Physician Health Burnout The Silent Anguish of Healers

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Physician HealthBurnout The Silent Anguish
of Healers

• James L. Wieberg, L.P.C.
• September 13, 2009

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GOALS

• Identify the Missouri Association of Osteopathic
  Physicians and Surgeons (M.A.O.P.S.) Physician
  Health Program (PHP)
• Physician personality factors
• Unique stressors in the workplace/home
• Review the definition of burnout and its sources
• Resources/Ways to prevent burnout

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M.A.O.P.S. PHP

• James L. Wieberg, M.Ed., LPC, Director
• Jeffrey Dryden, D.O., Medical Director
• Colin Duggan, PsyD, Associate
• Address 1125 Madison St Jefferson City, MO 65102
• Phone Number [phone]
• Pager s [phone] Jim Wieberg
• [phone] Colin Duggan
• Email jwieberg_at_mail.crmc.org
• cduggan_at_mail.crmc.org
• jdrydendo_at_msn.com

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• It is an ethical responsibility for all
  Physicians to maintain their own health and
  wellness and to look out for each others health
  and well-being on a continuing basis.
• (AMA Council on Ethical and Judicial Affairs)

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• The M.A.O.P.S. PHP is your occupations
• attempt at Physician wellness
• What is it? Doctors best friend!
• Advocacy A labor of love not laws!

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Purpose of MAOPS PHP is (1987)

• Confidential
• Family Oriented
• Supportive
• Educational
• Non-disciplinary
• Available
• Consistent
• A conspiracy of constructive compassion

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Programs Functional Elements

• Outreach And Education
• Case Identification And Referral
• Intervention
• Clinical Evaluation
• Monitoring
• Advocacy

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Advocacy to

• State Medical Boards
• Regulatory Agencies
• Managed care Companies
• Malpractice Insurance
• Hospitals
• Criminal / Legal Issues

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What Can Be Said About Us as Physicians?

• We are trained to be
• Independent
• Creative
• Assertive
• Competitive
• Hard-Driving

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We Are

• Perfectionistic
• Rigid
• Skeptical
• Self directed
• Reluctant to admit vulnerability
• Determined
• Have difficult time expressing feelings
• Poor delegation
• Delayed gratification
• Compulsive triad self-doubt, guilt, exaggerated
  sense of responsibility

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Characteristics That Put Doctors At Risk

• Need for control / Exaggerated sense of
  responsibilities
• Suppress feelings
• Loss of control over the practice
• Hard time relaxing
• Excessive guilt
• Government regulations
• More paperwork
• Decreased income

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Occupational Stressors

• High patient to caregiver ratio
• No time for emotional breathers
• Excessive and continuous contact with patients
• No system for caregiver to care for each other
• Lack of professional and support systems

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Occupational Stressors

• Hard problems with no easy solutions
• Lack of social skills to effectively interact
  with others
• Blame people rather than situations and systems
• Repetitive tasks
• The indispensable syndrome

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The Expected Stressors

• Inherent Uncertainties built into patient care
• Chronic fatigue badge of honor
• Life and death issues
• Difficult, demanding and chronically ill patient
• Long years of preparation Medicine is a stern
  mistress
• Monitoring clinical competence Medicine has
  exploded

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Unexpected Stressors

• Government regulations
• 3rd party intrusions
• Increased malpractice litigations
• Practicing defensive medicine
• Diminished public image of physicians
• Changing doctor/patient relationship
• Inadequate support/personnel
• Fear of the violent patient
• Decreased compensation

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Myths in Medicine

• Physicians know all
• Uncertainty is a sign of weakness
• Patients come first
• Doctors do not have needs
• Immune to illness
• Emotions are a sign of weakness
• Try to please all at home, work, and play

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Signs of Burnout

• Emotional exhaustion
• Cynicism/irritability
• Perceived clinical ineffectiveness
• Sleep disturbance
• Poor concentration
• Memory loss
• Loss of motivation
• Burnout is ALWAYS a problem with boundaries

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Cognitive Distortions of the Burnt Out Physician

• People-pleasing thinking
• Pessimistic thinking world is hostile
• Helplessness thinking, victim thinking
• Serious thinking no place or time for humor
• Externalized thinking if I get the outside stuff
  right, I will feel ok

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Cognitive Distortions of the Burnt Out Physician
Cont.

