The relationship between duty loading and the stress responses in physicians

Stress not only influences our endocrine systems and neural systems but also plays an important role in various physiological responses. Stress could result in onset, development, or progression of pathophysiological cardiovascular disease. It’s generally accepted that the more the stress, the more the cardiovascular disease. The working stress and long working hours may lead to atherosclerosis and cardiovascular diseases, while short term extreme stress maybe lead to acute myocardial infarction or cerebrovascular attack. Interest in dose response effect between stressor and stress response is growing, and more effective strategies for prevention of stressor related diseases are needed. It seems that the stress of active job, such as physicians, could be double or triple. For example, physicians could care twofold or threefold of patients at the same time. We are interested in “the relationship between the duty loading and the stress response of physicians”. The aim of this study is to evaluate the work burden of physicians of internal medicine and how duty loading stress inference heart rate variability, blood pressure and other stress indicators. This study would also explore if there dose response effect between different duty loading in an observational method. We also exam the effects of night duty events on blood pressure and autonomic tone in physicians. Moreover, we also exam whether treadmill heart rate recovery and circadian blood pressure drop predict elevated BP and sympathetic parameters during duty period. We identified dose-dependent stress responses of the cardiovascular system that were caused by the duty load of physicians. These results indicate that heavy duty loads might be hazardous to physicians in the long run. Sleep deprivation and the number of new patients admitted during duty nights were probably the most critical factors for the observed stress markers. Additional studies with a large sample are warranted for determining adverse cardiovascular effects at the recovery phase of duty load by comparing intensive and less-intensive duties. Among physicians on night duty, sympathetic tone and blood pressure were elevated by clinical events and these effects lasted for 30 minutes. The effect of duty loading on circadian change and autonomic tone modulations for up to 30 minutes shows that nighttime shifts for physicians may cause impaired performance and adverse effects on their subjective health. Higher treadmill heart rate recovery within first minute right after stopping running and higher circadian SBP drop were significantly associated with lower difference of blood pressure change caused by duty load. Higher circadian DBP drop was significantly associated with lower difference of blood pressure change and autonomic tone caused by duty load.