The interrelationships between working conditions, job satisfaction, burnout and mental health among hospital physicians in Japan: a path analysis.

A growing number of physicians are leaving their hospitals because of painful working conditions in hospitals throughout Japan. We set out to analyze the interrelationships between working conditions, job satisfaction, burnout and mental health among Japanese physicians. A cross-sectional survey was conducted in 2007 for hospital physicians throughout Japan. A path analysis based on structural equation modeling was utilized for examining the interrelationships between work control, on-call duty volume, job satisfaction (the Japan Hospital Physicians Satisfaction Scale), burnout (the Japanese version of the Maslach Burnout Inventory) and mental health (the General Health Questionnaire). Of 336 physicians who received a solicitation E-mail, 236 participated in our study (response rate, 70%). Sixty physicians (25.4%) were women with a mean age of 41 yr. In the path analysis, burnout and poor mental health were related directly to job dissatisfaction and short sleeping time, while they were related indirectly to poor work control and heavy on-call duty. In the multi-group path analysis of both genders, sleeping time was related to job satisfaction more likely among female physicians but less among male physicians. Healthcare policy makers need to implement immediate, extensive and decisive measures to improve work condition and to reduce overwork among hospital physicians.

The influence of medical jargon mixed with foreign terminology in the Japanese clinical environment.

OBJECTIVES: To identify patient reports about their difficulties with medical jargon, to classify the most problematic types, and to examine the socio-demographic factors associated with them. METHODS: A cross-sectional nationwide survey (October 6 and November 4, 2004) was conducted. Out of 4,500 Japanese people (aged 15 years and older) who had seen physicians, 3,090 agreed to participate (response rate: 69%). Participants were asked the following: "Do you find physicians that use medical jargon difficult to understand?" and "What type of words did your physician use that required further explanation or clarification?" RESULTS: Of 3,090 respondents, 1,117 participants (36.1%; 95% confidence interval, 34.5-37.8%) reported difficulties understanding medical jargon. Those between the ages of 30 and 49 years, self-employed workers, homemakers, and unemployed individuals experienced the most difficulties. Difficult jargon included: 1) technical Japanese words, such as Kakutan Saibo-shin (sputum cytology) (57% of participants); 2) English medical terminology, such as clinical path (57%); and 3) English medical abbreviations, such as EBM (47%). CONCLUSIONS: In addition to avoiding technical words when communicating with their patients, Japanese physicians should consider the unique medical situation in which foreign terminology and abbreviations are used in Japan. Translation of foreign terminology into Japanese can be helpful for patients. Physicians should take the initiative to educate patients and familiarize them with foreign terminology and abbreviations.

Physicians' attitudes toward anticoagulant therapy in patients with chronic atrial fibrillation.

INTRODUCTION: Although many clinical trials have demonstrated that anticoagulant therapy substantially reduces the risk of ischemic stroke in patients with atrial fibrillation (AF), some physicians are reluctant to use anticoagulants. We investigated attitudes of physicians in Japan toward anticoagulant therapy in chronic AF patients. METHODS: We conducted a survey at the annual meeting of the Japanese Society of General Medicine. We presented subject physicians with 8 vignettes of chronic AF patients and requested that they indicate their most favored choice of therapy from among 6 strategies including warfarin and aspirin. RESULTS: We distributed 209 questionnaires and received 139 replies (67% response rate). For all 8 vignettes presented, only 26% of the respondents preferred to use anticoagulant therapy in AF patients. Longer clinical experiences and responsibility at a teaching hospital were associated with negative attitude toward anticoagulant therapy, while experience of preventive therapy in patients with thromboembolism due to AF and strong influence of clinical trials of anticoagulant prophylaxis on their practice were associated with positive attitude toward the therapy. Among patient characteristics in the vignettes, a risk of thromboembolism was positively associated with preference for anticoagulant therapy, but an advanced age and a risk of bleeding complications were negatively associated with the preference for the therapy. CONCLUSIONS: The physicians in Japan in this survey, especially those with longer clinical experiences or responsibility at a teaching hospital, have a negative attitude toward anticoagulant therapy in chronic AF patients. An advanced age and a risk of bleeding complications of patients are deterrent factors to the use of anticoagulant therapy.