2019 LIMA DECLARATION

This Declaration has emanated from the Latin American Conference on Person-Centered Medicine, held in Lima-Peru on December 13 and 14, 2019, organized by the Peruvian Association of Person Centered Medicine (APEMCP), the Latin American Network of Person Centered Medicine (RLMCP), and the International College of Person Centered Medicine (ICPCM); under the auspices of the Peruvian Association of Faculties of Medicine (ASPEFAM), the Pan American Health Organization (PAHO / WHO), and the San Marcos National University (UNMSM).

WORK–LIFE BALANCE IN THE CURRENT JAPANESE CONTEXT

Background: Work style reform in Japan is under way in response to a predicted shortfall in the workforce owing to the country’s low birth rate and high longevity, health problems due to excessive working hours, and the need for diversification of employment. A legal limit for physicians’ overtime work will be introduced in 2024. Objectives: This study examines the work–life balance among Japan’s doctors in the context of ongoing work style reform. Methodology: The study applied included selective reviews of demographic shifts, legislation against long working hours, and trends in doctors’ participation in the labor force. Results: Japan’s doctors work long hours, which creates a conflict between their working and private lives. The proportion of female doctors in Japan is the lowest among the Organisation for Economic Co-operation and Development (OECD) countries. Employment trends among women doctors by age group show an M-curve: many quit their jobs upon marriage or childbirth. Gender role stereotyping has led male Japanese doctors to devote themselves entirely to their professions and working excessively long hours: they leave all family work to their female partners. This stereotyping obliges female doctors to undertake household chores in addition to their career tasks, which makes it difficult for them to re-enter their careers. Because of the harsh working conditions (including long working hours), there has been a decline in newly graduated doctors in some medical specialties. Conclusions: For sustainable, effective health care in Japan, it is necessary to improve the work conditions for Japan’s doctors towards achieving work–life harmony.

2019 TOKYO DECLARATION

As the Congress explored the nature of burnout among doctors and health professionals in differing settings and in different nations it is clear that burnout is a global phenomenon. An organizational paradigm changes to a person- and people-centered system that incorporates complexity, is adaptive and integrative is essential. Such a change will enable continuing medical education be effective and the current unaffordable and unnecessary waste of human resources that the Congress identified reduced. The Congress reviewed a range of features precipitating burnout including a dysfunctional work–life balance and a variety of relatively simple individually protective factors. It is because of this variety that person- and people-centered initiatives rather than narrowly based top-down management solutions will prove effective Individual-level actions can be taken to reduce stress and poor health symptoms through effective coping and promoting healthy behavior. But there needs to be a much better alignment between the health system and the individual physician so that there are shared professional values within a clear medical ethical framework [23] that encourages professional development and adaptation to the health service environment and health system.

EDITORIAL INTRODUCTION

If you are an employee or employer, occupational health physician, or a physician concerned with the work–life balance of your patient, this fourth issue on work–life balance and burnout is for you. It culminates in practical guidance captured in the Tokyo Declaration on Work–Life balance together with five articles that clarifies the golden reach of person-centered medicine (PCM) in occupational health of both a clinician and a patient. How this golden reach extends much further than patient-centered medicine is captured in the first article. An employed person, whether patient or practitioner, works within an interpersonal context in which all role players including the employer should actively contribute in nurturing an employee’s well-being and work–life balance. The second article engages with the reach of PCM in reporting on the personality features needed to cope with (or avert) unemployment as is evident in a comparison between 245 long-term unemployed individuals and a control group of 1,948. The third article articulates how the golden reach of PCM is informed by the empirical relationship between work engagement and burnout. The fourth article considers the work–life balance among Japan’s physicians in the context of ongoing work style reform. The fifth article underscores that a person-centered work environment is crucial in addressing the challenges of burnout among physicians and medical students.

BURNOUT SYNDROME

Background: Burnout syndrome in medical students and medical staff has been reported in Peru as a serious and frequent entity, which can have grievous personal and professional consequences. Although there are many studies carried out in other countries, the information on burnout syndrome in students of medicine and Peruvian doctors is still insufficient. Objective: To review and make a synthesis of published works on burnout syndrome in Peruvian students of medicine, medical residents and physicians during the last five years. Methodology: A literature search was performed using various databases (PubMed, SCOPUS, Scielo) regarding original articles on burnout in medical professional population and students of medicine published from 2015 to 2020. Results are presented in narrative form. Results: The prevalence of burnout syndrome in Peru has been reported in the range of 2.44–57.6% in students of medicine; 9.65–51.4% in medical residents; and 2.67–80% in physicians. Conclusions: Burnout syndrome in Peru has been reported with prevalence rates of a broad range, varying a lot. However, in the reviewed studies, methodological shortcomings were detected including little conceptual consensus among researchers by which criteria the presence of burnout should be identified, little consideration of the work environment and cultural factors in its analysis and a lack of longitudinal studies. All this hinders the global appreciation of the phenomenon and the use of the generated knowledge in proposing appropriate coping strategies.

