinking problems or alcohol addiction within their family history in 2017 (Thomas, 2019). Also, in 2017, statistics revealed that illicit drugs make women more likely to develop a prescription painkiller dependency than men, mostly inspired by chronic pain and high-dosage prescriptions (Thomas, 2019). Another study conducted by an addiction center from 1990 to 2010 reported a rise in an anesthetic named Propofol (Decker & Hughes, 2013). 22 healthcare professionals were identified, but they were all practitioners who had easy access to other anesthetics (Decker & Hughes, 2013). Propofol users have been a majority female, and have expressed experiencing depression, including a history of childhood physical or sexual (Decker & Hughes, 2013). The dependence of Propofol has been increasing within 1.6% of healthcare addiction cases that are requesting treatment (Decker & Hughes, 2013).

With the number of male nurses increasing drastically from 1970 to 2011, female nurses still dominate the nursing field by over 90% (United States Census Bureau [USCB], 2013). With the American Nurses Association estimating a probability where one in ten nurses defer to abuse drugs or alcohol, the chances of them being female is a high expectation (Gonzales, 2018). Aside from depression and post-traumatic stress disorder (PTSD), nurses practicing substance dependency normally experience fatigue from prolonged shift work, stress from providing emotional and physical support to patients and their families and being tempted by easy access to prescribed drugs (Gonzales, 2018). There has also been a long history of nurses partaking in substance abuse for decades, especially with fentanyl back in the 1970s (Gonzales, 2018). Without proper supervision of the hospital staff, nurses would remove the opioids from their vials and replace them with saline, causing an influx of addictions and overdoses among professionals (Gonzales, 2018).

A more unfortunate impact on the nursing profession that is not addressed is the sheer fact that they have developed loyalty within their ranks, usually from friendships established with one another (Gonzales, 2018). This incites an enabling behavior and allows their coworkers to ignore the side effects of the onset of addiction, which also leaves some nurses to not report the substance abuse for fear of colleagues being reprimanded (Gonzales, 2018). In generalization, nurses are not to be singled out for their substance abuse, but instead all healthcare professionals since 1842 (Butler Center for Research [BCR], 2015). Because a number of healthcare professionals were experienced with knowledge of the effects of most opioids, they began to exercise their use on patients, but it only further complicated the tempting need for professionals to engage more in other prescription drugs readily available to them (BCR, 2015).

Even with the highly regarded positions doctors and nurses are in, they are not exempt from the aftereffects of an alcoholic or opioid addiction. Only in the 1970s was the American Medical Association forced to develop a formal policy in response to impairment from either drugs or alcohol (BCR, 2015). With a policy in effect, many states have refined programs to help healthcare professionals combat their addictions and ensure they do not lose their licenses or practice (Juergens, 2019). There have been concerns about evaluations and treatments being undermined for fear of negative financial, legal, professional, or social consequences (BCR, 2015). There are also problematic attitudes and behaviors of healthcare professionals that will conflict with the treatment that they need, such as their independence, perseverance, and self-reliance (BCR, 2015). It affects their personal judgment to ask for help when it is truly warranted.

Since the treatment plans for these professions need to be of a much higher standard due to the safety of the patients affected, state medical boards have taken precautions to ensure critical treatment intervention is up to standard (BCR, 2015). Thorough evaluations and assessments are in order and are only to remain non-punitive and confidential if criminal or legal actions have not been filed against the healthcare provider for substance abuse (“Treating a Healthcare,” 2019). Of course, detoxification is the first order of business once the professional has voluntarily opted to engage in the program (“Treating a Healthcare,” 2019). This process, if successful, will determine the type of treatment program that is necessary (“Treating a Healthcare,” 2019). The options are either inpatient or outpatient, with the latter being the most flexible to allow the volunteer to continue with daily tasks, but still restrictive when involving patient care (“Treating a Healthcare,” 2019). The former is more restrictive, but structured and tailored to focus on the volunteer’s recovery (“Treating a Healthcare,” 2019). Even with the treatment programs available to them, no bad deed goes unpunished. There is a high chance of license suspension or even revocation (Santiago, 2017). This disciplinary action does stay on the healthcare worker’s record and raises some red flags to other employers if they wish to relocate to another facility, thus causing major retraction from professionals from even admitting they have a problem (Santiago, 2017). The positive note to take away is the fact that those who have received treatment are highest rated to remain sober (Juergens, 2019).

