This is a descriptive, cross-sectional study on a sample of 40 junior doctors in a hospital in Kuala. Lumpur. The aim of this study was to look at the prevalence of ...
..... f ,. ui y Vol.5, No.1, March 1997
Research Paper
EMOTIONAL DISTRESS, JOB SATISFACTION AND JOB RELATED TENSION AMONG JUNIOR DOCTORS Hatta Sidi T. Maniam ABSTRACT This is a descriptive, cross-sectional study on a sample of 40 junior doctors in a hospital in Kuala Lumpur. The aim of this study was to look at the prevalence of emotional distress, the level of job satisfaction and job related tension among junior doctors. The differences in relation to gender and marital status were studied. Out of40, 31 (77.5%) doctors were found to be positive for emotional distress on the General Health Questionnaire (GHQ) which was used as a screening test. They were compared with teachers teaching in Kuala Lumpur who were matched for age, sex, marital status, race and level of qualification. Level of satisfaction was measured using the Job Satisfaction Questionnaire and level of job tension studied using the Job Related Tension Questionnaire. Junior doctors were found to be generally dissatisfied (t = -6.82, p < 0.005) and had more job related tension (t = 4.88, p < 0.005) than teachers. Junior doctors were dissatisfied compared to teachers in relation to physical condition, freedom to choose method of working, recognition one gets for good work, amount of responsibility that was given, rate of pay, opportunity to use one's abilities, relationship between administrator and Junior doctors in the department, chance of promotion, the way how the department was managed, the attention paid to suggestion one makes and hours of work. However there were no differences in relation to the fellow workers, the immediate boss, variety in the job and job security. There were no significant differences between doctors who had emotional distress and those who did not in terms of gender and marital status. Key words: Emotional distress, job satisfaction, junior doctors
INTRODUCTION Malaysian medical and health services have expanded tremendously in the past few years. In the delivery of services, the role of manpower is crucial, especially that of young doctors who are the first to attend to patients and who serve the frontline in emergencies. Recently, the issue of shortage of doctors in the public sector has drawn the attention of many quarters. The shortage has caused more workload to junior doctors who cannot resign before the three years of compulsory service, and any emotional distress that they previously experienced may be intensified. Many doctors report feeling angry, bored, easily irritable at times and have frequent episodes of cognitive impairment due to sleep deprivation (1). The issues related to stress in the workplace, presence of affective symptoms (2) and ambivalence in further career choice have been the serious concern of officialdom (3).
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Related Tension Among Junior Doctors
The aim of this study was to find out the degree of emotional distress and job satisfaction among junior doctors in comparison to a control group of graduate teachers in the same locality. METHODOLOGY This is a cross-sectional study of junior doctors. The population in this study consisted of all junior doctors in a hospital in Kuala Lumpur. All doctors who had served less than 3 years were included irrespective of the posting they were undergoing. Doctors who had served more than 3 years, who had chronic or severe physical illnesses or who refused consent or declined to cooperate in this study were excluded. Controls were chosen among graduate teachers whose salaries were similar to that of junior doctors (ranged between RM 1,200 to RM 2,000 per month). The following study instruments were used: (i) General Health Questionnaire -30 (4,5). A score of 5 or more indicates that the person in likely to be a psychiatric case, (ii) Preliminary Tavistock Questionnaire (3), looking for personal data, amount of sleep, hours of working and future plan in medical services. It was also used in a modified form for teachers, (iii) Therapist Job Satisfaction Questionnaire (6,7), consists of questions about the worker's feeling about his or her job position, with items of relationship, personal growth and system dimensions; these are questions with Likertscores Ito 4, based on the degree of satisfaction which can be transferred into standard scores with high scores indicating more satisfaction, and (iv) Job Related Tension Questionnaire (7,8). Respondents indicate how frequently they felt bothered about named features of work with answers scored from l to 5, with higher value indicating more tension. Each interview began with an explanation of the purpose of the study. RESULTS Sixty-five doctors in this hospital who fulfilled the inclusion criteria were given General Health Questionnaire (QHQ-30). Only 40 responded to the screening test, whereas the remaining failed to return the questionnaire. Of the 40 doctors who responded, 31 (77.5%) were found to be positive ("cases") on screening using GHQ (score of 5 or more). The demographic data is given in Tables 1,2 and 3. The age, sex and marital status between junior doctors and teachers were matched (no significant differences on t-test analysis). The duration of working hours among doctors and teachers is given in Table 4. The doctors' distress score according to gender and marital status is given in Tables 5 and 6. There were no significant differences between doctors who had emotional distress in terms of gender and marital status. The distress score among junior doctors and teachers is given in Table 7. There was a highly significant difference in the mean distress scores among doctors and teachers who had emotional distress, and doctors experienced more distress. The job satisfaction scores among doctors and teachers is given in Table 8 and job related tension in Table 9. There was a highly significant difference between the mean job satisfaction scores and job related tension scores between doctors and teachers who had emotional distress. Doctors were less satisfied and more tense than teachers in terms of their job. Differences between doctors and teachers in term of various items in job satisfaction is given in Table 10.
