Burnout is an occupational phenomenon and we need to look beyond the individual to find effective solutions, argue A Montgomery and colleagues

Several types of methodological design have been used to assess the influence of stereotypes among doctors on various aspects of healthcare delivery. This review highlights the key findings and the shortcomings of the different methodological designs used to assess the impact of stereotypes on healthcare delivery, with an emphasis on medical decision-making. It is argued that while prospective, retrospective, and experimental methods of assessment have progressively established a valid and reliable link between stereotyping and healthcare outcomes, the methodology did not assess directly the presence of stereotypes, but assumed their existence from the differences in socio-demographic characteristics. Stereotypes, however, concern socially sensitive, implicit cognitive bias, and as such they can be neither overtly observed nor explicitly measured or manipulated. In addition, the relevant studies focused on broad and multi-factorial indicators of healthcare delivery (e.g., admission for surgery), while evidence regarding the impact of stereotypes on medical decision-making is very limited. It is further argued that despite evidence produced by the social and cognitive sciences that implicit assessment is the only reliable way to assess stereotypical thinking, a systematic approach to studying implicit bias in healthcare does not appear to have been taken. Based on current documentation, a shift away from the use of complex multifaceted indicators of healthcare towards a focus on medical decision-making is suggested, and specific lines of research are proposed, with the use of implicit measurements in stereotype assessment.

BACKGROUND:There is a culture within medicine that doctors do not expect themselves or their colleagues to be sick. Thus, the associated complexities of self-diagnosis, self-referral and self-treatment among physicians are significant and may have repercussions for both their own health and, by implication, for the quality of care delivered to patients.AIMS:To collate what is known about the self-treatment behaviour of physicians and medical students.METHODS:The following databases were searched: PubMed, PsychInfo, EBSCO, Medline, BioMed central and Science Direct. Inclusion criteria specified research assessing self-treatment and self-medicating of prescription drugs among physicians and/or medical students. Only peer-reviewed English language empirical studies published between 1990 and 2009 were included.RESULTS:Twenty-seven studies were identified that fitted the inclusion criteria. Self-treatment and self-medicating was found to be a significant issue for both physicians and medical students. In 76% of studies, reported self-treatment was >50% (range: 12-99%). Overall, only one of two respondents was registered with a general practitioner or primary care physician (mean = 56%, range = 21-96). Deeper analysis of studies revealed that physicians believed it was appropriate to self-treat both acute and chronic conditions and that informal care paths were common within the medical profession.CONCLUSIONS:Self-treatment is strongly embedded within the culture of both physicians and medical students as an accepted way to enhance/buffer work performance. The authors believe that these complex self-directed care behaviours could be regarded as an occupational hazard for the medical profession.