Symptoms of disturbed eating behavior risk: Gender and study factors in a cross-sectional study of two Norwegian medical schools.

BACKGROUND: Studies about medical student's stress associated with disturbed eating behavior are scarce. OBJECTIVES: To study the explanatory role of curricular factors and distress in disturbed eating behavior among medical students and whether this varies according to gender, study stage, curriculum model, study stress and mental distress. METHODS: The cross-sectional sample surveyed consisted of Norwegian medical students at two faculties with different curricular models (traditional and integrated). The total response rate was 64% (1044/1635). We tested differences in disturbed eating behavior symptoms (EDS) and their correlates using stepwise linear regression analysis. RESULTS: In total, 18.3% were cases of disturbed eating behavior symptoms, including 23.5% of female and 5.6% of male participants. Disturbed eating behavior symptoms were independently associated with the medical school stress factors "medical school is cold and threatening" (ß = 0.07, p = .041), "worries about work and competence" (ß =0.15, p < .001) and "worries about finances and accommodation" (ß = 0.07, p = .018), in addition to female gender (ß = 0.30, p < .001), mental distress (ß = 0.17, p < .001), and body mass index (ß = 0.28, p < .001). The variables explained 28.9% of the variance in disturbed eating behavior symptoms, and medical school stress contributed 9%. "Worries about work and competence" was more important among the female students. CONCLUSIONS: Nearly one in five female medical students in the current sample reported symptoms of disturbed eating behavior. The symptoms were associated with medical school stress factors, mental distress, and body mass index.

Comparing mental distress and help-seeking among first-year medical students in Norway: results of two cross-sectional surveys 20 years apart.

OBJECTIVE: To investigate any changes in mental distress levels over 20 years among medical students, as well as the clinical importance of these changes. DESIGN: Two cross-sectional surveys 20 years apart. SETTING: The surveys were performed at two Norwegian medical faculties in 1993 and 2015. PARTICIPANTS: One hundred and seventy-four first-year medical students in 1993 were compared with 169 students in 2015. MAIN OUTCOME MEASURES: Mental distress (Hopkins Symptom Checklist 5) and Mental Health Problems in Need of Treatment. RESULTS: Mental distress increased from 1993 to 2015 (p<0.001) due to a larger increase among female students, which seemed to be of clinical importance (Cohen's d=0.63). There was a significant gender difference in mental distress in 2015 (p=0.007), but not in 1993. Independent factors associated with mental distress in 2015 were female sex (p<0.001), low perceived social support from parents (p=0.023) and low perceived social support from other friends (p=0.048). Additional analyses showed that social support from friends was more important for female students than for their male peers. From 1993 to 2015, there was no significant increase in the proportion of female students reporting previous mental health problems in need of treatment (21.3% vs 27.8%), but we found a significant increase in help-seeking among those in need of treatment over these years from 30.0% (6/20) to 74.3% (26/35; p=0.003). CONCLUSIONS: We found a significant increase in mental distress among female medical students over the past 20 years, but also a promising increase in help-seeking among those in need of treatment. The strong and important association between low social support and mental distress should urge both universities and students to maintain students' social life after entering medical school.

An Open Time Perspective and Social Support to Sustain in Healthcare Work: Results of a Two-Wave Complete Panel Study.

Based on lifespan developmental psychology and psychosocial work characteristics theory, we examined longitudinal relations between calendar age, occupational time perspective, different types of job demands and job resources in relation to sustainable employability (i.e., work ability, vitality and employability) among healthcare workers in Netherlands (N = 1478). Results of our two-wave complete panel study revealed satisfactory fit indices for the metric invariance of the included variables across the two waves (6-month time lag). Our results revealed a negative relation between calendar age and external employability of healthcare workers (limited support for hypothesis 1), and more consistent evidence for positive relations between an open future time perspective and across-time changes in vitality, work ability and external employability (supporting hypothesis 2). Few significant findings were found for relations between specific job demands or job resources and indicators of sustainable employability of healthcare workers (mixed results hypotheses 3 and 4). Our explorative tests of possible moderating effects of age or occupational time perspective in predicting relations between psychosocial work characteristics and indicators of sustainable employability revealed only a significant interaction effect of supervisor support and future time perspective in explaining across-time changes in external employability of healthcare workers (rejecting hypothesis 5 and confirming hypothesis 6). We discuss the practical as well as theoretical implications of these findings, and present recommendations for future research.