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Hatta Sidi et al.
Table 1: Age distribution among doctors and teachers who were "emotionally distressed"
Doctors
Age distribution ( Years)
n=31
20 - 24
0
0
8
25.8
25-29
27
87.1
13
41.9
30-34
4
12.9
6
19.4
35-41
0
0
4
12.9
Teachers n
=
%
31
Mean Age
26.83
28.13
Standard Deviation
2.05
4.63
(t = 1.44, degrees for freedom = 60, p > 0.05)
Table 2 : Sex distribution among doctors and teachers who were "emotionally distressed"
Sex
Doctors
Teachers
n=31
%
n=31
Male
14
45.2
13
41.9
Female
17
54.8
18
58.1
(X 2 = 0.06, degree of freedom = 1, p > 0.05)
Table 3 : Marital status distribution among doctors and teachers who were "emotionally distressed"
Marital Status
18
Doctors
Teachers =
n=31
%
n
Single
15
48.4
15
48.4
Married
16
51.6
16
51.6
31
%
Emotional Distre.cc..Joh ,S'ati.cfaction and _hh
Related Tension Among Junior Doctors
Table 4 : Duration of working hours per week among junior doctors and teachers Teachers
Doctors
Hours of work (per week)
n=31
%
n=31
< 40
0
0
31
100
40-99
6
19.4
0
0
> 100
25
80.6
0
0
Table 5 : Number of male and female doctors who scored positive and negative by GENERAL HEALTH QUESTIONNAIRE Doctors
General Health Questionnaire Score
Male
%
Female
Positive Screening
13
32.5
18
45.0
2
5.0
7
17.5
( 0.05
Not significant
6.
The amount of responsibility you are given
5.31
< 0.05
Significant
7.
Your rate of pay (monthly income)
26.49
< 0.001
Highly significant
8.
Your opportunity to use your abilities
14.52
< 0.001
Highly significant
9.
Relation between administrators and workers
13.32
< 0.001
Highly significant
10. Your chance of promotion
9.81
< 0.005
-
ii. The way your firm is managed
16.53
< 0.001
Highly significant
12. The attention paid to your suggestion
6.46
< 0.02
Significant
13. Your hours of work
39.16
< 0.001
Highly significant
14. The amount of variety in
0
> 0.005
Not significant
2.54
> 0.05
Not significant
Highly significant
your job 15. Your job security
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Related Tension Among Junior Doctors
DISCUSSION
Dr. Esther Gunaseli Pegawai Perubatan Per::batan Psikologi
Housemanship is a period for acquisition of medical knowledge and skill. During housemanship many doctors perceive medical training as rewarding and promoting self-growth. Some find it stressful, and to a certain extent regret having chosen the medical field as a career. Some show chronic anger towards the system (I). Unfortunately, a few of them breakdown under pressure (9). From this study, a very high proportion (77.5%) of junior doctors experienced emotional distress. This study also supports earlier studies from Western countries regarding the high degree of emotional distress among junior doctors (10). Menninger (11) found that emotional distress is common among most physicians who are "compulsive", manifesting in traits such as attention to detail, hyperconscientiousness and deep commitment to patients. Doctors tend to be "perfectionist", "workaholic", and "markedly guilt prone". Furthermore, doctors tend to be self-sacrificing that they feel "guilty about any attention to their own needs." Emotional reaction among doctors due to stress include anxiety (tension, inability to relax), hostility (anger at minor things), "scapegoating" (blaming others, fault finding, being critical and hard to please) and depression. Junior doctors in this study were found to be generally dissatisfied (t=-6.82, p < 0.005) and have more job related tension (t = 4.88, p < 0.005) than teachers. Junior doctors were dissatisfied compared to teachers in relation to physical conditions, freedom to choose methods of working, recognition one gets for good work, amount of responsibilities that were given, rate of pay, opportunity to use one abilities, relations between administrators and junior doctors in the department, chances of promotion, the way how departments were managed, the attention paid to suggestions one makes, and hours of work. However there were no differences with respect to relation to fellow workers, the immediate boss, variety in the job and job security. There were many factors associated with joh dissatisfaction and job tension among junior doctors. Firstly, the long working hours and sleep deprivation were repeatedly noted as one of major precipitating factors (12). In this study, 19.4 % (6) of junior doctors work between 40 to 99 hours per week and a majority of them, 80.6% (25) work for 100 or more hours per week, and many ofthem suffer from sleep deprivation (average working hours in a routine Malaysian government office is about 45 hours per week). Mawardi (13) found