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"Ich habe in meinen ersten Wochen sehr viel geweint."
"Ich sehe es weniger als chirurgische Ausbildung und mehr als Resilienz-Training."
Auf beiden Seiten (Ärzt:innen & Patient:innen) gibt es relevante [1], rezente [2] und eindrucksvolle [3] Studien und Forschungen zu den von mir wahrgenommenen Brennpunkten.
[1] 1233 Resultate zu Stichwortsuche vascular surgery patient anxiety auf PubMed.
[2] 367 Resultate davon seit 2019
[3] Diese werden als nächstes vorgestellt.
Conclusion: Nearly one-half of vascular surgery trainees reported symptoms of burnout, which was associated with frequency of mistreatment and duty-hour violations. Interventions to improve well-being in vascular surgery must be tailored to the local training environment to address trainee experiences that contribute to burnout.
Burnout and medical errors among American surgeons (Annals of Surgery; Jun 2010)
Conclusion: Major medical errors reported by surgeons are strongly related to a surgeon's degree of burnout and their mental QOL. Studies are needed to determine how to reduce surgeon distress and how to support surgeons when medical errors occur.
Physician Burnout: The Hidden Health Care Crisis (Clin Gastroenterol Hepatol. 2018 Mar;)
Why does it matter? Physicians who are burned out are more likely to have lower patient satisfaction scores, as well as experience an increased association with medical errors. The latter point is highlighted by the American College of Surgeons study,
showing that medical errors were associated with longer work hours, more time spent on call, and more time in the operating room. Medical and surgical errors not only may cause patient harm, but also may harm the physician (increased likelihood of a lawsuit), the physician’s family (burnout affecting home life), and the physician’s institution. As reimbursements become tied to patient care outcomes, medical errors and quality will have the potential for financial implications. In addition, reporting a medical or surgical error has significant downstream consequences. The American College of Surgeons survey found that reporting an error was associated with a high prevalence of emotional exhaustion, higher rates of depersonalization, and a doubling of depression rates.
Physician Stress and Burnout (Am. Journal of Medicine)
The often-repeated goals of the Triple Aim (enhancing patient experience, improving population health, and reducing costs) may be unreachable until we recognize and address burnout in healthcare provider, reframing the discussion to include interventions to address physician burnout (a Quadruple Aim strategy).34
Without our own oxygen mask in place, we cannot help those around us.
Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training
Conclusion: Mistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.
American Journal of Surgery 2002
Understanding perioperative pathophysiology and implementation of care regimes to reduce the stress of an operation, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge. Developments and improvements of multimodal interventions within the context of "fast track" surgery programs represents the major challenge for the medical professionals working to achieve a "pain and risk free" perioperative course.
The majority of patients awaiting surgery are anxious1, and some degree of anxiety is a natural reaction to the unpredictable and potentially threatening situations typical of the preoperative period2. However, an excessive level of anxiety may have a negative impact on treatment outcomes, and this has been demonstrated in patients in different medical settings.
Armfield et al.3 demonstrated that dental fear is associated with more decayed and missing teeth but fewer filled teeth. Moreover, people with higher dental fear experience significantly more caries.
It is well established that increased levels of preoperative anxiety are associated with worse postoperative pain, extended hospital stays and frequent readmission4–6.
The negative influence of patient-reported anxiety on outcomes has also been demonstrated in patients undergoing cardiac surgery.
Székely et al.7 studied patients who underwent cardiac surgery and found an independent association between anxiety and mortality.
Preoperative anxiety was evaluated in a cohort of older patients undergoing cardiac surgery by Williams et al.5, and significantly higher mortality was observed among older patients who experienced high levels of preoperative anxiety
World Journal of Surgery
2022
Background: Preoperative anxiety is associated with increased morbidity and/or mortality in surgical patients. This study investigated the incidence, predictors, and association of preoperative anxiety with postoperative complications in vascular surgery.
Methods: Consecutive patients undergoing aortic, carotid, and peripheral artery surgery, under general and regional anesthesia, from February until October 2019 were included in a cross-sectional study. Anesthesiologists assessed preoperative anxiety using a validated Serbian version of the Amsterdam Preoperative Anxiety and Information Scale. Patients were divided into groups with low/high anxiety, both anesthesia- and surgery-related. Statistical analysis included multivariate linear logistic regression and point-biserial correlation.
Results: Of 402 patients interviewed, 16 were excluded and one patient refused to participate (response rate 99.7%). Out of 385 patients included (age range 39-86 years), 62.3% had previous surgery. High-level anesthesia- and surgery-related anxieties were present in 31.2 and 43.4% of patients, respectively. Independent predictors of high-level anesthesia-related anxiety were having no children (OR = 0.443, 95% CI: 0.239-0.821, p = 0.01), personal bad experiences with anesthesia (OR = 2.294, 95% CI: 1.043-5.045, p = 0.039), and time since diagnosis for ≥ 4 months (OR = 1.634, 95% CI: 1.023-5.983, p = 0.04). The female sex independently predicted high-level surgery-related preoperative anxiety (OR = 2.387, 95% CI: 1.432-3.979, p = 0.001). High-level anesthesia-related anxiety correlated with postoperative mental disorders (rpb = 0.193, p = 0.001) and pulmonary complications (rpb = 0.104, p = 0.042). Postoperative nausea (rpb = 0.111, p = 0.03) and postoperative mental disorders (rpb = 0.160, p = 0.002) correlated with high-level surgery-related preoperative anxiety.
Conclusions: Since preoperative anxiety affects the postoperative course and almost every third patient experiences anxiety preoperatively, routine screening might be recommended in vascular surgery.
Kurz zum Begriff "Kritik"
Einsicht von Notwendigkeit;
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Of the 16 specialties included, pediatric (86% to 96%) and endocrine (96%) surgeons demonstrated the highest career satisfaction, whereas a portion of plastic surgeons (33%) and vascular surgeons (64%) were least satisfied.
Those further in training had lower levels of burnout, while residents suffered more than their seniors. Burnout is associated with a lower personal quality of life, depression and alcohol misuse. Academic work and emotional intelligence may be protective of burnout. Certain personality types are less likely to be burnt out. Mentorship may reduce levels of burnout.
The findings suggest that the health professionals who responded to the survey were aware of behavioural signs of stress, anxiety and mood problems in their patients with chronic wounds. Furthermore, the majority of practitioners did not feel that their patients were receiving help or treatment for these problems. It is therefore suggested that increased awareness of the behavioural signs of stress, anxiety and mood problems among patients with wounds could help to improve the patient's experience of wound care, as acknowledgement of mood problems could lead to the most appropriate form of treatment or help for individual patients.
The two groups were identical at baseline regarding anxiety, socio-demographic and clinical characteristics. After the patient-centered intervention, the IG showed lower levels of preoperative anxiety (p < 0.001) and pain (p < 0.001), better surgery recovery (p < 0.01) and higher levels of daily activity (p < 0.001) and of satisfaction with the information received (p < 0.01) than the CG. The IG also showed better wound healing (tissue type, p < 0.01; local pain, p < 0.01).
Sozioökonomische Überlegungen des Gesundheitssystem.
Wofür überhaupt Chirurgie, wenn nicht...
PatientInnenwohl.
Ordentliche Anamnese?
Fragen ob die Patient:Innen Angst haben?
Seelsorge?
Psycholog:in/Psychiater:in?
Benzodiazepine?
Süffisante Fragen oder tatsächlich Grundlegendes Problem?
TikTok browsing for anxiety relief in the preoperative period: A randomized clinical trial (Gu et al., 2021)