Are We Healthy? Caring for Ourselves Linda Blust, MD Center for Palliative Medicine
Feb 11, 2016
Are We Healthy? Caring for Ourselves
Linda Blust, MDCenter for Palliative Medicine
“How often do you . . .”
a) Almost Alwaysb) Oftenc) Seldomd) Almost Never
Case
• It’s been a very busy six months. At the request of your supervisor, you have taken on new committee responsibilities in addition to your teaching and clinical/research duties. Your co-workers are beginning to grumble that you’re not available when they need you. Tenure is looming, but you can’t seem to complete the portfolio.
What’s happening?
• Physical Stress• Your working harder with the same amount of
time• Emotional Stress
• You can’t be in two places at once• Spiritual Stress
• Is this really why you choose to do your work?
Intro to Humans: Care and Feeding
• Adequate Sleep: 6-9 hours/day• Nutrition: 1500-1800 kcal/day; balanced• Exercise: Aerobic• Safety
• Injury avoidance• Illness avoidance
• Regular check-ups
Facts
• Direct patient care largest cause of low back injury
in U.S.
• 2/3 docs DO NOT have a PMD
• Sleep deprivation increases work-related errors
• Women encounter a glass ceiling in academia
Strategies
• Recognize physical signs• Irritability• Inattention• Insomnia
• Value your physical health• Sleep when you need • See the Doctor• Etc.
Emotional Health
• Do I get what I need from my job????• Workload• Control• Reward• Community• Fairness• Values
Emotional Health
• Workload• Appropriate number/resources/training
• Control• Empowerment without abandonment
• Reward• Is it meaningful to you?
Emotional Health
• Community/Co-workers• Supportive
• Fairness• Workload/resources/reward
• Values• Organization shares your basic values
Facts
• No job is perfect!!• Know yourself well
• What is essential
• What is intolerable
• What is negotiable
Strategies
• Don’t just sit there, do something!• Identify the problem: name it truthfully!• Plan an intervention: what can I realistically do
about it?• ACT: address problem directly. Remember,
• What is essential• What is negotiable• What is intolerable
Strategies
• Be Creative
• Can I work a different schedule?
• Can I work with different people?
• Can I get different rewards?
Strategies
• Return to beginning
• Why did I choose this?
• Does that reasoning still hold?
• Eyes on the Prize
Caveat Emptor
• Realize the cost of addressing/not addressing the problem• Impaired work performance• Burn-out• Depression
• You may need to explore other options
Spiritual Health
• Does what I do reflect who I am?
• Can I nurture/protect my essential beliefs?
• Does this make sense to me?
Facts
• It is impossible to sustain competence doing
something that “isn’t you”
• Patients/families/coworkers often challenge
our belief systems
• “Crazy-making” will make you crazy
Strategies
• Identify: Be Truthful!
• Plan: Realistically, what can be done?
• Act: Your essential self is at stake: DON’T
IGNORE THIS!
Consequences
• Burnout
• Illness
• Addiction
• Poor work performance
• Unprofessional conduct
• Suicide
What is Burnout?
• Syndrome• Emotional Exhaustion
• Depersonalization/Cynicism
• Sense of Low Personal Accomplishment/
Sense of Inefficacy
Emotional Exhaustion
• “I feel drained. . .”
• Likely a result of high workload and time
pressure
• Precursor to Depersonalization/Cynicism
Depersonalization
• Distance Self from Patients/Clients/co-workers
• Ignore unique qualities of patients/co-workers
• Creation of “other”
• Easier to manage demands
• Protects self from emotional demands of work
Sense of Inefficacy
• “I’m not doing a good job . . .”
• Concurrent with exhaustion/cynicism
• Linked to lack of resources
Stages of Burnout
• Stress Arousal• Energy Conservation• Exhaustion
• Proceed in order• Cycle can be interrupted at any point
Risk Factors
• Individual• demographics, personality, attitudes
• Situational• job, occupation, organization
• Situational Risks More Predictive of Burnout than Individual Risks!!!!!
Demographic Risks
• Young: survival bias?
• Unmarried
• Highly educated
• Gender NOT predictive
Risks: Attitudes
• High job expectations• nature of work• achievement
• Unclear if this correlates with burnout
Individual Risks for Burnout
• Type-A Behavior
• Lack of “Hardiness”• Open to change
• Sense of control
• Involved with daily function
• Low Self Esteem
Poor Work Performance
• Lateness for Work• Needed 3-day weekends• Turning in work late• Resentfulness• Suboptimal performance
• Practice• Attitudes
Addiction
• 10-14% MDs become addicted during career
• Alcohol is primary drug of choice• Addiction is cause for impairment over
70% of the time• We police ourselves and each other
Unprofessional Conduct
• Unprofessional students are THREE TIMES more likely to receive disciplinary action as MDs• Severely irresponsible: odds ratio of 8.5 for
disciplinary action• Severely unable to improve behavior: odds
ratio of 3.1• We police ourselves and each other
Suicide
• Male MDs: relative risk 3.4• Female: 5.7
• Completed suicide = male rate• More likely to die of suicide than other
professionals
Conclusion
• Health has 3 major elements: Don’t ignore any of them!
• Know who you are and what you need• Don’t complain: ACT• Remember, no job is worth your physical,
emotional, or spiritual health.
References• Booth, JV et al. Substance Abuse Among Physicians: A Survey of
Academic Anesthesiology Programs. Anesthesia and Analgesia 2002;95:1024-30.
• Center, C et al. Confronting Depression and Suicide in Physicians: A Consensus Statement. JAMA 2003;289:3161-3167.
• Girdino, DA et al. Controlling Stress and Tension, Allyn & Bacon, Needham Heights MA, 1996.
• Gross, CP et al. Physician, Heal Thyself? Archives of Internal Medicine 2000;160:3209-3214.
• Gundersen, L. Physician Burnout. Annals of Internal Medicine 2001;135:145-148.
References, II
• Maslach, C et al. Job Burnout. Annual Review of Psychology 2001;52:397-422.
• Papadakis, MA et al. Disciplinary Action by Medical Boards and Prior Behavior in Medical School. NEJM;353:2673-2682.
• Shanafelt, TD et al. Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program. Annals of Internal Medicine 2002;136:358-367.
• Texas Medical Association CME website. www.texmed.org/cme/phn/psb/burnout.asp
Case• An elderly man has been transferred to
4NW with a grave prognosis from neurologic injury. Tube feedings were stopped 3 weeks ago, and hydration consists of 120 cc/day from his PCA. He continues to make stool and >1L urine/day. All involved with his care are irritable and angry with the primary care team.
What’s happening?
• Physical stress• Caring for dying patient for 3 weeks
• Emotional stress• Am I doing this right?
• Spiritual stress• Why isn’t he dying????