that being on call, carrying a heavy work load and not having personal time were the most prevalent sources of physician dissatisfaction with work. Secondly, excessive work load could also lead to sleep deprivation and be perceived by doctors as stressful and cause morejob tension and dissatisfaction (12,14,15). Many junior doctors complained of excessive and unnecessary work in the Tavistock Preliminary Questionnaire. Thirdly, patient care responsibility, as Cramond (16) has concluded, such as results of therapeutic failure, diagnostic difficulties, and the death of young patients were most stressful for practising doctors. Fourthly, perpetually changing work conditions and peer competition caused further anxiety and sometimes this was threatening (1). As junior doctors became emotionally distressed, their job satisfaction became less and they experienced morejob tension (17). Studies have shown that the degree of stress and job satisfaction were inversely correlated with each other (18). It is important to consider in any discussion of job satisfaction the role of desires and expectations. When high expectations are not met, people often become dissatisfied whereas those with lower expectations are often satisfied with their job.
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Hatta Sidi et al.
There were no significant differences between doctors who had emotional distress and those who did not in terms of gender and marital status, as compared to other studies in Canada (19, 20). This is probably because the sample size studied here was relatively small and different study instruments were used. The limitation of the study were: (i) small sample size, (ii) major personal events in junior doctors' lives such as interpersonal difficulties, marital discord; changes in behaviour and attitude, such as decreased social contact; personality factors and cognitive aspects that may interfere with a person's daily life activities in giving meaning to everyday's satisfaction were not considered, (iii) temporal relationship, such as duration and type of housemanship postings in relation to emotional distress, job satisfaction and job tension were not studied, (iv) there is a possibility that junior doctors who participated in this study tend to report more distress and job dissatisfaction than those who did not, and (v) effects of sleep deprivation on cognitive function during interview and other non-specific factors such as anger and hostility would interfere with "giving the true answer." These were not studied. Future investigation into issues related to stress, job satisfaction, job related tension and outcome of formal psychiatric help among internship should include efforts to identify interplay of factors such as perceived support, time demands, and personality traits. The following are recommendations to help our interns:(a) I mproved work condition. One study has recommended a decrease in duration of work shifts (12). For example, interns who were active on-call to be allowed time off or if it is not feasible, to come slightly late for morning round; (b) Support groups. The use of a group based on a didactic or supportive model has been suggested, to promote group cohesiveness. To be a successful group, they should make participation optional, clarify the purpose of the group, maintain a nonjudgemental attitude towards group members and avoid passivity and ethnic clinging. However, this kind of support group needs motivation from the group members; (c) Counselling and psychiatric referral. Counselling helps to relieve occupational stress (21). The difficulties of the job as a doctor at all levels should be acknowledged from the time of entry to the medical school. Consultants, medical specialists and medical officers should be more humane in their approach when commenting on mistakes made by junior doctors. Starting from the first day of duty, they should be encouraged to discuss freely related topics such as responsibility, making decisions in the area of uncertainty and illusions of omnipotence as physicians. If possible, junior doctors who are depressed and with poor social or family support should be referred to psychiatrists for psychotherapy and other necessary psychosocial interventions.
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Emotional / l7CtYPCC In l , cn ti fnntin» nn,] Inl Related Tension Among Junior Doctors
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Corresponding Address: Dr Hatta Sidi MBBS, MMed(Psych) Lecturer & Psychiatrist Department of Psychiatry Universiti Kebangsaan Malaysia Jalan Tenteram 56000 Kuala Lumpur
