Stress has been defined as a process by which certain situational demands are appraised by an individual as exceeding his own resources, resulting in undesirable health consequences.[4
] When the stressed person is a doctor, this can have profound implications on the patients as well as on his/her interpersonal relationships.
Most anaesthetists who responded to the survey worked in government or private medical colleges. This could be because anaesthetists in teaching institutions are more academically inclined and therefore attend academic programmes, or doctors working in other setups do not get relieved from clinical duties to attend such programmes.
In our study, we found that 18.3% of anaesthesiologists did not have any trainees in their hospital which could be the group working as freelancers or those in private hospitals. Hence, they were probably overworked. They were also probably the group who did not have professional support in the event of a complication. This is further strengthened by the fact that 21% were on call everyday and 22.6% were on call once in 2–3 days. According to the Association of Anaesthetists of Great Britain and Ireland Guidelines, disruption of normal circadian rhythms increases the likelihood of fatigue and shift work poses risk to performance.[5
Murray and Dodds investigated the effect of sleep deprivation on the level of vigilance and found that sleep deprivation leads to fatigue.[6
] The Australian Incident Study implicated human errors in 83% of incidents, and found that fatigue was a causative factor in 2.7%. Chronic sleep deprivation (in the first third of the night) is more likely to be seen in doctors who work frequent on calls or who have young children.[6
] Experience and training does not decrease the chances of a fatigue-related error.[6
] Gravenstein et al
. found that anaesthesiologists worked at least occasionally beyond the perceived self-limitations and they had made errors in the administration of anaesthesia due to fatigue.[7
] In a previous study, inherently difficult job situations (e.g. difficult intubation or recovery), interpersonal conflicts (e.g. lack of communication within the team, with the surgeon), and life career worries have been the cause of stress in anaesthesiologists.[4
] However, anaesthesiologists also reported high levels of job satisfaction, job challenge, work commitment and empowerment. This is known to negate the effect of stress.[4
] In our study, 80.9% anaesthetists reported some form of professional support when faced with complications. Only 3.5% of them were involved in litigations.
In a study conducted on Canadian postgraduate trainees, 68.1% felt stressed and 23.4% had thought about leaving the training programme.[1
] Trainee anaesthetists often feel inadequate at work and are exposed to stress.[8
] However, specialist anaesthetists have reported being content with their job.[9
] Inexperienced anaesthetists are at a greater risk of burnout.[4
] Resident burnout is associated with depression and problematic clinical performance.[10
] In trainee anaesthetists, the support provided by seniors not only helps in developing professional competence, but also helps them learn how to handle stress. Our study had 11.3% trainee anaesthetists who did not have the support of their senior colleagues.
In our study 30.4–60% of the anaesthetists reported to have excellent to good relationship with the surgeons, which is also a factor for stress among anaesthetists.[4
] Lack of respect from surgeons has been found to be an insignificant problem, easily solved by means of good communication.[11
Availability of adequate monitors in the intraoperative setting can help in decreasing the levels of stress experienced by anaesthesiologists. End-tidal capnograph has been described in the minimum monitoring standards, and hence is mandatory.[12
] It should be made available to all practicing anaesthesiologists.
Negative health consequences of stress include headache, stomach ache, ulcer, allergy and myocardial infarction, which were also found in our study. The high incidence of backache could be due to the fact that many of the anaesthetists were females or due to the prolonged hours of standing and the fact that anaesthetists work in multitude of areas like the intensive care, cardiac arrest teams, pain management, labour analgesia, remote anaesthesia for radiotherapy, computed tomography (CT), magnetic resonance imaging (MRI) etc. Many of them also travel long distances inthe private setup. High incidence of acid peptic disease could be due to working in shift duty, ingestion of caffeine and alcohol. The low reporting of depression may be due to the social stigma associated with it in India or because most of them were married. Studies have shown that residents who were married (65%) or in a common-law relationship (30%) had less stress.[1
Coping with stress involves efforts at solving problems that arise to cause stress. It also includes the ways the stressors may be turned into positive challenges, and thus their negative physical and psychological effects may be reduced.[13
According to the Audit Commission report at London, anaesthesia has been described as a “poorly understood medical specialty”. Many patients do not realise that anaesthetists are doctors,[13
] which can be solved by effective communication.
Anaesthetists’ activities affect up to two-thirds of the income generated, yet accounting for only 3% of the salaries paid in many hospitals.[14
] In our study also, it was observed that 26.1% of the anaesthetists received poor remuneration. It also shows the disparity in the number of hours of work they put in and the remuneration they receive.
Reading journals and updating our knowledge is an important aspect of our career. Attending conferences as well as interacting with other members of our specialty help us achieve this goal.