Cataract surgery is one of the most commonly performed surgery in
the world and the predicted number of people to develop cataract by 2020 is an
alarming 30 million1. The standard procedure performed for removal
of cataract is a technique which employs ultrasonic waves to break and emulsify
the cataract and this process is known as Phacoemulsification2.
Although Phacoemulsification is considered as a safe surgical technique corneal
endothelial damage can occur and this can lead to bullous keratopathy with unpredictable
post operative visual acuity3. This causes a Phaco surgeon to strive
to do the best surgery possible with minimal damage to surrounding tissue so
that better visual acuity results can be obtained. In this process Phaco
surgeons suffer from severe professional distress and burnout. Burnout symptoms
include impaired decision making power, body fatigue, guilt, depersonalization
and a constant awareness of personal failure. Various studies have been conducted
on doctors of different sub-specialties and have shown a high burnout rate
amongst surgeons ranging from 30 to 38%4-7.
Without a doubt the life of a surgeons is very stressful. In a
paper written by Sy Kraft approximately 8000 doctors were surveyed in 2010 and
an alarming 501 admitted to thoughts of suicide8. Surgeons have to
endure long unpredictable working hours with minimal sleep and rest. They are
under constant pressure to meet the high expectations of his patients and fail
to have mental peace even after work and at home. As a result of this not only
does their family life suffer such as marital discord but they also experience
physical exhaustion, mental fatigue, drug addiction, poor performance, depression,
and a growing sense of anxiety that gradually starts to consume them and leads
to slow self deterioration and may even lead to suicide.
The
purpose of this study is to identify the signs and symptoms of stress in
surgeons and the correlation of it to their working experience in years. Also
we intend to create awareness amongst the medical personnel to introduce
effective surgical training programs for young budding doctors in particular to
minimize stress during surgery, to hold group discussions/workshops regularly
in which doctors can discuss personal, social, psychological and professional
problems they encounter and ways to manage stress and to help surgeons map a
career pathway that integrates personal and professional goals so as to achieve
both personal and work satisfaction. To our knowledge no similar study has been
conducted in our country on surgeons performing phacoemulsification.
MATERIAL AND METHODS
This was an analytical questionnaire based study. A questionnaire
was developed and consisted a total of 12 questions. It included gender,
working experience in years, step in which posterior capsule rent occurs the
most, physical symptoms experienced while doing surgery such as dry mouth,
chest pain/palpitation, dry mouth, stomach cramps, hand tremors, changes in breathing (shallow/rapid),
headache, aches/tense muscles, cold and sweaty hands and/or excessive sweating.
This questionnaire was taken to various centers in different parts of the city
and only qualified consultant ophthalmologists were asked to fill it. There was
a space made available in the questionnaire for comments. In order to study the
association between working experience and stress the doctors were categorized
into three groups: Category A with more 5 years working experience, category B
with 6 to 14 years working experience and category C with more than 15 years
working experience. Stress was further categorized into three levels: mild,
moderate and high based on the number of physical symptoms. Mild stress was
classified as a group that experienced at least one physical or no physical
symptoms, moderate group consisted of individuals that had two to three
physical while high stress level were those that experienced four or more
physical symptoms.
The data was analyzed on IBM SPSS version 21.0 and the
results were presented as Frequency and Percentages for Gender, surgical work
experience, and PC rent, and physical symptoms. Stress level was computed using
physical symptoms. It is categorized as a person having one physical symptom as
mild, two or three as moderate, four and above as high. Statistical association
was performed between gender and surgical experience versus stress level using
chi-square. Graphs were made for physical symptoms and between surgical
experience and stress level. A p-value of 0.05 or less was considered
statistically significant.
RESULTS
Total 25 subjects were analyzed
having at least one physical symptom. Table 01 reported that males were 22
(88.0%) and females were 3 (12.0%). People having less than 5 years or more
than 15 years’ experience are higher i.e. 9 (36.0%) and 10 (40.0%)
respectively. For PC rent cortex removal and nuclear removal are found to be 11
(44.0%) and 10 (40.0%) respectively. Figure 01 shows that the most common
physical symptoms found were changes in breathing 11 (44.0%) followed by dry
mouth 10 (40.0%), hand tremor 8 (32.0%), Palpitation or Chest Pain, headache,
and stomach cramps (table 02).
Table 03 describes association of stress level with gender
and surgical experience. Both mild and moderate stress level were found in males
but in females there was high stress level. About surgical experience having
more than 15 years have mild stress level i.e. 6 (24.0%). Six to 14 years
experience have high stress level i.e. 3 (12.0%) and last less than 5 years
surgical experience has moderate stress level i.e. 6 (24.0%). For each
experience range there were different stress levels which are shown in figure
02. The p-value was 0.041 and was found to be significant.
DISCUSSION
Surgery is one of the most stressful occupations out
there. Different surgeons experienced different levels of stress and showed a
strong association with surgical experience. The stress symptoms varied in
different individuals and to different degrees. Claude Bernard
Table 1: Descriptive Statistics.
|
|
N = 25 (%) |
|
Gender |
|
|
Male |
22 (88.0) |
|
Female |
3 (12.0) |
|
Surgical Work Experience |
|
|
< 5 years |
9 (36.0) |
|
6 - 14 years |
6 (24.0) |
|
> 15 years |
10 (40.0) |
|
PC Rent |
|
|
Nucleus removal |
10 (40.0) |
|
Cortex removal |
11 (44.0) |
|
Lens insertion |
4 (16.0) |
Table 2: Descriptive Statistics for
Physical Symptoms.
|
Physical
Symptoms |
N
= 25 (%) |
|
Changes in
Breathing |
11 (44.0) |
|
Dry Mouth |
10 (40.0) |
|
Palpitation
/ Chest Pain |
7 (28.0) |
|
Stomach
Cramps |
2 (8.0) |
|
Hand Tremor |
8 (32.0) |
|
Headache |
3 (12.0) |
stated that the maintenance of life
is significantly dependent on keeping our internal milieu constant despite a
change in external environment9. Thus it is important to recognize
the stress associated with surgery and to take measures to reduce it.
Strategies for reducing stress include identifying the factors leading to
stress, building strong relationship with colleagues/family/friends, resting
your mind and body and getting help when you feel out of control10.