PERSONALITY PROFILES IN A SWEDISH LONG-TERM UNEMPLOYED SAMPLE

Background: Long-term unemployment is associated with psychiatric problems, higher risk of suicide, low levels of well-being, and high levels of burnout. In this context, among other factors such as sociodemographic status and IQ, specific personality traits are important for individuals’ chances to finding a job, getting hired, and retaining that job, as well as for coping with the mental health risks related to long-term unemployment. Thus, in order to use person-centered methods to promote public health and sustainable employment during the current and future challenges of the 21st century, an important research area is the mapping and understanding of personality profiles of individuals who are unemployed. Objectives: We mapped the personality traits and profiles in a sample of Swedish long-term unemployed (i.e., ≥ 6 months without work) in relation to a control group from the Swedish general population. Method: 245 long-term unemployed individuals (136 men and 157 women, range 18 to 60 years; M = 25.7; SD = 9.6) were recruited at the beginning of different well-being and employment projects in Blekinge, Sweden. The participants reported gender, age, and other basic demographics, as well as their personality using the Temperament and Character Inventory (TCI). We calculated the T-scores and percentiles for the personality traits using the Swedish normative data (N = 1,948) and clustered participants in different temperament (high/low novelty seeking: N/n, high/low harm avoidance: H/h, high/low reward dependence: R/r) and character profiles (high/low self-directedness: S/s, high/low cooperativeness: C/c, high/low self-transcendence: T/t). Results: Compared to the general population, the long-term unemployed were extremely higher in harm avoidance (> 1.5 standard deviation), moderately lower in persistence (> 0.5 standard deviation), extremely lower in self-directedness (> 2 standard deviations), and moderately lower in novelty seeking (> 0.5 standard deviation). That is, consistent with past research, our study shows that the personality of long-term unemployed is denoted by being pessimistic, fearful, easily fatigable, underachieving, blaming, helpless, and unfulfilled (i.e., high harm avoidance, low persistence, and low self-directedness), but also by being reserved and rigid (i.e., low novelty seeking). Furthermore, within the unemployed population, as much as 71.60% reported a methodical (nHr) or cautious profile (nHR), and as much as 64.00% reported an apathetic (sct) or a disorganized profile (scT). Moreover, the profile analyses allowed us to show that, within this unemployed population and in relation to each individual’s own profile, about 91.70% were high in harm avoidance, 98.60% were low in self-directedness, 64.00% were low in cooperativeness, and 44.40% low in self-transcendence. Conclusions: These results indicate a high predictive value by the TCI, especially regarding the specific basic health-related traits or abilities (i.e., self-directedness, cooperativeness, and self-transcendence) needed to cope with the risks related to unemployment. Specifically, long-term unemployed populations have temperament profiles that present difficulties for them to adapt to the circumstances of unemployment, but also finding, getting, and retaining a job and character profiles that diminish their possibilities to self-regulate the emotions derived from their temperament through self-directed choices that improve their health and all aspects of their lives. Hence, evidence-based interventions targeting stress reduction and the development of health-related traits or abilities (i.e., self-directedness, cooperativeness, and self-transcendence) are urgently needed.

THE BROADENED SCOPE OF A PERSON-CENTERED APPROACH TO WORK, HEALTH, AND WELL-BEING

Background: Person-centered medicine (PCM) broadens the practical scope in health practice beyond patient-centered medicine. Objectives: The objective of this article is to consider what a broadened scope mean in understanding how employment/work relates to the promotion of health and well-being of the patient and the practitioner. Method: The conceptual scope of PCM is applied in considering the connections of work with health and well-being. The scope of occupational health is accordingly expanded in accounting for the work and well-being of the patient and the practitioner. Results: PCM puts the person and people before their work. It recognizes that an employed person, whether patient or practitioner, works in a context that is interpersonal and in which all the role players contribute to a healthy milieu. This means that a healthy work–life balance should not be pursued merely as an attribute of an individual, but as a pursuit to which all role players should actively contribute and take joint responsibility. Both the employer and the employee should accordingly invest in a healthy work–life balance, for example. An employer that recognizes in a person-centered way its role in the well-being of its employee is investing in the employee as a valued asset not merely by attending to the person’s ill health and the prevention of ill health and burnout (as is commonly the objective in occupational health programs), but by promoting his or her positive health and well-being. Furthermore, PCM guides the pursuit of a person’s well-being in a healthy work context by accounting for the person’s subjective experiences, values, preferences and interests. Conclusion: PCM provides for an approach to a healthy work context in which the patient or the practitioner may flourish through active investments for which both the employer and the employee should take responsibility.

WORK ENGAGEMENT AMONG HOSPITAL VOLUNTEERS

Background: Work engagement is defined as a positive, fulfilling, work-related state of mind characterized by vigor, dedication, and absorption. Even though volunteers at hospitals are deeply engaged in their unpaid work, there are no quick tools for measuring work engagement among these volunteers. The Ultra-short UWES-3 is a valuable research tool to measure engagement, indicating the need for its validation among volunteers. Several recent studies have explored the role of work engagement in volunteer work, mostly focusing on volunteers working in social and nonprofit settings. Little is known about how work engagement contributes to the well-being and quality of life of volunteers working in hospitals. Furthermore, in this context, the relationship between work engagement and burnout, referred to as a psychological syndrome of emotional exhaustion, is poorly understood. Objectives: The objectives of this study were to examine the factor structure of the UWES-3, and to undercover possible associations between work engagement, well-being, quality of life, and burnout among volunteers. Methodology: This cross-sectional study collected self-reported anonymous data from adults connected to volunteer organizations in Guadalajara, Mexico. Results: Confirmatory factor analysis supported the scale’s unidimensional structure. While well-being and quality of life were positively associated with work engagement, exhaustion showed the strongest negative relationship to work engagement. Discussion: Our results support the validity of the UWES-3 and suggest that work engagement contributes to well-being and quality of life, while exhaustion is negatively associated with work engagement. From a wider perspective, results from this study provide important insights to guide stakeholders, such as hospital administrators and volunteer organizations. Conclusions: Our findings support the validity of the UWES-3 among hospital volunteers, suggesting that the scale is an appropriate work engagement measure in this setting. This study provides a new understanding of the relationship between work engagement, burnout, and psychological variables among hospital volunteers.