Date post: | 22-May-2015 |
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STRESS MANAGEMENT FOR DOCTORS
Dr.KMH-IMA
Dr.Jaikumar(Psychiatrist)
IMPORTANCE & EVIDENCE
Little education; evidence building 30-60% MD have distress and burnout MDs suicide > other prof. & gen pop. One physician per day; PhD – unclear Grossly underestimated Depression/bipolar & substance abuse =
suicide risk
“Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressure of Success.” Cole, Goodrich & Gritz, 2009.
IMPORTANCE & EVIDENCE Academic faculty:
Worked longer hoursTook less vacation
10% with mild depression 27% with elevated anxiety
No sig difference clinical vs. academic Litigation/named in law suite
Lin 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. The Impact onof the changing Health Care Environment on the Health and Well-being of faculty at Four Medical Schools. Academ Med 2006 81(1):27-34.
TYPE A PERSONALITY TRAITS
WHAT IT TAKES OBSESSIVENESS COMPULSIVENESS EXAGGERATED SENSE OF RESPONSIBILITY CHRONIC FEELINGS OF NOT DOING ENOUGH DIFFICULTY SETTING LIMITS
DELAYED GRATIFICATION
The ability to delay personal and pleasurable self interests until more important goals are achieved
DOCTORS are MASTERS of this
The ability to delay attending to significant relationships and other sources of renewal until all the work is done BUT
PHYSICANS ARE PRONE TO MARITAL AND RELATIONSHIP PROBLEMS
THEN VS NOWTraditionally, doctors were men who were
often married to a homemakerToday:1/3 of doctors are women½ of medical students are womenWomen struggle more with balancing
home and work responsibilities
THE PRACTICE OF MEDICINE IS CHANGING
LONGER HOURS MORE PAPERWORK DECREASING COMPENSATION STRINGENT GOVERNMENT AND INSURANCE
REGULATIONS MALPRACTICE ACCUSATIONS
COMMON STRESS ASSOCIATED DISEASES Diminished Immunity Headache Fatigue Weight gain Dyslipidemia Hypertension Heart Disease Psoriasis/Eczema Digestive problems
Depression Alcoholism Substance abuse Anxiety Insomnia Irritable bowel
syndrome Fibromyalgia Decreased sex
drive
OVERVIEW OF TERMINOLOGY Stress: A state of disharmony or a threat to
homeostasisPhysiological changes increase alertness, focus,
and energyPerceived demands may exceed the perceived
resources Coping: The ability to maintain control, think
rationally, and problem solve Resilience: Resistant quality that permits a
person to recovery quickly and thrive in spite of adversity
OVERVIEW OF TERMINOLOGY
STRESS ACUTE STRESS- immediate response to
a threat or stressor CHRONIC STRESS: -long term acute stress -More subtle but lasting -Nagging -Unrelenting
CAUSES OF STRESS External causes
Family, work, economics, work, school,
major life changes, unforeseen events,
etc.
Internal causes
Worry, uncertainty, fear, attitudes,
unrealistic expectations, etc.
STAGES OF THE STRESS RESPONSEGENERAL ADAPTATION SYNDROME OF HANS SELYE (1907-1982)
Alarm—when one feels threatenedActivation of the fight or flight reaction
Resistance—mobilization of resources to solve the problemContinued stress causes adaptation
ExhaustionAdaptation fails and level of function
decreases
BURNOUT The cumulative result of unaddressed stress
A state of physical, emotional and mental exhaustion
“an erosion of the soul” “silent anguish of the healers”
A relationship gone bad
BURNOUT Grows gradually over time Perhaps beginning in medical school or residency
Disillusioned Cynical It becomes very difficult to do a competent job
COSTS OF BURNOUT Personal and family
losses
Decreased productivity
Medical mistakes
Physician turnover
HEADLINES“Frustrated physicians find careers outside of
medicine”“Suicide rate of women doctors in US is twice
that of other working women”“Suicide rate high in female doctors”“Many doctors prone to stress”
COPINGAdaptive Coping
Contribute to resolution of the stress response
Maladaptive Coping
Strategies that cause further problems
Active Coping
Actively seeking resolution to the stress
BURNOUT PREVENTION 1)Physician’s personal
responsibility (INTRINSIC) but should include
2)help from the workplace (EXTRINSIC)
Should start in medical school! and continue through retirement
In 2001, the Joint Commission mandated that hospitals address physician well-being
HEALTH AND HAPPINESS INVENTORY-Listen to your SELF TALK-Are you content and satisfied?-Are you always complaining to yourself?-What causes you to feel stressed?-What makes you happy? Are you happy?Are you irritable? Anxious? Depressed?
