Jane Lemaire MD FRCPC

Health and Wellness Rounds

Department of Anesthesiology

University of Alberta

Edmonton, AlbertaMarch 21, 2014

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*Dr Jean Wallace

Department of Medicine

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* 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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*

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*Patient demographics

*Technology

*Advancements in health care

*Gender and generational shifts

*Expectations

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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.

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* 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

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* Emotional

exhaustion

* Depersonalization

* Reduced sense of

accomplishment

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* Individual factors

* Profession–related

factors

* Workplace factors

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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.

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*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)

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* 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 I’m not sure that the link between their (physicians’) own health and patient care is probably very clear. Because you can’t believe that right? You can’t believe if you’re having a bad day that you’re going to provide poor patient care ‘cause that’s just not what you do.”

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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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*

*

*

*

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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):e154–e163.

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

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• 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