Anaesthesia
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Multicenter Study
Decision-making around admission to intensive care in the UK pre-COVID-19: a multicentre ethnographic study.
Predicting who will benefit from admission to an intensive care unit is not straightforward and admission processes vary. Our aim was to understand how decisions to admit or not are made. We observed 55 decision-making events in six NHS hospitals. ⋯ They were rarely explicit in balancing burdens and benefits of intensive care for patients, so consistency and equity cannot be judged. The use of a framework for intensive care admission decisions that reminds doctors to seek patient or family views and encourages explicit balancing of burdens and benefits could improve decision-making. However, a supportive, adequately resourced context is also needed.
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In the UK, the proportion of female medical students has remained static over the last decade, at around 55%; however, at consultant level, only 36.6% of doctors are women. The reasons for this drop in numbers are not clear. ⋯ It explores how gender stereotypes and implicit gender bias can affect the way women are perceived in the workplace, especially in leadership positions, and discusses health issues particular to the female medical workforce. While the issues in this article may not affect all women, the cumulative effect of being subject to gender stereotypes within a workplace not designed to accommodate the health needs of women may contribute to a work environment that may promote the attrition of women from our specialties.
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Physician burnout and poor mental health are prevalent and often stigmatised. Anaesthetists may be at particular risk and this is further increased for women anaesthetists due to biases and inequities within the specialty. However, gender-related risk factors for and experiences of burnout and poor mental health remain under-researched and under-reported. ⋯ We discuss the impact of anaesthesia and gender on burnout and mental health using the COVID-19 pandemic as an example illustrating how women and men differentially experience stressors and burnout. COVID-19 has further accentuated the gendered effects of burnout and poor mental health on anaesthetists and brought further urgency to the need to address these issues. While both personal and organisational factors contribute to burnout and poor mental health, organisational changes that recognise and acknowledge inequities are pivotal to bolster physician mental health.