Have medical students' attitudes towards clinical communication skills changed over a 12- year period? A comparative long-term study.

BACKGROUND: Attitudes towards learning clinical communication skills at the end of medical school are likely to reflect the students' training and motivation for the continued development of their skills as doctors. Students from two Norwegian medical schools, one with a traditional, and the other with an integrated curriculum, were approached in 2003 and 2015; with regard to changes in students' attitudes towards acquiring communication skills in two diverse learning environments. This comparison might reveal the effects of the training programs from a long-term perspective, as neither of the medical schools made any major curriculum changes within the study period. METHODS: The samples comprised final-year medical students. Two separate cross-sectional surveys performed 12 years apart (2003 and 2015) used items from the Communication Skills Attitude Scale in addition to age and gender. The traditional curriculum included only theoretical teaching and no contact with patients was made during the first 2 to 2.5 years of medical school. However, the integrated curriculum combined training in theoretical and clinical communication skills with early patient contact from the beginning. RESULTS: Attitudes improved from the first to the second survey at both schools, however, students from the integrated school reported more positive attitudes than those from the traditional school. Female students from the integrated school contributed the most to the difference in attitudes in both surveys. CONCLUSIONS: Students in both traditional and integrated curricula improved their attitudes from the first to the second assessment. However, compared with the traditional curriculum, the integrated one fostered even higher levels of positive attitudes towards acquiring communication skills, and a pronounced influence was observed on female students. These findings suggest that an educational program with greater emphasis on improving attitudes among male students may be required.

Change in subjective well-being over 20 years at two Norwegian medical schools and factors linked to well-being today: a survey.

BACKGROUND: There is a lack of studies on factors in the curriculum, study environment and individual differences that can promote well-being among medical students as a response to the frequent reports on the negative health effects of study demands among medical students worldwide. OBJECTIVE: This study investigates differences in well-being among today's Norwegian medical students compared with students 20 years ago, the most important predictors of well-being today, and whether there have been any changes in the levels of some of these factors since the period analysed. METHODS: We analysed cross-sectional survey data among all medical students (63.9%, N = 1044/1635) at two medical faculties with different curriculums (traditional and integrated) in Norway in 2015 (STUDMED 2015). We used comparison data from a longitudinal survey among medical students from the same medical faculties in 1993 to 1999: the NORDOC project (T1 = 89%, T2 = 72% and T3 = 68%). Differences in subjective well-being and correlates by demographic, curriculum, and study environment factors among the present students were tested by t-tests and stepwise linear regression analysis. RESULTS: Students today scored lower on their levels of subjective well-being than students 20 years ago. The difference was found among female and males in different study stages. The final model showed that subjective well-being today was associated with self-esteem (ß = .98, p < .001) and social support from medical school friends (ß = .22, p < .001), a partner (ß = .08, p = .020) or other family members (ß = .04, p = .041), as well as perception of medical curriculum and environment (ß = -.38, p < .001), personal competence (ß = -.40, p < .001), finance/accommodation (ß = -.22, p < .001) and perceived exam stress (ß = -.26, p < .001). CONCLUSIONS: The results show a decrease in subjective well-being among medical students and, in particular, among female students. The faculties should pay attention to the factors identified in the study environment and curriculum associated with subjective well-being in order to promote their student's well-being and stimulate health and academic performance.

Physician Parents Attending Work Despite Own Sick Children: A Qualitative Study on Caregiver Presenteeism Among Norwegian Hospital Physicians.

BACKGROUND: Studies have shown that physicians manifest a clear duty to work, even in the face of personal risk, and despite their own symptoms of ill health; this is termed presenteeism. We lack knowledge on their willingness to attend work when their children are sick or in times of concern for their unborn; this is termed caregiver presenteeism. To gain a comprehensive knowledge on the occurrence of presenteeism among physicians, it is important to include caregiver presenteeism. OBJECTIVE: The aim of this study is to explore the perception and experience with caregiver presenteeism among hospital physicians who are parents or pregnant and to explore its foundations and its consequences. METHODS: Secondary thematic analysis of semi-structured interviews of hospital physicians (N = 18). RESULTS: Positive and negative dimensions associated with (1) situations with severe pregnancy symptoms or responsibility for sick children; (2) the perceived impact on their work commitments, personal health, and adequate care for own children; (3) accompanying moderators in the organisational structure and professional culture; and (4) proposed approaches to resolve caregiver and work responsibilities simultaneously contributing to caregiver presenteeism. CONCLUSIONS: The study underlines the impact of factors in organisational structure, professional culture, and the personal sphere affecting caregiver presenteeism. It appears that targeting factors contributing to attendance pressure in physicians, including those who are pregnant, is particularly important. This includes changing attitudes towards caregiver responsibilities among physician colleagues, department leaders, and physicians themselves, as well as simple cost-efficient organisational interventions in staffing, routines of absence, and work adjustment.