Due to a large number of addictions within the healthcare field involving social interaction, it would be best to determine that symbolic interactionism is the most prominent theory to help us understand this social problem. It usually stems from a healthcare worker needing help dealing with either the long hours, the stressors of work, or both, and they confide in their peers/supervisors for advice. Their peers/supervisors show them which drug to use to assist with their performance or post-work stability, explain the procedures to take once the effects have taken over, and then entertain the idea of sticking to the continuation of relying on that substance as the only means to get through their day (Barkan, 2016). With an imposed “team player” mentality amongst healthcare professionals, this concept is widely accepted, even amongst others who do not engage in this type of behavior. The sheer fact that it happens without being reported is a prime example of professionals unwilling to cause distrust amongst their co-workers.

The treatment plans for these healthcare professionals are highly essential to be effective not only to provide the professional with a plan that will help them combat their illness but to ensure the safety of their patients. Patient care is still the primary staple of these treatment programs, and with voluntary submission, these professionals will learn to not endanger the safety of their patients, coworkers, or themselves (“Treating a Healthcare,” 2019).

Judging from the sources I have reviewed when treatment plans are laid out, I find it very difficult to properly judge an effective solution aside from what the states have already laid out. It is difficult enough to get people to admit they have a problem, let alone go about trying to solve the problem in general. This was a difficult social issue to tackle, and I am glad to have been able to do so, but my augmentation would most likely steer towards quarterly training seminars from an outside professional so as not to bring about bias. I would also enforce random drug testing either monthly or bi-monthly in order to help prevent further substance abuse. There is also the need to have a system for two-way authentication of all inventory. One authentication is from the personnel assigned to the pharmaceutical department and another is from a senior officiate from administration. This may help with keeping accountability at its peak without worry of loss of inventory.

References

1. Barkan, S. E. (2016). Social problems: Continuity and change. Minneapolis: University of Minnesota Press.
2. Butler Center for Research. (2015). healthcare Professionals: Addiction and Treatment. Retrieved from https://www.hazeldenbettyford.org/education/bcr/addiction-research/health-care-professionals-substance-abuse-ru-615
3. Decker, R. & Hughes, C. (2013). Study Shows Rising Rate of Propofol Abuse by healthcare Professionals. Retrieved from https://wolterskluwer.com/company/newsroom/news/health/2013/03/study-shows-rising-rate-of-propofol-abuse-by-health-care-professionals.html
4. Gonzales, M. (2018). Nurses and Addiction. Retrieved from https://www.drugrehab.com/addiction/nurses/
5. Juergens, J. (2019). Substance Abuse in healthcare. Retrieved from https://www.addictioncenter.com/addiction/medical-professionals/
6. Santiago, A. C. (2017). Why Substance Abuse Is Growing Among Medical Staff. Retrieved from https://www.verywellhealth.com/substance-abuse-in-the-healthcare-workforce-4125792
7. Thomas, S., M.D. (2019). Alcohol and Drug Abuse Statistics. Retrieved from https://americanaddictioncenters.org/rehab-guide/addiction-statistics
8. Treating a Healthcare Industry Worker for Alcohol Abuse Issues. (2019, July 18). American Addiction Centers, Inc. Retrieved from https://www.alcohol.org/professions/medical-professionals/
9. United States Census Bureau. (2013). Male Nurses Becoming More Commonplace, Census Bureau Reports (Publication No. CB13-32). Retrieved February 25, 2013, from USCB Web site via GPO Access: https://www.census.gov/newsroom/press-releases/2013/cb13-32.html
10. Yagoda, R. (2016). Understanding the Link Between Stressful Occupations and Addiction. Retrieved from https://health.usnews.com/health-news/patient-advice/articles/2016-09-26/understanding-the-link-between-stressful-occupations-and-addiction

