clarke abbotsford rounds 2009-02-11

c o n n e c t i n g p h y s i c i a n s t o h e a l t h

Physician Heal Thyself

Andrew Clarke, MD

Executive Director, Physician Health Program of BC

Presentation at Abbotsford Regional Hospital

2009-02-11This work is licensed under the Creative Commons Attribution-Noncommercial-Share Alike 2.5 Canada License. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-sa/2.5/ca/

http://creativecommons.org/licenses/by-nc-sa/2.5/ca/


Physician Healthy Self

Andrew Clarke, MD






Physicians Heal Thyselves

Andrew Clarke, MD






Agenda

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Do physicians work too much?

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What is burnout and what are its signs and symptoms?

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When and how should I get help?


How do I get help?

Imagine someone stopping you after this session and saying:•

John, I’ve been hearing rumors about your behavior lately. When I hear gossip like that, I feel concerned. I’d really like some reassurance that you’re doing ok. Would you be willing to sit for a while and check in with me about how things are going for you?

•

Jane, when notice you falling asleep during the presentation, I wonder if you’re feeling tired and needing some rest. Could we take a few minutes and catch up on how you’re doing these days?

What would your likely reaction be?Could anyone say this to you without provoking a defensive reaction?


Your trusted network might include…

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A spouse or partner

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A friend, or “über-friend”

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A colleague, or mentor (either official or unofficial)

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A family doctor*

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A counsellor


What if your answer is “no one”?

Then please call us at the Physician Health Program. We’ll help connect you to people who can be in this role for you.

+1 800 663 6729* If you don’t have a formal relationship with a family doctor of your own, please call us

and let us help you find one.


Agenda

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Agenda

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What do you mean by help?


When you need help depends on what help means to you

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Help can mean a stable network of long-term, trusted relationships you can rely on for inspiration, reflection and support.

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Or it can mean someone to give you advice about what to do, when

you can’t seem to figure it out for yourself.

Everyone needs this first kind of help. All the time. You need this now. Get this kind of help immediately.

The trouble with this second kind of help is that the more you need it, the less likely you are to recognize your need. You need a trusted network

to help you recognize WHEN to get this kind of help.


Agenda

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Signs of trouble in physicians

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Signs that you

are having trouble

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Signs that a colleague

might be having trouble


Mamta

Gautam’s

signs of trouble (for you personally)

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more physical problems

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more trouble in relationships

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more negative thoughts and feelings

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more bad habits -

whatever your personal ones are

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more exhaustion

Gautam

M. IRONDOC: Practical Stress Management Tools for Physicians. Book Coach Press; 2004.


Jenny Firth-Cozens’

signs of trouble (in a colleague)

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rigidity (lack of flexibility)

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anger (openly expressed in the workplace)

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difficulty in prioritizing (knowing which corners can be cut, and when)

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unexplained absences (“I lost my pager”)

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bypass syndrome –

people are avoiding dealing with your colleague

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lack of confidence in judgment

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unwillingness or inability to recognize limitations

Firth-Cozens J. Improving the health of psychiatrists. Advances in Psychiatric Treatment. 2007;13(3):161-168.


Agenda

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Burnout vs. psychiatric illness

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Burnout

is a specific syndrome, but not a DSM-IV diagnosis. Think of

it as disillusionment with a career in a helping profession. It’s related to, but not the same as, chronic overstress.

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It has three independently measurable1

characteristics:–

emotional exhaustion–

depersonalization (treating other people as objects / diseases)–

decreased sense of personal accomplishment

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It has four stages:2

–

enthusiasm (“I love this job –

I’m doing great things, with more to come!”)–

stagnation (“Well, it’s not exactly all I hoped for.”)–

frustration (“This system is seriously broken, but I’m trapped in it.”)–

apathy (“It’s a job. I’m just putting in my time until I can get out of here.”)

1 1. Maslach

C, Jackson SE. The measurement of experienced burnout. J Occup Behav. 1981;2:99-113.2

1. Edelwich

J, Brodsky A. Burn-out: Stages of Disillusionment in the Helping Professions. Human Sciences Press New York; 1980.


Burnout

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Unlike psychiatric illness, burnout seems to be contagious.

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It has very high prevalence among physicians (20% –

75%) with a lot

of local variation, just like an infectious disease.–

This is probably because cynical attitudes tend to spread in workplaces.

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It can co-occur with depression, but isn’t the same thing–

does not respond to anti-depressant medications–

does not generally respond to CBT, although other types of counselling are effective

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guided life reflection •

reality therapy

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does not have the same effect on objective work performance as depression•

has as great or greater effect on SUBJECTIVE work performance


Agenda

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Maybe

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Studies show that reducing working hours is not by itself enough

to

alleviate burnout.

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Others show that people who do get over burnout usually wind up working fewer hours.

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Reduced working hours seem to be an outcome of effective burnout

treatment, but not an effective single intervention for burnout.


Time check

Next four slides: current health issues for physicians


What are important health issues for docs these days?

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Focus groups in 2007: ~20 physicians from all over the province

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Made a long wish list of items that are of concern

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Three themes emerged:–

Collegiality

–

Advocacy

–

Wellness


Collegiality theme

CONCERNS RAISED BY PHYSICIANS

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What do I do when I notice a colleague who may be in distress, or vulnerable?

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What are some reasons why physicians don’t “get along”?

FACTORS UNDERLYING THE CONCERNS

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Physicians value autonomy highly: their own and their patients’.

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Entry to medical school is granted on the basis of success in a competitive, individualistic education system.

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Teamwork is not a strong component of medical education.

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Teamwork is, however, a reality of modern medical practice in most settings.


Advocacy Theme


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How can I effectively advocate for changes to the systems in which I practice?

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Why am I not consulted on decisions that affect me, and my patients?


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Physicians are used to seeing a problem, and fixing it. Immediately.

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Effective advocacy for social change requires several intermediate steps.

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Physicians can be perceived by others as “bullies”

or “not team players”

when they use their usual action strategies to advocate for social change.

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Decision-makers respond defensively by alienating and excluding physicians.


Wellness Theme


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How do I take what I know about health and apply it to my own life?

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What are the barriers to finding and keeping a family physician if you are a physician?

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Is there anything special to keep in mind when I have another physician as my patient?

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If there are things about physician-

patients that are unique, how are they ethically justified?


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I should be able to manage this on my own.

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I don’t want to seem like a “whiner”

to a colleague.

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If I consult a colleague for this problem, I’ll be using up a scarce resource.

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I don’t have the time, motivation, or permission to improve my health

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Meaning of terms like: health, wellness, sustainability


Thanks!

800-663-6729

[email protected]

clarke abbotsford rounds 2009-02-11

Health & Medicine