• Perfectionistic thinking anything less than
  perfect is unacceptable
• All-or-nothing thinking, overgeneralization,
  black or white thinking
• Magnification of the negative
• Blurred boundaries around work roles spill over

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Burnout Leads to Poor Health

• Headaches
• Marital Difficulties
• Hypertension
• Anxiety
• Depression
• Myocardial infarction
• Alcoholism / Drug addiction

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Consequences of Burnout

• Addictive behaviors
• Relationship distress
• Emotional and behavioral problems
• Severe professional consequences
• Restless, irritable, discontented if not
  working
• Blackout even when hes home, hes not
• Impatience might cause mistakes because going
  off half-cocked

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Consequences of Burnout Cont.

• Human Doing only as good as my last
  achievement
• Neglect self-care never enough time
• Time pressure hurry sickness
• Need for control others will not get it right
• No room for mistakes by self/others
• Binge work pattern self-inflicted deadlines

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Response to Intense Burnout Signals

• We just try harder.that is what we know
  (maladaptive)
• Our main mechanism for coping with fear is to try
  to control it
• We respond to a rigid system with equal rigidity
• Frequent conflict with people, places, situations
  that we perceive as threatening

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The Burnt Out Physician Actually Says

• Cant stop the pain
• Cant think clearly cant get control
• Cant make decisions
• Cant see any way out
• Cant make the sadness go away
• Cant see a future without pain
• Cant see myself as worthwhile
• Cant get anyones attention

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Others Actually Say

• More tired
• Irritable
• Distracted
• Cant concentrate
• Cant seem to make a decision
• Losing weight?

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• The last person in the room to recognize either
  the burnout or its severity is the burnt out
  physician

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• The Cost of replacing a Primary Care Physician is
  250,000
• Spickard, Gabbe, Christensen (2002)

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Professional Satisfaction

• The single most important factor to predict
  professional satisfaction is a sense of control
  over the practice environment
• 3 additional factors that predict satisfaction
  are
• Perceived work demands
• Social support from colleagues
• Satisfaction with resources
• Spickard, Gabbe, Christensen (2002)

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Professional Satisfaction Cont.

• Older physicians have a higher level of
  satisfaction and commitment to health care and
  lower levels of burnout
• Spickard, Gabbe, Christensen (2002)

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Female Physicians

• By 2010 30 of all physicians and 50 of medical
  students will be women
• A 2000 study in the Journal of Internal Medicine
  reported that female physicians were 60 more
  likely than male physicians to report symptoms of
  burnout
• The odds of burnout in women increased 12 to 15
  for each additional 5 hours of work per week of
  more than 40 hours
• Spickard, Gabbe, Christensen (2002)

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Female Physicians Cont.

• Female physicians are more likely to experience
  sexual/general harassment from colleagues,
  patients or both
• Female physicians have responsibilities for
  managing the domestic setting and balancing
  motherhood and career roles
• Spickard, Gabbe, Christensen (2002)

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Physician Suicide Rates

• Physician suicide rate is estimated to be between
  28-40 per 100,000 per year
• Compared to general population rate of 12.3 per
  100,000
• 3 of all male physician deaths and 6.5 of all
  female physician deaths annually
• Most common cause of death for young physicians
  (26)
• Ref Council on Scientific Affairs Results and
  implications of
• the AMA-APA Physician Mortality Project, Stage
  II. JAMA
• 19872572949-53

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Risk Factors for Physician Suicide

• Two highest risk periods
• Establishing a new practice after residency
• Nearing retirement

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What Can Hospitals and Health Care Organizations
Do to Promote Physician Well Being

• Establish a mentor program where senior
  physicians guide junior physicians on career
  development and in personal lives
• Provide confidential monthly support groups with
  professional facilitators
• Well being retreats on company time
• Membership to a fitness center
• Require all physicians to have a personal
  physician
• A sabbatical program linked to productivity
  incentives
• Spickard, Gabbe, Christensen (2002)

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What Can Hospitals and Health Care Organizations
Do to Promote Physician Well Being Cont.

• Flexible scheduling to take care of critical
  family events such as births, deaths,
  graduations, caring for aging parents, etc.
• Leave of absences for travel and avocational
  retreats
• Paperwork reduction
• Spickard, Gabbe, Christensen (2002)

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What Can You Do to Promote Personal Well Being

• Acknowledge ones own self worth
• Keep physically fit
• Take time to waste time
• Find a hobby
• Improve conflict resolution skills
• Spiritual enrichment
• Shift into neutral
• Change self talk
• See the lighter side - humor

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What Can You Do to Promote Personal Well Being
Cont.

• Expect the unexpected
• Use Time Outs
• Set realistic goals
• Better time management
• Take smaller bites
• Dont sweat the small stuff
• Learn to say NO

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Energy Pie

• Behaviorally supporting what you say you value

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DO NO HARM

• A deep value of the medical profession is to do
  no harm. - Doing no harm begins with oneself!

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Closing Remarks

• Questions?
• Comments?