A study of unreasonable illegitimate tasks, administrative tasks, and sickness presenteeism amongst Norwegian physicians: an everyday struggle?

BACKGROUND: It has been shown that a recently defined stressor, 'illegitimate tasks', has negative effects on employees' work motivation and health. Better understanding of the illegitimate tasks undertaken by physicians might contribute to a more resource-efficient division of labour within the health care system, with beneficial effects on organisational economics and employee performance. We aimed to investigate the prevalence of unreasonable illegitimate tasks, their associations with workplace variables and their impact on health, in particular sickness presenteeism. METHODS: Cross-sectional data were collected in 2012. A sample of 545 Norwegian physicians answered an online questionnaire. The response rate was high (71.8%). The data were analysed using independent-samples t-tests, ANOVA and logistic regression. RESULTS: About 50.2% of physicians in all clinical positions reported that at least 11% of their everyday tasks could have been done by other hospital personnel. Seven percent of the physicians reported that at least 31% of their daily workload consisted of unreasonable illegitimate tasks. There were no significant differences in unreasonable illegitimate tasks according to clinical position, age or gender. Administrative task load and role conflict were positively associated with unreasonable illegitimate tasks that physicians reported could be reallocated to non-medical professionals. Moreover, unreasonable illegitimate task was associated with a higher probability of sickness presenteeism after controlling for age, gender, role conflict, control over work pace, exhaustion and administrative tasks. CONCLUSIONS: The results confirm that physicians' workload includes a high proportion of unreasonable illegitimate tasks and that this can contribute to sickness presenteeism. Investigation of work environmental factors can provide insight into the mechanisms behind unreasonable illegitimate tasks. Decreasing the amount of administrative tasks and role conflicts faced by physicians should be a priority. These findings could be used to make hospital task management more resource-efficient. Our results indicate that a substantial proportion of physicians' work capacity could be re-allocated to core tasks. Further research is needed into the specific type and content of unreasonable illegitimate tasks undertaken by physicians in order to determine to whom they should be allocated to ensure a healthy and motivated workforce and provision of high quality, resource-efficient health care services.

Why hospital physicians attend work while ill? The spiralling effect of positive and negative factors.

BACKGROUND: Recurrent reports from national and international studies show a persistent high prevalence of sickness presence among hospital physicians. Despite the negative consequences reported, we do not know a lot about the reasons why physicians choose to work when ill, and whether there may be some positive correlates of this behaviour that in turn may lead to the design of appropriate interventions. The aim of this study is to explore the perception and experience with sickness presenteeism among hospital physicians, and to explore possible positive and negative foundations and consequences associated with sickness presence. METHODS: Semi-structured interviews of 21 Norwegian university hospital physicians. RESULTS: Positive and negative dimensions associated with 1) evaluation of illness, 2) organizational structure, 3) organizational culture, and 4) individual factors simultaneously contributed to presenteeism. CONCLUSIONS: The study underlines the inherent complexity of the causal chain of events affecting sickness presenteeism, something that also inhibits intervention. It appears that sufficient staffing, predictability in employment, adequate communication of formal policies and senior physicians adopting the position of a positive role model are particularly important.

Possible reasons why female physicians publish fewer scientific articles than male physicians - a cross-sectional study.

