A Stor y of inte re st/ a rra ng e me nt o r a ffilia tio n with a - - PDF document

10/13/2019 1 A Stor y of Joy & Me a ning in Me dic ine

JOHN CHUCK , M.D. RE GIONAL CHAIRPE RSON, PHYSICIAN HE AL T H & WE L L NE SS L E ADE RS GROUP T HE PE RMANE NT E ME DICAL GROUP OAK L AND, CA

Disc lo sure sta te me nt

I ha ve no fina nc ia l inte re st/ a rra ng e me nt o r a ffilia tio n with a ny

• rg a niza tio n(s) tha t

c o uld b e pe rc e ive d a s a re a l o r a ppa re nt c o nflic t

• f inte re st in the c o nte nt
• f this e duc a tio na l

a c tivity

T ha nk yo u fo r b e ing he a le rs

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Cha pte r 1: A Ne w Dire c tio n

T he re le ntle ss pursuit o f pe rfe c tio n in Ame ric a n me dic ine ha s ha d uninte nde d c o nse q ue nc e s

Qua lity Outc ome s

T he T riple Aim

Me tr ic s & MSCI

Multiple Simulta ne o us Co nflic ting I mpe ra tive s (MSCI )

Burnout & Depression Burnout & Depression

Amo ng U.S. Physic ia ns 2011-2017

Ma yo Clin Pro c . 2019;94(9):1681-1694

Of 30,456 physic ia ns who re c e ive d a n invita tio n to pa rtic ipa te , 5197 (17.1%) c o mple te d surve ys. Whe n a sse sse d using the Ma sla c h Burno ut Inve nto ry, 43.9% (2147 o f 4893) o f the physic ia ns who c o mple te d the MBI re po rte d a t le a st o ne sympto m o f b urno ut in 2017 c o mpa re d with 54.4% (3680 o f 6767) in 2014 (P<.001) a nd 45.5% (3310 o f 7227) in 2011 (P=.04). T he pro po rtio n o f physic ia ns sc re e ning po sitive fo r d e pre ssio n sho we d a mo d e st b ut ste a d y inc re a se b e twe e n 2011 a nd 2017 (2011, 38.2% [2753 o f 7213]; 2014, 39.8% [2715 o f 6818]; 2017, 41.7% [2022 o f 4854]; P<.001). Burno ut a nd sa tisfa c tio n with wo rk-life inte g ra tio n a mo ng US physic ia ns impro ve d b e twe e n 2014 a nd 2017, with b urno ut c urre ntly ne a r 2011 le ve ls. Physic ia ns re ma in a t inc re a se d risk fo r b urno ut re la tive to wo rke rs in o the r fie ld s.

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Burno ut re duc e s q ua lity a nd sa fe ty

Summary: We found small to medium-sized relationships between burnout and both decreased quality

• f care and decreased safety. Of the burnout components, emotional exhaustion had the strongest

relationship with quality, followed by depersonalization and reduced personal accomplishment. In terms

• f quality, burnout had a medium-sized relationship with lower perceived (provider-reported) quality

and a weaker, but still significant, relationship with reduced patient satisfaction. provider burnout may contribute in part to real-world outcomes for patients, putting them at higher risk of an error or adverse

• event. In addition to the obvious implications for patient health and well-being, a greater number of

errors also leads to greater liability for healthcare organizations. Moderator analyses for safety suggest that the impact of burnout might be greater for nurses than for physicians or mixed provider samples. This finding is consistent with research showing that nursing care is more predictive of patient ratings of quality than physician care. As noted by Leiter and colleagues in one of the first studies linking nurse burnout with patient satisfaction, nurses have more direct patient contact and perform more of the daily care activities than other healthcare professionals such as physicians, which may have a more central impact on patients.

B U R N O U T

P e r for mance

Se amle ss E MR ac ross de partme nts and he alth syste ms ZE RO nosoc omial infe c tions and no antibiotic r e sistanc e Pe rfe c t staffing ratios R e ady supply of me dic ations and supplie s World c lass quality re porting

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Joy

• Jo y is a c ho ic e
• “Jo y is ha ppine ss fo r no g o o d

re a so n”

• Jo y is inse pa ra b le fro m

suffe ring

• T

he g re a te st jo y is to b ring jo y to o the rs = c o mpa ssio n = a c tive e mpa thy

Me a ning

T he de e p sa tisfa c tio n

• f kno wing tha t yo ur

e xiste nc e ma tte rs a nd tha t wha t yo u do ma ke s a po sitive diffe re nc e in the live s

• f o the rs.