HEALTH AND HAPPINESS INVENTORY How are your relationships going? Is your practice going well? Is it what you
expected? What is your body telling you? -Are you tired? -Do you get enough sleep? -Do you have headaches? Back pain?
PROMOTE ADAPTIVE COPING
TrainingPrepares for stressful events
NutritionEat healthy, avoid skipping meals
Exercise Include regular exercise
SleepGet adequate sleep—avoid fatigue
AVOID MALADAPTIVE COPING Blurring of
boundaries Avoidance/
withdrawal Negative attitude Anger outbursts Alcohol/Drugs Hopelessness Negative self-talk Resentment Violence
PROMOTE RESILIENCE FACTORS Positive Role
Models Optimism Humor Moral Compass Altruism Religion &
Spirituality Social Support
GOALS Work on self
acceptance-let go of perfection as a goal
Autonomy-internal locus of self-evaluation
Always work towards personal growth
PERSONAL GROWTH AND RENEWAL
-Not only for life outside of work
-Work does not have to be merely a domain of energy expenditure but also of energy renewal
-Learn to receive support, healing and meaning while giving
STRESS MANAGEMENT Decrease level of arousal and moderate
the stress response Decrease feelings of tension and arousal Increase sense of well-being and
peacefulness Increase sense of personal control
EASY to learn. EASY to do.
PROMOTE ADAPTIVE COPING Realistic expectations
Set realistic goals Planning
Anticipate problems, have a backup plan Reframing
Change the way you look at things Relaxation
Learn relaxation techniques, take time-out for leisure
Discuss the problemUtilize existing social supports to problem solve
HUMOR Highly effective Mature coping mechanism
“Another of the souls’ weapons for the fight for self-preservation, it is well known that humor, more then anything else in the human makeup, can provide an aloofness and the ability to rise above any situation, even for a few seconds.”
Viktor Frankl
MORAL COMPASS Conduct a moral inventory
“Look not for any greater harm then this, destroying the trustworthy, self-respecting, well-behaved man within you.” Epicetus
Maintain your integrity“Between stimulus and response there is
a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”
Viktor Frankl
ALTRUISM Unselfish regarding the welfare of
others
Believe in a meaningful cause
Mutual cooperation
Activates of the brain’s reward center
RELIGION & SPIRITUALITY Associated with psychological and
physical well being
Guards against despair
Provides social support
Provides positive role models
Provides a positive mission
SOCIAL SUPPORT Social support has a
profound effect on life expectancy
Patients have better outcomes with strong social support
Isolation and poor social support are associated with a poor stress response
Few hardy individuals “go it alone”
OPTIMISM Positive Beliefs
Associated with well beingCognitive reframingPositive thinkingRefute the negative thinkingBelieve in a meaningful cause
It is important to acknowledge relevant negative factors
GET ENOUGH SLEEP
NIX COFFEE?
MASSAGE
YOGA
WALKING
RESISTANCE TRAINING
VENTING
MINDFULNESS Fostered by
MEDITATION Being fully present
in the moment, to the person and the task at hand
COUNTERBALANCE for all the interrupted tasks and competing demands common to most work days
CHANGES IN THE WORKPLACE
Establish a Physician Health Committee
Mentor program Confidential
support groups Annual well-being
retreat
CHANGES IN THE WORKPLACE
Look at a physicians sense of meaning in their work and not just productivity
Membership to fitness clubs CME on topics related to well-being Flexible schedules Decrease paperwork
THANK YOU!
GO GET ‘EM!