Introduction

The topic to be developed is an issue which has arisen in important sectors of young people from Chaco. Around sixteen million of young women between the ages of fifteen and nineteen give birth each year – roughly eleven percent of all births worldwide. Complications related to childbirth and pregnancy are the main cause of death among adolescent girls, especially in developing countries. In Latin America, ten percent of girls aged fifteen to nineteen are mothers. In Argentina, the number of teenage pregnancies has increased since 2001, representing sixteen percent of pregnancies. The percentage recorded in some areas such as the Argentinian northeast and west was twenty-five percent. (1)

Teenage motherhood and fatherhood are more frequent among young, poor people who have a lower educational level. Eighty percent of teenagers who don’t have children attend school regularly, while twenty-five percent of teenagers who have children don’t. The number of teenage mothers with incomplete primary education trebles the number of those with incomplete secondary education. (2)

The national legislative framework contains rules as Law 25.673 which ensures that young people have the right to access to sexual and reproductive health. Law 26.150 states that individuals have the right to receive sexual integral education from elementary to superior level studies. Laws 25.58 and 25.273 provide that the continued attendance at school of pregnant students is guaranteed.

Carlos Dabalioni, Director of the Children and Adolescents Department of La Plata City Hall, Buenos Aires, has stated that, although in some cases pregnancy is the result of misinformation, it goes beyond mere teaching teenagers how to take care of themselves; because the problem is, in many cases, the lack of social and family support. To many women, having a child is their only asset, the chance to have the family they didn’t have when they were younger, the only way to keep their partners or give the baby all they lacked. When that kind of support is missing, there is no point in trying to teach young women how to take care of themselves. UNICEF’s Regional Office for Latin America and the Caribbean has claimed that “UNICEF is committed to focusing its efforts on the phases of adolescence as the opportunity to develop individual skills and abilities in favorable and safe surroundings, so as to enable the adolescent to contribute to and participate in the family, school, community and society”. (3)

Adolescence Stages

Adolescence can be divided into three different stages, which entail different ways to deal with pregnancy:

1- Early adolescence (10 -13 years old):

• Strong connection with the mother.
• Denial of pregnancy.
• Depression and social isolation caused by unplanned maternity.
• The father is absent from the mother’s plans and decisions.

2- Middle adolescence (14-16 years old):

• The mother sees the child as her possession and as an instrument to show independence from her parents.
• Ambivalent attitude: blame and pride.
• The father is given a more important role. He’s considered as a hope for the future.

3- Late adolescence (17-19 years old):

• Adaptation to the reality impact.
• Feelings of motherhood.
• Search for affection, commitment, and dedication from the baby’s father.
• Mother’s desire to have a settled life with her partner.

It is important to highlight that a teenage pregnant won’t reach mental and emotional maturity earlier than expected. She will behave in accordance with the stage she is going through. (4)

Consequences of an Unplanned Pregnancy

• High risk of maternal mortality
• Higher possibility of premature births
• Risk of having a child with low birth weight
• Difficulties in completing studies and having a life project.

At a global level, increased morbidity during teenage pregnancy is caused by:

• Abortion
• Anaemia
• Urinary infection
• Asymptomatic bacteriuria
• Gestational hypertension
• Preeclampsia – Eclampsia
• Little weight gain
• Maternal malnutrition
• Hemorrhages associated with placental conditions
• Preterm birth
• Preterm rupture of the membranes
• Cephalopelvic disproportion

Levels of Prevention

Primary Prevention

The first level concerns the application of measures to prevent unplanned teenage pregnancy.

