THRIVING (NOT JUST SURVIVING) IN A BUSY PRACTICE

WELFARE SIG MEETING SEPTEMBER 2016

Dr Kym Jenkins MB.ChB., FRANZCP, MPM, MEd, GAICD

Medical Director- Victorian Doctors Health Program

Psychiatrist and Medical Educator

President–elect RANZCP

IN THIS TALK

• A little about vdhp

• Mortality and morbidity

• Burn out

• Compassion fatigue

• Thriving

• Resilience

• Connectedness and suppports

THRIVING

• Growing strongly (flourishing) and vigorously

• Doing well/prospering

VDHP• Set up 2001

• to assist doctors and medical students whose condition will, or is likely to, impact adversely on their ability to continue to practice medicine.

• an independent legal entity

• confidential service

HEALTH PROGRAM

VICTORIAN DOCTORS

WORK OF VDHP

• Stress and distress

• Mental health problems

• Substance use disorders

• Physical health problems

HEALTH PROGRAM

VICTORIAN DOCTORS

VDHP ROLES

• Assessment /triage

• Counselling

• Education

• Prevention

• Case management

• +/-Monitoring

• ****Return to work programs ****

• Support group

HEALTH PROGRAM

VICTORIAN DOCTORS

WORK AT VDHP250 phone consultations per annum

• 150 face to face assessment/ triage appointments

• > 40 doctors case managed at any time

MORBIDITY AND MORTALITY

REFLECTING ON PRESENTATIONS TO VDHP

• Doctors who are stressed by the practice of their profession

• Doctors who are experiencing trauma/ life events that may no direct relationship with their profession

• Doctors with mental illnesses +/- SUD

MORBIDITY

• Stress – all sorts, workplace, relationships

• Burn out

• Mental illness – Depression, Anxiety, Eating disorders

• only cause of death for medical practitioners

where mortality rates are greater than for the general population.

• therefore likely that as medical practitioners, at some stage of our careers we will be affected by the

suicide of one of our colleagues or classmates

SUICIDE

• Importance of doctors mental health increasing recognition • Roll out in Australia of DrHS funding doctors health services

• Beyond blue – doctors mental health program

• RANZCP College welfare

• ANZCA welfare

• AMAvic anti-bullying initiative

• RACS –anti-bullying

DOCTORS MENTAL HEALTH

• All the above interventions will lead to a decrease in morbidity not a decrease in mortality

• Doctors may be happier, less stressed in the workplace –but will it really make any difference to the suicide rate

HYPOTHESIS

• Severe mental illness

• Substance use disorders –sometimes starting before medical school

• Workplaces supportive

• Reporting to AHPRA did not appear to be a precipitant but…

• Social isolation, rejection by loved ones

• Loss of structure through not working,

• Hopelessness and despair

VDHP STUDY 2016

• Whilst striving for healthier workplaces, including easing the stress of training, are essential doctors’ health endeavours: this study would suggest the impact is likely to be a decrease in morbidity, rather than in mortality rates

VDHP 2016

STRESS-BURN OUT -DEPRESSION

Like beauty :

In the eye of the beholder

STRESS

• Holmes and Rahe 1967

social readjustment scale

1 Death of spouse (100)

2 Divorce (73)

3 Marital separation (65)

4 Jail term (63)

5 Death of close family member (63)

6 Personal injury or illness (53)

7 Marriage (50)

8 Fired at work (47)

9 Marital reconciliation (45)

10 Retirement (45)

STRESS AND FUNCTIONING

YERKES -DODSON

• A tough job

• Idealism

• Arrogance/ pride

• Relationship problems

• Financial naivety

• Dealing with colleagues

• Being a good doctor and successful professionally doesn’t equate to being happy and fulfilled in personal life

COMMON THEMES FOR UNHAPPY DOCTORS

BURN OUT

• Result of chronic stress

• Exhaustion

• Lack of enthusiasm

• ↓ motivation

• Lots of negative emotions

• Symptoms of depression PLUS……..

• Dreading to see patients

• Chronic complaining

• Delaying doing paperwork

• Loss of confidence in ability

• Fantasizing about change in career

• Reliance on drugs and alcohol to unwind

WARNING SIGNS OF BURNOUT

COMPASSION FATIGUE

• Comes from social connectedness with patients and families- emotional engagement /intensity of interpersonal interactions

• Nothing left to give

• Empathy “bypass”

• Can be a warning sign of burnout

SELF COMPASSION

• Increasingly recognised as important concept in medical practice

• Doctors not good at it

• “lack of forgiveness causes almost all of our self sabotaging behaviour”

• “if you don’t love yourself, you cannot love others. You will not be able to love others. If you have no compassion for yourself then you are not able of developing compassion for others” –Dalai Lama

