SMJ 2003 48(4): 120-122
1Robert
K Peel MB BS hons MRCPUK
2Sunil
Bhandari MB ChB PhD MRCPUK
1
Specialist Registrar
2
Consultant Physician and Hon Senior Lecturer
Abstract
Introduction.
There are recommendations regarding many facets of lifestyle.
We proposed to look at hospital doctors’ habits in East Yorkshire.
Method.
A simple questionnaire was sent out to 574 doctors in the Hull and East
Yorkshire Hospitals NHS Trust. Non-responders
were re-mailed. Age, sex, grade,
specialty, number of portions of fruit and vegetable per day, alcohol intake,
smoking, exercise and hours worked.
Results.
301 doctors (238 males, 60 females) responded (response rate 58%). Approximately
half of doctors who responded were consultants.
Few respondents smoked (6.6%), and the mean alcohol consumption,
8.35units per week (SE 0.54), was less than the recommended limits for men and
women. Most doctors fell short of the “recommended” 5 portions
of fruit and vegetables per day (median 3 per day) and nearly half worked more
than 56 hours per week. Most
respondents took at least the recommended amount of exercise per week (112 SE25
minutes) although 26% of doctors took no exercise at all.
Conclusion.
In this trust the majority of doctors lead a relatively healthy
lifestyle; however there remains room for improvement. Consultant and
non-consultant career grade doctors appear to exhibit a healthier life-style in
comparison to junior doctors. We do
in general seem to practise what we preach.
Key
words alcohol, smoking, lifestyle, exercise,doctors.
Introduction
Doctors
and other healthcare professionals have been endowed with the responsibilities
in advising patients in many issues relating to a potential “healthy
lifestyle”. There are many facets
of a person’s lifestyle that could be modified.
These modifications may lead to an improved quality of life and potential
reductions in morbidity and mortality. Targets
have been suggested for the minimum amount of exercise taken per week1.
There have been extensive campaigns recommending that people consume at
least 5 portions of fruit and vegetable per day.2
Two separate weekly upper limits for alcohol consumption have been
advised and doctors have a reputation for being heavy drinkers.3, 4
The risks attributable to active smoking are already clear and need
no further clarification and the British and European Parliaments have set
limits for hours of work for people including doctors.5, 6, 7
As with many things in life what we advocate and what we actually do are
not always in harmony, the lifestyle practices of doctors are unknown.
With this in mind we performed a longitudinal study of the health
practices of all doctors employed in the Hull and East Yorkshire Hospitals NHS
Trust by means of an anonymous simple questionnaire.
Methods
The
names and addresses of all doctors (574 persons) employed by the Hull and East
Yorkshire Hospitals NHS Trust were obtained from the Human Resources Department
and a questionnaire, which included an explanatory covering letter and a stamped
addressed envelope, was mailed to all doctors.
Information on simple demographics – age, sex, clinical grade, and
specialties of doctors were sought from the questionnaire.
Questions relating to lifestyle were asked, including daily number of
portions of fruit and vegetable eaten; weekly alcohol consumption; tobacco
smoked per week; quantity of weekly exercise taken and number of hours of
estimated work. An offer to
publicize a summary of the final results of the survey was also included in the
covering letter to improve response rate. Identification
of individuals remained blinded to maintain confidentiality.
A duplicate questionnaire was then recirculated to non-responders and the
survey brought to the attention of doctors at the hospital grand round in order
to maximize returns. Statistical
analysis was performed using Excel (Microsoft Corporation, USA) and SPSS 10.1 (SPSS
Inc) software. Data are given as
means ±SEM, medians and confidence intervals are at the 95% level where
mentioned. The Mann-Whitney test
was used for comparing groups. A p
value of less than 0.05 was considered statistically significant.
Results
Results are summarized in table I. A total of 301 completed, and partially completed questionnaires were returned (response rate 53.4%). There were 574 doctors on the hospital records at the time of the questionnaire (15.01.2000): 215 consultants, 120 Non Consultant Career Grade doctors (NCCG), 204 Senior House Officers and House Officers (SHO/HO) and 35 Specialist Registrars. There were 58 Anaesthetists, 226 doctors in surgical specialties, 29 Radiologists, 10 Pathologists, 210 doctors in medical specialties, 40 doctors working in A&E and one GP working for the trust according to the Medical Staffing records used at the time of mailing the first questionnaire. At the time of the second mailing 54 of these were no longer employed in the trust. Ten questionnaires were returned, the various departments explained that the doctors concerned had left the respective units: the response rate when this is taken into account is 57.9%.
There were 238 males, 60 females and 3 unknowns responded; the mean age was 40.3±0.6 years (n =299, range 23-64 years). A higher percentage of consultants and NCCG doctors responded to the questionnaire compared to SHO /HO. The majority of doctors worked in either surgical, (including Obstetrics and Gynaecology), or medical specialties.