• Information distribution about gradual and sequential reproductive physiology not only in school but also in all areas.
• Appropriate use of mass media.
• Fostering strong parents/school-children communication and collective reflection on adolescence issues.
• Training of people who often deal with high-risk young people who quit school or job in order to help them reintegrate fully into society.

Secondary Prevention

The second level concerns the actions that should be taken if there is an existing pregnancy.

• Activities to improve maternal health through the promotion of pre-natal and post-partum health care programs for teenage mothers.
• Assistance should be given to the teenage father, helping him to assume his social role.
• Psychological support and information should be provided to young mothers who decide to place their children for adoption.

Tertiary Prevention

The third level concerns the monitoring of the mother/father-child bond and the support and fostering of the parents’ reinsertion in the labor market.

At an educational level, the emphasis is placed on the relevance of speaking about sexual and reproductive health with teenagers and their friends, parents, teachers, and trustworthy adults, teaching teenagers how to resist social pressures and delay the onset of sexual activity to prevent sexually transmitted diseases and unplanned pregnancies, teaching teenagers to support those who decide not to have sexual relations (they have to be prepared to say no and act firmly when faced with risk situations or threats), raising awareness about the importance of condom use during intercourse to ensure their protection, keeping reminding young people that they should avoid drinking alcohol or taking drugs when they are with their partners, so that they can make right and responsible decisions regarding sexuality and sexual behaviors, and promoting safe, healthy and responsible sexuality. Teenage pregnancy can be prevented, not cured. If an unplanned pregnancy happens, parents play a vital supportive role. They should teach their children to behave responsibly and confront life’s difficulties.

Caries Prevention during Pregnancy

It is well known that teeth and gums are affected during pregnancy since hormonal changes have a great impact on women’s gums. These may bleed spontaneously, and be edemized and red, causing halitosis.

There is a higher risk of tooth decay during pregnancy because of nausea, vomiting, reduced saliva pH and secretion, anxiety, and higher consumption of sweets. Caries can be prevented by adopting good oral hygiene (for at least 2 minutes), brushing the teeth three times or more per day, consuming calcium-rich foods (such as milk, yogurt, cheese), proteins (meat, eggs), vitamins and minerals (fruits, vegetables, cereals, beans), avoiding sugary foods and drinks, and visiting the dentist once each trimester during pregnancy.

Babies are born free from bacteria that cause tooth decay. Bacteria are spread through saliva when the mother kisses the baby in the mouth or cleans the bottle or the pacifier, and also when the baby’s first teeth appear. Babies shouldn’t sleep with the bottle in their mouths. The sugar contained in milk together with the bacteria produces an acid that can eat through the teeth, leading to dental enamel damage.

To eliminate or reduce caries risk factors in the baby is necessary to use a mouthwash-soaked gauze to clean inside the baby’s mouth after breastfeeding or drinking from a baby bottle, brushing their teeth from the first moment they appear, and visiting the dentist the baby so they can monitor your child’s oral health from birth and every six months.

Materials and Methods

A Mother-Child Programme was implemented in health centers, with multidisciplinary professionals’ participation. Dental care and prevention were taught through games, as well as a pre-birth gym.

Efforts were made to empower individuals and government agencies, civil associations, academic institutions, and the private sector.

Results and Discussion

The present research is based on a data field extracted from the UNFPA, an international cooperation organism for development formed in 1969. It has been running in Argentina since 2003, promoting women, men, and children’s rights to enjoy a healthy life and equality of opportunities. (5)

In 2018, the UNFPA struggled to achieve 3 transforming, ambitious goals that promise to change every man, woman, and child’s life: to put an end to family planning needs, to gender violence (6), and to preventable maternal death. (7)

Conclusions

Early pregnancy and motherhood are strictly linked to human rights issues. A pregnant child is pushed to drop out of school. In all regions of the world, poor children with a lack of education and living in rural areas are at risk of getting pregnant.

Pregnancy can have devastating effects on the young mother’s health. Many teenagers are not physically prepared to get pregnant or deliver; therefore, they are more vulnerable to complications. Besides, teenage pregnancy has tremendous costs on girls’ education and income potential.

