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CONTENTS
I. Introduction & BackgroundII. ObjectivesIII. Literature ReviewIV. Study DesignV. Eligibility CriteriaVI. Sampling Size & TechniqueVII. Ethical ConsiderationsVIII. Data Collection,Methods,Instruments,MeasurementsIX. Data management & Analysis PlanX. ResultsXI. DiscussionXII. ConclusionXIII. SuggestionsXIV. ReferencesXV. AcknowledgementsXVI. SummaryXVII. TimelineXVIII. Budget
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Consequences of stress include changes of behavior and attitude of theperson.
Diarrhea, anxiety, insomnia, headache, and psychological depression are thetypical symptoms of stress.
It can also be linked to an upset stomach, back pain, and trouble sleeping. It can weaken the immune system, making it harder to fight of disease. Stress can worse the disease and lead to depression and ultimately
unsatisfactory professional performance.
The proportion of doctors and other health professionals showing above
threshold levels of stress have stayed remarkably constant at around 28%, whether
the studies are cross sectional or longitudinal, compared with around 18% in the
general working population. 1 What has changed over the years is that, contrary to
the experience of the two registrars, doctors have become used to discussing thetopic of stress and even to admitting to it in themselves. They are more aware of their
colleagues' symptoms than they were, which means that they may be more likely to
help colleagues through a difficult time or suggest they get help when they need it.
Interest in stress has broadened as organizations have finally accepted that stress
costs them vast amounts of moneythrough absence, litigation, and the fact that
unhappy, tense, tired, or anxious doctors do not produce quality care.2 Indeed,
stressed doctors may make considerably more errors than those whose sense of well
being is high.3 This is particularly true if they have insufficient hours of sleep;4
however, we now know that working long hours in itself is not the cause of problems
provided a doctor feels well supported. Stress and all its related problems come both
from the workplace and from the individual. Individual causes may be to do withpersonality or with ways of thinking, such as being particularly self critical, or having
certain types of unsupportive early family relationships; or they may come from job
related factors such as lack of sleep, poor communication, and poor teamwork.2
Better teams have less stressed staff,5 probably because they support each other,
notice when one person is performing below par, and step in to help.
Objectives
Study level of stress in Doctors Compare stress between doctors of Govt. and Private hospitals Study factors which cause stress.
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A paper attempted to compare job satisfaction and mental wellbeing of male and
female general practitioners[GPs] of England from a quastionnaire study. Female GPs
showed positive signs of mental wellbeing. Conversely, male doctors showed
significantly higher anxiety and depression score than the females. However both
genders were unhappy about rate of pay, hours of work and amount of work they do.
Analysis disclosed 3 job stressors: pressure/interruptions, working
environment/communication, career and goal acheivments.[10]
In a research it was found that main causes of stress in GPs were uncertainity and
insecurity about work, isolation, a poor relationship with other doctors,
disillusionment with role of general practice and an awareness of changing demands.
Factor analysis of work stress in GPs highlighted new contract demands such as
Organizational management changes and communicating with health service
managers, working with practice staff and non-clinical routine.[11]
Materials And MethodologyStudy Design
It was a Descriptive type of study.
Eligibility Criteria
Inclusion Criteria:
y Doctors
y Both sexes
y Doctors currently doing job in a hospital.
Exclusion Criteria:
y Persons having recent accident or mishapy Persons with nervous breakdown
y Persons having any physical disability or any other significant medical issue
y Doctors above 60 years of age.
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Sampling size and TechniqueSample size was calculated usingEpi-info software programme.
Sample Size : 60
Technique : Stratified random Technique
Ethical ConsiderationsWe should properly introduce ourselves first, inform them(the doctors) about our research
and very politely request them to help us with data collection (in our case: questionnaires),
with their full co-operation.
Data collection Methods,Instruments,
Measurements.
Data Collection Methods:-
Specifically designed Questionnaires for socio-demographic characteristics, physical and
mental health, job stress, and satisfaction are to be distributed among Doctors.