SELF COMPASSION

• Being kind to yourself

• Plus –aware of common humanity- feeling connected to others rather than isolated in our suffering

• Plus –requires mindfulness-awareness of experience in a balanced way-don’t ignore or exaggerate our “pain”

RESILIENCE

• Variously defined but:

• A process/capacity that develops over time

• Bouncing back after adversity

• Growth after experiencing adversity

• “the ability to withstand, recover from and grow when encountering stressors and changing demands” -WA police-

ASPECTS OF BEING RESILIENT

• Self awareness

• Self-regulation

• Positive view of self

• Positive emotionality

• Self-efficacy

• Optimism

• Able to find meaning

• Perceived control

• Emotional awareness

• Adaptability/flexibility

• Interpersonal connectedness

• Positive relations with others

• Why are some people more resilient than others ?

• What is resilience training?

• Does it work?

• Is resilience training of value in the medical profession?

RESILIENCE

RESILIENCE

• Needed because a career in medicine is inherently stressful

• Set of skills and characteristics that can be taught

• Focuses on strengths

CONNECTEDNESS

• Family

• Friends

• Club, society, work place, place of worship

• Part of individual identity

• Sense of belonging

• Part of something larger than the self, collective identity

• Decreased isolation

BUFFERS AND SUPPORTS• Life outside medicine

• Relaxation

• Holidays

• Minibreaks and micro-breaks

• Preserve relationships

• Preserve friendships

• Develop and preserve hobbies

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THRIVING

THERE IS MORE TO LIFE THAN MEDICINE!!

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THRIVING

GET YOURSELF

A GP!!

CREATING YOUR OWN LIST OF WHERE YOU’D GET HELP IN VARIOUS

CIRCUMSTANCES

WHEN TO SEEK HELP

• Asking self is what I’m feeling normal

• Usual coping strategies not working

• Not feeling supported

• Despair/despondency extends beyond a critical incident

• Difficulty concentrating /functioning at work

HOW TO SEEK HELP

• ANZCA welfare officer

• GP

• VDHP (www.vdhp.org.au)

• DHAS (www.adhn.org.au)

• EAP

• Colleague –someone who’s a bit detached, but understands the situation, a respected peer or “buddy”,

WHAT YOU SHOULD EXPECT WHEN YOU GET HELP

• Confidentiality

• Supportive listening

• Non judgemental

• +/- counselling

• +/- supportive psychotherapy

• Monitoring/check up

HELPING OTHERS SURVIVE AND THRIVE

• RU OK

• BE AWARE -that colleagues may not be travelling too well

• OBSERVE -changes in behaviour/unusual moodiness

• don't be afraid to ASK

• make TIME to LISTEN then.....decide best course of action

• Suggest/enlist/ensure professional help –remember your role is as friend/colleague

BEING THERE FOR OTHERS IN THE WORKPLACE

• On the way in from the car park• You look a bit worn out already –are you going to be ok today

• In the doctors office at the start of the day• You don’t look too good. are you OK?

• In the cafe• Are you struggling a bit ? Shall we meet for a quick coffee after work?

• Handover at the end of the day• You look exhausted. Can I help at all?

• On the way out of the hospital• Things not going too well? Here’s my number, give me a call, we can talk.

FIVE MOMENTS OF CARING FOR EACH OTHER- COURTESY OF DR ANTOINETTE BRENNAN

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HELPING A COLLEAGUE

• Do HELP

• ask if OK,

• offer to listen,

• allow sufficient time

• BUT be clear re boundaries –friend, colleague, counsellor,

• Be clear re own role

• Be clear re limits of own expertise

• Know and be able to advise re other supports available

A FEW WORDS OF CAUTION

• If we think becoming more resilient will “fix everything”

we are at risk of trivialising experience /emotional state,

we may not be validating what someone is going through

or we maybe missing mental illness

• Being “kind to yourself” is particularly hard when suffering depression and the instruction to do so may give the depressed person something else to add to the list of things they’re failing at.

THRIVING not just SURVIVING• Surviving

• Remaining alive or in existence

• Carrying on despite hardships or trauma: persevering

• Remaining functional or usable

So being able to survive is actually quite useful

Periods of “just survival” inevitable in medicine

NB not the opposite of “thriving”- decline, wither, fail, stagnate: but somewhere on the way to thriving

THREE TAKE HOME MESSAGES

•Keys to thriving

Vigilance is important

IS YOUR LIFE IN BALANCE?

HAVE REALISTIC EXPECTATIONS

Victorian Doctors Health

ProgramTel. 03 9495 6011

Level 8, Aikenhead Building

27 Victoria Parade

Fitzroy Vic 3065

HEALTH PROGRAM

VICTORIAN DOCTORS