T he pro g re ss in JAMM is ite ra tive a nd re q uire s a te a m e ffo rt to re a c h its full po te ntia l

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Cha pte r 2: A Cha t with T he L ittle Ma n

“We a r e our c hoic e s.”

• J.P. Sa rtre

Vic to r F ra nkl – Man’ s S e arc h fo r Me aning

“Be twe e n stimulus a nd re spo nse , the re is a spa c e . In tha t spa c e is o ur po we r to c ho o se o ur re spo nse . In o ur re spo nse lie s o ur g ro wth a nd o ur fre e do m.”

Cho ic e is de stiny

K e lly Mc Go nig a l, Ph.D., He a lth Psyc ho lo g ist

1998-2006: Na tio na l He a lth Surve y o f 186 millio n a dults linke d to na tio na l mo rta lity da ta . Hig he r le ve ls o f re po rte d stre ss a nd the b e lie f tha t stre ss a dve rse ly a ffe c ts he a lth we re inde pe nde ntly a sso c ia te d with wo rse he a lth a nd me nta l he a lth o utc o me s. T ho se who re po rte d hig h stre ss a nd b e lie ve d stre ss impa c te d the ir he a lth ha d a 43% inc re a se d risk o f pre ma ture de a th o ve r a 9 ye a r fo llo w up pe rio d. T ho se who re po rte d hig h stre ss b ut did no t b e lie ve tha t stre ss a dve rse ly a ffe c ts he a lth sho we d no inc re a se d mo rta lity.

• Ke lle r, L

itze lman, Wisk, e t al. He alth Psyc ho l. 2012 S e p 31(5): 677-684

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I re c omme nd the following c hoic e s

• n the me nu of life
• Slo w do wn a nd spe nd mo re time in the swe e t

spo t

• Be g ra te ful
• E

mb ra c e lo fty va lue s a nd g o a ls

• K

e e p yo ur b o dy mo ving

• Ada pt to c ha ng e a nd suffe ring a nd e me rg e a

b e tte r pe rso n

• Inve st in re la tio nships
• F
• rg ive yo urse lf a nd o the rs fo r b e ing le ss tha n

pe rfe c t

Choose to slow down

• Dia l b a c k b usyne ss
• Dia l up stra te g ic sla c king

T he swe e t spo t

Ac c omplishme nt E a se

T he drive to suc c e e d is like Brylc re e m

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Choose g ra titude

I invite yo u to ma ke the tra nsitio n fro m . . .

Woe is me

WOW is me !!!

Co mpa re yo urse lf to the ma sse s le ss fo rtuna te , no t the fe w who ha ve mo re .

T HE MASSE S

Pa rtne r up a nd sha re o ne thing yo u a re g ra te ful fo r to da y.

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Choose lofty va lue s a nd g oa ls

“My o nly ho pe fo r yo u is tha t a t so me po int in yo ur life yo u will wo rk with o the r pe o ple fo r a c a use g re a te r tha n yo urse lf.”

• Mr. Williams,

Davis S e nio r Hig h S c ho o l Graduatio n spe e c h, 2013

A big thought from Jack

“At the c o re o f the jo urne y must b e a fund a me nta l se nse o f who I a m, wha t I a m inspire d b y, a nd wha t I a m willing to c o mmit to in ma king a diffe re nc e fo r wha t I truly c a re a b o ut.”

• Ja c k Ro za nc e , M.D., Physic ia n in Chie f

E me ritus, Sa c ra me nto

Choose move me nt

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T he ma g ic o f mo ve me nt

Move Na tur a lly T he wo rld’ s lo ng e st-live d pe o ple do n’ t pump iro n, run ma ra tho ns o r jo in g yms. Inste a d, the y live in e nviro nme nts tha t c o nsta ntly nud g e the m into mo ving witho ut thinking a b o ut it. T he y g ro w g a rde ns a nd d o n’ t ha ve me c ha nic a l c o nve nie nc e s fo r ho use a nd ya rd wo rk.

Choose to a da pt to c ha ng e a nd suffe ring

and e me rg e a be tte r pe rso n

• K

intsug i c e le b ra te s the fa c t tha t b re a ka g e a nd re pa ir a re e sse ntia l e le me nts o f who we a re .

• “T

he mo st b e a utiful pe o ple we ha ve kno wn a re tho se who ha ve kno wn de fe a t, kno wn suffe ring , kno wn strug g le , kno wn lo ss, a nd ha ve fo und the ir wa y o ut o f the de pths. T he se pe rso ns ha ve a n a ppre c ia tio n, a se nsitivity, a nd a n unde rsta nding o f life tha t fills the m with c o mpa ssio n, g e ntle ne ss, a nd a de e p lo ving c o nc e rn. Be a utiful pe o ple do no t just ha ppe n.”

