Occupational stress: a survey of management in general practice.
OBJECTIVE
To identify approaches to and barriers associated with the management of patients with work-related stress by general practitioners (GPs).


METHODS
Cross-sectional postal survey using a self-administered questionnaire which included a case vignette of a patient with work-related stress and questions ascertaining perceived barriers to the effective general practice management of work-related stress.


METHODS
450 Western Australian GPs on the mailing list of a GP journal. The survey was conducted between 22 March and 28 April 2000.


METHODS
Likelihood that GPs would (i) choose to open a workers compensation claim and (ii) provide time off work for the patient described in the vignette.


RESULTS
Response rate was 50.1%. Eighty-five percent (95% CI, 79.6%-19.7%) of respondents advised the hypothetical patient to take time away from work; however, only 44.0% (95% CI, 37.2%-50.7%) chose to initiate a workers compensation claim. GPs with training or experience in occupational health were less likely to advise the patient to stay away from work (odds ratio [OR], 0.30; 95% CI, 0.12-0.73), but were just as likely to initiate a claim. GPs were reluctant to involve the employer in management decisions, because of concern about patient confidentiality and the potential to make matters worse for the patient. These, and the adversarial nature of the workers compensation system, were the strongest perceived barriers to effective management of the condition.


CONCLUSIONS
Our findings indicate that general practitioners take a pragmatic and varied approach to the management of work-related stress. The perceived difficulties with contacting employers challenges the principles of injury management within a workers compensation system which is dependent on liaison between system stakeholders.
Russell
Grant M
GM
Centre for Studies in Family Medicine, London, Ontario, Canada. grussell@uwo.ca
Roach
Sally M
SM
D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000175:diagnosis*; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology; D011795:Surveys and Questionnaires; D014904:Western Australia; D014942:Workers' Compensation