There were 20 smokers (6.6%) consisting of 15 cigarette users, 4 cigar smokers, and 1 pipe smoker. No individual specialty, grade or sex had an excess of smokers although numbers were small (p>0.05).
The average fruit and vegetable consumption for the whole population studied was 3.37 ±0.1 portions of fruit and vegetables per day, median 3 per day. Fruit and vegetable consumption was greater amongst consultant and NCCG doctors when compared to doctors in training (SHO, HO, SpR; p<0.005), and in females compared to males (p=0.004). There was little variation between specialties. Mean alcohol consumption was 8.35±0.54 units per week, n=295. Consultants consumed more alcohol than both NCCG doctors and SHO/HO groups (10.5 versus 6.0 [p<0.05] versus 6.4 [p<0.05] units per week respectively). Most doctors in all groups consumed considerably less than the recommended maximum levels. Men consumed more than women (9.0 versus 5.2 units per week; p=0.02). There was no difference between specialties.
Average exercise per week was 112 minutes (SE 7.1), n=297, but 79 (26%) doctors took no exercise. Consultants and NCCG doctors took more exercise than the SHO/HO group (126, 137 [p= 0.02], and 78 [p= 0.021] minutes per week respectively): however there was no difference between specialties (p>0.05) or between the sexes (p= 0.44).
The
mean hours worked were 55.8 hours per week (SE 0.9), n=294. SHOs and HOs worked
longer hours than consultants (63 versus 55 hours per week; p<0.005), and
consultants worked longer hours than NCCG doctors (55 versus 47 hours per week;
p<0.000). NCCG doctors worked less than other grades.
Pathologists worked shorter hours than the Physicians (p=0.01). There was
no difference in working hours between Pathologists and Anaesthetists or
Surgical specialties (p=0.074 & p=0.64 respectively). Female doctors worked
fewer hours in the hospital than their male colleagues (57 versus 50 hours per
week; p= 0.004)
Discussion
This longitudinal study of the lifestyle practices of all doctors employed in the Hull and East Yorkshire Hospitals NHS Trust provides some insight into the practices within this region. The response rate from this survey was not optimal despite attempts to maximize returns with a second invitation to complete the questionnaire and a mention at the hospital grand round. Hence it is clear that doctors respond poorly to questionnaires but those that do have reasonably healthy lifestyles. This lack of willingness to complete a simple questionnaire is not easily explained but may revolve around interest, apparent time constraints and perhaps not receiving the questionnaire. Indeed the large numbers of consultant-grade, and NCCG doctors responding compared to those of doctors SHO / HO posts is perhaps because of the haphazard postal system for junior doctors in this trust. Consultants and NCCG doctors may also have more time on their hands to fill in such a questionnaire. The proportion of missing or invalid responses in the study was however very low.
In
the general population the prevalence of smoking for men is 28% (n=6,579), while
for women it is 26% (n= 7,830).8
In this survey the rate was low at only 6.6%%.
This finding may be due to a number of factors; a greater degree of
awareness of the risks of smoking among doctors; and the relatively large
proportion of doctors from ethnic minorities employed within in the Hull and
East Yorkshire Hospitals NHS Trust.
All groups in this survey ate less than the recommended amount of fruit and vegetables. Women fared better than men; and consultant and NCCG doctors who tend not to be resident in hospital when on-call also fare better. Perhaps a relationship to the availability of fruit and vegetables to doctors especially when resident on-call may exist but this concept was not explored.
Total weekly alcohol consumption was low. This may reflect the ethnic mix employed within this region. The differences observed between grades may be partly explained by a greater degree of openness from consultants but may also once more reflect differences in ethnic origin between grades. The greater alcohol consumption by male compared with female doctors reflects trends observed in the general population: male 16 units per week and females 6.3 units per week. 9
Time
spent exercising per week was above national recommended levels of 20 minutes
three times per week, but there were significant variations in this study.
Interestingly consultants and NCCG doctors do more weekly exercise.
This may reflect a greater amount of leisure time with no potential
pending academic examinations and a tendency to work fewer hours per week.
The older age of these two groups may be a reason for their greater
exercise- as they may sense they are more in need of regular exercise perhaps to
keep at bay the ravages of advancing years.
A large number of doctors, particularly those in training grades worked more than the maximum recommended of 56 hours per week. Differences between grades are presumably a reflection of on-call commitments, and this may perhaps be true to some extent of the differences between specialties. The most likely explanation of the gender differences is the amount of part time or flexible work undertaken within Trust hospitals by women, reflecting the females greater commitments in the areas of child-care and homemaking.
As a group there remain areas where we could improve our apparently “healthy” lifestyle, particularly in terms of fruit and vegetable consumption, and hours of work, but it is not all doom and gloom. However as with so many things in life we do not always practise what we preach.
References
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