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Recovering the Joy of Medical Practice: Avoiding Burnout

Learn about the importance of physician well-being and how to prevent burnout in the medical profession. Explore countermeasures to reduce burnout and improve clinical practice.

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Recovering the Joy of Medical Practice: Avoiding Burnout

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  1. Faculty Development Committee Department of Obstetrics and Gynecology Professional Development Series October 16th, 2014 Avoiding Burnout: Recovering the Joy of Medical Practice Professor Emeritus Norman M Jensen, MD, Department of Medicine American Academy on Communication in Healthcare President, 2007-2009 Board Chair, 2011-2013 Faculty Guide for Distance Fellows Faculty for Clinical Skills Enhancement Courses: - Philadelphia, PA in June, 2015

  2. Avoiding Burnout: Recovering the Joy of Medical Practice • Our Aims today are: • Understand contribution of physician personal well-being to good clinical practice • What is burnout? • Score our own Ob/Gyn Well-Being Index (clicker questions) • What are the best counter measures for physicians? • Resolve to undertake one measure to ward off or diminish burnout (will be mailed to you in 2 months)

  3. “In a culture where work can be a religion, burnout is its crisis of faith.”Jennifer Senior, November 26, 2006, New Yorker Magazine Burnout “The cost of caring” Norm Jensen MD MS Professor (CHS) Emeritus Department of Medicine nmj@medicine.wisc.edu

  4. Personal Bio • Rural Wisconsin, public schools • UW college and med school • Harvard - Boston City residency • Drafted Navy doctor, Viet Nam Years • UW Grad school - social psychology • Fellowship - clinical communication • Teacher - Clinician 44+ years • Academic focus: clinical skills • No conflict of interest with this talk

  5. Intended Learning Outcomes • Cognitive • What’s burnout • How am I doing? • What helps? • What hurts? • Attitudinal: just a touch of • Self awareness

  6. The Story Begins What is Professional Burnout? Why is it important?

  7. Burnout, professional (MH) • An excessive stress reaction to work. • manifest by feelings of • emotional and physical exhaustion • & sense of frustration and failure. • (NLM-MESH)

  8. Burnout defined • Work-related distress that combines • Emotional exhaustion • Depersonalization • treating people in an unfeeling, impersonal way • Sense of low personal accomplishment • Ramirez. Lancet 1996;347:724-28. • ICD-10: "Problems related to life-management difficulty".

  9. Research concept • 1970 Maslach & Jackson • Maslach Burnout Inventory • exhaustion, cynicism, inefficacy • Maslach & Leiter • Burnout antithesis = “engagement” • energy, involvement, efficacy

  10. 7395 Medline Publications Burnout, professional (MH) Updated September 29, 2014 MESH: STRESS, PSYCHOLOGICAL 1983-89, STRESS, PSYCHOLOGIC 1969-72

  11. Burnout: What’s the big deal? • It’s prevalent • It harms the clinician personally • It harms the clinician’s clinical skill • It risks harm to patients • It is costly to the healthcare system • Inefficiency and waste • Professional workforce attrition

  12. Physician’s Well-Being Index Dyrbye LN, et. al. J Gen Intern Med 2012;28:421-27. DURING THE PAST MONTH • 1. Have you felt burned out from work? • 2. Have you worried that your work is hardening you emotionally? • 3. Have you often been bothered by feeling down, depressed, or hopeless?

  13. 4. Have you fallen asleep while stopped in traffic or driving? 5. Have you felt that all the things you had to do were pilling up so high that you could not overcome them? 6. Have you been bothered by emotional problems, such as feeling anxious, depressed, or irritable? 7. Has your physical health interfered with your ability to do your daily work at home or away from home?

  14. A Personal Inventory • Each of the next 7 slides has one personal question. • Please answer “yes” or “no”, quickly, the first response that comes to mind. • Keep a personal count of the number of “yes” answers. • Use your “clicker” for anonymous group prevalence. Clickers: press A = yes press B = no

  15. DURING THE PAST MONTH 1. Have you felt burned out from work? Clickers: press A = yes press B = no

  16. DURING THE PAST MONTH 2. Have you worried that your work is hardening you emotionally? Clickers: press A = yes press B = no

  17. DURING THE PAST MONTH 3. Have you often been bothered by feeling down, depressed, or hopeless? Clickers: press A = yes press B = no

  18. DURING THE PAST MONTH 4. Have you fallen asleep while stopped in traffic or driving? Clickers: press A = yes press B = no

  19. DURING THE PAST MONTH 5. Have you felt that all the things you had to do were pilling up so high that you could not overcome them? Clickers: press A = yes press B = no

  20. DURING THE PAST MONTH 6. Have you been bothered by emotional problems, such as feeling anxious, depressed, or irritable? Clickers: press A = yes press B = no

  21. DURING THE PAST MONTH 7. Has your physical health interfered with your ability to do your daily work at home or away from home? Clickers: press A = yes press B = no

  22. If you responded “YES” to four or more, click“Yes”now Clickers: press A = yes press B = no

  23. Physician’s Well-Being IndexDyrbye LN, et. al. J Gen Intern Med 2012;28:421-27. • => 4 “yes” • Likelihood ratio 3.85 • Specificity 86% • < 4 “yes” • Likelihood ratio .033 Likelihood of Low Physician Well Being

  24. The Story Develops • Prevalence • Profession • By specialty • Life cycle • Consequences • Personal • Healthcare • Risk Correlates • Personal • Work conditions • Moral Injury concept

  25. Physician Burnout Prevalence • Practicing physicians • 30 – 65% • Lancet 2009, JAMA 2009, Mayo ClinProc 2013, JAMA Intern Med 2012 • Hospitalists 30% • JGIM 2011 • Pediatric residents 74% • BMJ. 2008 Mar 1;336(7642):488-91. • Med Students 50%, > 6% suicide thoughts • Ann Intern Med 2008 • Highest mid-career • Mayo Clinic Proceedings 2013 • Difference among specialties …

  26. USA Physician Burnout Survey, Arch Intern Med 2012;172;1381 Burn out %

  27. USA Physician Burnout Survey, Arch Intern Med 2012;172;1381 Work-Life Balance

  28. Mayo Clinic Proceedings 2013;88:1363

  29. Personal correlates • Personal suffering • Lancet1996;347:724-8 (Hospital consultants) • Stress Hormone excess • YALE J BIOL MED 2002;75:199-205. • Coronary artery disease + • Psych Bulletin 2006;132:327–353 • + metabolic syndrome, HPA dysreg, sympathetic activation, sleep disturbance, systemic inflammation, and impaired immunity, blood coagulation, and fibrinolysis, and poor health behaviors. • Mental health • Anxiety, mood, adjustment, AODA, Suicide • ICD-10: "Problems related to life-management difficulty"

  30. Healthcare Correlates • On the job error • Ann Surg 2010 Jun;251(6):995-1000 (surgeons) • BMJ. 2008 Mar 1;336(7642):488-91. (Peds res) • Clinician empathy – compassion fatigue • Career & job dissatisfaction - disability • Sick leave, early retirement, job turnover • Patient dissatisfaction / adherence • € 20 Billion economic loss (Awa 2010) • $115 - 587,000 to replace a physician • Threat to & from healthcare reform?

  31. Correlating factors • Work load • Meaning in work • Work conditions • Feeling poorly managed and resourced • Effort : reward • Work demands : skills • Low autonomy & control • Patient suffering – “moral injury” • Intellectual stimulation • Work variety • “Work place bullying”

  32. Correlating factors • Work-life balance • Life style • Lack of life partner • Personal • Woman • Personal management skill • Communication skills • Self care – resiliency • Mid-career

  33. Multivariate AnalysisMayo Clinic Proc 2013;88:1364

  34. The Story Develops • What helps? • Work focused • Person focused (resilience) • Work - Person Interaction • State of the art review of evidence • Burnout prevention: A review of intervention programs. Patient Education and Counseling 2010;78:184-190.