In Argentina, efforts are being made to prevent teenage pregnancy, trying to change factors such as inequality of gender, poverty, sexual violence, and coercion. Such an approach must include the provision of suitable, integral sexual education for every young man and woman, as well as investment in girls’ education and measures to guarantee access to information about sexual and reproductive health and services to facilitate young people’s life choices.

Bibliography

1. Gómez P. et al (2011). Factores relacionados con el embarazo y la maternidad en menores de 15 años en América Latina y El Caribe. Lima: Federación Latinoamericana de Sociedades de Obstetricia y Ginecología. https://www.sguruguay.org/documentos/6factores-relacionadosmaternidad-menores-15-anos-lac.pdf
2. UNICEF (2011). Estado mundial de la infancia- La adolescencia Una época de oportunidades, Fondo de las Naciones Unidas para la Infancia, 2. https://www.unicef.org/honduras/Estado_mundial_infancia_2011.pdf
3. UNICEF (2014). The State of the World’s Children 2014 in Numbers. Every Child Counts: Revealing disparities, advancing children’s rights. Nueva York.
4. UNFPA (2015). Girlhood, Not Motherhood: Preventing Adolescent Pregnancy Published by the United Nations Population Fund. New York, 7.
5. UNFPA (2016). Fecundidad y Maternidad Adolescente en el Cono Sur: Apuntes para la Construcción de una Agenda Común, 9.
6. UNFPA. Fondo de Población de las Naciones Unidas .El embarazo en la adolescencia. http://www.unfpa.org.ar/sitio/index.php?option=com_content&view=article&id=190.
7. Conde-Agudelo, A., et al (2005). “Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-Sectional study”. (Morbilidad y mortalidad materno- perinatal asociada con el embarazo adolescente en América Latina: Estudio Transversal.) American Journal of Obstetrics and Gynecology, 192, 342-349.

Abstract

Job satisfaction has different perspectives. Considering the point of view of an employee, it reveals the benefits people might be looking for while taking the job. And these benefits are agreed by the employer considering their own strategies, benefits and profits. Moreover organizational factors that affect their satisfaction articulate employees’ aspiration to utilize their potential to make a valuable and meaningful contribution towards fulfilling their individual goals. From an organization’s point of view, they take up people to perform explicit jobs in order to achieve their business goals. A win -win situation happens when the organization finds people who are ready to work for the required business goals happily. In medical profession, the level of job satisfaction of doctors directly affects their attitudes towards colleagues, students and above all the patients. This paper highlights the impact of organizational factors on job satisfaction among the doctors in teaching hospitals and also suggests job satisfaction should be recognized as a measure, must to be included in quality improvement programmes and institutions must realize the importance of having satisfied employees.

Keywords: job satisfaction, teaching hospitals, doctors

Introduction

Job satisfaction has been defined as a pleasurable emotional state resulting from the evaluation of one’s job; an affective reaction to one’s job; and an attitude towards one’s Job. In other words it describes how satisfied an individual is with his job. Job satisfaction has many variables. One may be content with one factor of job but at the same time might not be satisfied with other factor related to the same job. For example a doctor may be satisfied with his designation but may not be satisfied with work load.

Job satisfaction of a doctor has an effect on his behavior with co-workers, seniors and particularly the patient care. Quality of medical care and doctor-patient relationship is beyond doubt reliant on the level of job satisfaction. In general doctor’s effectiveness includes timely treatment, availability, the way he communicates and explains the treatments and tests to the patients and their relatives. Several studies have been taken by different researchers and it was seen doctor’s performance and behavior in the organization is related to job satisfaction. It has also been seen if the employee is satisfied with his job, organization can expect better performance from him. In case of a teaching hospital, other than all these behaviors the dissatisfaction of a doctor may extent to the point where it might affect their teaching quality and present a negative impression to the students and the new recruits under him.

