In case of emergency, please put on your own oxygen mask before assisting others

ImPRINT Module: Physician Wellness Presenter: Emily F. Ratner, MD Clinical Professor, Department of Anesthesia September 20, 2012

Goals for module:

Emphasize to physicians that we must take care of ourselves in order to take care of others effectively

Introduce an expanded definition of wellness

Describe the characteristics of physicians that make us great doctors..and leave us vulnerable

Define burnout, its elements, and consequences

Discuss how to prevent, minimize, reverse burnout

Wellness
Definition
More than the absence of disease Includes optimal states of physical, mental, emotional and spiritual health synchrony of mind and body

Reaching your full potential as a person

Includes healthy lifestyle choices Integration of an individual, including elements of daily life, and the internal and external environments The harmonious balance of mind, body and spirit leading to inner resilience which allows an individual to meet the endeavors of daily living with equanimity

Common physician characteristics

Psychological strengths of physicians Psychological vulnerabilities of physicians

Thoroughness
Commitment Healthy skepticism

Over-compulsive, guilt about not doing enough

Exaggerated sense of responsibility, self-blame Overwhelming doubt and need for certainty

Altruism, stoicism
Hard work, engagement with patients Caring

Not recognizing needs of self & family

Never home, thinks about work all the time Compassion fatigue

Rationality
Calm confidence Self-criticism

Emotional distance
Cool detachment Undervaluing oneself

Burnout
Definition Emotional exhaustion Depersonalization Lack of Personal Accomplishment The result of a problem relationship between an individual and the workplace, disharmony Individual factors

Six elements of burnout

Workload
Too much work, not enough resources

Control
Micromanagement, lack of influence, accountability without power

Reward
Not enough pay, acknowledgement or satisfaction
Maslach, Leiter 2005

Six elements of burnout

Community
Isolation, conflict, disrespect

Fairness
Discrimination, favoritism

Values
Ethical conflicts, meaningless tasks

Maslach, Leiter 2005

Consequences of burnout
Lower empathy Poorer self-reported patient care More errors Auto accidents Stress-related health problems Poor relationships Substance abuse Quitting practice Depression, suicidal ideation, suicide

Addressing burnout
Prevention is this possible?
Building engagement Emphasize the positives - reframing Sometimes, cant do much about the negatives anyway

Reversing
Individual approach Identify mismatch Enlist colleagues and organization to address issues Organizational approach Identify mismatch survey Connect with individuals to narrow the gaps

Individual Wellness Strategies

Healthy philosophical attitude toward life
not taking self too seriously perspective simplifying balance self-compassion

Self-care, self-awareness, self-monitor

Exercise, nutrition, rest Mindfulness, meditation, narrative writing Stress reduction Community
Build and sustain relationships Friends, family, supportive partner Support group - peers

Religious/spiritual life

Treating depression and other illnesses

Avoiding intoxicants Taking time off few breaths, hour, evening, weekend, vacation

Positive Cycle
Healthy work
Meaning Relationships Self-efficacy Self-compassion Self-worth

Physician job satisfaction

Greater patient satisfaction Greater patient adherence

Fewer errors
Greater retention Greater empathy

Discussion topics
What qualities do you have that make you a good doctor ? Could any of these qualities contribute to vulnerabilities that you have? Difficult patient situations