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Physician Health - Managing Stress
Dr. Carolyn ThomsonProfessional Support Program, Doctors Nova Scotia
Objectives
1. To identify key areas of stress in a physician’s life and understand its effect on performance
2. To understand the influence of the physician personality on the interpretation of potentially stressful events
3. To discuss the warning signs of burnout4. To identify and develop tools to manage stress
and enhance resilience5. To appreciate key components of life balance
and develop skills to enhance it
Disclosures No affiliation with industry
“I am more and more convinced that our happiness or
unhappiness depends more on the way we meet the events of life than on the nature of those
events themselves”Alexander Humboldt
Why Physician Health?
The Royal College values physician wellness: CANMEDS Professional Role:
“Physicians’ maintenance of their own health and well-being is an essential component of their professional role.”
CanMEDS Physician Health Guide, 2009
When did you first feel drawn to medicine?
What did it feel like? Has that feeling grown or diminished
over time? How does your life in clinical practice
differ from your expectations upon entering medical school?
Are We Healthy?Canadian Physician Health Study
> 90% of physicians report good health Majority comply with Canadian personal health
screening guidelines, but:
Only 57% report good work-life balance25% have chronic physical or mental
health condition that impacts their ability to work as they otherwise would
>60% will work when ill
Are we happy?
8,000 practicing physicians revealed that:
23% of physicians feel depressed 33% admit their work day causes stress 60% have so much work that it prevents
them from pursuing personal and family interests
Canadian Physician Health Survey 2008
Career Satisfaction of US Women Physicians:
The Women Physicians’ Health Study
4,501 female physicians surveyed
31% would not choose to be a physician again
38% would prefer to change their specialty
• Erica Frank et al, Arch Inter Med. 1999; 159: 1417 - 1426
Major Determinants of Dissatisfaction
Lack of work controlo Those with unpredictable hours had more
stress o Those with an unhappy practice
environment had more stress Work stress
o 44% reported working too much Home stress Lack of religious or spiritual life Fewer children
o Those with an imbalance between family and home had more stress
Protective Factors 2144 physicians surveyed, aged
35-54 What decreased stress &
increased work satisfaction:o Participation in community
activities o Leadership roles & control oCollegial supporto Factors Explaining Career Satisfaction Among Psychiatrists and
Surgeons in Canada, Rein Lepnurm, DrPH, Roy Dobson, PhD, Allen Backman, PhD, David Keegan, MD, Canadian J Psychiatry, March 2006
Are You Happy in Your Work?
Do you experience joy in your work?
Do others experience joy as a result of your work?
What do Physicians want?
Controllable hours Balance between family and
work life Less stress Income that equals our effort Fun! Love
What Stands in the Way?
Health care reimbursement? Hospital administration? Colleagues? Families? Patients? Ourselves?
The Physician Personality
We Are:o IntelligentoCaringoSensitiveo Inquisitive
We are also…
Type A Competitive Perfectionistic Safety seeking
We combine that with…
Developing an ability to
emotionally dissociate because…
“A physician in training sees more trauma in one month that most others see in a lifetime.”
By the end of medical training many physicians are:
Exhausted Isolated from
friends and family
In debt
Ego-centric as an expression of insecurity
Emotionally dissociated
Stress
Too much work leads to:
Emotional fatigue Stress Resentment
Some Definitions
Stress: How the body reacts to a stressor, real or imagined
Stressor: Anything external that knocks the body out of homeostasis forcing the body to take action
Eustress: Where stress enhances function (physical or mental)
Distress: Persistent stress that is not resolved through coping or adaptation
Warning signs Increased physical problems & illness Increased problems with relationships Increased negative thoughts & feelings Increased unhealthy behaviours Inability to continue pushing oneself
Stress
Directly linked
Heart diseaseStrokeInjurySuicideHomicide
Indirectly linked
CancerChronic liver
diseaseEmphysemaChronic
bronchitis
Contributors to Stress
Disruptive behaviours Intimidation/harassment at
work Difficult interactions with
patients and colleagues Unexpected outcomes – error,
complaint, litigation Personal health issues
#1 Cause of stress: sense of lack of control
#1 Solution: Challenge this perception
PERCEPTION: Your Historian
Sense of self arises from experiences we had as a child
Draw conclusions (often concrete) based on how we were treated
Not reality but perception of reality History is the “ultimate” distortion and
concrete thinking persists
The 90:10 Rule 10% of your reaction is due to
that particular situation
90% is what you automatically assume from past experience (your “historian”).
