Caring for Those who Care for Others Balancing Work and Life

Transcription

1 Caring for Those who Care for Others Balancing Work and Life ACGME 2015 Shakaib U. Rehman MD, FACP, FAACH Professor of Medicine, University of Arizona College of Medicine- Phoenix Associate Chief of Staff for Education, V.A. Medical Center, Phoenix, AZ

2 Disclosure of Financial Relationships All faculty have no relationships with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

3 Objectives Identify the barriers to balancing work and family. Explore strategies on how to prioritize to achieve balance. Discuss techniques, tools and skills to achieve balance and joy. Discover personal goals and learn skills to achieve those goals.

4 Why is Balance important? for you? General health and well-being Career sustainability and satisfaction for your patients? Doctor-patient relationship Quality of care and safety for your employer? Retention and Recruitment Cost-effective care for our profession? Changing health care environment The heart and soul of medicine

5 The Epidemic of Clinician Burnout

6 The Concept of Burnout A literal collapse of the human spirit (Storlie 1979). The loss of concern for the people with whom one is working (Maslach 1976). Psychological withdrawal from work in response to excessive stress and dissatisfaction (Cherniss 1980).

7 Burnout Emotional exhaustion, Depersonalization, Diminished feelings of personal accomplishment Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001; 52:

8 PREVALENCE Physician burnout rates of more than 60%. Chopra SS. Physician Burnout. JAMA, 2004;291:633

9 PREVALENCE 46% to 80% reporting moderate to high levels of emotional exhaustion 22% to 93% reporting moderate to high levels of depersonalization, 16% to 79% reporting low to moderate levels of personal achievement. Keller KL, Koenig WJ. Management of stress and prevention of burnout in emergency physicians. Ann Emerg Med. 1989;18: Lloyd S, et al. Burnout, depression, life job satisfaction among Canadian emergency physicians. J Emerg Med. 1994;12: Grunfeld E, et al. Cancer care workers in Ontario. CMAJ. 2000;163: Thommasen HV, et al, job satisfaction, and intention to relocate: opinions of physicians in rural. British Columbia. Can Fam Physician. 2001;47:

10 Consequences of Physician Burnout Loss of job satisfaction (Mirvis) Changing jobs or reducing work hours (Grunfeld). Associated with major depressive disorder (Shanafelt). 51% positive result on a depression screen 31% self-reported major depression Mirvis DM. J Health Hum Serv Adm. 1999;21: Grunfeld E, CMAJ. 2000;163: Shanafelt TD, ET AL. Ann Intern Med. 2002;136:

11 Consequences Suboptimal patient care practice Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:

12 Dissatisfied physicians have patients that are.. Less satisfied (Haas 2000) Less adherent with meds (DiMatteo 1993) More likely to leave MD (Keating 2002) Most likely to get questionable Rx Chloramphenicol, tranquilizers, & more Rx

13 Managing one's own stresses is the toughest part of practicing medicine. Oscar London M.D.

14 What is Balance?

15 What prevents physicians from leading balanced lives?

16 Demand-control model of job stress Demands balanced by control and support Stress increases if demands rise or control diminishes Support can facilitate impact of control Bottom line support and control prevent stress Karasek et al. Am J Public Health 1981;71: Demands Control Support

17 Burnout a long term stress reaction Predictors of stress well known (time pressure, lack of control, work home interference, lack of support, chaos, lack of values alignment) Burnout is predictable, and thus preventable Predictors Stress Burnout Interventions Linzer M, et al. JGIM 2014.

18 Appreciative Inquiry Take a moment to think when you were at your best What was the situation? Who were the people? How did you feel? What made it so positive? What can you apply to other situations?

19 Self-care Rest Nutrition and Exercise Personal physician Stay in touch with your values and priorities Appreciate the good that you do Self-awareness and reflection Spirituality Share feelings and responsibilities Quill and Williamson. Arch Intern Med 1990;150:1857 Weiner, Swain. Western J Med 2001:174:19-23

20 Components of Stress Management Professional Demand Patient #, complexity, time pressure, chaos Personal Souse, children, parents, conflict Control Support Organization, hours, schedule, work flow Patients, boss, staff colleagues Personal time, selfcare, fun/relax Family, friends, groups, therapist, hobbies

21 Tips to Help Stress and Burnout Increase sense of control Hope Relationship skills Attitude change challenge, control, commitment Time management Self-protective choices Be a team builder Be honest about stress Seek feedback Balance leave work at work

