Yemeni doctors’ stress can affect their quality of care [Archives:2008/1146/Health]

Jamal Al-Najjar
For Yemen Times
A recent study conducted a few months ago by a group of Sana'a University medical students found that Yemeni doctors suffer physical and psychological symptoms of stress as a result of administrative, financial and social issues while working in public hospitals. Not only is such stress negatively affecting the physicians' health, it also is affecting the quality of health care they give to patients.

The study sought to identify the source and symptoms of stress among Yemeni physicians at Sana'a teaching hospitals, namely Kuwait, Al-Jumhury, Al-Saba'een and Al-Thawra.

After surveying 405 physicians in varying medical specializations, the study revealed that the majority experience physical symptoms of stress such as feeling exhausted, back pain, gastric upset and heartburn.

Additionally, they complained of psychological symptoms of stress including difficulty awakening in the morning and weak concentration. These symptoms were coupled with habits that indicate psychological stress, such as tapping the fingers.

Regarding stress-related diseases, the study showed that 12 percent of the sampled physicians had peptic ulcers, eight percent had dermatological diseases and seven percent suffered hypertension (high blood pressure). Physicians with peptic ulcers experienced more physical and psychological symptoms of stress, whereas those with dermatological diseases particularly had more psychological stress.

According to the study, financial difficulty is the primary source of stress for physicians and general practitioners, whose average monthly income is around YR 40,000 (approximately $200). Because such salaries can't cover their basic needs, consequently, physicians remain preoccupied with their financial situations and this preoccupation can negatively impact a physician's performance.

Administrative and systematic problems also are among the outstanding factors causing both physical and psychological stress-related diseases. How public hospitals are run, patient admission procedures and performing medical checks-up are all obstacles to physicians who can't handle them without encountering difficulties from hospital administration.

Compared to the number of field doctors, the number of administrators at Yemeni public hospitals is large and because of this, administrators consume a great portion of hospital finances in the form of rewards at the expense of doctors.

Additionally, patients face difficulties because they must deal with numerous administrators during any medical check-up or surgical procedure, which delays their treatment, according to Dr. Mohammed Al-Mahbashi, an ear, nose and throat, or ENT, specialist at Al-Thawra Hospital.

“Administrators are supposed to help both patients and doctors, but what we see is the opposite. For example, sometimes, if we need a piece of equipment, we must follow a lengthy routine of procedures and wait a long time until the administrators meet to decide upon it,” Al-Mahbashi explains.

He further claims that Finance Ministry officials pay no attention to hospitals' financial needs, thereby hindering doctors' performance.

His colleague, Al-Thawra general practitioner Mohammed Al-Alie, says that due to negative administrative routines and lack of proper services at Yemeni hospitals, many patients wait a long time either to conduct medical tests assigned by their doctors or to receive the results of such testing.

“We face multi-faceted problems at our hospital, especially those related to handling patients. For example, some patients remain in the admissions department more than a week in an effort to obtain their results of medical investigations assigned by their doctors, such as those needing echocardiography [a type of heart examination],” Al-Alie laments.

He adds, “Some are delayed because they can't pay the testing fee. In this case, we as doctors feel obliged to discharge such patients and ask them to do these tests outside of the hospital.”

Al-Alie points out that the majority of patients are poor and can't afford the often-costly check-ups. “For example, one particular type of tuberculosis test is very expensive and patients can't afford it, so this affects both patients and doctors because the treatment procedure doesn't meet patients' needs,” he explains.

The study also found that female physicians were subjected to more stress and consequential diseases than males, which was attributed to the dual responsibility placed upon female doctors, who have both their work duties at the hospital and home duties such as caring for their children. Married physicians – both males and females – were less affected by stress than singles.

Doctors also affirm that crowding at public hospitals yields both physical and psychological problems. As a solution, they suggest establishing qualified hospitals in all Yemeni governorates with the required equipment and specialized personnel to enable physicians to offer quality health services.

“Public hospitals in Sana'a are crowded because they receive patients from all areas of Yemen,” Al-Alie points out, “If the government would build and equip hospitals in the various governorates, the situation of both patients and doctors would improve.”

Finally, the study recommended immediate steps be taken to provide hospitals with required equipment and grant doctors more authority in decisions related to dealing with patients and conducting medical investigations.
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