DOCTORS PERCEPTIONS OF THE LINKS BETWEEN STRESS AND LOWERED CLINICAL CARE

We know from numerous industrial studies that stress, particularly in the form of tiredness and sleep deprivation, has a detrimental effect upon work performance, though this is not so clear-cut in studies of d octors, despite their stress levels being particularly high. This stud y explores the doctors' views on this using anonymous questionnaires f rom a population of 225 hospital doctors and general practitioners, 82 of whom reported recent incidents where they considered that symptoms of stress had negatively affected their patient care. The qualitative accounts they gave were coded for the attribution (type of stress sym ptom) made, and the effect it had. Half of these effects concerned low ered standards of care; 40% were the expression of irritability or ang er; 7% were serious mistakes which still avoided directly leading to d eath; and two resulted in patient death. The attributions given for th ese were largely to do with tiredness (57%) and the pressure of overwo rk (28%), followed by depression or anxiety (8%), and the effects of a lcohol (5%). The data are discussed in terms of the links made by the doctors between their fatigue or work pressure and the way they care f or patients. It presumes that these incidents had been previously unre ported and talks about the effects this secrecy has on the emotional s tate of the doctors concerned. It offers ways forward for tackling the problem, of interest to the profession, managers and commissioners. ( C) 1997 Elsevier Science Ltd.