Professionalism & Professional Health:

Faculty Overview

Charlene M. Dewey, M.D., M.Ed., FACPAssociate Professor of Medical Education and Administration

Associate Professor of MedicineCo-Director & Chair

William H. Swiggart, M.S.,LPC/MHSPAssistant in Medicine

Co-Director

Center for Professional Health, Faculty and Physician Wellness Committee, Vanderbilt University School of Medicine

Purpose

• To raise awareness of issues related to professionalism and professional health and to provide an overview of key resources in/outside of Vanderbilt.

Participant Objectives

1. List ways to improve your professional health.

2. Compare and contrast workplace stress and burnout.

3. Describe distressed behaviors and how to report them.

4. State resources available for faculty and physicians in/out of Vanderbilt.

Agenda

1. Professional Wellness

2. Workplace stress, burnout and suicide

3. Distressed behaviors

4. Resources

5. Q&A and Summary

Professional Health Spectrum

High FunctioningHigh Productivity

Fair FunctioningDecreasing Productivity

Fair FunctioningReduced ProductivityRelationships Suffer

Fair-Not FunctioningFair-Not ProductiveInstitution & Family Loses

Coping Mechanisms Risk of MH issues and suicide

Faculty vitality Stress & Burnout

Importance & Evidence

• MDs suicide > other prof. & gen pop.

• One physician per day; PhD – unclear

• Grossly underestimated

• Little education on topic

• 30-60% MD have distress and burnout

• Depression/bipolar & substance abuse = suicide risk

“Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressure of Success.” Cole, Goodrich & Gritz, 2009.

Importance & Evidence

• Reduced wellness professional lapses

• Gender differences:• Females > anxiety, depression, burnout• F>M MD suicides

• Reduced use of care by physician

• Stigma & anonymity

http://www.aamc.org/members/gwims/statistics/stats09/start.htmLin et al.1985. Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty. JAMA 254(19):2775-82. (Schindler et al 2006)“High physician suicide rates suggest lack of treatment for depression.” - MD Consult News June 11, 2008

Professional Wellness1. Self-care

2. Work-place stress

Balance takes effort, but worth the reward!

Mind, Body and Spirit

Professional Wellness

• Self-care issues:– Sleep– Balanced meals– Physical activity– Socialization– Vacations/down times– Spiritual engagement– Have a physician

Mind Body

Soul

Work-Place Stress

Work-place stress:– Manage energy– Reduce distractions– Plan appropriately– Managing failures and successes

ManageEnergy

ReduceDistractions

Planning

“The first wealthis

health.”~ Ralph Waldo Emerson

Stress & Burnout

• Stress and burnout occurs for different reasons in different individuals.

• Work load ≠ level of stress or burnout in all situations.

• Multifactorial

Stress & Productivity

Declining Function

Produ

ctiv

e Str

ess

No Prolonged Stress

BurnoutStressedSituational Stress

Non-Functional

Prolonged Stress

Burnout

“In the current climate, burnout thrives in the workplace. Burnout is always more likely when there is a major mismatch between the nature of the job and the nature of the person who does the job.”

~Christina Maslach

The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. Maslach & Leiter pg 9; 1997

Risk Factors for Burnout

• Single• Gender/sexual orientation• ># of children at home• Family problems• Mid-late career• Previous mental health

issues (depression)• Fatigue & sleep

deprivation

• General dissatisfaction• Alcohol and drugs • Minority/international• Teaching & research

demands• Potential litigation

Puddester D. West J Med 2001;174:5-7Myers MJ West J Med 2001;174:30-33Gautam M West J Med 2001;174:37-41

1.Work overload

2.Lack of control

3.Insufficient reward

4.Unfairness

5.Breakdown of community

6.Value conflict

Maslach & Leiter, 1997. “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.”