• E

lisabe th Kuble r-Ro ss

Choose to inve st in re la tionships

"T he c le a re st me ssa g e tha t we g e t fro m o ur 75-ye a r stud y is this: Go o d re la tio nships ke e p us ha ppie r a nd he a lthie r. Pe rio d .“

• Ro be rt Walding e r

"T he c le a re st me ssa g e tha t we g e t fro m o ur 75-ye a r stud y is this: Go o d re la tio nships ke e p us ha ppie r a nd he a lthie r. Pe rio d .“

• Ro be rt Walding e r

Gra nt a nd Glue c k Study

• f Adult De ve lo pme nt

Gra nt a nd Glue c k Study

• f Adult De ve lo pme nt

E ve ryo ne a g re e s: it’ s a b o ut re la tio nships

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T he va lue o f trib e s

T he wo rld ’ s lo ng e st live d pe o ple c ho se –o r we re b o rn into –so c ia l c irc le s tha t suppo rte d he a lthy b e ha vio rs, Okina wa ns c re a te d ”mo a is”–g ro ups o f five frie nds tha t c o mmitte d to e a c h o the r fo r life . Re se a rc h fro m the F ra ming ha m Studie s sho ws tha t smo king ,

• b e sity, ha ppine ss, a nd e ve n

lo ne line ss a re c o nta g io us. So the so c ia l ne two rks o f lo ng -live d pe o ple ha ve fa vo ra b ly sha pe d the ir he a lth b e ha vio rs.

F a mily & frie nds: “T he q ua lity o f pe rso na l re la tio nships is o ne o f the mo st po we rful pre dic to rs

• f re silie nc e .” – Wayne S
• tile

So c ia l life b o nus tip: e ng a g e in a c o unse ling re la tio nship. I t wo rks.

“My E AP c o unse lo r Ma rissa Pie rc e he lps to ke e p me mo re rig ht in the he a d.”

• JMC

Choose to love yourse lf a nd othe rs . . . wa rts a nd a ll

• “Be wa re o f ‘ supe rpe rso n synd ro me .’

Re c o g nize tha t fe e ling like g uilt, sha me , a nd humilia tio n a re na tura l in the a fte rma th o f the ‘ supe rpe rso n synd ro me ’ tha t me d ic a l tra ining pe rpe tua te s. “ - S

• tile
• “T

he ma n who o pts fo r re ve ng e sho uld d ig two g ra ve s.” - Chine se pro ve rb

• “Re se ntme nt is like d rinking po iso n a nd

ho ping yo ur e ne mie s will d ie .”

• Ne lso n Mande la

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T he Po we r o f Vulne ra b ility & Sha me

• 20 millio n o nline vie ws o f he r T

E D ta lk

• We live in a vulne ra b le wo rld a nd o ne o f the wa ys we

d e a l with it is to numb o urse lve s to it b y b uying thing s, e a ting fo o d , d rinking a lc o ho l, a nd ta king d rug s.

T he So lutio n: Who le He a rte d L iving

• It sta rts with a po sitio n o f se lf wo rth
• Wa ke up e a c h mo rning thinking “My b e st e ffo rts

to da y will b e e no ug h.”

• Go to b e d b e lie ving , “Ye s, I a m impe rfe c t a nd

vulne ra b le a nd so me time s a fra id, b ut tha t do e sn’ t c ha ng e the truth tha t I a m a lso b ra ve a nd wo rthy o f lo ve a nd b e lo ng ing .”

SE L F AF F IRMAT ION

Cha pte r 3: Pla ytime with T he E le pha nt

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I t’ s time to re mo ve the b a rrie rs tha t se pa ra te us fro m o ur jo y a nd me a ning Joy & Meaning

E xhaustion

Re c o nne c ting to o ur jo y a nd me a ning is a ma tte r o f the he a rt a nd so ul > a c o g nitive e xe rc ise

Joy & Meaning

Dra w a pic ture tha t c a pture s yo ur o rig ina l mo tiva tio n fo r pursuing a c a re e r in he a lthc a re

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T e ll yo ur pa rtne r a sto ry o f he a ling in whic h yo u we re he ale d, we re the he a le r,

• r o bse rve d he aling

Wha t’ s yo ur fo xho le ma ntra ?

T his is what yo u say to yo urse lf whe n time s are (ve ry) to ug h.