Brit J Hosp Med
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Perioperative medicine can pose myriad challenges to professionalism and ethical practice. Medicine is a science, but definite end points, and predictable results and outcomes do not consistently occur. ⋯ Examination findings, laboratory investigations, diagnosis, plans for and outcomes of surgery and long-term outcomes can all be uncertain and/or not meet expectations. Factors including pressures in the workplace, conflicts, ego, prescribed guidelines and pathways, the need to achieve healthcare targets, desire for autonomy and need to maintain multidisciplinary involvement in patient care can lead to an environment in which it is challenging for professionalism and ethics to thrive.
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Burnout, mental health disorders and suicide are more common among doctors than the general population. Burnt-out doctors self-report increased rates of medical errors and the provision of suboptimal patient care. Surgeons in training are particularly at risk of burnout and are also less likely to seek professional support. ⋯ Schwartz rounds and mindfulness training have been shown to be effective, but only in those motivated to participate. A reduction in working hours has conflicting results, particularly among surgical trainees, which may be linked to the subsequent reduction in training opportunities, such as operative time and the ability to complete assessments. Early identification and targeted support of at-risk individuals is a potentially effective strategy that requires further research.