Six Sources of Burnout

Symptoms of Burnout

1.Chronic exhaustion

2.Cynical and detached

3.Increasingly ineffective at work

4.Leads to:1. isolation

2. avoidance

3. interpersonal conflicts

4. high turnover

Maslach & Leiter, 1997. “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.” pg 17

Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50

Protective Factors

• Personal:– Tend to self care issues first– Address Maslach’s 6 sources of burnout– Influence happiness through personal values

and choices– Adapt a healthy philosophy/outlook– Spend time with family & friends

Protective Factors

– A supportive spouse or partner– Engage in religious or spiritual activity– Hobbies– Mentor (s)

Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50

Protective Factors

• Work:– Address Maslach’s 6 sources of burnout– Gain control over environment & workload– Find meaning in work – Set limits and maintain balance– Have a mentor– Obtain adequate administrative support

systems

Individual Approach Organizational ApproachStarts with

person

Becomes group project

Connects to organization

Outcomes affects related mismatches

Outcome is a process

Starts with management

Becomes organizational project

Connects to people

Figure 5.1 (pg 80) Maslach, C & Leiter, MP. “The Truth About Burnout: How Organizations Cause Personal Stress and What to do About It.” 1997

Preventing & Resolving Burnout

Case 1:

It’s 10:30 PM and you pass your colleague in the hall. She is a 48 yo female physician, recently divorced with one kid. You can tell she was crying. When you ask what is wrong she shapes up and replies, “Nothing really. I am so frustrated with the system!” You offer to talk and she declines.

•What are your concerns?•What are her risk factors for stress & burnout?

Suicide

• “Friends who work with people in medicine need to be aware that, if they see something that concerns them, they need to transmit the message to the powers that be.”

Dr. W. Gerald Austen, surgeon-in-chief emeritus

Massachusetts General Hospital

Case 2: Dr S has struggled for the last year to “fit in.” He often seems emotionless and flat. He has been considered “unsocial” because he does not participate in any of the faculty gatherings. He has missed several deadlines and often calls in sick. His students say he doesn’t teach and is erratic at times. Once on his day off you saw him leaving a bar possibly drunk and on his post call day he was not responding to emails or pages for several hours. Just after the holidays he was found dead after a single vehicle MVA.

• What are you concerned with here? • What barriers may play a role in this case?

Suicide

• “However, hard and stressful work alone does not result in suicide. Those who do commit suicide almost always have significant identifiable underlying mental illnesses, such as major depression and/or bipolar disorders, usually coupled with alcoholism and major drug use.”

~Eugene V. Boisaubin

Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressures of Success. Pg 32; 2009

Signs of Addiction

• Unprofessional behaviors

• Decreased performance

• Diverting drugs• Unusual pharmacy

orders• PE signs of either

intoxication or withdrawal

• Isolation & withdrawal from friends

• Mood changes• Overreactions to

criticism• Long sleeves• Frequent restroom

stops• Asks for extra calls

Wearing Masks II. 1993 rainbow productions. www.Allanestesia.com

Addiction

• Residents are more prone (especially anesthesia) than faculty

• Increases accidental and intended deaths

• Denial, cover-ups, easy access

• History of addiction – individual or family

• “Tried it just once or twice.”

Wearing Masks II. 1993 rainbow productions. www.Allanestesia.com

Addiction

• >50% residents self-prescribe1

• ETOH most commonly used substance2

• 10% faculty use daily; 9% binge2

• 8% use opiates without MD supervision2

• Recovery can be successful treatment!

2. Hughes et al. 1992 Prevalence of substance use among US physicians. JAMA 267:2333-39.

1. Christie et al. 1998 Prescription Drug use and self-prescription among residents. JAMA 280:1253-55)

“Inaction is NOT an option.” ~Dr John Lecky – recovering addicted physician

Report concerns to:Superiors

Physician’s Health Program – confidentialWellness Programs – FPWP

FPWC Members

Case 3:Dr D is an OB/GYN who was fired from one residency program. She joined the faculty 6 mo ago. Since then, she has had five pt and staff generated complaints about her aggressive, loud behavior. In stressful situations, she becomes loud, forceful and rude. She slammed the door after a heated discussion with a nurse in front of a patient. She has also changed OR times without team permission to “take care of VIP patients.” She is quoted as saying, “This is how I get things done.”

• What do her behaviors tell us?•Are her behaviors ok if her skills are outstanding?

Distressed Physicians• Internal Factors:

– Alcohol and drug addiction– Compulsive behavior around

sexual acting out, compulsive gambling, eating, working, etc.

