Physician Health - Managing Stress

Dr. Carolyn ThomsonProfessional Support Program, Doctors Nova Scotia

Objectives

1. To identify key areas of stress in a physician’s life and understand its effect on performance

2. To understand the influence of the physician personality on the interpretation of potentially stressful events

3. To discuss the warning signs of burnout4. To identify and develop tools to manage stress

and enhance resilience5. To appreciate key components of life balance

and develop skills to enhance it

Disclosures No affiliation with industry

“I am more and more convinced that our happiness or

unhappiness depends more on the way we meet the events of life than on the nature of those

events themselves”Alexander Humboldt

Why Physician Health?

The Royal College values physician wellness: CANMEDS Professional Role:

“Physicians’ maintenance of their own health and well-being is an essential component of their professional role.”

CanMEDS Physician Health Guide, 2009

When did you first feel drawn to medicine?

What did it feel like? Has that feeling grown or diminished

over time? How does your life in clinical practice

differ from your expectations upon entering medical school?

Are We Healthy?Canadian Physician Health Study

> 90% of physicians report good health Majority comply with Canadian personal health

screening guidelines, but:

Only 57% report good work-life balance25% have chronic physical or mental

health condition that impacts their ability to work as they otherwise would

>60% will work when ill

Are we happy?

8,000 practicing physicians revealed that:

23% of physicians feel depressed 33% admit their work day causes stress 60% have so much work that it prevents

them from pursuing personal and family interests

Canadian Physician Health Survey 2008

Career Satisfaction of US Women Physicians:

The Women Physicians’ Health Study

4,501 female physicians surveyed

31% would not choose to be a physician again

38% would prefer to change their specialty

• Erica Frank et al, Arch Inter Med. 1999; 159: 1417 - 1426

Major Determinants of Dissatisfaction

Lack of work controlo Those with unpredictable hours had more

stress o Those with an unhappy practice

environment had more stress Work stress

o 44% reported working too much Home stress Lack of religious or spiritual life Fewer children

o Those with an imbalance between family and home had more stress

Protective Factors 2144 physicians surveyed, aged

35-54 What decreased stress &

increased work satisfaction:o Participation in community

activities o Leadership roles & control oCollegial supporto Factors Explaining Career Satisfaction Among Psychiatrists and

Surgeons in Canada, Rein Lepnurm, DrPH, Roy Dobson, PhD, Allen Backman, PhD, David Keegan, MD, Canadian J Psychiatry, March 2006

Are You Happy in Your Work?

Do you experience joy in your work?

Do others experience joy as a result of your work?

What do Physicians want?

Controllable hours Balance between family and

work life Less stress Income that equals our effort Fun! Love

What Stands in the Way?

Health care reimbursement? Hospital administration? Colleagues? Families? Patients? Ourselves?

The Physician Personality

We Are:o IntelligentoCaringoSensitiveo Inquisitive

We are also…

Type A Competitive Perfectionistic Safety seeking

We combine that with…

Developing an ability to

emotionally dissociate because…

“A physician in training sees more trauma in one month that most others see in a lifetime.”

By the end of medical training many physicians are:

Exhausted Isolated from

friends and family

In debt

Ego-centric as an expression of insecurity

Emotionally dissociated

Stress

Too much work leads to:

Emotional fatigue Stress Resentment

Some Definitions

Stress: How the body reacts to a stressor, real or imagined

Stressor: Anything external that knocks the body out of homeostasis forcing the body to take action

Eustress: Where stress enhances function (physical or mental)

Distress: Persistent stress that is not resolved through coping or adaptation

Warning signs Increased physical problems & illness Increased problems with relationships Increased negative thoughts & feelings Increased unhealthy behaviours Inability to continue pushing oneself

Stress

Directly linked

Heart diseaseStrokeInjurySuicideHomicide

Indirectly linked

CancerChronic liver

diseaseEmphysemaChronic

bronchitis

Contributors to Stress

Disruptive behaviours Intimidation/harassment at

work Difficult interactions with

patients and colleagues Unexpected outcomes – error,

complaint, litigation Personal health issues

#1 Cause of stress: sense of lack of control

#1 Solution: Challenge this perception

PERCEPTION: Your Historian

Sense of self arises from experiences we had as a child

Draw conclusions (often concrete) based on how we were treated

Not reality but perception of reality History is the “ultimate” distortion and

concrete thinking persists

The 90:10 Rule 10% of your reaction is due to

that particular situation

90% is what you automatically assume from past experience (your “historian”).

