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A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand in partial fulfillment for the degree of Master of Science in Medicine: Bioethics and Health Law Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa. January 2017 / Doctors serving in public health services in Kenya under the employment of the Government went on strike in December 2011 and September 2012. The strikes were national and doctors withdrew all their services including attending to emergencies in hospitals. The reasons for the strikes were poor salaries, poor working conditions and poor state of public health services. The aim of this research was to analyse legal and ethical aspects of the strikes by doctors in Kenya and to explore ways to minimize harm to patients and society. The research examined the circumstances and contexts of the strike to enable an understanding of the status of health services and the nature of the demands by doctors. Kenyan laws relating to strikes were analysed to ascertain legal compliance or violations during the strikes. Obligations of the medical profession and ethical codes and rules of conduct for doctors were discussed in relation to the strike. Ethical theories of deontology, consequentialism and virtue ethics were applied to establish moral justification or lack thereof. Analysis of the legal provisions of the Labour Relations Act No.14 of 2007 revealed that it did not provide adequate processes for resolving trade disputes involving workers and employers in essential services. Suggestions were made on some ways to improve the conciliation process to foster appropriate resolution of disputes before strike action becomes necessary. Examination of the reasons for the strikes and status of public health services revealed that there were compelling reasons and circumstances for the strike action by doctors. It was acknowledged that harm and benefits resulted from the strikes. Some grounds for moral justification of the strikes were discussed and found valid. However, comprehensive justification of the strikes was difficult, considering the professional and ethical obligations of doctors to society and to patients. In particular the withdrawal of emergency services made it difficult to find moral justification for the doctors‟ strikes. Failure to provide emergency services expunged any moral justification for strike action. / MT2017

<p>Numerous theories were established as to why doctors are leaving the country. A collection of stressors have presented itself and are seen as the contributing factors that lead to the outflow of doctors to other countries. Masia et al (2010) suggest that heavy workloads, afterhour calls, conflicts between work and personal lives, and dealing with life and death situations are stressors that form part of the daily routine of medical practitioners as well as financial pressures, insufficient budgets, a challenging working environment, information overload and threats of litigation can threaten the health and well-being of the medical practitioner. Various reasons contributed to doctor&rsquo / s leaving the country and can be explained and addressed by the push-pull theory of migration. Investigations were conducted to identify the reasons for doctors leaving the country. The significant push factors that were identified as most frequently noted in investigations were poor remuneration and wages, lack of job satisfaction, lack of future prospects (further education and career development), poor working conditions, HIV/AIDS, lack of quality of life, high levels of crime and violence, civil conflict and political instability, and a decline in the quality of the school education system. Relevant non-financial incentives shown to be significant in retaining medical practitioners include support, teamwork and feedback from supervisors. Training and recognition was also noted by medical practitioners as deciding factors on whether to stay in a rural area. South Africa has witnessed a major outflow of doctors that have left the country to seek employment elsewhere and has been seen as a potential problem for the near future. However, not enough research has been conducted to study the various sources of stress and determine ways in which to combat these stressors. This study aims to present an understanding of the various sources of stress that doctors face on a daily basis and also distinguish between various coping mechanisms. A sample of 150 doctors was used for the purpose of this study and was selected primarily from 3 Western provincial hospitals. Informed consent was obtained from the relevant authorities before participating in the study. A 36-item Stressor Checklist and a Ways of coping checklist, which were adapted from previous research, were administered. No significant differences in sources of stress were found, although males evaluated their experiences as being more stressful. Significant differences were, however, obtained in terms of coping mechanisms utilised. Female doctors had a greater propensity to utilise problem and appraisal-focused coping. However, males were more apt to utilise avoidance-coping. The research findings indicate a need for further research to be done, and can be highly beneficial for the purpose of therapeutic intervention.</p>

<p>Numerous theories were established as to why doctors are leaving the country. A collection of stressors have presented itself and are seen as the contributing factors that lead to the outflow of doctors to other countries. Masia et al (2010) suggest that heavy workloads, afterhour calls, conflicts between work and personal lives, and dealing with life and death situations are stressors that form part of the daily routine of medical practitioners as well as financial pressures, insufficient budgets, a challenging working environment, information overload and threats of litigation can threaten the health and well-being of the medical practitioner. Various reasons contributed to doctor&rsquo / s leaving the country and can be explained and addressed by the push-pull theory of migration. Investigations were conducted to identify the reasons for doctors leaving the country. The significant push factors that were identified as most frequently noted in investigations were poor remuneration and wages, lack of job satisfaction, lack of future prospects (further education and career development), poor working conditions, HIV/AIDS, lack of quality of life, high levels of crime and violence, civil conflict and political instability, and a decline in the quality of the school education system. Relevant non-financial incentives shown to be significant in retaining medical practitioners include support, teamwork and feedback from supervisors. Training and recognition was also noted by medical practitioners as deciding factors on whether to stay in a rural area. South Africa has witnessed a major outflow of doctors that have left the country to seek employment elsewhere and has been seen as a potential problem for the near future. However, not enough research has been conducted to study the various sources of stress and determine ways in which to combat these stressors. This study aims to present an understanding of the various sources of stress that doctors face on a daily basis and also distinguish between various coping mechanisms. A sample of 150 doctors was used for the purpose of this study and was selected primarily from 3 Western provincial hospitals. Informed consent was obtained from the relevant authorities before participating in the study. A 36-item Stressor Checklist and a Ways of coping checklist, which were adapted from previous research, were administered. No significant differences in sources of stress were found, although males evaluated their experiences as being more stressful. Significant differences were, however, obtained in terms of coping mechanisms utilised. Female doctors had a greater propensity to utilise problem and appraisal-focused coping. However, males were more apt to utilise avoidance-coping. The research findings indicate a need for further research to be done, and can be highly beneficial for the purpose of therapeutic intervention.</p>

