Legenes helse
PSL, 29.8 2014
Olaf Gjerløw Aasland
Legeforskningsinstituttet
www.legeforsk.org
Innnbyggere pr. lege i Norge
4000
3000
2000
1970: 743
2014: 214
1000
0
1880
1900
1920
1940
1960
1980
2000
2020
Legene er en viktig indikatorgruppe på
folkehelse fordi:
• De er en homogen gruppe med høy
sosioøkonomisk status
• De vet “alt” om helserisiko
• De kjenner symptomer og faresignaler ved akutt,
livstruende sykdom
• De røyker svært lite
• De har ekstremt lavt sykefravær
• De er rollemodeller (enten de vil eller ikke)
• Det finnes ofte legeregistre med god kvalitet
Forholdet mellom kulturell og individuell risiko
(etter Skog, 1991)
Risikanter i kulturer
med høy sykelighet
Risikanter i kulturer
med lav sykelighet
Lav risiko
(leger)
Normal risiko
Høy risiko
(pasienter)
5
The Doctor's Robe
Early in the 1600s, doctors
began wearing a robe of toilecirée, linen coated with a
wax paste. The idea was that
the plague came from
"venemous atoms" which
infected salubrious air
making it "miasmatic". These
atoms were "sticky", clinging
to things the way smoke or
perfume clings to things. The
waxed robe presumably
provided no surface to cling
to. The breathing tube beak
was filled with materials
imbued with perfume.
6
John William Ogle (1824-1905)
!
Filemon (368 –264 BC.): ”And this I know for
sure: we all know that doctors talk about the
importance of self control, but when they
themselves are exposed, they do all kinds of
things they never allowed others to do.”
Professor til 30 ferske medisin-studenter ved
Universitetet i Oslo i 1913:
“I løpet av studiet vil fire av dere dø av
tuberkulose”
Prof.dr.med.
Georg Waaler
(1895-1983)
1966
Documented occupational hazards for doctors before
1977 (Doll and Peto)
Radiologists
Leukemia and other cancers
Psychiatrists
Suicide
Laboratory doctors
General practitioners
Anaesthesiologists
Tuberculosis
Coronary trombosis
Cancer
14
Table IV from Doll R and Peto R. Mortality among doctors in different occupations. BMJ, 4 June 1977
Specific causes of death significantly (P < 0.05) more or less common among doctors in one particular specialty than
among doctors in other specialties
6 977 of 20 540 doctors who died between November 1951 and November 1971
Specialty
General practice, single-handed
General practice, in partnership
Public health
Hospital, medical specialty
Hospital, surgical specialty
Anaesthetics
Radiology
Armed Forces
Part-time anaesthetic users
Cause of death
More iscaemic heart disease1)
More chronic bronchitis2)
More bladder cancer
More alcoholism and cirrhosis of the liver
More Parkinsonism
More nephritis
Fewer aortic aneurysms
Less chronic bronchitis
Less ischaemic heart disease
Less ischaemic heart disease
More cancer of pancreas
More non-trombotic cerebrovascular disease
More oesophageal cancer
Less lung cancer
** P < 0.01; *** P < 0.001; all others nominally P < 0.05
1) And myocardial degeneration
2) And emphysema and pulmonary heart disease
3) 2 on the degree of freedom with continuity correction
# observed
1066
90
28
28
16
14
1
7
231
235
5
13
8
5
# expected
932.2
71.3
19.2
20.3
6.8
8.3
7.1
19.1
263.4
307.5
1.7
6.7
3.5
12.9
2-test 3)
28.9***
7.0**
5.4
3.9
13.6***
4.0
4.7
7.8**
4.3
19.0***
4.7
5.2
4.9
4.4
“general practitioners had higher mortality
from various causes, cardio-vascular in
particular, and hospital doctors had a
lower than expected mortality from
ischemic disease.”
Highlights from the UK doctor study
 About half of all regular cigarette smokers will
eventually be killed by their habit (BMJ 1994; 309: 901-11)
 People who stop smoking, even well into middle
age, avoid most of their subsequent risk of lung
cancer. (BMJ 2000; 321: 323-9)
 The consumption of alcohol appeared to reduce
the risk of ischaemic heart disease, largely
irrespective of amount. (BMJ 1994; 309: 911-8)
16
Some spinoffs from the US Physician Health Study
Exercise vigorous enough to work up a sweat is
associated with decreased stroke risk in men. (Stroke 1999;
99: 1161-4)
Vertex pattern baldness appears to be a marker for
increased risk of CVD events, especially among men
with hypertension or high cholesterol levels (Arch Intern
Med 3000; 160; 165-71)
Moderate drinking decreases the risk for angina
pectoris and myocardial infarction in apparently
healthy men (Ann Intern Med 1997; 126: 371-5)
17
The Women Physicians’ Health Study
 Women physicians report having generally good health habits
even when compared with other socioeconomically advantaged
women (Arch Intern med 1998; 158: 342-8)
 Women physicians spend little time on domestic activities that can
be done for them by others, including cooking, housework, and
especially gardening. Women physicians spend somewhat less
time on child care and substantially less time on housework than
do other US women (Arch Fam Med 2000; 9: 134-40)
 Female physicians contracept differently than do women in the
general population, in ways consistent with delaying and reducing
total fertility (Obstet Gynecol 1999; 94: 666-71)
18
Between 1960 and 2000 mortality for
doctors converged towards the mortality for
other university graduates and for people in
human service occupations. However, there
was a parallel increase in the gap between
these groups and the rest of the population.