Managing Stress

Event + Response = OutcomeoEliminate the causeoChange our perception of the stress

Appreciate the difference

What you can change Perceptions of ourselves and

the situation Recognise learned behaviours

and assumptions that do not help us

Attain a +ve attitude Become more assertive and

set limits and boundaries More confident at reaching

out and connecting with others

ID aspects that we value in all parts of our lives- work, relationships, family, home, self- and decide what we are going to do to maintain these priorities

What you can’t change Parents

Childhood experiences

Upbringing

Genetics

Cognitive Distortions:Applying a mental filter

Dwelling on a single negative detail If you made an error with a patient

this will override all the good things you’ve done with and for that individual

If you do something embarrassing an entire experience can be ruined

This can negate the benefit of a great relationship or life experience

LET GO! Of cognitive distortionsoAll or nothing thinking

Perfectionismo“Anything worth doing is worth doing half-assed”

• Rachael Naomi Remen

Stress Management- Why?

Lower catecholamines Lower cortisol Enhance cortical function

Stress Management Tools

Meditation Yoga Tai Chi Prayer Exercise Hobbies

Yankee Rose Yankee Rose

Stress & Burnout

Common cause of early retirement

Job dissatisfactionPoor working relationships

Burnout

Mayo Clinic:Almost half of American physicians are

emotionally exhausted, suffering from depersonalization, and struggling with a low sense of personal accomplishment

Top three: Emergency physicians General Internal Medicine Family Physicians

Shanafelt, T et al. Arch Intern Med

Three Dimensions of Burnout

“Gradual erosion of the person”

Emotional ExhaustionDepersonalizationLoss of professional satisfaction

Are you at risk?

Burnout We lose perspective and blame others We judge others harshly We begin to externalize our frustrations

and feel bad about it Our type A tendencies are running at max We become hyper-irritable Our personal lives crash We hit survival mode

o Numbnesso Loss of creativityo Reflex behaviors predominate

Key Point

Burnout is easier to prevent than

to treat

Prevention

Commitment, self-efficacy, resourcefulness and hope

May have to address at organizational level

Cognitive – behavioural strategies

Exhaustion more easily treated

Addressing Burnout

The “3R” Approach: Recognize Reverse Resilience

RESILIENCE: the ultimate life skill

Why do some people cope better than others?American Psychological Association:

“The ability to adapt well in the face of adversity, trauma, tragedy, threats and

from sources of stress such as work pressures, health, family and relationship

problems.”

The ability to bounce back

Characteristics of Resilience

Optimism & hopeConfidenceLearn lessons from experienceAssume things will work out wellFocus on learning and coping

rather than blaming and being a victim

If you don’t design your own life plan, chances are you fall into someone else’s

plan. And guess what they have planned for you? Not

much.

What is Work Life Balance?

Mental Physical Emotional Spiritual

The Corporate Athlete

• Physical capacity o Builds endurance and

promotes mental and physical recovery

• Emotional capacity o Creates the internal climate

that drives performance• Mental capacity

o Focuses mental and emotional energy on the task at hand

• Spiritual capacityo Provides powerful

source of motivation, determination and endurance

Typical Physician Plan I’ll exercise for one hour a day Then, I’ll tell all my friends and

family that I love them Maybe I’ll call then while I’m on

the treadmill Then, I’ll pray for 30 minutes,

meditate for 20 minutes and read the literature for an hour

Balance

Spiritual

Mental

Physical

Emotional

Wellness Strategies1. Identify personal and professional values and

priorities2. Enhance areas of work that are most personally

meaningful3. Identify and nurture personal wellness strategies

that are important to you4. Self care5. Hobbies and personal interests

Shanafelt, TD. J Support Oncol 2005;3(2):157-62

What works for you

Identify the things that bring you joy and do more of them

Identify the things that drain you and do less of them

Make choices about what you can and can’t do

"Imagine life as a game in which you are juggling five balls in the air. You name them - work, family, health, friends, and spirit - and

you're keeping all of these in the air. You will soon understand that work is a rubber ball. If you drop it, it will bounce back. But the

other four balls - family, health, friends, and spirit are made of glass. If you drop one of these, they will be irrevocably scuffed, marked, nicked, damaged, or even shattered. They will never be the same.

You must understand that and strive for balance in your life."-- Brian Dyson, CEO of Coca Cola Enterprises 1959-1994

-- Brian Dyson, CEO of Coca Cola Enterprises from 1959-1994

Resources: General Health:

o www.Ephysicianhealth.como CanMeds Physician Health Guide: A Practical Handbook

for Physician Health and Well-Being• Puddester, Flynn, Cohen• Available on line

The Resilient Physician o Sotile and Sotile

Finding Balance in a Medical Lifeo Lipsenthal

Reaching out:

Family, friend or colleague you can trust – find one!

Family Physician-get one Provincial Physician Health Program

o Listed with contact information on CMA.ca wesite Substance Use Concerns:

o AA, NA CMPA Physician Wellness Resources

o http://www.cmpa-acpm.ca