Literature review

Job dissatisfaction and stress among doctors affect the quality of health care. The area under discussion of job satisfaction is of great concern due to the fact that organizational and employees’ health and welfare lies a great deal on job satisfaction (Adams et al, 2000). Various studies have ascertained that dissatisfaction with one’s job may upshot employee turnover, absenteeism, sluggishness and grievances. Improved job satisfaction, on the other hand, results in increased productivity (White, 2000). Satisfied employees tend to be more productive and committed to their jobs (Al-Hussami, 2008). In a healthcare industry, employee satisfaction has been found to be positively related to quality of service and patient satisfaction (Tzeng, 2002). Various factors that lead to dissatisfaction in doctors are an average number of working hours, work environment and salary( Kaur S. et al 2011), workload, system of promotion( Sultana A. etal 2009). Another study found perks, conducive working environment, job security, insolent behaviour, undue interference, personal protection due to law and order situation and biased attitudes etc, are some of causes of their uneasiness (Aijaz A. Sohag 2012). Singh Rajkumar G. (2013) stated that the positive performance of employee in the organization is result of his pleasing job experience. He also found Pay and compensation factors were the most important factors positively correlated with employee job satisfaction.

Rationale of proposed investigation

A number of studies have addressed job satisfaction among health care professionals. Indian studies are limited to nurses and other individual professions. Given the noticeable lack of studies addressing job satisfaction among doctors in teaching hospitals of Navi Mumbai, this study will attempt to address the gap in the literature.

Objective

To study the relationship between organizational factors and job satisfaction, among doctors working in teaching hospitals of Navi Mumbai.

Research Methodology

For the purpose of the study, the target group of doctors working in different Teaching Hospitals was selected. A total of 60 questionnaires were returned, which had questions based on their demography and organizational factors. The organizational factors consisted of Work environment, Job security, financial benefits, Non financial benefits, Pay and promotion potential, freedom to patient care, Work relationships, Use of skills and abilities, Work activities, Opportunity to develop and Time pressure.

Analysis

In the first section the respondents were asked to rate the importance of the following factors in job satisfaction while working in your organization, using five point Likert’s scale. As represented in the table 1, it showed work environment (4.1) as the most important factors required for job satisfaction, followed by freedom to work with patients (4.08), financial benefits (3.9), work load (3.8) and job organisation (3.7). Similar results were seen in a study by Sharma M. et al. among Indian physicians which stated physical work conditions, freedom to choose desired method of working, attitude of fellow workers, recognition for good work, , rate of pay, opportunity to use abilities as the factors extensively associated with their job satisfaction.

The second section asked the respondents to rate their job satisfaction for all the factors and sub factors. The first Factor under study Work activities, included variety of job responsibilities, Degree of independence associated with work roles, Workload with regard to clinical aspect, Workload with respect to teaching aspect. 73% of the respondents were satisfied with the variety of job responsibilities, 66% said they were unsatisfied with the degree of independence 72% were unsatisfied with the workload. Aijaz A. Sohag1(2012) found 76.2% doctors were found to be completely dissatisfied with their jobs. A significant portion of these doctors were found to be dissatisfied with factors like work load, conducive working environment, job security, undue interference from seniors and management.

Factors

Number of people responded ( N)

