Hekim-Hasta İlişkisinde Önemli Bir Sorun: Tükenmişlik ve Aile Hekimlerinde Tükenmişliği Etkileyen Faktörler

Yıl 2021, Cilt: 10 Sayı: 4, 705 - 713, 29.12.2021

Mustafa Samancı , Elif Dikmetaş Yardan

https://doi.org/10.37989/gumussagbil.907358

Öz

Çalışma, hekim-hasta ilişkisinde önemli bir faktör olan hekimlerin tükenmişlik düzeylerini ve bu düzeyi etkileyen faktörleri belirlemeyi amaçlamaktadır. Çalışma 21.03.2018 - 21.03.2019 tarihleri arasında Samsun'daki aile sağlığı merkezlerinde uygulanmıştır. Araştırmanın evrenini aile sağlığı merkezlerinde aktif olarak görev yapan 395 aile hekimi oluşturmaktadır. Araştırmada anket yöntemi kullanılmış ve tüm evrene ulaşılması amaçlanmıştır. Çalışmada evrenin % 75,8'ine (299 kişi) ulaşılmıştır. Araştırmanın yürütülmesi için OMÜ Klinik Araştırmalar Etik Kurulu raporu ve gerekli izinler alınmıştır. Çalışmada aile hekimlerinin duygusal tükenme düzeyleri ile çalıştıkları ilçe, günlük bakılan ortalama hasta sayısı, mesleki yeterlilik ve kurumdan memnuniyetleri arasında anlamlı farklılıklar bulunmuştur. Araştırmada aile hekimlerinin duyarsızlaşma düzeyleri ile Tıpta Uzmanlık Sınavı’ına (TUS) girme durumu ve kurumdan memnuniyet arasında anlamlı farklılıklar bulunurken, düşük kişisel başarı düzeyleri ile mesleki yeterlilik ve kurumdan memnuniyet arasında anlamlı farklılıklar bulunmuştur. Merkez ilçelerde çalışan aile hekimleri diğer ilçelere göre daha fazla duygusal tükenme yaşarken, günde 60'tan fazla hastaya bakan aile hekimleri, daha az hastaya bakanlara göre daha fazla duygusal tükenme yaşamaktadır. Ayrıca kendilerini mesleki olarak yeterli bulmayan aile hekimleri, kendilerini mesleki olarak yeterli bulanlara göre daha fazla duygusal tükenme yaşarlarken, kişisel başarı düzeyleri ise daha düşüktür.

Anahtar Kelimeler

Tükenmişlik, aile hekimliği, aile hekimleri, birinci basamak

Destekleyen Kurum

Ondokuz Mayıs Üniversitesi Bilimsel Araştırma Projeleri Birimi

Proje Numarası

OMÜ BAP Proje No: PYO.SBF.1904.18.007

An Important Problem in Physician-Patient Relationship: Burnout and Factors Affecing Burnout in Family Physicians

Öz

The study aimed to determine the burnout levels of physicians, which is an important factor in the physician-patient relationship, and the factors affecting this level. The study was applied in family health centers in Samsun between 21.03.2018 - 21.03.2019. The universe of the research consists of 395 family physicians who actively work in family health centers. Questionnaire method was used in the research and it was aimed to reach the whole universe. In the study, 75.8% of the universe (299 people) was reached. To conduct the research, OMÜ Clinical Research Ethics Committee report and necessary permissions were obtained. In the study, significant differences were found between the emotional exhaustion levels of family physicians and the district they work in, the average number of patients looked at per day, professional competence and satisfaction with the institution. In the study, while there were significant differences between the desensitization levels of family physicians and the status of entering TUS and satisfaction with the institution, significant differences were found between low personal achievement levels and professional competence and institution satisfaction. While family physicians working in the central districts experience more emotional exhaustion than those in other districts, family physicians who look at more than 60 patients per day experience more emotional exhaustion than those who look at less patients per day. In addition, family physicians, who do not find themselves professionally competent, experience more emotional exhaustion and lower personal success than those who find themselves professionally sufficient.