– Little or no training in conflict resolution, leadership skills, communication and teaching skills

– Psychiatric disorders• Narcissistic personality

disorder• Depression/bipolar• Dementia etc.

• External Factors:– High system demands and

low system support– Disruptive behavior is

reinforced by the system – Bully doc gets preferential

operating time– Masking ineffective managers– Failure to act– The system fails to provide

physician with complaints and/or feedback

– Life cycle events (i.e. death in the family, children leaving home, divorce, etc.)

Swiggart, Dewey, Hickson, Finlayson. 4/09

Aggressive Passive Passive

Aggressive

Figure 1

Spectrum of Disruptive Behaviors

Inappropriate anger, threats

Yelling, publicly degrading team members

Intimidating staff, patients, colleagues, etc.

Pushing, throwing objects

Swearing

Outburst of anger &physical abuse

Hostile notes, emails

Derogatory comments about institution,

hospital, group, etc.

Inappropriate joking

SexualHarassment

Complaining,Blaming

Chronically late

Failure to return calls

Inappropriate/inadequate chart notes

Avoiding meetings & individuals

Non-participation

Ill-prepared, not prepared

Swiggart, Dewey, Hickson, Finlayson. 4/09

Distressed Colleagues

• Focus on behaviors

• Document behaviors

• Discuss with leadership

• Report in VERITAS

• Re-training can be successful

Distressed Physicians

“This leadership course has brought about change in the way I perceive others and how I am perceived as a professional, husband and father. This intervention should have occurred earlier.”

~CPH participant 07-08

Resources

Faculty and Physician Wellness Committee (FPWC)Rahn K. Bailey, M.D. – MMCChad Boomershine, M.D.Donald W. Brady, M.D.Ildiko Csiki, M.D. (resident)Larry Churchill, Ph.D.Roy Elam, M.D.A.J. Reid Finlayson, M.D.Kimberly Garcia, M.D. (resident)Stephan Heckers, M.D.Gerald B. Hickson, M.D.Jerry Jaboin, M.D. (resident)

Tracy Jackson, M.D.Peter Martin, M.D.Jeanette J. Norden, Ph.D.James O’Neill, Jr., M.D.Paul W. Ragan, M.D.David S. Raiford, M.D.Scott M. Rodgers, M.D.Debbie Smith, M.A.William Swiggart, M.S., LPC/MHSPDonna Seger, M.D.Anderson Spickard, Jr., M.D. Mary Yarbrough, M.D., MPH

Charlene M. Dewey, M.D., M.Ed., FACP (chair)

Vanderbilt Internal ResourcesAbbrev. Program Focus Contact Number

FPWC Faculty and Physician Wellness Committee

All issues of professional health

Charlene Dewey x6-0678

FPWP Faculty and Physician Wellness Program –

Work/Life Connections EAP

Treatment of faculty and employees

Mary Yarbrough X6-1327

CPH Center for Professional Health

Training physicians Bill Swiggart x6-0678

VCAP Vanderbilt Comprehensive Assessment Program for

Professionals

Fit for duty assessments and

treatment

Reid Finlayson X2-4567

CPPA Center for Patient and Professional Advocacy

Identification and assistance

Jerry Hickson X3-4500

Vanderbilt Internal Resources

• Center for Integrated Health (CIH)

• Health Plus

• Go for the Gold program• Center for Professional Health Educational

Resource web page/on-line classroom (in

development)

• Dayani center & ortho exercise facility

• VERITAS

Other Resources

• Primary care provider

• Centerstone, Elam Center or other private counseling services

• Cumblerland Heights & Evelyn Fry for substance use related issues

• 1-800-273-TALK: suicide prevention hotline

• YMCA/YWCA

• State physician health programs

Q&AQ&AQ&AQ&A

Summary

• Good professional health protects both you and your career

• Workplace stress and burnout are common in AMC – be aware of the risks and try to prevent it when possible

• Seek assistance when needed

• Vanderbilt has several resources to assist

More Information

• Please feel free to contact us:– Charlene.dewey@vanderbilt.edu– Wiliam.swiggart@vanderbilt.edu

FPWC

CPH & FPWC Web Pagehttp://www.mc.vanderbilt.edu/cph

CPH

Center for Professional Health * 1107 Oxford House * x6-0678