  35. What helps? Work Focused • How days are organized • Modulate pace of work • Minimize hassles, interruptions & paperwork • Support staff share tasks requiring little / no professional judgment

  36. What helps? • Work control improvements • ↑ clinician participation in management – decentralize control • Monitoring work load • Promoting teamwork • Orientation of the new to set reasonable job expectations • Management by goal setting & feedback

  37. What helps? Person focused • Right job for the right person • Sabbaticals, vacations, breaks • Work-home-life balance • Self care • AMA book, The Resilient Physician

  38. What helps? Personal & professional learning • Mindfullness training • Advanced communication skills • JAMA 2009;302:1284-92. • Stress Management skills • CBT vs Yoga (RCT) • Cog Behav Therapy • Physical Exercise • Conflict management skills • Personal Management, life coach

  39. Concept of Resilience“The long-term ability to survive in and thrive on adversity.” Med Ed 2012;46:349-356. • Self – efficacy • Self – control • Cognitive: plan and act • Emotional intelligence • Self aware & modulation • Learn from difficulty • Persistence • Social intelligence • Engage help & support

  40. What helps?Work - Person Interaction • Employers / supervisors must • Understand sources of work-home interference & help manage • Cross coverage • Child care • Part-time practice • Flexible work hours • Advocacy

  41. c. 1970s

  42. The Story ContinuesACTIONABLES

  43. Resilience Plan Burnout meter awareness How’s the energy supply? Mindfulness skills Awareness of me Revise priorities regularly Really, is this what you want? Personal maintenance “Keep the saw sharp”

  44. Check Burnout Meter Monthly 1. burned out from work? 2. emotionally hardened? 3. mood down, hopeless? 4. daytime sleepiness? 5. overwhelmed by work? 6. emotional problems? 7. physical symptoms?

  45. Enhancing Mindfulness Skills Reading Jon Kabat-Zinn, Wherever You Go, There You Are. Hyperion, New York, 1994 ZinnJ-K, Davidson RJ, The Mind’s Own Physician. New Harbinger Publications, Oakland, CA, 2011 Training classes, UWHealth http://www.psychiatry.wisc.edu/uwpMindfulness.html https://www.uwhealth.org/onlineservices/classes/class/viewClass/21 CME courses http://www.urmc.rochester.edu/family-medicine/mindful-practice/presentations-workshops.aspx Personal practice

  46. Revise Priorities Annually Personal Family Professional Keep dynamic record Revise New Year’s Day Share with significant others

  47. Personal Maintenance • Social life • Personal physician / clinician • Optimize personal health • Emotional intelligence • Food intelligence • Weight control • Physical activity • Sleep, R, R, & R • Disease screening

  48. Assess your risk at http://www.mindtools.com/stress/Brn/BurnoutSelfTest.htm AMA book store, $35, $30 for members. Continue learning

  49. CHAPTERS • Defining & Exploring Personal Assessment & Management Strategies • What really stresses physicians? • Self-Assessment: How are you doing? • The psychology of physicians • Stress resilience • The balancing act • Understanding & Managing Relationships in the Medical Workplace • Conflict self-assessment • Anger management • Negotiating conflict • The disruptive physician • Listening & communication skills • Coping with change • Understanding & managing the stress of medical training • Making your workplace a positive interpersonal culture

  50. Continue learning • Chapters • Beyond Expertise • The New Yardstick • Competencies of the Stars • Hard case for soft skills • Self Mastery • The Inner Rudder • Self Control • What moves us • People Skills • Social Radar • The Arts of Influence • Collaboration, teams, group IQ • A New Learning Model • The Billion-Dollar Mistake • Best Practices • Emotionally Intelligent Organization • Taking Organizational Pulse • The Heart of Performance

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