PHYSICIAN BURNOUT · 2018-05-05 · • “Burnout Among Health Care Professional s: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care.” National

PHYSICIAN BURNOUTA BURNING EPIDEMIC

DISCLOSURES....

I HAVE NO DISCLOSURES TO REPORT.

HISTORICAL DEFINITION…….

• FREUDENBERGER…..1974 coined the term “Burnout.”

• PROCESS ……One Year Progression

• Historical term used to refer to the effects of CHRONIC DRUG ABUSE

CURRENT DEFINITION…..

• A SYNDROME OF EMOTIONAL EXHAUSTION, DEPERSONALIZATION

AND REDUCED SENSE OF PERSONAL ACCOMPLISHMENT

WHY???

• WHAT IS THE SIGNIFICANCE OR RELEVANCE OF BURNOUT ??

NEGATIVE OUTCOMES FOR…..

• PHYSICIANS

• INSTITUTIONS

• PATIENTS

PHYSICIAN OUTCOMES……

• PHYSICAL and EMOTIONAL ILLNESSES….Depression Anxiety Substance abuseSuicide Completion

• DECREASE WORK-SATISFACTION

CASE PRESENTATIONS…..

• 37 year old dentist…..

• Chief Complaint.. “I just don’t want to do anything.”• Anxiety….stress (financial and emotional)• Increased work hours • Additional Symptoms....• Medications...

• Pulmonologist.....

INSTITUTION OUTCOMES…..

• INCREASED TURNOVER OF PHYSICIANS

• ABSENTEEISM

• POOR PERFORMANCE

• NEGATIVE ATTITUDES

PATIENT OUTCOMES….

• DECREASED QUALITY OF MEDICAL CARE

• INCREASED MEDICAL ERRORS

• DECREASED PATIENT SAFETY

DO NO HARM

PHYSICIAN BURNOUT….

• MORE THAN HALF OF PHYSICIANS ARE EXPERIENCING SIGNIFICANT SYMPTOMS OF BURNOUT……

• BURNOUT ….TWO TIMES MORE PREVALENT THAN COMPARED TO OTHER U.S. WORKERS

• MOST AFFECTED SPECIALITIES…..

RISK FACTORS…..

• DEMANDING WORKLOAD

• CONFLICTS BETWEEN WORK AND HOME

• CHILDREN AT HOME ( < 21 YEARS OF AGE)

• MIDWAY THROUGH MEDICAL CAREER

• NUMBER OF NIGHTS ON CALL

• PARTNER WHO IS ALSO A PHYSICIAN

• MEDICAL ERRORS

• DECREASED AUTONOMY

• GENDER

2 MAJOR EFFECTS ON PHYSICIANS….

• SUICIDE COMPLETION…..

• SUBSTANCE USE DISORDERS (SUD’S)….

SUICIDE…

• 300-400 DOCTORS DIE BY SUICIDE ANNUALLY

• ONE MILLION U.S. PATIENTS LOSE THEIR DOCTORS TO SUICIDE EACH YEAR

• 10-15 PERCENT NEVER RECEIVE TREATMENT

DR. VERUN’S LETTER

Dear Pamela,Hi, der. I don’t know how thankful I am to you for writing that article on physician’s suicide. I really wanted to hug you after reading it. I had really rough day after seeing 130 outpatients and around 60 admission emergency in a 12 hour duty. I work as a final year MD internal medicine resident in one of the busiest hospital in India. I saw a part of myself in every page of your article Just couldn’t stop reading the article. It is 3:00 am in the morning here and after a physically and mentally demanding day of work and studies reading your article was the best thing today.It takes me 5 hours by flight to reach my home from my hospital. I have my wife and 6 month old son (whom I been with for 15 days since his birth) at home. I work day in and out just to be with them once in 3 months. I don’t see my colleagues smile, I hear my patients misery every day. I smile and crack jokes even when I am sad so that I can bring some joy into my patients sorrowful life.Today I saw this patient who died, married with a son, the only earning member of his family …….his widow just wouldn’t accept that he was dead. She kept talking to him. I just didn’t know what to feel ….. I was numb for a minute thinking what if that was me …. And the kid is my son…..

DR. VERUN’S LETTER

I see deaths everyday in ward …..I don’t know if you would believe me, but 4 deaths per day in a single ward of 40 beds overcrowded to 125 patients admitted at a time. Two patients on a bed, two lying together on the floor. Poverty, misery and pain all around. I have declared 12 patients dead in a day during one of my duties. I just don’t feel death anymore, just don’t feel human. My uncle died recently, I felt nothing deep inside just some memories and that is it.I write this mail hoping that the way I survive my day would help you in helping others.I always wish my colleagues and say hi when I see them in the morning. Say hi to everyone from my ward sweeper to the guard in the ward. I never eat alone and always make sure I share my food. I always smile whenever I talk to my patients. I hold their hands when I talk. Listen music whenever possible. And everyday whenever possible I talk to my wife, father, mother, and brother (all of them are doctors).But still this profession demands too much from us. I have thought about giving up and suicide a thousand times ……the misery was too much for me to see 12 people die in a day. The only thing that keeps me moving forward is my family and friends.I appreciate what you are doing. It took me 4 hours to write this mail. It is 7 am in the morning. But your article was worth it. Thank you. Thanks a lot…..Dr. Varun

DR. VERUN’S LETTER

Varun died by suicide on June 14, 2016.