The slightly higher mortality for doctors
compared with mortality for other university
graduates may be explained by the higher
suicide rate for doctors.
The Norwegian burnout study
females
males
females
males
368/500
315/500
Doctors
291/369
232/314
342/500
342/500
Nurses
278/342
218/342
312/500
276/500
Lawyers
218/312
194/342
342/500
342/500
Teachers
247/342
257/342
263/401
411/500
Church
ministers
190/263
310/411
297/500
286/500
Bus drivers
191/297
190/286
318/500
282/500
Information
technology
186/318
172/282
289/500
227/500
Advertisement
166/289
138/227
October 2003
October 2005
Burnout-scores (OLBI), Norwegian sample, 2003
2,3
Teachers
2,89
2,55
Bus drivers
Religious mnisters
2,75
1,98
2,74
2,07
DOCTORS
2,74
2,55
Advertisement
2,73
2,31
Nurses
2,69
2,5
IT-consultants
2,63
2,17
Lawyers
2,57
Emotional exhaustion
Detachment from work
Work–home conflict was a
particularly strong burnout predictor
in female physicians whereas
workload was the strongest burnout
predictor in male physicians. The
findings may have implications when
planning future interventions.
Self-employed GPs and private
practice specialist reported
lower sickness absence than
employed hospital doctors.
Differences in sickness
compensation, and
organisational and individual
factors may to a certain extent
explain this finding.
Jobbtilfredshet blant norske leger
Nylenna M, Aasland OG. Tidsskr Nor Legeforen 2010; 130: 1028-31.
Sammendrag:
Bakgrunn: Legers jobbtilfredshet har vært diskutert internasjonalt de senere årene på
bakgrunn av rapporter om økende profesjonell misnøye. Vi har studert norske legers
jobbtilfredshet og generelle tilfredshet.
Materiale og metode: En spørreskjemaundersøkelse ble høsten 2008 utført blant et
representativt utvalg yrkesaktive, norske leger. Jobbtilfredshet ble vurdert ved hjelp av
måleinstrumentet Job Satisfaction Scale som inkluderer ti aspekter ved arbeidsforholdene.
Resultater: I alt 1 072 leger (65 %) besvarte spørsmålene. Legene rapporterte en
gjennomsnittlig jobbtilfredshet på 5,3 på en skala fra 1 (svært misfornøyd) til 7 (svært fornøyd).
Jobbtilfredsheten økte med økende alder. Privatpraktiserende spesialister hadde høyest
jobbtilfredshet (5,8), og allmennleger (5,5) høyere jobbtilfredshet enn sykehusleger (5,1).
Vurdert etter spesialitetsgrupper skåret samfunnsmedisinere høyest (5,6) og leger i kirurgiske
fag lavest (5,0). Mens lang arbeidstid var negativt korrelert med jobbtilfredsheten, var det å ha
bistilling(er) og opplevelsen av å være faglig oppdatert positivt korrelert. 52,9 % av legene anga
meget høy generell tilfredshet.
Fortolkning: Norske leger har en høy grad av tilfredshet både med tilværelsen i sin
alminnelighet og med jobben. Den generelle tilfredsheten med tilværelsen var minst på linje
med den norske befolkningens.
“Sidespor”:
The young doctor should look about early for an
avocation, a pastime, that will take him away from
patients, pills, and potions . . . No [person] is really
happy or safe without one, and it makes precious
little difference what the outside interest may be –
botany, beetles or butterflies, roses, tulips, or irises,
fishing mountaineering or antiquities – anything will
do so long as he straddles a hobby and rides it hard.
Sir William Osler 1899
Norske leger prioriterer
kulturelle og musikalske
aktiviteter. At leger har et
særlig nært forhold til
musikk, er mer enn en myte.
Indeks for legenes kulturelle aktivitet:
• lesing av ikke-medisinsk litteratur i mer enn 20 minutter siste dag – 1 poeng
• spille et musikkinstrument - 1 poeng
• spille i orkester eller synge i kor – 1 poeng
• Besøk på kino, teater, opera, klassiske konserter og konserter med
populærmusikk siste 12 måneder:
• 1 – 4 besøk – 1 poeng
• fem eller flere besøk - 2 poeng
For både kvinnelige og mannlige leger har kulturindeksen økt fra 1993 til 2010. For
mennene er denne økningen statistisk signifikant.
•
•
•
•
•
Korrelasjon med jobbtilfredshet: ρ = 0,105 (p = 0,002)
Korrelasjoen med generell tilfredshet: ρ = 0,071 (p = 0,033
Korrelasjon med selvvurdert helse: ρ = 0,084 (p = 0,013)
Korrelasjoen med fysisk aktivitet: ρ = 0,171 (p < 0,001)
Korrelasjoen med jobbstress: ρ = –0,102 (p = 0,003)