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Peradeniya Teaching Hospital: Doctors stressed out, study finds 

20 Jan 2021

  • Administrators and policymakers urged to take note 

  By Ruwan Laknath Jayakody   Doctors – specifically, non-specialist medical officers – working at the Teaching Hospital in Peradeniya are suffering from medium to high levels of organisational role-related stress, as revealed by a recent study conducted into the relatively unresearched area of work-related stress among doctors in Sri Lanka. The major role-related problems reported were what is known as inter-role distance, role stagnation, role overload, and personal inadequacy, while role ambiguity was found to be the least problematic role stressor among doctors. Inter-role distance occurs when there is a conflict between the organisational role (doctor) and the nonorganisational roles (head of the family and member of a society), where one role demands more of the individual's time and attention, creating a situation where it will then cost the others. Role stagnation is the feeling of being stuck in the same role for long due to the lack of opportunities or development. Role overload is when the individual is required to do too much, or faces situations where they feel that there are too many responsibilities and activities expected of them. Personal inadequacy results from the lack of adequate knowledge, skills, or training to undertake the role, or not having sufficient time to prepare for the assigned role, and the resultant inability to meet the demands of one's role. Role ambiguity is due to the lack of clarity about the demands of one’s role, others’ expectations from the role, or the lack of feedback on how one's performance is regarded by others. A role, in this context, is understood to be a set of functions an individual performs in response to the expectations of others as well as their own. Other types of organisational role stress include role expectation conflict (resulting due to conflicting demands originating from superiors, subordinates, or peers), role erosion (a feeling that arises when others are performing certain functions that should have been a part of one's role), role isolation (when one's role is isolated from the mainstream organisational life), self-role distance (due to the gap between one's concept of self and the demands of one's role), and resource inadequacy (the human and material resources allocated being inadequate to meet the role's demands). These findings were made in a research paper authored by Nuwara Eliya Regional Director of Health Services Office Consultant Community Physician D.A. Gunawardane, Peradeniya Teaching Hospital Senior Registrar in Psychiatry S.I. Mallawaarachchi, and Medical Officers attached to the same hospital, P.H.M. Herath, R.S. Anwarama, and W.P.G.S. Warnasuriya, and published recently in the Journal of the Ruhunu Clinical Society. This was a descriptive cross-sectional study conducted at the Peradeniya Teaching Hospital from January to March 2014. The data was collected from non-specialist medical officers using a self-administered standardised questionnaire. Organisational role stress scores were classified into four categories: low-stress group (0-50), low-medium stress group (51-100), high-medium stress group (101-150), and the very high stress group (151-200). The study included 76 respondents (out of 138 doctors) from the different wards and units at the said hospital. The researchers noted that the reluctance of doctors to fill the questionnaire was a major difficulty in carrying out this study, giving rise to a high rate of non-response. The majority were male (41-53.9%) and married (59-77.6%). The mean age was 36.51 years, with working experience on average being 7.94 years. The mean organisational role stress score of the study group was 65.5. The majority (39-51.3%) of the doctors were experiencing low-medium role stress, and 27 (35.5%) had low role stress. However, nine (11.8%) had high-medium role stress, and one (1.3%) had very high role stress. It was found that, even though it was not statistically significant, male doctors had higher role stress than the female doctors. A statistically significant relationship was found, however, between marital status, age, years of experience, and management level. The study showed that role stress was experienced in comparatively higher amounts by medical officers, when compared to the reported norms. The mean scores of most of the stressors were found to be on the higher side, except for role erosion and role isolation. Timely promotions and the provision of postgraduate study opportunities, the authors noted, could address the issue of role stagnation. Personal inadequacy may be because 44.7% of the doctors have five or less than five years of experience, the researchers pointed out, adding that this could be diminished with appropriate training and the development of skills required for doctors based on their specific role. In this regard, continuous professional development programmes, which are tailor-made for the new challenges appearing in the health sector, are a prerequisite to address this issue. “Stress is described as a nonspecific response of the body to any demand made upon it, and factors affecting it include work, home, and personality. Stress in professions depends on the hierarchy of the position, and the scope of the competencies and responsibilities. Compared to the general working population, doctors and other health professionals show a higher level of stress,” the study observed. “Stress in medical professionals has potentially serious consequences, not only to the medical practitioner but also to the community, as stress and strain in medical professionals are likely to affect their work performance, including the quality of patient consultations and prescribing, as well as adversely affect their own personal and family life.  “It has been found that job stress impacts not only on the doctor’s health, but also their abilities to cope with the job demands. Work stress is a major contributing factor to growing job dissatisfaction among doctors. This will seriously impair the provision of quality care and the efficacy of the health service delivery.” Therefore, the authors emphasised, the findings of this study demand the attention of administrators and policymakers to provide an attractive working climate, to decrease the side effects and consequences of role-related stress, and to increase the productivity of doctors.


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