Instruments:-
y Questionnaires
Measurements:-
y Frequency Tables (Age/Duration of job)
y Grading of stressy Sex distribution
y Number of working hours
y Proper security
y Frequency of vacations
y Family support
y Average income
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y Graphical representations of the above
y Relation of above factors with the stress level of the doctors
y Comparison of stress among doctors of Govt. and Private hospitals.
Data Management and Analysis PlanMicrosoft Excel was used for the purpose of tabulation, calculations and data management.
RESULTS
Data was collected from 60 Doctors who were currently working in hospitals. 30 doctors
from :
Government hospitals:
y Services Hospital Lahore
y Punjab Institute of Cardiology,Lahore
And 30 from Private hospitals:
y FMH,Lahore
y Umar Hospital,Lahore
y Cardiac..
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Distribution of data in Government hospitals is:
Sex Distribution:
Fig.1 Distribution of data according to sex
Above figure, shows that out of 30 doctors under study 70% i.e.21 were males and 7 werefemales.
Stress Score:
Level of stress along with its frequency was:
Table 1: Stress score with its frequency
and percentage
The table scores stress in 3 levels in which 23.3% doctors have mild stress, 50.0% have
moderate stress and 26.7% suffer from severe stress.
Given below is the graphical representation of the stress scores in the Table.1
Figure.2: Stress score
30%
70%
SEX DISTRIBUTIONfemale male
23.30%
50.00%
26.70%
mild moderate severe
stress score
Percent
stress score Frequency Percent Cum Percent
mild 7 23.3% 23.3%
moderate 15 50.0% 73.3%
severe 8 26.7% 100.0%
Total 30 100.0% 100.0%
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Headache Associated with stress:
Table.2: Headache associated with stress in males and
females
oddratio=0.6
chi-square=0.2922
Table.2 tells us the percentage of males and females who have headache associated with
stress i.e in females 66.7% of the doctors said yes,while 33.3% do not have headache
associated stress.
In male doctors, 73.3% have stress with headache while 26.7% do not have headache
associated stress.
In total 73.3% doctors(including both males and females) have headache with stress while
26.7% do not have headache with stress.
Change in attitude associated with sex:
in many cases behavior of the person is reflected by his/her profession. To study the change
in attitude the results obtained are tabulated below:
CHANGE IN ATTITUDE
sex Yes No TOTAL
female
Row %
Col %
6
66.7
28.6
3
33.3
33.3
9
100.0
30.0
male
Row %
Col %
15
71.4
71.4
6
28.6
66.7
21
100.0
70.0
TOTALRow %
Col %
21
70.0
100.0
9
30.0
100.0
30
100.0
100.0
HEADACHE / INSOMNIA
sex Yes No TOTALfemaleRow %
Col %
6
66.7
27.3
3
33.3
37.5
9
100.0
30.0
maleRow %
Col %
16
76.2
72.7
5
23.8
62.5
21
100.0
70.0
TOTAL
Row %
Col %
22
73.3
100.0
8
26.7
100.0
30
100.0
100.0
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Table.3: Percentage of change in attitude associated with sex
Odd ratio=0.800
Chi-square= 0.068
Studies have shown that in female doctors 66.7% have change in attitude due to stress
while 33.3% do not. On the other hand 71.4% male doctors have change of attitude
because of stress,and 28.6% do not have change of attitude.
FACTORS AFFECTING STRESS
SEX:
To study any effect of gender on the level and degree of stress in the doctors.According to
survey it was analysed that :
Table.4: Stress affected by gender of the doctor
Single Table Analysis
Chi-square df Probability
5.4870 2 0.0643
INCOME:
Income plays a very crucial role not only in the profession of medicine but in every
profession. According to research carried out it was observed that doctors satisfied with
STRESS SCORE
sex mild moderate severe TOTAL
femaleRow %
Col %
5
55.6
62.5
2
22.2
18.2
2
22.2
18.2
9
100.0
30.0
male
Row %
Col %
3
14.3
37.5
9
42.9
81.8
9
42.9
81.8
21
100.0
70.0
TOTAL
Row %
Col %
8
26.7
100.0
11
36.7
100.0
11
36.7
100.0
30
100.0
100.0
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their income had less severe stress while doctors not satisfied with the income were more in
stress.