Research into doctor patient communication and their roles is reviewed. Two series of semi-structured interviews with general practitioners (e.p.e) and patients separately are reported. In the first, 4 g. p. s each selected 6 patients for 3 groups; terminally ill with knowledge, terminally ill without, and chronic controls. Content analysis of patient transcripts revealed differences in frequency of utterances classed as showing knowledge. Differences between groups and qualitative analysis of all interviews, verified g.p.s’ categorisation. Knowledge was not simply absent or present, since all groups show awareness, but differ in the degree to which the nature of illness is openly acknowledged. One g.p. reported routinely informing patients, but others did not, although agreed this is occasionally appropriate. A typology of methods g.p.s and patients use to control information exchange is proposed. g.p.s' role formulations appear to underpin their reported communicative behaviour. 22 g.p.s were interviewed in the second series. Again they were asked to select patients, but few did this within the time allotted: therefore analysis focused upon g.p.s. Content analysis of interviews splits g.p.s into "informers" and "non informers". Qualitative analysis of g.p.s’ reported communication strategies suggests that underlying this simple dichotomy is a continuum from revelation through passive response to concealment. Strategies are implemented by various tactics; e.g. euphemism, uncertainty, denial, evasion, prompting questions. Differences in reported intentions and behaviour are interpreted by recourse to g.p.s' descriptions of their role during terminal care. Those who conceal attempt to maintain the Parsonian curative physician role and are reluctant to classify patients as terminal. Those who reveal try to abandon this role for one modelled on that of counsellor. Nearly all experience role ambiguity and attempt to resolve this in ways predicted by role theory.

Thesis (Ph. D.)--State University of New York at Binghamton, Decker School of Nursing, 2007. / Includes bibliographical references.

Magister Commercii (Industrial Psychology) - MCom(IPS) / Numerous theories were established as to why doctors are leaving the country. A collection of stressors have presented itself and are seen as the contributing factors that lead to the outflow of doctors to other countries. Masia et al (2010) suggest that heavy workloads, after hour calls, conflicts between work and personal lives, and dealing with life and death situations are stressors that form part of the daily routine of medical practitioners as well as financial pressures, insufficient budgets, a challenging working environment, information overload and threats of litigation can threaten the health and well-being of the medical practitioner. Various reasons contributed to doctor's leaving the country and can be explained and addressed by the push-pull theory of migration. Investigations were conducted to identify the reasons for doctors leaving the country. The significant push factors that were identified as most frequently noted in investigations were poor remuneration and wages, lack of job satisfaction, lack of future prospects (further education and career development), poor working conditions, HIV/AIDS, lack of quality of life, high levels of crime and violence, civil conflict and political instability, and a decline in the quality of the school education system. Relevant non-financial incentives shown to be significant in retaining medical practitioners include support, teamwork and feedback from supervisors. Training and recognition was also noted by medical practitioners as deciding factors on whether to stay in a rural area. South Africa has witnessed a major outflow of doctors that have left the country to seek employment elsewhere and has been seen as a potential problem for the near future. However, not enough research has been conducted to study the various sources of stress and determine ways in which to combat these stressors. This study aims to present an understanding of the various sources of stress that doctors face on a daily basis and also distinguish between various coping mechanisms. A sample of 150 doctors was used for the purpose of this study and was selected primarily from 3 Western provincial hospitals. Informed consent was obtained from the relevant authorities before participating in the study. A 36-item Stressor Checklist and a Ways of coping checklist, which were adapted from previous research, were administered. No significant differences in sources of stress were found, although males evaluated their experiences as being more stressful. Significant differences were, however, obtained in terms of coping mechanisms utilised. Female doctors had a greater propensity to utilise problem and appraisal-focused coping. However, males were more apt to utilise avoidance-coping. The research findings indicate a need for further research to be done, and can be highly beneficial for the purpose of therapeutic intervention. / South Africa

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