Average Rating

Unimportant

Least Important

Moderately Important

Important

Very important

Work load

N

4

5

10

21

20

3.8

%

6.66

8.33

16.66

35.00

33.33

Financial benefits

N

2

4

15

15

24

3.9

%

3.3

6.66

25

25

40

Non financial benefits

N

6

6

13

20

15

3.5

%

10

10

21.66

33.33

25

Pay and promotion potential

N

5

10

15

15

15

3.4

%

20

16.66

25

25

25

Work relationships

N

12

13

15

11

9

2.8

%

20

21.66

25

18.33

15

Use of skills and abilities

N

14

10

10

11

15

3.05

%

23.33

16.66

16.66

18.33

25

Work Environment

N

1

4

10

17

28

4.1

%

1.66

6.66

16.66

28.33

13.33

Opportunity to develop

N

13

10

11

11

15

3.08

%

21.66

16.66

18.33

18.33

25

Job organisation

N

6

5

10

18

21

3.7

%

10

20

16.66

30

35.00

Freedom of Patient care

N

2

2

10

21

25

4.08

%

3.3

3.3

16.66

35.00

41.66

Time pressure

N

2

4

12

20

22

3.9

%

3.3

6.66

20

33.33

36.66

Table 1

Second factor under consideration was ‘Financial benefits’ and it includes salary in comparison to other organizations, Annual increments, other benefits like provident fund, gratuity and provision for leave encashment. 68% of the respondents rated themselves as highly unsatisfied with the salary followed by 63% for the annual increments and leave encashment. Cozen 2001 reported that different attractions regarding job satisfaction in terms of financial gain motivates doctors at tertiary care hospital especially as it characterized by high degree of independence in work planning and decision making. Similar results were seen in a study by Tran BX etal. 2013 who investigated factors associated with job satisfaction among commune health workers. The results demonstrated that respondents were least satisfied with the salary and incentives, followed by benefit packages, equipment, and environment. Wu D. et al. 2014 also found factors which contributed most to low job satisfaction were low income and long working hours.

‘Non financial benefits’ refers to other benefits your employer offers – flexible working hours, Insurance, health care, child care etc, recognition by the superiors, and reward for research work. 61% of the respondents were very highly unsatisfied with their work recognition. 74% of them were unsatisfied with the rewards for the research work. Selebi C., & Minnar A. (2007) conducted a survey in South Africa and found that all doctors experienced low satisfaction with responsibility, opportunity for creativity and innovation, independence, and recognition. Another study by M I Rehman, R Parveen (2008) among teachers of Bangladesh found the areas of pay, promotion and recognition from authority were the major characteristics of the job satisfaction profiles of dissatisfied faculty members.

‘Pay and promotion potential’, the next factor consisted of Salary, Opportunities for Promotion, promotion transparency, fairness of the salary package, Incentives for high achievements. 72% of the total respondents were unsatisfied with the opportunities for promotion followed by transparency of the system, where 70% of the respondents were unsatisfied. The results coincided with the results of the study by Bhatnagar K., & Srivastava K. (2011) to measure job satisfaction status of medical teachers. Poor utilization of skills, poor promotional prospects, inadequate pay and allowances combined with work conditions were the factors contributing toward job dissatisfaction. Sultana A. et al. 2009 also found most of the respondents were not satisfied with system of promotion.

‘Work relationships’ consisted of variables like relationships with employers, relationships with seniors and colleagues, participation in decision making, colleagues support, Professional stimulation. 63% of the respondents were satisfied with their relation with their colleagues and 61% of the same said they can depend on their colleagues for support. But 68% said they were not involved in the decision making. Persefoni Lambrou et al. (2010) investigated motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital. The survey revealed achievements, remuneration, co-workers and job attributes as the four main motivators. Different studies by M. Willis etal. (2008) and L. Fogarty 2014 reported similar results in low- and middle-income countries. In addition it was also observed that acknowledgement for work and relationships with colleagues have a high impact on job satisfaction directing to more positive work environment.

Next factor understudy was ‘Use of skills and abilities’ and had variables, scope to practice and learn new skills, freedom to decide the work, freedom to initiate changes. Majority of the respondents were not satisfied with the use of skills and abilities. Similar results were seen in different studies conducted by Cozens 2001 and Bhatnagar K. & Srivastava K. (2011) which indicated that job satisfaction level which was mostly found as “not satisfied” was related with non-availability of facilities for the improvement of qualifications or poor utilization of skills. 61% of the respondents were satisfied with the freedom to decide the work. Abida S. et al. 2009 found 64.6% respondents in Rawalpindi Medical College and teaching hospitals were satisfied with the freedom to choose their method of work.