BACKGROUND: The proportion of women in medicine is approaching that of men, but female physicians are still in the minority as regards positions of power. Female physicians are struggling to reach the highest positions in academic medicine. One reason for the disparities between the genders in academic medicine is the fact that female physicians, in comparison to their male colleagues, have a lower rate of scientific publishing, which is an important factor affecting promotion in academic medicine. Clinical physicians work in a stressful environment, and the extent to which they can control their work conditions varies. The aim of this paper was to examine potential impeding and supportive work factors affecting the frequency with which clinical physicians publish scientific papers on academic medicine. METHODS: Cross-sectional multivariate analysis was performed among 198 female and 305 male Swedish MD/PhD graduates. The main outcome variable was the number of published scientific articles. RESULTS: Male physicians published significantly more articles than female physicians p <. 001. In respective multivariate models for female and male physicians, age and academic positions were significantly related to a higher number of published articles, as was collaborating with a former PhD advisor for both female physicians (OR = 2.97; 95% CI 1.22-7.20) and male physicians (OR = 2.10; 95% CI 1.08-4.10). Control at work was significantly associated with a higher number of published articles for male physicians only (OR = 1.50; 95% CI 1.08-2.09). Exhaustion had a significant negative impact on number of published articles among female physicians (OR = 0.29; 95% CI 0.12-0.70) whilst the publishing rate among male physicians was not affected by exhaustion. CONCLUSIONS: Women physicians represent an expanding sector of the physician work force; it is essential that they are represented in future fields of research, and in academic publications. This is necessary from a gender perspective, and to ensure that physicians are among the research staff in biomedical research in the future.

Suicidal ideation among surgeons in Italy and Sweden - a cross-sectional study.

BACKGROUND: Suicidal ideation is more prevalent among physicians, compared to the population in general, but little is known about the factors behind surgeons' suicidal ideation. A surgeon's work environment can be competitive and characterised by degrading experiences, which could contribute to burnout, depression and even thoughts of suicide. Being a surgeon has been reported to be predictor for not seeking help when psychological distressed. The aim of the present study was to investigate to what extent surgeons in Italy and Sweden are affected by suicidal ideation, and how suicidal ideation can be associated with psychosocial work conditions. METHODS: A cross-sectional study of surgeons was performed in Italy (N = 149) and Sweden (N = 272), where having suicidal ideation was the outcome variable. Work-related factors, such as harassment, depression and social support, were also measured. RESULTS: Suicidal ideation within the previous twelve months was affirmatively reported by 18% of the Italian surgeons, and by 12% of the Swedish surgeons in the present study. The strongest association with having recent suicidal ideation for both countries was being subjected to degrading experiences/harassment at work by a senior physician. Sickness presenteeism, exhaustion and disengagement were related to recent suicidal ideation among Italian surgeons, while role conflicts and sickness presenteeism were associated with recent suicidal ideation in the Swedish group. For both countries, regular meetings to discuss situations at work were found to be protective. CONCLUSIONS: A high percentage of surgeons at two university hospitals in Italy and Sweden reported suicidal ideation during the year before the investigation. This reflects a tough workload, including sickness presenteeism, harassment at work, exhaustion/disengagement and role conflicts. Regular meetings to discuss work situations might be protective.

A comparison of risk and protective factors related to suicide ideation among residents and specialists in academic medicine.

BACKGROUND: Physicians have an elevated risk of experiencing suicidal thoughts, which might be due to work-related factors. However, the hierarchical work positions as well as work-related health differ among resident and specialist physicians. As such, the correlates of suicide ideation may also vary between these two groups. METHODS: In the present study, work- and health-related factors and their association with suicidal thoughts among residents (n=234) and specialists (n=813) working at a university hospital were examined using cross-sectional data. RESULTS: Logistic regression analysis showed that having supportive meetings was associated with a lower level of suicide ideation among specialists (OR=0.68, 95% CI: 0.50-0.94), while an empowering leadership was related to a lower level of suicide ideation among residents (OR=0.55, 95% CI: 0.32-0.94). Having been harassed at work was associated with suicidal ideation among specialists (OR=2.26, 95% CI: 1.31-3.91). In addition, sickness presenteeism and work disengagement were associated with suicide ideation in both groups of physicians. CONCLUSIONS: These findings suggest that different workplace interventions are needed to prevent suicide ideation in residents and specialists.

Confidentiality as a barrier to support seeking among physicians: the influence of psychosocial work factors in four European hospitals (the HOUPE study).

