Jane Lemaire MD FRCPC - University of Alberta .Jane Lemaire MD FRCPC Health and Wellness Rounds Department

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  • Jane Lemaire MD FRCPC

    Health and Wellness Rounds

    Department of Anesthesiology

    University of Alberta

    Edmonton, AlbertaMarch 21, 2014

  • *

  • *Dr Jean Wallace

    Department of Medicine

  • *

    * To discuss why physicians are at risk of burnout

    * To review the personal and professional impacts of burnout

    * To consider how physicians can shift from burnout to wellness with some simple

    strategies

  • *

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  • *Patient demographics*Technology*Advancements in health care*Gender and generational shifts*Expectations

    *

  • Prepared by

    Jean E. Wallace

    Jane Lemaire

    Alyssa Jovanovic

    Prepared for the Alberta Heritage Foundation for Medical Research

    and the Calgary Health Region

    All physicians within the Calgary

    Health Region

    Stage One: Physician interviews (N=42)

    Physician job observations (N=44)

    Spouse interviews (N=32)

    Stage Two: Survey to all physicians in the CHR

    Received 1178 surveys (40% RR)

    Jean E Wallace, Jane Lemaire, William Ghali,

    Dave Megran, Todd Watkins, Maeve Obeirne,

    Alyssa Borkosky

    Determinants of Physician Well Being

  • Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374:1714-1721.

  • *

    * Workload* Long hours* Emotional and

    cognitive

    demands

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    *Depression*Suicide*Substance abuse*Relationship difficulties*Job or career change*Coronary artery disease*Decreased immunity*Accelerated aging

  • *

    * Emotional exhaustion

    * Depersonalization* Reduced sense of

    accomplishment

  • *

    * Individual factors* Professionrelated

    factors

    * Workplace factors

  • *

    Workaholic vs. not

    Emotional exhaustion

    Depression

    Job satisfaction

    Rewarding patient experiences

    Career commitment

    Type A vs. not

    Emotional exhaustion

    Depression

    Anxiety

    Control Freak vs. not

    Emotional exhaustion

    Depression

    Anxiety

    Poor mental health

    Wallace JE, Lemaire JB. Physicians personality traits: sound familiar? Abstracts. Doctors Health Matters-

    Finding the Balance. 2008 BMA-AMA-CMA International Conference on Doctors Health.

  • *

  • *Negative peer pressure

    33

    42

    21

    4

    0

    10

    20

    30

    40

    Not Important at All Not Very Important Somewhat Important Very Important

    % o

    f R

    esp

    onse

    s

    Negative Peer Pressure Affects my Ability to Improve my own Health and Well Being

    Source: 2009 Determinants of Physician Well Being: Stage Two Report (n=1178)

  • *

    0

    20

    40

    60

    80%

    of

    Res

    po

    nse

    s

    Oft

    en o

    r m

    ost

    of

    the

    tim

    e

    Family

    Medical

    Surgical

    2009 Determinants of Physician Well-Being: Stage Two Report (n=1178)

  • *

    * Job and career turnover* Productivity/efficiency* Patient encounters* Job satisfaction/patient

    compliance

    * Role modeling for patients

  • Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374:1714-1721.

  • *

  • *

    0

    50

    100

    150

    200

    250

    300

    350

    400

    450

    500

    1972-1981 1982-1991 1992-2001 2002-2012

    Nu

    mb

    er

    of

    Sear

    ch R

    esu

    lts

    Years Searched

  • *But Im not sure that the link between their (physicians) own health and patient care is probably very clear. Because you cant believe that right? You cant believe if youre having a bad day that youre going to provide poor patient care cause thats just not what you do.

    *

    Wallace JE, Lemaire JB. Physician well being and quality of patient care: an exploratory study of the missing link. Psychol Health Med.

    2009;14:545-52.

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  • How does workplace nutrition affect

    physicians?

    Well Doc? Module 1

  • Nutrition and cognition

    Lemaire, Wallace et al. Physician nutrition and cognition during work hours:effect of a nutrition based

    intervention. BMC Health Serv Res. 2010;10:241.