Next factor labeled as ‘Work Environment’ consisted of variables including safety of working place, infrastructure, satisfaction over a communication channel, resources adequacies, volume, variety and quality. Among these 68% of the respondents were highly unsatisfied with the infrastructure and majority of them mentioned this hindered the delivery of health care.73% of the respondents were satisfied with the volume and variety of work. Around 58% were not satisfied with the communication channels being used. A similar result was seen in a study conducted in Tanzania by Leshabari M. T et al (2008), which reported poor job satisfaction in their health system due to poor rewards system, discouraging working environment and weak communications in the staff. Cozen 2001 found inadequate resources at doctor’s disposal might be one of the factors causing ‘dissatisfaction. Madaan (2008), explored Job Satisfaction among the medical faculties and residents of a tertiary care hospital, and revealed that salary, lack of incentives, poor working environment followed by inadequate infrastructural facilities were the major reasons dissatisfaction among doctors.

‘Opportunity to develop’’ consisted of variation in work, Support for additional training and education, financial assistance to attend academic conferences. 71% of the respondents were not satisfied with the opportunities provided to them. Nirpuma Madaan (2007), in her survey found Nearly 2/ 3rd of the responding doctors are happy with their jobs, but would appreciate a raise in salary and the availability of greater opportunity to grow for a more fulfilling professional life. Sharma M. et al. (2012) fund opportunity to use abilities was one of the factors extensively associated with job satisfaction of physicians.

‘Job organisation’ consisted of variables including shift length, Job description, Organisation structure, and satisfaction over call procedure. 68% of the respondents were highly unsatisfied with the length of the work shifts. Similar results were seen in a study conducted in a tertiary hospital in Delhi by Kaur S. etal. 2009 and another study by Taha N. and Amal S. 2013 in Al-Kadhimiya Teaching Hospital’s where nearly 50% doctors indicated dissatisfaction with the average number of working hours per day. In the current study 66% were not satisfied with the job description given to them. 63% of the respondents, majority of which were residents, were unsatisfied with the call rotation procedure. ‘Freedom to Patient care’ which included freedom to handle patient, sufficient time for each patient, physical and staff resources to take care of patients. 61% of them were satisfied with the freedom to handle patient but said they do not sufficient time for each patient. 59% responded that they were unsatisfied with the physical and staff resources available to them. In his study Deshwal, P. (2011) also suggested medical faculty members should get freedom in their work as it was a big cause of dissatisfaction among the doctors in the medical colleges of different universities in Uttar Pradesh. Abida S et al. 2009 found 64.6% were satisfied with the freedom to choose their method of work. Bjorvell (2002) studied job satisfaction of 153 hospital staff members including physicians, registered nurses, nurse assistants and aides, which revealed them as less satisfied with help received from superiors and sufficient time for patient care.

‘Time pressure’ consisted of many non-clinical tasks that need to do spend more time doing documentation and paperwork and sufficient time to sleep. 66% of the respondents reported unsatisfied with time pressure, and majority of them said they were spending lot of time for non clinical tasks and documentation. Mosadeghrad AM et al (2011) found too much of work, shortage of staff, time pressure, were the major factors with which the respondents were dissatisfied with. Different studies by (Fanny 2012, 2013) found more than half of the doctors reported disturbed work-life balance, reduced productivity, work quality, and prolonged fatigue level, sleepiness and extreme tiredness.

Conclusion

The study reveals doctors have low job satisfaction overall. Doctors play the major role in health care industry and are the first ones who are thought about when we talk about health care and thus it is necessary that their needs have to be taken care and a better working environment is created for them to work with utmost job satisfaction and content, the result of which would be a high quality care. It is suggested to that teaching hospitals need to improve infrastructure, develop a fixed criteria based and transparent promotion policy, raise their salaries and create opportunities for their medical professionals as it would also lead to raise Job satisfaction of young entrants making the way for effective delivery of health care.

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