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TFME 2013 Organizational Professionalism Conference
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Physician Well-Being:Creating an Oasis for You
Foundation for Medical ExcellenceOctober 6, 2012
Alderbrook
Dr. Paul [email protected]
2000’s
1990’s
1980’s
1970’s 1960’s
‘Impairment’ Substance Use
Disorders
Depression, Other Mental Health
Disorders
Other Potentially ‘Impairing’ Conditions
‘Disruptive Doctor’, Behavioral Issues, Stress & Burnout,
Physician Well-Being
Prevention, Health Promotion, Renewal, Career Counselling,
Coaching
Scope of problems presented to Physician Health Programs
Physicians & their Temperaments
4
“The most important quality of a physician is compulsiveness.”
The Triad of Compulsiveness
Self-Doubt
Guilt feelings
Exaggerated sense of responsibility
Gabbard, 1985
Compulsiveness
‘Perfectionism’
• Contains an element of pressure associated with a sense of helplessness and hopelessness.
• Perfectionism is a vulnerability factor for burnout, and anxiety.
• The desire to excel must be differentiated from the desire to be perfect.
• Believing that others will value you only if you are perfect is associated with both depression and suicide.
- Flett & Hewitt, 2002
Individuals with compulsive and perfectionistic traits are attracted to medical careers
Stressors in the environment of an academic setting do not create these personality features – they exacerbate pre-existing traits
Internally driven Compulsiveness
• Challenging the external environment ignores the inner demands & doesn’t help the discomfort
• By believing these internal demands are natural it allows us to avoid looking at ourselves and our own behaviours as part of the problem
• Our outward focus on the patient, the disease, the diagnosis, the procedure, the treatment reinforces our reluctance to look inwards
Menninger
Culture of Medicine
Competitive, Controlling, PerfectionisticOverWork is the normBlurred boundariesNeglect health and relationships‘Psychology of Postponement’
Physicians and Intimate Relationships
• “In many physicians, the character armour that enables them to do their daily work becomes hypertrophied and is carried from the workplace into the home”
• “Hence, giving and receiving love in the medical ‘marriage’ becomes a challenge”
Myers M. The medical ‘marriage’. Paper presented at the American Psychiatric Association Annual Scientific Meeting, San Francisco, May 22, 2003
‘If I work hard(er),
I will be loved’
Roots of Physician Stress Explored Lynne Lamberg
JAMA 1999;282:13-14
Myth of Invincibility
Medical profession does not encourage physicians to admit health vulnerabilities or seek help
- Levine & Bryant, 2000
‘Illness doesn’t belong to us. It belongs to them, the patients. Doctors need to be taught to be ill. We need permission to be ill and to acknowledge that we are not superhuman’
McKevitt C, Morgan M.Illness doesn’t belong to us
J R Soc Med 1997;90: 491 -495
Definitions of Stress
Automatic non-specific response 'Relationship between the person and the
environment that is appraised as taxing or exceeding his or her resources and endangering his or her well-being'
The response is mediated by the autonomic nervous system.
Emotional Exhaustion – feeling emotionally overrun/exhausted by one’s work – little left to give
Reduced Personal Accomplishment – perception of clinical ineffectiveness, dissatisfaction with achievement
Depersonalization – Becoming distant and cynical, view others as objects, avoidance of people. Negative attitude towards others and self
Maslach
‘Burnout’ – 3 dimensions
Burnout produces feelings of
Hopelessness,
Powerlessness,
Cynicism,
Stagnation
Reduced productivity
Resentment
How Can We Become More Resilient?
“capable of recoiling from pressure or shock unchanged or undamaged.” Funk & Wagnalls
Difficulty balancing personal and professional life is a major
contributor to physician distress
Unbalanced lives in terms of: Work Relationships Play Personal Time
Six-Category Framework
Workload(Too much work, Not enough resources) Control(Micromanagement, Lack of influence,
Accountability without power) Reward(Not enough pay, acknowledgement or
satisfaction) Community(Isolation, Conflict, Disrespect) Fairness( Discrimination, Favouritism) Values(Ethical Conflicts, Meaningless Tasks)
Maslach & Leiter
Both individuals and organizations can use this framework to diagnose which catagories are especially troublesome for them, and then to design interventions that target these problem areas.
Narrow the gap between your expectations and your work reality
1.Self-Awareness
2.Self-Care
3.Sharing of feelings and responsibilities
4.Developing a personal philosophy
5.Non-traditional coping skills
A physician's personal growth and development – 5 areas of focus
Williamson
4 main aspects of Physician Resilience
1) Attitudes and Perspectives 2) Balance and Prioritization 3) Practice Management Style 4) Supportive Relations
Jensen, Trollope-Kumar, Waters, Everson
Happiness
The man who thinks he can live without others is mistaken; the one who thinks others can't live without him is even more deluded.
~ Hasidic Saying”
‘The areas that contributed most to doctor’s happiness with their lives as physicians seem to focus on the people they work with, the people they live with, and most of all the people for whom they provide medical care’.
• ‘Interpersonal relationships are the number one predictor of well-being’ Tal Ben-Shahar
Burnout
'Joyless Striving'
Holmes & Rahe
Positive change doesn't just happen We must take action and well-informed
action at that.
When there is balance in my life I am more resilient
Check-in:
Getting overloaded by taking on too much
Procrastination
Take a step back - I need to regroup & get organized!
GOALS:
To be healthy emotionally, spiritually and physically
To be happy and excited about the work that I am doing
To not feel overwhelmed, unsatisfied, angry or resentful
ACTIONS
Believe that I can change - Being Proactive is about not being Reactive
Maintain positive philosophy with sense of optimism
Loving-Kindness Meditation - regularly
Inventory – Mad, Sad, Glad or Afraid?
Daily Gratitude List
Keep a sense of humour, daily
ACTIONS
Define my limits & boundaries, and share them with others - appropriate assertiveness
Work on balance between work, home and self - small steps... A Sanctuary, 'Sabbath'..
Work on friendships, focus on two special people
Be mindful for the moments of wonder
ACTIONSIncorporate physical fitness, and more plant based
diet as part of my wellbeing
Get enough sleep
Do something I like outside medicine - Give myself permission for leisure time – e.g.15 mins rule
Plan for retirement
Ask for help when I need it
REMEMBER:
My job is what I do, not who I am
We have more control than we think