Anahtar Kelimeler

Burnout, family medicine, family physicians, primary care, psychology

Proje Numarası

OMÜ BAP Proje No: PYO.SBF.1904.18.007

Kaynakça

• Maslach, C, Schaufeli, W.B. and Leiter, M.P. (2001). “Job Burnout”. Annual Reviews. Psychol, 52, 397-422.
• Freudenberger, H.J. (1975). “Staff Burn- Out”. Journal of Social Issues,30 (1), 159-165.
• Bauernhofer, K, Bassa, D. Canazei, M. et al. (2018). “Subtypes in Clinical Burnout Patients Enrolled in An Employee Rehabilitation Program: Differences in Burnout Profiles, Depression, and Recovery/Resources-Stress Balance.” BMC Psychiatry, 18 (10). https://doi.org/10.1186/s12888-018-1589-y
• Maslach, C. and Jackson, S.E. (1981). “The Measurement of Experienced Burnout”. Journal of Occupational Behaviour, 2, 99-113.
• Jager, A.J, Tutty, M.A. and Kao, A.C. (2016). “Association Between Physician Burnout and Identification With Medicine as a Calling”. Mayo Clinic Proceedings. 2016, 1-8.
• Shanafelt, T.D, Hasan, O, Dyrbye, L.N. et al. (2015). “Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014”. Mayo Clinic Proceedings, 90 (12), 1600-1613.
• Yates, W.S. (2020). “Physician Stress and Burnout”. The American Journal of Medicine, 133 (2), 160-164.
• Mundt, M.P. and Zakletskaia, L.I. (2019). “Professional Communication Networks and Job Satisfaction in Primary Care Clinics”. Annals of Family Medicine, 17 (5), 428-435.
• Shanafelt, T, Goh, J. and Sinsky, C. (2017). “The Business Case for Investing in Physician Well-being”. JAMA Internal Medicine, 177 (12), 1826–1832.
• Thomas, L.R, Ripp, J.A. and West, C.P. (2018). “Charter on Physician Well-being”. JAMA, 319 (15), 1541–1542.
• Creager, J, Coutinho, A.J and Peterson, L.E. (2019). “Associations Between Burnout and Practice Organization in Family Physicians”. Annals of Family Medicine, 17 (6), 502-509.
• Dyrbye, L.N, Massie, F.S, Eacker, A. et al. (2010). “Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students”. JAMA, 304 (11), 1173-1180.
• Martin, S. (2002). “More Hours, More Tired, More To Do: Results From The CMA’s 2002 Physician Resource Questionnaire”. Canadian Medical Association Journal, 167 (5), 521-522.
• Virtanen, P, Oksanen, T, Kvimaki, M, Virtanen, M, Pentti, J. and Vahtera, J. (2008). “Work Stress and Health in Primary Health Care Physicians and Hospital Physicians”. Occupational and Environmental Medicine, 65, 364–366.
• Williams, E.S, Konrad, T.R, Scheckler, W.E. et al. (2010). “Understanding Physicians’ Intentions To Withdraw from Practice: The Role of Job Satisfaction, Job Stress, Mental and Physical Health”. Health Care Management Review, 35 (2), 105-115.
• Hoff, T, Whitcomb, W.F. and Nelson, J.R. (2002). “Thriving and Surviving in a New Medical Career: The Case of Hospitalist Physicians”. Journal of Health and Social Behavior, 43 (1), 72-91.
• Doolittle, B.R. (2016). “Are We the Walking Dead? Burnout as Zombie Apocalypse”. Annals of Family Medicine, 14, 578-580.
• Shanafelt, T.D, Balch, C.M, Bechamps, G.J. et al. (2009). “Burnout and Career Satisfaction Among American Surgeons”. Annals of Surgery, 250, 107-115.
• Shanafelt, T.D, Boone, S, Tan, L. et al. (2012). “Burnout and Satisfaction With Work-Life Balance among US Physicians Relative to the General US Population”. Archives of Internal Medicine, 172 (18), 1377-1385.
• Rassolian, M, Peterson, L.E, Fang, B. et al. (2017). “Workplace Factors Associated With Burnout of Family Physicians”. JAMA Internal Medicine, 177 (7), 1391.