BACKGROUND: Concerns about protecting patient's privacy can interfere with proper stress adaptation which is associated with physician's health. It is important to investigate relevant organizational confounders to this phenomenon to enable interventions that can ameliorate the subjective burden of patient confidentiality. OBJECTIVES: This study investigates factors in the psychosocial work environment that can explain patient confidentiality's prominence in social support seeking among physicians, and if these factors covary differently with support seeking according to country. PARTICIPANTS: University hospital physicians in four European cities (N=2095) in Sweden, Norway, Iceland and Italy participated in a cross-sectional survey. METHODS: Questionnaire comprised items on psychosocial work environment, basic socio-demographics, presence of formal and informal meetings at work, and measurement of confidentiality as a barrier for support. RESULTS: High role conflict, availability of formal or informal meetings, lack of control over decisions, and lack of control over work pace were predictors of confidentiality as a barrier to support. There were differences between countries in how these factors covaried with confidentiality as a barrier to support. High role conflict was the strongest predictor of confidentiality as a barrier to support across all samples. CONCLUSIONS: Psychosocial work factors predicted confidentiality as a barrier to support seeking among physicians. It is important to create routines and an organizational framework that ensures both the patient's right to privacy and physician's ability to cope with emotional demanding situations from work.

What makes physicians go to work while sick: a comparative study of sickness presenteeism in four European countries (HOUPE).

QUESTIONS UNDER STUDY: Sickness presenteeism is common in the health sector, especially among physicians, leading to high costs in terms of medical errors and loss in productivity. This study investigates predictors of sickness presenteeism in university hospitals, which might be especially exposed to competitive presenteeism. The study included comparisons of university hospitals in four European countries. METHODS: A cross-sectional survey analysis of factors related to sickness behaviour and work patterns in the field of academic medicine was performed among permanently employed physicians from the HOUPE (Health and Organisation among University Physicians Europe) study: (Sweden n = 1,031, Norway n= 354, Iceland n = 242, Italy n = 369). The outcome measure was sickness presenteeism. RESULTS: Sickness presence was more common among Italian physicians (86%) compared with physicians in other countries (70%­76%). Country-stratified analyses showed that sickness presenteeism was associated with sickness behaviour and role conflicts in all countries. Competition in the form of publishing articles was a predictor in Italy and Sweden. Organisational care for physician well-being reduced sickness presenteeism in all countries. CONCLUSION: Sickness presenteeism in university hospitals is part of a larger behavioural pattern where physicians seem to neglect or hide their own illness. Factors associated with competitive climate and myths about a healthy doctor might contribute to these behaviours. Importantly, it is suggested that managers and organisations should work actively to address these questions since organisational care might reduce the extent of these behaviours.

Associations between confidentiality requirements, support seeking and burnout among university hospital physicians in Norway, Sweden, Iceland and Italy (the HOUPE study).

Concerns about protecting patient's privacy are experienced as a limitation in the opportunity to obtain and utilize social support by many physicians. As resources of social support can modify the process of burnout, patient confidentiality may increase risk of this syndrome by interfering with proper stress adaptation. This study investigates if experiencing limitations in seeking social support due to confidentiality concerns are associated with burnout. University hospital physicians in four European countries completed measures of burnout, (Index) of Confidentiality as a Barrier for Support (ICBS), and factors of social resources and job demands. Linear regression analysis showed that ICBS was significantly associated with the burnout dimension of Exhaustion and not with Disengagement. These findings were present when controlling for factors known to diminish or increase the likelihood of burnout. These results are the first to demonstrate that patient confidentiality is associated with burnout in the process of stress management among physicians.

Work environment and recent suicidal thoughts among male university hospital physicians in Sweden and Italy: the health and organization among university hospital physicians in Europe (HOUPE) study.

BACKGROUND: Male and female physicians are at elevated suicide risk. The work environment has become a focus of attention as a possible contributor to this risk. The potential association between work environment and suicidal thoughts has been examined among female physicians in several countries, and significant findings have been reported. OBJECTIVE: The purpose of this study was to examine the role of the work environment in relation to suicidal thoughts among male university hospital physicians in 2 European countries. METHODS: Cross-sectional multivariate analysis was performed to identify significant associations between work-related factors and suicide risk among male physicians from the Health and Organization among University Hospital Physicians in Europe (HOUPE) study. The dependent variable was termed recent suicidal thoughts, which includes having thought about suicide and/or having thought about specific ways to commit suicide within the previous year. Adjusted odds ratios (ORs) and CIs are reported. RESULTS: Of the 456 Swedish (56%) and 241 Italian (39%) male physicians who participated, 12% of the physicians from each country reported affirmatively regarding recent suicidal thoughts. Degrading work experiences were associated with recent suicidal thoughts for the Swedish and Italian physicians (OR = 2.1; 95% CI, 1.01-4.5; OR = 3.3; 95% CI, 1.3-8.0, respectively). Role conflict was associated with recent suicidal thoughts among the Swedish physicians (OR = 1.6; 95% CI, 1.1-2.2). Support at work when difficulties arose appeared to be protective for the Swedish physicians (OR = 0.7; 95% CI, 0.5-0.96). Italian physicians with little control over working conditions had an increased risk of recent suicidal thoughts, whereas confidential discussions about work experiences appeared to be protective (OR = 0.6; 95% CI, 0.4-0.9). CONCLUSION: Attention should be paid to the work environment as it relates to suicide risk among male university hospital physicians, particularly to bolstering social support and preventing harassment.