22 The Core of the Art Doctoring is a vocation that requires constant renewal of mind and heart and spirit if we want to avoid burnout, take joy in our work and grow in our service to patients and trainees. As we seek renewal, there are two primary sources to which we can turn: the inner self who speaks in solitude and our community

23 Emotional Intelligence Self-Awareness: the ability to recognize and understand your moods, emotions and drives and their effects on others Self-Regulation: the ability to control disruptive impulses and moods, to suspend judgment, to think before acting Motivation: a passion to work for reasons that go beyond money or status; to pursue goals with energy and persistence Empathy: the ability to understand the emotional make-up of other people; skill in treating people according to their emotional reactions

24 Two Types of Intelligence Intellectual Learning Lectures Problem Analysis Critical Thinking Reading Writing Emotional Learning Appreciative Inquiry Reflection Journaling Feedback Coaching Relationships Reading Writing

25 Self Awareness Value Different Perspectives Skilled Inner Listening Notice your own inner reactions Think: What is the story I am telling myself? Describe your reactions using non-judgmental language

26 Whole Person Body Spirit YOU Heart Mind Stephen Covey. The 8 th Habit. New York, Free Press, 2004

27 BODY You have just had a heart-attack 1. What are your reactions, thoughts, feelings? 2. What do you care about now? 3. What would you change in your life if you could go back before the heart attack?

28 BODY You have just had a heart-attack 1. What are your reactions, thoughts, feelings? 2. What do you care about now? 3. What would you change in your life if you could go back before the heart attack?. LIVE ACCORDINGLY NOW!

29 MIND In two years, you will develop a type of dementia which leaves you unable to learn new concepts/skills, although you can remember all you have already learned. 1. What will that means for your future career? 2. What will that means for your future life?..prepare ACCORDINGLY!

30 Whole Person Body NEED/TALENT Discipline Spirit Conscience YOU Heart Passion Mind Vision Stephen Covey. The 8 th Habit. New York, Free Press, 2004

31 Whole Person Body TO LIVE Survival Spirit TO LEAVE A LEGACY Meaning and Contribution YOU Heart TO LOVE Relationship Mind TO LEARN Growth and Development

32 How ready are you to make changes in your life to achieve balance on a routine basis?

33 Change Challenge and Courage Hang in there Attitude Necessary Go for it Efforts and Enthusiasm

34 Ask the Right Questions! Brain is built to answer questions Only we can decide what question to ask Right questions will get you right answers Wrong questions will lead to wrong answers

35 Values Name 5 family or friends who helped you on the way Write the reasons why you remember them

36 5 Steps Balancing 1. Take care of yourself (Thy heal yourself) 2. Take a personal snapshot -Create your dream work schedule 3. Seek out resources (If you need help, go and get it (family, peers, mentors etc) 4. Set boundaries + Learn to say no (and not feel guilty about it) 5. Fight the grass-is-greener syndrome

37 Strategies to Prevent Burnout Personal Influence happiness through personal values and choices Spending time with family and friends Religious and spiritual activities Personal Self-care (nutrition, exercise) Adopting to healthy philosophical outlook A supportive spouse or partner Spickard A. Et al. JAMA 2002;288:

38 Strategies to Prevent Burnout Work Control over environment: workload Finding meaning in work and setting limits Having a mentor Having adequate administrative support systems Spickard A. Et al. JAMA 2002;288:

39 Resources Bickel J, Brown AJ. Generation X: implications for faculty recruitment and development in academic health centers. Acad Med. 2005;80(3): Brown, Judy, (Cone in the box)a Leader s Guide to Reflective Practice, Trafford Publishing, Epstein RM. Mindful practice. JAMA 1999;282: Goleman D. Emotional Intelligence. New York: Bantam Books, Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of Linzer M, Konrad TR, Douglas J, et al. Managed care, time pressure, and physician job satisfaction: results from the Physician Worklife Study. J Gen Intern Med 2000;15: Skilled listening, inquiry, advocacy; and the Ladder of Inference reference is: New York, Currency/Doubleday, Linzer M, Gerrity M, Douglas JA et al. Physician job stress: results from the physician worklife survey. Stress and Health 2002;18: McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K, for the SGIM Career Satisfaction Study Group. The work lives of women physicians; results from the Physician Worklife Study. J Gen Intern Med 2000;15(6): Nonnemaker L. Women physicians in academic medicine: new insights from cohort studies. N Engl J Med. 2000;342(6): Novack DH, Suchman MD, et al. Calibrating the physician: personal awareness and effective patient care. JAMA 1997;278: Quill TE, Williamson PR. Healthy approaches to physician stress. Arch Int Med 1990;150:

40 Resources Redman S, Saltman D, Straton J, et al. Determinants of career choices among women and men medical students and interns. Med Educ. 1994;28: Senge, Peter, Roberts,Charlotteools, Ross, Richard, et. al, The Firth Discipline Fieldbook: Strategies and Tools for Building a Learning Organization, Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136: Sobecks, NW, Justice AC, Hinze S, et al. When doctors marry doctors: a survey exploring the professional and family lives of young physicians. Ann Intern Med. 1999;130(4): Spickard A, Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA 2002;288: Suchman AL, Ramamurthy G. Physician Well-being. In Feldman MD, Christensen JF (Eds.). Behavioral Medicine in Primary Care: a Practical Guide. Appleton & Lange, Tresolini, CP and the Pew-Fetzer Task Force. Health Professions Education and Relationship-centered Care. San Francisco, CA: Pew Health Professions Commission, Warde C, Allen W, Gelberg L. Physician role conflict and resulting career changes. Gender and generational differences. J Gen Intern Med. 1996;11(12): Weiner EL, Swain GR, et al. A qualitative study of physicians own wellness-promotion practices. West J Med 2001;1745: Williams J. Unbending Gender: Why Family and Work Conflict and What to Do About It. New York, NY: Oxford University Press; 2001.

41 Resources Shollen SL, Bland CJ, Finstad DA, Taylor AL. Organizational climate and family life: how these factors affect the status of women faculty at one medical school. Acad Med. 2009;84:87-94 McMurray JE, et al. The work lives of women physicians: results from the physician work life study. J Gen Intern Med 2000;15: Krasner MS, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA 2009;302: Shanafelt TD, et al. Career fit and burnout among academic faculty. Arch Intern Med 2009;169: Bickel J, Brown AJ. Generation X: implications for faculty recruitment and development in academic health centers. Acad Med 2005; 80: Thomas PA, et al. Results of an academic promotion and career path survey of faculty at the Johns Hopkins University school of medicine. Acad Med 2004;79: Buckley LM, Sanders K, Shih M, Hampton CL. Attitudes of clinical faculty about career progress, career success and recognition, and commitment to academic medicine. Arch Intern Med 2000;160: The 7 Habits of Highly Effective People Stephen R. Covey Free Press/Simon & Schuster, Inc. New York, NY. 1989, 2004

42 Resources Schindler A, et al. The impact of the changing health care environment on the heatlh and well-being of faculty at four medical schools. Acad Med 2006;81:27-34 Kalet AL, Fletcher KE, Ferdman DJ, Bickell NA. Defining, navigating, and negotiating success: the experiences of mid-career Robert Wood Johnson clinical scholar women. J Gen Intern Med 2006;21: Fox G, Schwartz A, Hart KM. Work-family balance and academic advancement in medical schools. Acad Psych 2006;30: Yedidia MJ, Bickel J. Why aren t there more women leaders in academic medicine? The views of clinical department chairs. Acad Med 2001;76: Wright AL, et al. Gender differences in academic advancement: patterns, causes, and potential solutions in one U.S. college of medicine. Acad Med 2003;78: Carr PL, et al. Relation of family responsibilities and gender to the productivity and career satisfaction of medical faculty. Ann Intern Med 1998;129: Dannels S, et al. Medical school deans perceptions of organizational climate: useful indicators for advancement of women faculty and evaluation of a leadership program s impact. Acad Med 2009;84:67-79 McGuire LK, Bergen MR, Polan ML. Career advancement for women faculty in a U.S. school of medicine: perceived needs. Acad Med 2004;79:

43 Organizations and Websites Northwest Center for Physician Well-Being The Foundation for Medical Excellence 4000 Kruse Way Place, Bldg. 2, Suite 100 Lake Oswego, OR (503) MD CareerNet Boston, MA (617) Website: Center for Professional Well- Being Durham, NC (919) Website: cpwb.home.mindspring.com Menninger Clinic s Professionals in Crisis program Topeka, KS (800) Website: Center for Professional and Personal Renewal Palo Alto, CA (800) Website: pmoskowitz@batnet.com

44 Organizations and Websites Physician Wellness Foundation Los Osos, CA (805) Website: Center for Physician Renewal Bellevue, WA (253) Personal-Professional Balance Interest Group Society of General Internal Medicine Website: The Center for Professional Health Vanderbilt University Medical Center 1107 Oxford House Nashville, TN (615) Website: Institute for Health and Healing California Pacific Medical Center San Francisco, Cal Phone: Website: