Utility of a Brief Screening Tool to Identify Physicians in Distress

ABSTRACT

BACKGROUND

Despite a high prevalence of distress, few physicians seek help. Earlier identification of physicians in distress has been hampered by the lack of a brief screening instrument to assess the common forms of distress.

OBJECTIVE

To evaluate the ability of the seven-item Physician Well-Being Index (PWBI) to i) stratify physician well-being in several important dimensions (mental quality of life [QOL], fatigue, suicidal ideation); and ii) identify physicians whose degree of distress may negatively impact their practice (career satisfaction, intent to leave current position, medical errors).

DESIGN

Cross-sectional study.

PARTICIPANTS

National sample of 6,994 U.S. physicians.

MAIN MEASURES

PWBI, Mental QOL, fatigue, suicidal ideation, career satisfaction,and clinical practice measures.

KEY RESULTS

Physicians with low mental QOL, high fatigue, or recent (< 12 months) suicidal ideation were more likely to endorse each of the seven PWBI items and a greater number of total items (all P < 0 .001). Assuming a prevalence of 19 %, the PWBI could reduce the post-test probability of a physician having low mental QOL to < 1 % or raise it to > 75 %. The likelihood ratio for low mental QOL among physicians with PWBI scores ≥ 4 was 3.85 in comparison to 0.33 for those with scores < 4. At a threshold score of >4, the PWBI’s specificity for identifying physicians with low mental QOL, high fatigue, or recent suicidal ideation were 85.8 %. PWBI score also stratified physicians’ career satisfaction, reported intent to leave current practice, and self-reported medical errors.

CONCLUSIONS

The seven-item PWBI appears to be a useful screening index to identify physicians with distress in a variety of dimensions and whose degree of distress may negatively impact their practice.

This is a preview of subscription content, access via your institution.

REFERENCES

  1. 1.

    Gundersen L. Physician burnout. Ann Intern Med. 2001;135(2):145–8.

    PubMed  CAS  Google Scholar 

  2. 2.

    Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–21.

    PubMed  Article  Google Scholar 

  3. 3.

    Center C, et al. Confronting depression and suicide in physicians: a consensus statement. JAMA. 2003;289(23):3161–6.

    PubMed  Article  Google Scholar 

  4. 4.

    Shanafelt TD, et al. Burnout and satisfaction with work-life balance among U.S. physicians relative to the general U.S. population. Arch Intern Med. 2012. doi:10.1001/archinternmed.2012.3199.

  5. 5.

    Balch C, et al. Personal consequences of malpractice lawsuits on American Surgeons. J Am Coll Surg. 2011;213(5):657–67.

    PubMed  Article  Google Scholar 

  6. 6.

    Oreskovich MR, et al. The prevalence of alcohol use disorders among American surgeons. Arch Surg. 2011;147(2):168–174.

    Article  Google Scholar 

  7. 7.

    Shanafelt TD, et al. Suicidal ideation among American surgeons. Arch Surg. 2011;146(1):54–62.

    PubMed  Article  Google Scholar 

  8. 8.

    Shanafelt TD, et al. Why do surgeons consider leaving practice? J Am Coll Surg. 2011;212(3):421–2.

    PubMed  Article  Google Scholar 

  9. 9.

    Dyrbye LN, et al. Efficacy of a brief screening tool to identify medical students in distress. Acad Med. 2011;86:907–914.

    PubMed  Article  Google Scholar 

  10. 10.

    Dyrbye LN, et al. Development and preliminary psychometric properties of a well-being index for medical students. BMC Med Educ. 2010;10:8.

    PubMed  Article  Google Scholar 

  11. 11.

    Gudex C, Dolan P, Kind P, Williams A. Health state valuations from the general public using the visual analogue scale. Quality of Life Research. 1996;5(6):521–531.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Rummans T, et al. Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial. J Clin Oncol. 2006;24(4):635–642.

    PubMed  Article  Google Scholar 

  13. 13.

    West CP, et al. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009;302(12):1294–300.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    National Comorbidity Survey. Collaborative Psychiatric Epidemiology Surveys. Suicidality. Accessed at http://www.icpsr.umich.edu/cocoon/cpes/cpes/BLSUICIDALITY/all/section.xml on October 3, 2012.

  15. 15.

    U.S. Department of Health and Human Services, Youth Risk Behavior Survey. Centers for Disease Control and Prevention. National Center for Health Statistics. Hyattsville, MD. Accessed at http://www.cdc.gov/HealthyYouth/yrbs/trends.htm, accessed October 3, 2012.

  16. 16.

    Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory manual. 3rd ed. Palo Alto: Consulting Psychologists Press; 1996.

    Google Scholar 

  17. 17.

    Shanafelt TD, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250(3):463–71.

    PubMed  Google Scholar 

  18. 18.

    Frank E, et al. Career satisfaction of US women physicians. Arch Intern Med. 1999;159:1417–1426.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Lemkau J, Rafferty J, Gordon R Jr. Burnout and career-choice regret among family practice physicians in early practice. Fam Pract Res J. 1994;14(3):213–22.

    PubMed  CAS  Google Scholar 

  20. 20.

    Norman GR, Sloan JA, Wyrwich KW. The truly remarkable universality of half a standard deviation: confirmation through another look. Expert Rev Pharmacoecon Outcomes Res. 2004;4(5):515–519.

    Article  Google Scholar 

  21. 21.

    Shanafelt TD, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995–1000.

    PubMed  Article  Google Scholar 

  22. 22.

    Taub S, et al. Physician health and wellness. Occupational Medicine. 56(2):77–82. Oxford.

  23. 23.

    Schloss EP, et al. Some hidden costs of faculty turnover in clinical departments in one academic medical center. Acad Med. 2009;84(1):32–36.

    PubMed  Article  Google Scholar 

  24. 24.

    Lyness JM, et al. Screening for depression in elderly primary care patients. A comparison of the Center for Epidemiologic Studies-Depression Scale and the Geriatric Depression Scale. Arch Intern Med.;157(4):449–54.

  25. 25.

    Beck A, Steer R, Garbin M. Psychometirc properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev. 1988;8:77–100.

    Article  Google Scholar 

  26. 26.

    Spitzer RL, et al. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA. 1994;272(22):1749–56.

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Whooley MA, et al. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997;12(7):439–45.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Hirschfeld RM, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000;157(11):1873–5.

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Kroenke K, et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25.

    PubMed  Google Scholar 

  31. 31.

    Spitzer RL, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.

    PubMed  Article  Google Scholar 

Download references

Acknowledgements

Sources of Funding

Funding for this study was provided by the American Medical Association and the Mayo Clinic Department of Medicine Program on Physician Well-Being.

Role of Sponsor

The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Conflict of Interest

Dyrbye and Shanafelt developed the Medical Student Well-Being Index, and Mayo Clinic holds the copyright on this technology, which is referenced in the article. Mayo Clinic and Dr. Dyrbye and Dr. Shanafelt have a financial interest in the technology, which has been licensed to a commercial entity although no royalities have been received to date.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Liselotte N. Dyrbye MD MHPE.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Dyrbye, L.N., Satele, D., Sloan, J. et al. Utility of a Brief Screening Tool to Identify Physicians in Distress. J GEN INTERN MED 28, 421–427 (2013). https://doi.org/10.1007/s11606-012-2252-9

Download citation

KEY WORDS

  • physicians
  • quality of life
  • mental health
  • self-assessment tool
  • physician well-being index
  • PWBI