December 1999 Bulletin

Stress a leading job hazard

Loss of autonomy is major factor

Emotional and psychological stress is one of the major occupational hazards of orthopaedic surgeons.

You can blame it on managed care, says David Florence, MD, chairman of the Occupational Health Committee. A survey of occupational safety hazards in orthopaedics, conducted by the AAOS department of research and scientific affairs, found that stress was the leading hazard of all the respondents, which included orthopaedists, physician assistants, nurses and technician/ technologists.

"In my day, when there weren't an abundance of orthopaedic surgeons, there was a high percentage of physicians with emotional stress and fatigue. We thought it was from working long hours.

"Now, there is an abundance of orthopaedic surgeons and many are not working as long hours, and there still is a high level of stress."

He sees that as a result, in part, of having to work faster for less reimbursement in the managed care environment. It's also because orthopaedic surgeons have lost autonomy, says Dr. Florence. For some physicians, he believes, "it has gone beyond explaining 'how I do, what I do' and has frequently becomes explaining 'what I do.'

"When physicians have lost external control, abnormal behavior sets in.

"Orthopaedic surgeons are structured, dynamic, focused and results-oriented. They tend to sublimate things that get in the way."

Eventually, they pay the price. He cites the example of an orthopaedic surgeon who was noted for working extremely long hours and suddenly became depressed, nonfunctional and required hospitalization. It's an example of an orthopaedist who didn't recognize when he was headed for a psychological problem, says Dr. Florence.

To prove that orthopaedists "sublimate" some problems, he points out that most of the orthopaedists who responded to the survey said the leading hazards were HIV and blood borne pathogens, needles and sharps, and radiation and sources of energy.

Dr. Florence doesn't doubt that these are major hazards. However, 65 percent of the orthopaedists said HIV and blood borne pathogen issues were being "extremely well" or "well" addressed and 86 percent said needles and sharps issues were being "extremely well" or "well" addressed. "That is a fallacy," he said.

Fifty-eight percent said radiation and sources of energy issues were being "extremely well" or "well" addressed, but Dr. Florence says most orthopaedists don't know the dangers from lasers and electric coagulation devices.

What can the orthopaedist do to avoid the pitfalls of stress? They should learn to "recognize the stressors and how it is affecting them," says Dr. Florence. "And, they shouldn't let little problems grow into big problems."

Five most serious hazards

Emotional/psychological stress58.2%
HIV and blood borne pathogens58.1
Needles and sharps52.8
Fatigue (tiredness)49.2
Physical stress/strain (on body parts, joints)49.1

Source: AAOS Occupational Safety Hazards in Orthopaedics Survey of 200 members of each organization: AAOS, National Association of Orthopaedic Technicians, National Association of Orthopaedic Nurses and American Society of Orthopaedic Physician Assistants.

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