The world has lost a beautiful healer. RIP sweet, sweet soul.

Dr. Varun’s letters published in Physician Suicide Letters and his words recited on the TEDMED stage:

Pamela Wible, M.D. is a family doctor who is dedicated to physician suicide prevention. Please be kind to your doctor. The life you save may save you. Photo credit: Dr. Varun (and his newborn son). If you are suffering, please reach out for help. Contact Dr. Wible.

ANOTHER MAJOR EFFECT ON PHYSICIANS…

• SUBSTANCE USE DISORDERS…

DEFINITION OF SUD’S….

• TWO OR MORE OF THE FOLLOWING SYMPTOMS (12 MONTH PERIOD)

• Taking more substances than intended• Unsuccessful efforts to ”cut down”• Significant time spent using or recovering • Cravings • Failure to perform major role obligations • Continued use despite interference with social/occupational activities• Use in hazardous situations • Use despite negative impact on health• Tolerance/Withdrawal

PHYSICIAN IMPAIRMENT…..

• DEFINITION….

• THE INABILITY TO PRACTICE MEDICINE WITH REASONABLE SKILL AND SAFETY TO PATIENTS BY REASON OF PSYCHIATRIC OR GENERAL-MEDICAL CONDITION..

• SUD’S …MOST COMMON CONDITION LEADING PHYSICIANS TO BECOME IMPAIRED.

SUBSTANCES….

• ALCOHOL…MOST FREQUENTLY ABUSED SUBSTANCE IN PHYSICIANS WITH SUD’S

• PRESCRIPTION OPIOIDS ….2ND MOST FREQUENTLY ABUSED SUBSTANCE…

• HIGHER RATES OF PRESCRIPTION DRUG MISUSE

RESTROSPECTIVE STUDY….

• BETWEEN 1980-2002-RETROSPECTIVE STUDY OF 3,604 PHYSICIANS..

DRUG OF CHOICE (DOC)..

ETOH 25%OPIOIDS 25%MJ 12%COCAINE 11%SEDATIVES 10%AMPHETAMINES 4%OTHER 8%

LITERATURE SUGGESTS THAT RATES ARE INCREASING

COMORBIDITIES

• HIGH RATES OF MENTAL HEALTH COMBORBITIES..

• MDD 33.0%

• BIPOLAR DO 11.0%

• ASPD 7.0%

• GAD 7.1%

MENTAL HEALTH COMBORBIDITIES ASSOCIATED WITH HIGHER RATES OF RELAPSE ON SUBSTANCES.

CHARACTERISTICS/RISK FACTORS..

• GREATER ACCESS TO RX DRUGS

• HIGH WORK STRESS

• PHYSICIANS ”TRAITS” • STRONG DRIVE FOR ACHIEVMENT• TENDENCY TO DENY PERSONAL PROBLEMS • ABILITY TO PERFORM UNDER STRESS • SOPHISTICATED DENIAL PROCESSES• DIFFICULTY TAKING INPUT/DIRECTIONS FROM OTHERS (AUTONOMY)• GENDER (FEMALES REFERRED LESS FOR SUD TREATMENT)

MEDICAL SPECIALTIES..

• EMERGENCY MEDICINE…

• ANESTHESIOLOGY…

• HIGHEST RISK SPECIALTIES..

PREVENTION OF BURNOUT…

• SELF-CARE..

• CONNECTIONS ARE VITAL…

• MODEL WELLNESS..

• SEEK HELP…

• OTHER MODALITIES…

BIBLIOGRAPHY....

• Arora, Manit, et al. “Review Article: Burnout in Emergency Medicine Physicians.” Emergency Medicine Australasia, vol. 25, no. 6, Sept. 2013, pp. 491–495., doi:10.1111/1742-6723.12135.

• Arora, Manit, et al. “Review Article: Burnout in Emergency Medicine Physicians.” Emergency Medicine Australasia, vol. 25, no. 6, Sept. 2013, pp. 491–495., doi:10.1111/1742-6723.12135.

• “Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care.” National Academy of Medicine, National Academy of Medicine, 5 Feb. 2018, nam.edu/burnout-among-health-care-professionals-a-call-to-explore-and-address-this-underrecognized-threat-to-safe-high-quality-care/.

BIBLIOGRAPHY....

• “Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care.” National Academy of Medicine, National Academy of Medicine, 5 Feb. 2018, nam.edu/burnout-among-health-care-professionals-a-call-to-explore-and-address-this-underrecognized-threat-to-safe-high-quality-care/.

• “Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care.” National Academy of Medicine, National Academy of Medicine, 5 Feb. 2018, nam.edu/burnout-among-health-care-professionals-a-call-to-explo

• Maslach, Christina. “Www.wilmarschaufeli.nl.” Historical and Conceptual Development of Burnout, www.bing.com/cr?IG=51B59F2E16E14CAB97BE995EF0A2EC03&CID=2CB22CA97DD560C42F8D27627C7A6136&rd=1&h=dabBICRYH-LHSsNwN13UhakIu-kuXnlXAFOGrXYv--k&v=1&r=http://www.wilmarschaufeli.nl/publications/Schaufeli/043.pdf&p=DevEx,5068.1.re-and-address-this-underrecognized-threat-to-safe-high-quality-care/.