Table.5: Income affecting stress levels
Single Table Analysis
Chi-square df Probability
3.2323 2 0.1987
Working hour:
Stamina and energy levels after continuous work gradually star depleting and therefore tire
the doctor which directly causes stress. Severe form of stress has been seen in doctors
working more than 50 hours a week.
Table.6: Relation of working hours and
stress
Single Table Analysis
Chi-square df Probability
STRESS SCORE
enough income mild moderate severe TOTAL
YesRow %
Col %
2
66.7
25.0
1
33.3
9.1
0
0.0
0.0
3
100.0
10.0
No
Row %
Col %
6
22.2
75.0
10
37.0
90.9
11
40.7
100.0
27
100.0
90.0
TOTAL
Row %
Col %
8
26.7
100.0
11
36.7
100.0
11
36.7
100.0
30
100.0
100.0
working hrs mild moderate severe TOTAL
50
Row %
Col %
3
13.6
37.5
10
45.5
90.9
9
40.9
81.8
22
100.0
73.3
TOTAL
Row %Col %
8
26.7100.0
11
36.7100.0
11
36.7100.0
30
100.0100.0
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7.3954 2 0.0248
Family support:Family support and decisions play a very important part in the performance and energy level
of the doctor both directly and indirectly.
Table.7:Family support and stress
Single Table Analysis
Chi-square df Probability
.6676 2 0.7162
Security:
Freedom of performance and activity is also dependant upon the security and the
environment in which the doctor is working.Lack of security greatly affects the work and
causes severe forms of stress in 58.8% of the doctors under study.
family support mild moderate severe TOTAL
YesRow %
Col %
7
29.2
87.5
9
37.5
81.8
8
33.3
72.7
24
100.0
80.0
No
Row %
Col %
1
16.7
12.5
2
33.3
18.2
3
50.0
27.3
6
100.0
20.0
TOTAL
Row %
Col %
8
26.7
100.0
11
36.7
100.0
11
36.7
100.0
30
100.0
100.0
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Table.8: Security and stress
Single Table Analysis
Chi-square df Probability
11.6279 2 0.0030
Vacations:
Some leaves and vacations for entertainment or rest is necessary in every profession
hence,less vacations lead to frequency of more stress.
Table.9: Security and stress
Single Table Analysis
Chi-square df Probability
1.1580 2 0.5605
STRES SCORE
proper security mild moderate severe TOTAL
YesRow %
Col %
7
53.8
87.5
5
38.5
45.5
1
7.7
9.1
13
100.0
43.3
No
Row %
Col %
1
5.9
12.5
6
35.3
54.5
10
58.8
90.9
17
100.0
56.7
TOTAL
Row %
Col %
8
26.7
100.0
11
36.7
100.0
11
36.7
100.0
30
100.0
100.0
STRESS SCORE
proper vacations mild moderate severe TOTAL
YesRow %
Col %
3
33.3
37.5
4
44.4
36.4
2
22.2
18.2
9
100.0
30.0
NoRow %
Col %
5
23.8
62.5
7
33.3
63.6
9
42.9
81.8
21
100.0
70.0
TOTALRow %
Col %
8
26.7
100.0
11
36.7
100.0
11
36.7
100.0
30
100.0
100.0
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PRIVATE HOSPITALS
Sex Distribution:
Fig.3: Distribution of data according to sex
Above figure, shows that out of 30 doctors under study 70% i.e.21 were males and 30% i.e:
7 were females.
Stress Score:
Level of stress along with its frequency was:
stress score Frequency Percent Cum Percent
mild 5 16.7% 16.7%
moderate 22 73.3% 90.0%
sever 3 10.0% 100.0%
Total 30 100.0% 100.0%
Table.10: Stress score with its frequency and percentage
The table scores stress in 3 levels in which 16.7% doctors have mild stress, 73.3% have
moderate stress and 10.0% suffer from severe stress.
Given below is the graphical representation of the stress scores in the Table.10
70%
30%
Sex Distribution
Male
Female
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Fig.4: Stress Score
Headache Associated with stress:
Table.11: Headache associated with stress
odd ratio=1.125
chi-square=0.0155
Table.11 tells us the percentage of males and females who have headache associated with
stress i.e in females 75.0% of the doctors said yes,while 25.0% do not have headache
associated stress.
In male doctors, 72.7% have stress with headache while 27.3% do not have headache
associated stress.
In total 73.3% doctors(including both males and females) have headache with stress while
26.7% do not have headache with stress.
16.70%
73.30%
10.00%
mild moderate sever
Percent
Percent
HEADACHE/INSOMNIA/FATIGUE
sex Yes No TOTAL
femaleRow %
Col %
6
75.0
27.3
2
25.0
25.0
8
100.0
26.7
male
Row %
Col %
16
72.7
72.7
6
27.3
75.0
22
100.0
73.3
TOTAL
Row %
Col %
22
73.3
100.0
8
26.7
100.0
30
100.0
100.0
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Change in attitude associated with sex:
Table.12: Percentage of change in attitude associated
with sex
odd ratio=0.667
chi-square=0.1705
FACTORS AFFECTING STRESS
SEX:
Table.13: Stress affected by gender of the
doctor
Single Table Analysis
Chi-square df Probability
4.1064 2 0.1283
CHANGE IN ATTITUDE
sex Yes No TOTAL
female
Row %
Col %
6
75.0
25.0
2
25.0
33.3
8
100.0
26.7
male
Row %
Col %
18
81.8
75.0
4
18.2
66.7
22
100.0
73.3
TOTALRow %
Col %
24
80.0
100.0
6
20.0
100.0
30
100.0
100.0
sex mild moderate sever TOTAL
female
Row %
Col %
3
37.5
60.0
5
62.5
22.7
0
0.0
0.0
8
100.0
26.7
male
Row %
Col %
2
9.1
40.0
17
77.3
77.3
3
13.6
100.0
22
100.0
73.3
TOTALRow %
Col %
5
16.7
100.0
22
73.3
100.0
3
10.0
100.0
30
100.0
100.0
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INCOME:
Table.15: Income affecting stress
levels
Single Table Analysis
Chi-square df Probability
1.5496 2 0.4608
Working Hours:
Table.16:Relation of Working Hours and
stress
Single Table Analysis
STRESS SCORE
enough income mild moderate sever TOTAL
Yes
Row %
Col %
2
25.0
40.0
6
75.0
27.3
0
0.0
0.0
8
100.0
26.7
No
Row %
Col %
3
13.6
60.0
16
72.7
72.7
3
13.6
100.0
22
100.0
73.3
TOTALRow %
Col %
5
16.7
100.0
22
73.3
100.0
3
10.0
100.0
30
100.0
100.0
STRESS SCORE
Working hours mild moderate sever TOTAL
50Row %
Col %
0
0.0
0.0
12
80.0
54.5
3
20.0
100.0
15
100.0
50.0
TOTAL
Row %
Col %
5
16.7
100.0
22
73.3
100.0
3
10.0
100.0
30
100.0
100.0
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Chi-square df Probability
8.1818 2 0.0167
Family Support:
Table.17:Family support and stress
Single Table Analysis
Chi-square df Probability
1.6364 2 0.4412
Security:
Table.18:Security and stress
STRESS SCORE
family support mild moderate sever TOTAL
YesRow %
Col %
5
20.0
100.0
18
72.0
81.8
2
8.0
66.7
25
100.0
83.3
NoRow %
Col %
0
0.0
0.0
4
80.0
18.2
1
20.0
33.3
5
100.0
16.7
TOTAL
Row %
Col %
5
16.7
100.0
22
73.3
100.0
3
10.0
100.0
30
100.0
100.0
STRESS SCORE
Proper security mild moderate sever TOTAL
Yes
Row %
Col %
4
23.5
80.0
13
76.5
59.1
0
0.0
0.0
17
100.0
56.7
No
Row %
Col %
1
7.7
20.0
9
69.2
40.9
3
23.1
100.0
13
100.0
43.3
TOTALRow %
Col %
5
16.7
100.0
22
73.3
100.0
3
10.0
100.0
30
100.0
100.0
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Single Table Analysis
Chi-square df Probability
5.0843 2 0.0787
Vacations:
Table.19:Vacations and stress
Single Table Analysis
Chi-square df Probability
2.0455 2 0.3596
..
COMPARISON BETWEEN GOVERNMENT
AND PRIVATE
STRESS:
stress score Frequency Percent Cum Percent
mild 7 23.3% 23.3%
moderate 15 50.0% 73.3%
severe 8 26.7% 100.0%
STRESS SCORE
prpoper vacations mild moderate sever TOTAL
Yes
Row %
Col %
2
33.3
40.0
4
66.7
18.2
0
0.0
0.0
6
100.0
20.0No
Row %
Col %
3
12.5
60.0
18
75.0
81.8
3
12.5
100.0
24
100.0
80.0
TOTALRow %
Col %
5
16.7
100.0
22
73.3
100.0
3
10.0
100.0
30
100.0
100.0
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Total 30 100.0% 100.0%
stress score Frequency Percent Cum Percent
mild 5 16.7% 16.7%
moderate 22 73.3% 90.0%sever 3 10.0% 100.0%
Total 30 100.0% 100.0%
stress
score
private govt
mild 5 7
moderate 22 15
severe 3 8
total 30 30
Chi-square=3.93
According to the above graphical representation, it is seen that stress levels vary among
doctors working in Govt and private hospitals. Doctors of private hospitals have less mild
stress ,while more moderate form of stress than doctors of Govt.hospitals. On the other
hand severe stress is seen in doctors of government hospitals rather than private ones.
23.30%
50.00%
26.70%16.70%
73.30%
10.00%
Mild Moderate Severe
stress score
Stress Score Govt. Percent Stress Score Private Percent
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Headache:
headache /
insomnia/fatigue
Frequency Percent Cum
Percent
Yes 22 73.3% 73.3%
No 8 26.7% 100.0%
Total 30 100.0% 100.0%
headache/insomnia/fatigue Frequency Percent Cum Percent
Yes 22 73.3% 73.3%
No 8 26.7% 100.0%
Total 30 100.0% 100.0%
headache private govt
yes 22 22no 8 8
Frequency of headache is seen equally in doctors of both government and private hospitals.
Attitude
change inattitude Frequency Percent Cum Percent
Yes 21 70.0% 70.0%
No 9 30.0% 100.0%
Total 30 100.0% 100.0%
73.30%
26.70%
73.30%
26.70%
Yes No
headache/insomnia/fatigue
Chart Title
Govt. Private
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change in attitude Frequency Percent Cum Percent
Yes 24 80.0% 80.0%
No 6 20.0% 100.0%
Total 30 100.0% 100.0%
change in
attitude
private govt
yes 24 21
no 6 9
Oddratio=0.58
Chi-square=0.8
FACTORS AFFECTING STRESS:
Income
enough income Frequency Percent Cum Percent
Yes 3 10.0% 10.0%
No 27 90.0% 100.0%
Total 30 100.0% 100.0%
enough income Frequency Percent Cum Percent
Yes 8 26.7% 26.7%
No 22 73.3% 100.0%
70.00%
30.00%
80.00%
20.00%
yes No
Change in attitude
Govt. Private
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no 13 18
Odd ratio=0.51
Chi-square=1.67
Vacations:
proper vacations Frequency Percent Cum Percent
Yes 9 30.0% 30.0%
No 21 70.0% 100.0%
Total 30 100.0% 100.0%
proper vacations Frequency Percent Cum Percent
Yes 6 20.0% 20.0%
No 24 80.0% 100.0%
Total 30 100.0% 100.0%
vacations private govt
yes 6 9
no 24 21
40.00%
60.00%56.70%
43.30%
yes No
Proper security
Chart Title
Govt. Private
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Odd ratio = 0.58
Chi-square= 0.80
DISCUSSIONA lot of previous researches have been done on topic of 'Stress level in doctors' but we could'vt
find any research on topic of 'Comparison of stress level among doctors of Government andPrivate Hospitals'
A research was conducted at teaching hospitals of Karachi by Community Department ofAga
Khan Medical University. According to this research 68% doctors were not satisfied their jobs
anr among them 65% were males and 72% were males.[1]
According to a research conducted at Bahawal-Victorea Hospital/Quaid-e-Azam Medical College
Bahawalpur, 56% doctors were not satisfied with their jobs.[2]
According to our research: in government hospitals, 23.3% doctors had mild stress, 50.0% had
moderate stress and 26.7% had severe stress. In private hospitals: 16.7% doctors had mildstress, 73.3% had moderate stress and 10.0% had severe stress.