• Kjeldmand, D. and Holmström, I. (2008). “Balint Groups as a Means to Increase Job Satisfaction and Prevent Burnout among General Practitioners”. Annals of Family Medicine, 6, 138-145.
• Shanafelt, T.D, Sinsky, C, Dyrbye, L.N, Trockel, M. and West, C.P. (2019). “Burnout Among Physicians Compared With İndividuals With A Professional or Doctoral Degree in A Field Outside of Medicine”. Mayo Clinic Proceedings, 94 (3), 549-551.
• Dikmetaş, E, Top, M. ve Ergin, G. (2011). “Asistan Hekimlerin Tükenmişlik ve Mobbing Düzeylerinin İncelenmesi”. Türk Psikiyatri Dergisi, 22 (3), 137-149.
• Weidner, A.K.H, Phillips, R.L, Fang, B. and Peterson, L.E. (2018). “Burnout and Scope of Practice in New Family Physicians”. Annals of Family Medicine, 16, 200-205.
• Soler, J.K, Yaman, H. and Esteva, M. (2008). “Burnout in European Family Doctors: The EGPRN Study”. Family Practice, 25, 245-65.
• Sayıl, I, Haran, S, Ölmez, Ş. ve Özgüven, D.H. (1997). “Ankara Üniversitesi Hastanelerinde Çalışan Doktor ve Hemşirelerin Tükenmişlik Düzeyleri”. Kriz Dergisi, 5 (2), 71-77.
• Güdük, M, Erol, Ş, Yağcıbulut, Ö, Uğur, Z, Özvarış, Ş.B. ve Aslan, D. (2005). “Ankara’da Bir Tıp Fakültesinde Okuyan Son Sınıf Öğrencilerde Tükenmişlik Sendromu”. Sürekli Tıp Eğitimi Dergisi, 14 (8), 169-173.
• Kurçer, M.A. (2005). “Harran Üniversitesi Tıp Fakültesi Hemşirelerinin İş Doyumu ve Tükenmişlik Düzeyleri”. Harran Universitesi Tıp Fakültesi Dergisi, 2 (3), 10-15.
• Taycan, O, Kutlu, L, Çimen, S. ve Aydın, N. (2006). “Bir Üniversite Hastanesinde Çalışan Hemşirelerde Depresyon ve Tükenmişlik Düzeyinin Sosyodemografik Özelliklerle İlişkisi”. Anadolu Psikiyatri Dergisi, 7, 100-108.
• Sünter, A.T, Canbaz, S, Dabak, Ş, Pekşen, Y. ve Öz, H. (2006). “Pratisyen Hekimlerde Tükenmişlik, İşe Bağlı Gerginlik ve İş Doyumu Düzeyleri”. Genel Tıp Dergisi, 16 (1), 9-14.
• Helvacı, I. ve Turhan, M. (2013). “Tükenmişlik Düzeylerinin İncelenmesi: Silifke’de Görev Yapan Sağlık Çalışanları Üzerinde Bir Araştırma”. İşletme ve İktisat Çalışmaları Dergisi, 1 (4), 58-68.
• Baykan, Z, Çetinkaya, F, Naçar, M, Kaya, A. ve Işıldak, N.Ü. (2014). “Aile Hekimlerinin Tükenmişlik Durumları ve İlişkili Faktörler”. Türkiye Aile Hekimliği Dergisi, 18 (3), 122-133.
• Şerik, B, Erdoğan, N, Ekerbiçer, Ç.H. et al. (2016). “Sakarya’da Aile Sağlığı Merkezlerinde Çalışan Aile Hekimlerinin Tükenmişlik Düzeyleri ve İlişkili Faktörler”. Sakarya Tıp Dergisi, (6) 2, 60-66.
• Elbi, H, Balcı, G.U, Nazik, F, Korkmaz, H. ve Öngel, K. (2014). “Afyonkarahisar İlinde Aile Hekimliği Sistemindeki Sağlık Çalışanlarının Tükenmişlik Düzeyleri”. Smyrna Tıp Dergisi, 36-40.
• Medscape. (2018). “Medscape National Physician Burnout and Depression Report 2018”. https://www.medscape.com/slide show/2018-lifestyle-burnout-depression-6009235#20 (cited 2020 May 3).
• Medscape. (2020). “Medscape National Physician Burnout and Suicide Report 2020: The Generational Divide”. https://www. medscape.com/slideshow/2020-lifestyle-burnout-6012460#14 (cited 2020 May 3).
• Rabinowitz, S, Kushnir, T. and Ribak, J. (1996). “Preventing Burnout Increasing Professional Self Efficacy in Primary Care Nurses in A Balint Group”. AAOHN Journal, 44 (1), 28-32.
• Samuel, O. (1989). “How Doctors Learn in a Balint Group”. Family Practice, 6 (2), 108-113.
• Salinsky, J. (2002). “The Balint Movement Worldwide: Present State and Future Outlook: A Brief Hıstory of Balint Around The World”. American Journal of Psychoanalysis, 62 (4), 327-335.
• Johnson, A.H. (2001). “The Balint Movement in America”. Family Medicine, 33 (3), 174-177.