    . Lemaire, Wallace et al. Food for thought: an exploratory study of how physicians experience poor workplace

    nutrition. Nutr J. 2011;10:18.

  • Does a portablebiofeedback tool help

    reduce physician stress?

    Well Doc? Module 2

  • Regulating the endocrine and autonomic

    nervous system response to stress

    Lemaire JB, Wallace JE, Lewin AM, de Grood J, Schaefer JP. The effect of a biofeedback-based stress

    management tool on physician stress: a randomized controlled clinical trial. Open Med. 2011;5(4):e154e163.

  • What physician coping strategies are

    most effective against burnout?

    Well Doc? Module 3

  • 0

    20

    40

    60

    80

    100

    Concentrate on what to do

    next

    Make a plan of action

    Use humour to lighten situation

    Keep it to myself

    Talk with colleagues

    Go on as nothing has happened

    Take a time out

    % o

    f Res

    pons

    es

    Most of the Time

    Often

    Sometimes

    Frequency of use of physician coping strategies at work (n=1151)

    Lemaire JB, Wallace JE. Not all coping strategies are created equal: a mixed methods study exploring physicians self reported coping strategies. BMC Health Serv Res. 2010;10:208.

  • 0

    20

    40

    60

    80

    Spend time with family

    Talk to spouse Find time to exercise Leave work at work Make quiet time outside of work

    % o

    f Res

    pons

    es

    Most of the Time

    Often

    Sometimes

    Frequency of use of physician coping strategies outside of work (n=1151)

    Lemaire JB, Wallace JE. Not all coping strategies are created equal: a mixed methods study exploring physicians self reported coping strategies. BMC Health Serv Res. 2010;10:208.

  • Coping styles and affect

    High positive

    affectN=493

    More problem solving

    More seeking support

    More time outs

    High negative

    affectN=281

    More denial

    More keeping to self

    Wallace JE, Lemaire JB. Physician coping styles and emotional exhaustion. Indus relations. 2013;68;187-209.

  • *

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    *Use humor*Take a time out*Eat and drink*Make a plan of action*Talk with colleagues

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    *Time off*Quiet time*Family*Friends*Exercise*Hobbies

  • *

    Time outs Some work free nights/weekends Real vacations Sabbatical leaves Nature

  • *

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    *Positive psychology*Mindfulness/gratitude*Relaxation techniques*Narratives

  • *Wellness goes beyond merely the absence of distress and includes being challenged, thriving, and achieving success in various aspects of personal and professional life (Shanafelt et al 2003)

    *

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  • *Frank E, Dresner Y, Shani M, Vinker S. The association between physicians and patients preventive health practices.

    CMAJ.2013;185:649-653.

  • *

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    *Our work is rich but difficult*We are at risk for burnout *We can learn to prevent and mitigate poor stress-related health outcomes

    *We can message and role model mental health for our patients

    *We can target wellness

  • Well Doc?

    Physician Wellness:

    Fundamental for Doctors.Vital for Patients.

    Jane Lemaire MD

    Jean E Wallace PhD

    William A Ghali MD MPH

    Jeffrey P Schaefer MD

    Delia Roberts PhD

    Jill de Grood MA

    Kelly Dinsmore MSc

    Adriane Lewin MSc

    Alyssa Jovanovic PhD

    Judy Boychuk Duchscher RN PhD

    Alicia Polachek MA

    Debbie Gray BSw MSc

    Krista Warners BN MSc

    Teri Dingwell BN

    Mamta Gautam MD

    Peter Sargious MD

    Maria Bacchus MD

    Kelly Zarnke MD

    David Ward MD

    Sonja Morrison RN

    Rhonda Niebrugge RN

    Jennifer Cowles RN

    Susan Campeau RN

    Mary Widas RN

    Katherine Bright RN

    Kristen Desjarlais-deKlerk ABD

    Jaya Dixit MA