Harassment among university hospital physicians in four European cities. Results from a cross-sectional study in Norway, Sweden, Iceland and Italy (the HOUPE study).

OBJECTIVES: The objective of this cross-national study was to identify work-related factors related to the prevalence of harassment, and identify potential similarities and differences in harassment levels and appointed perpetrators within the same professional group across four European cities. PARTICIPANTS: 2078 physicians working in university hospitals in Trondheim, Stockholm, Reykjavik, and Padova participated in the study. METHODS: Questionnaire comprised items on direct and indirect experience of workplace harassment, appointed perpetrators, psychosocial work environment and basic socio-demographics. RESULTS: Harassment was found to be a relatively frequent work environment problem among physicians in all four European cities, with particular high levels in Padova. Role conflict, human resource primacy, empowerment leadership, and control over work pace were all found to be significantly related to workplace harassment. CONCLUSIONS: Differences in harassment prevalence and perpetrators indicated a cultural difference between the Italian and the Nordic hospitals. Harassment followed the line of command in Padova in contrast to being a horizontal phenomenon in the Scandinavian hospitals. This may be explained by national differences in organizational systems and traditions. In order to decrease harassment level and create a positive and productive work environment, each organization must employ different strategies in accordance with their harassment patterns.

Confidentiality and physicians' health. A cross-sectional study of University Hospital Physicians in four European cities (the HOUPE-study).

OBJECTIVE: To investigate how the subjective burden of confidentiality can act as a stressor that affects physicians' psychological health and wellbeing. METHOD: Cross-sectional survey data from a sample of university hospital physicians (N=1,956) in four European countries (Sweden, Norway, Iceland and Italy) who participated in the HOUPE (Health and Organization among University hospital Physicians in Europe) study was analysed. RESULTS: About 25% of the participants reported that confidentiality impedes emotional support to a considerable degree. An index of confidentiality as a barrier to seeking support (ICBS) had a negative effect on physicians' health and wellbeing. The effect of ICBS was confirmed and slightly increased when controlled for variables known to buffer the adverse mental and physical effects of stress. Though the physicians in Iceland and in Norway found confidentiality the most challenging, it was the physicians in Italy and Sweden who showed a significant effect of ICBS on their health and wellbeing. CONCLUSIONS: Whether confidentiality is a stressor in its own right or an amplifier of stressful situations in medical practice should be further investigated to gain a better understanding of the effect of confidentiality on physicians' coping, stress and health. In addition, there is a need to investigate how physicians can balance coping with the inevitable emotional demands of medical practice and maintaining the ethics of confidentiality in a way that protects both patients' privacy rights and physicians' health and wellbeing.

Professional secrecy as a stressor among norwegian physicians

The aim of the present study is to assess how the necessary practice of professional secrecy may be a stressor for doctors, and to what extent MM (mortality and morbidity)-meetings and having a doctor as a spouse or partner, may serve as outlets foremotional charge. A postal survey was sent to a stratified sample of 780 doctors working in and outside hospitals in a health region in Norway (1.1 million inhabitants). With a response rate of 46percent (358 / 780), 22 percent of the respondents were identified as being high on stress and low on coping. 26 percent of the doctors participated regularly in MM-meetings. The risk of being stressed increased with increasing score on the scale for perceived lack of possibilities to discuss emotionally charged issues at work and at home. The doctors who participated in MM-meetings had a significantly reduced stress risk. Having a doctor as partner did not affect the stress level significantly. The results indicate that MM-meetings are effective in stress reduction among Norwegian doctors and should be a self-evident part of ordinary clinical activities (AU)