Research of teaching hospitals of Karachi showed that 45% of doctors reported that job stress
affects their physical health and 53% said that it affects their mental health however these
results were not different in different sex.[1]
According to a research conducted at German Hospital Institute, physicians with exessively
30.00%
70.00%
20.00%
80.00%
yes No
Proper Vacations
Chart Title
Govt. Private
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long working hours had significantly high sum score of health complaints and significantly
increased mental and physical fatigue symptoms [feeling faint,languor,uneasiness,heavy
legs,insomnia,mood changes], GI [nausea,weight loss], heart disorders, chest pain.[3]
According to our research: in government hospitals, 73.3% doctors were having
headache/insomnia/fatigue at the end of working hours. In private hospitals, 75% doctors were
having headache/insomnia/fatigue at the end of working hours.
According to our research: in government hospitals, 66.7% of total females and 71.4%of total
males were having change in their attitude at the end of their working hours. In private sector,
75% of total females and 81.8% of total males were having change in their attitude at the end
of working hours.
According to a study at Karachi overall 56% doctors were not satisfied with level of their
income. It was found that 92% of all the doctors were neither satisfied with the present servicestructure nor with the career prospects in Pakistan.
[1]
According to our research: in government hospitals,90% doctors were not satisfied with their
monthly income. In private hospitals, 73.3% doctors were not satisfied with their monthly
income.
Work has to be done to compare stress level of Government and Private Hospitals so that
better facilities can be given to doctors.
CONCLUSIONBoth the doctors working in Government and Private hospitals are facing a lot of stress. More
doctors of Government Hospitals were suffering from severe stress as compared to doctors of
Private Hospitals. The factors causing stress were different. Lack of proper income, long
working hours, lack of proper security at workplace are causing more stress in doctors of
Government hospitals whereas inadequate number of vacation is causing more stress in
doctors of Private Hospitals. Level of headache at the end of working hours is equal in bothwhereas doctors of Private hospitals feel more change in their attitude at the end of working
hours.
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SUGGESTIONSFollowing measures should be taken to reduce stress level in doctors:
y Working hours should be reduced.
y Income of doctors should be raised so that they can fulfill their necessities of life.
y Families of doctors should support them in terms of their professional life.
y Doctors should be given proper security at workplace.
y Proper vacations should be given.
y Patients should encourage doctors.
y Proper working environment should be given.
y Doctors should be given opportunities for professional growth.
y Work should be done on Government level to reduce stress in doctors.
REFERENCES
1. Wall TD, Bolden RI, Borrill CS, Carter AJ, Golya DA, Hardy GE, et al
. Minor psychiatric disorders in NHS trust staff: occupational and gender
2. Firth-Cozens J
. Interventions to improve physicians' wellbeing and patient care. Soc Sci Med 2001; 52: 215222
[CrossRef][Medline][Web of Science]
3. Jones JW, Barge BN, Steffy BD, Fay LM, Kunz LK, et al
. Stress and medical malpractice: Organizational risk assessment and intervention. J Applied Psychol 1988;
4: 727735
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ACKNOWLEDGEMENTSWe are thankful to all doctors who participated whole heartidely in our research and
encouraged us for highlighting their job stress issues.
Prof. Dr.Shahid Mahmood
Professor / Head of Department of Community Medicine
SIMS/Lahore
Dr. Abdul Rauf
Demonstrator Department of Community Medicine
SIMS/Lahore.
ANNEXURE