Managing Stress
Event + Response = OutcomeoEliminate the causeoChange our perception of the stress
Appreciate the difference
What you can change Perceptions of ourselves and
the situation Recognise learned behaviours
and assumptions that do not help us
Attain a +ve attitude Become more assertive and
set limits and boundaries More confident at reaching
out and connecting with others
ID aspects that we value in all parts of our lives- work, relationships, family, home, self- and decide what we are going to do to maintain these priorities
What you can’t change Parents
Childhood experiences
Upbringing
Genetics
Cognitive Distortions:Applying a mental filter
Dwelling on a single negative detail If you made an error with a patient
this will override all the good things you’ve done with and for that individual
If you do something embarrassing an entire experience can be ruined
This can negate the benefit of a great relationship or life experience
LET GO! Of cognitive distortionsoAll or nothing thinking
Perfectionismo“Anything worth doing is worth doing half-assed”
• Rachael Naomi Remen
Stress Management- Why?
Lower catecholamines Lower cortisol Enhance cortical function
Stress Management Tools
Meditation Yoga Tai Chi Prayer Exercise Hobbies
Yankee Rose Yankee Rose
Stress & Burnout
Common cause of early retirement
Job dissatisfactionPoor working relationships
Burnout
Mayo Clinic:Almost half of American physicians are
emotionally exhausted, suffering from depersonalization, and struggling with a low sense of personal accomplishment
Top three: Emergency physicians General Internal Medicine Family Physicians
Shanafelt, T et al. Arch Intern Med
Three Dimensions of Burnout
“Gradual erosion of the person”
Emotional ExhaustionDepersonalizationLoss of professional satisfaction
Are you at risk?
Burnout We lose perspective and blame others We judge others harshly We begin to externalize our frustrations
and feel bad about it Our type A tendencies are running at max We become hyper-irritable Our personal lives crash We hit survival mode
o Numbnesso Loss of creativityo Reflex behaviors predominate
Key Point
Burnout is easier to prevent than
to treat
Prevention
Commitment, self-efficacy, resourcefulness and hope
May have to address at organizational level
Cognitive – behavioural strategies
Exhaustion more easily treated
Addressing Burnout
The “3R” Approach: Recognize Reverse Resilience
RESILIENCE: the ultimate life skill
Why do some people cope better than others?American Psychological Association:
“The ability to adapt well in the face of adversity, trauma, tragedy, threats and
from sources of stress such as work pressures, health, family and relationship
problems.”
The ability to bounce back
Characteristics of Resilience
Optimism & hopeConfidenceLearn lessons from experienceAssume things will work out wellFocus on learning and coping
rather than blaming and being a victim
If you don’t design your own life plan, chances are you fall into someone else’s
plan. And guess what they have planned for you? Not
much.
What is Work Life Balance?
Mental Physical Emotional Spiritual
The Corporate Athlete
• Physical capacity o Builds endurance and
promotes mental and physical recovery
• Emotional capacity o Creates the internal climate
that drives performance• Mental capacity
o Focuses mental and emotional energy on the task at hand
• Spiritual capacityo Provides powerful
source of motivation, determination and endurance
Typical Physician Plan I’ll exercise for one hour a day Then, I’ll tell all my friends and
family that I love them Maybe I’ll call then while I’m on
the treadmill Then, I’ll pray for 30 minutes,
meditate for 20 minutes and read the literature for an hour
Balance
Spiritual
Mental
Physical
Emotional
Wellness Strategies1. Identify personal and professional values and
priorities2. Enhance areas of work that are most personally
meaningful3. Identify and nurture personal wellness strategies
that are important to you4. Self care5. Hobbies and personal interests
Shanafelt, TD. J Support Oncol 2005;3(2):157-62
What works for you
Identify the things that bring you joy and do more of them
Identify the things that drain you and do less of them
Make choices about what you can and can’t do
"Imagine life as a game in which you are juggling five balls in the air. You name them - work, family, health, friends, and spirit - and
you're keeping all of these in the air. You will soon understand that work is a rubber ball. If you drop it, it will bounce back. But the
other four balls - family, health, friends, and spirit are made of glass. If you drop one of these, they will be irrevocably scuffed, marked, nicked, damaged, or even shattered. They will never be the same.
You must understand that and strive for balance in your life."-- Brian Dyson, CEO of Coca Cola Enterprises 1959-1994
-- Brian Dyson, CEO of Coca Cola Enterprises from 1959-1994
Resources: General Health:
o www.Ephysicianhealth.como CanMeds Physician Health Guide: A Practical Handbook
for Physician Health and Well-Being• Puddester, Flynn, Cohen• Available on line
The Resilient Physician o Sotile and Sotile
Finding Balance in a Medical Lifeo Lipsenthal
Reaching out:
Family, friend or colleague you can trust – find one!
Family Physician-get one Provincial Physician Health Program
o Listed with contact information on CMA.ca wesite Substance Use Concerns:
o AA, NA CMPA Physician Wellness Resources
o http://www.cmpa-acpm.ca