Part D: Section D.2 Maintaining Personal Wellness 1 Part A: - PowerPoint PPT Presentation

Part D: Section D.2 Maintaining Personal Wellness 1 Part A: Understanding Grief and Loss in Children and Their Families

Goals of this Session o Discuss the rewards and challenges of our profession o Provide a forum to discuss these contrasts o Learn about adaptive strategies to enhance well being and develop resiliency in our lives o Develop an individualized wellness learning plan 2 Part A: Understanding Grief and Loss in Children and Their Families

Objectives Learners will be able to o Define wellness and it’s importance for the practicing physician. o Recognize how a physician’s response to grief and loss may impact others. o Identify one’s own responses to grief and loss. o Learn adaptive strategies both in the moment and long term to enhance well being and develop resilience. o Recognize the benefits of good self-care. o Develop an individualized wellness learning plan. 3 Part A: Understanding Grief and Loss in Children and Their Families

Our Profession as Pediatricians o We have a rewarding profession in providing service to our patients. o Yet, our work in our profession can be challenging at times. o We partner with patients and families who experience suffering. o The impact of unexpected outcomes, emotions of family and team, fatigue, and uncertainty can take a personal toll. 4 Part A: Understanding Grief and Loss in Children and Their Families

What are the rewarding aspects of our profession? 5 Part A: Understanding Grief and Loss in Children and Their Families

Rewarding Aspects o Provide a service to others o Partner with families and patients o Work as part of a team o Identify the correct diagnosis o Help patients to get better o Help patients/families to adapt/thrive o Contribute to something greater than self 6 Part A: Understanding Grief and Loss in Children and Their Families

What are some of the challenges? 7 Part A: Understanding Grief and Loss in Children and Their Families

Challenges o Patients may not get better o Situations with high emotions o Grappling with uncertainty o Medical errors o Perfectionism of providers o Fatigue o Death of a patient 8 Part A: Understanding Grief and Loss in Children and Their Families

How are these juxtaposed? 9 Part A: Understanding Grief and Loss in Children and Their Families

The word patient comes from the Latin word “ Patiens ” Which means “to suffer” 10 10 Part A: Understanding Grief and Loss in Children and Their Families Part A: Understanding Grief and Loss in Children and Their Families

“In the sufferer, let me see only the human being.” – Prayer of Maimonides 11 11 Part A: Understanding Grief and Loss in Children and Their Families Part A: Understanding Grief and Loss in Children and Their Families

Humanism “Set of deep - seated convictions about one’s obligations to others, especially those in need. Encompassing a spirit of sincere concern for the centrality of human values in every aspect of professional activity.” – Edward Pellegrino, Humanism and the Physician , 1979 12 Part A: Understanding Grief and Loss in Children and Their Families

Concept of Dual Intelligence “The practice of medicine combines the life sciences with humanism. The science and art are not antagonistic, but supplementary.” – Robichaud, Bioethics , 2003 Both science and humanism are essential. 13 Part A: Understanding Grief and Loss in Children and Their Families

“Humanism is the passion that animates professionalism” – Jordan Cohen 14 14 Part A: Understanding Grief and Loss in Children and Their Families Part A: Understanding Grief and Loss in Children and Their Families

Miller and Schmidt. Acad Med , 1999 1. Identify multiple perspectives Embrace patient suffering 2. Reflect on how they converge or conflict 3. Choose to act altruistically 15 15 Part A: Understanding Grief and Loss in Children and Their Families Part A: Understanding Grief and Loss in Children and Their Families

Acknowledging Our Own Humanism as Providers 16 Part A: Understanding Grief and Loss in Children and Their Families

Humanism to Self Acknowledge our imperfections, fatigue, mistakes, discomfort with medical uncertainty 17 17 Part A: Understanding Grief and Loss in Children and Their Families Part A: Understanding Grief and Loss in Children and Their Families

Critical Incidents During Medical Education and Practice Affect Us 18 18 Part A: Understanding Grief and Loss in Children and Their Families Part A: Understanding Grief and Loss in Children and Their Families

What is an example of a critical incident that has stayed with you? Influenced your life? 19 Part A: Understanding Grief and Loss in Children and Their Families

Examples of Critical Incidents o Sudden decompensation of a patient o Unexpected outcome o Medical error o Angry parents o Death of a patient o Recognizing and coping with uncertainty o Inability to control outcomes 20 Part A: Understanding Grief and Loss in Children and Their Families

Important to Have Forum for Discussion of CIs o Debrief with team, faculty member, colleague or friend o Address intellectual decision making o Acknowledge and articulate emotional impact o Address ways to integrate experiences, rather than pretend that “it never happened” o You need to have direct and deliberate dialogue to move beyond a critical incident 21 Part A: Understanding Grief and Loss in Children and Their Families

Stress! 22 22 Part A: Understanding Grief and Loss in Children and Their Families Part A: Understanding Grief and Loss in Children and Their Families

“We have an obligation as educators to share with learners how we have coped with feelings of anger, anguish, shame or uncertainty in caring for patients.” – Novack DH et al. Acad Med , 1999 23 Part A: Understanding Grief and Loss in Children and Their Families

Defining Stress o Stress is the arousal of mind and body in response to demands made on them. o Distress results when the arousal is too high or too low. o Each individual has his/her own zone of positive stress. 24 Part A: Understanding Grief and Loss in Children and Their Families

Factors Associated with Intern Stress o Consider programmatic changes to reduce stress: o Improve sleep quality o Foster teamwork o Train in conflict resolution o Decreasing the number of duty hours may be insufficient to reduce intern fatigue Freisen, 2008 25 Part A: Understanding Grief and Loss in Children and Their Families

Develop self-awareness regarding stress o Anticipate stressors o Interpret stress as a sign or an opportunity o Believe that you can influence events and reactions to them o Talking about feelings and emotions can be healthy 26 Part A: Understanding Grief and Loss in Children and Their Families

Managing Stress: Coping o You have a choice in how you respond to difficult situations and emotions o Learn to respond in a healthy and productive manner 27 Part A: Understanding Grief and Loss in Children and Their Families

“The Violence of Modern Life” “There is a form of modern violence to which the idealist most easily succumbs: activism and overwork. The rush and pressure of modern life are a form, perhaps the most common form, of its innate violence.” – Thomas Merton 28 Part A: Understanding Grief and Loss in Children and Their Families

Depressed Residents? o Study that included 220 residents from 3 large residency training programs o 19.6% of residents screened positive for depression o No significant change with work hour changes Landrigan CP, 2008 29 Part A: Understanding Grief and Loss in Children and Their Families

Burned out Residents? o 220 Residents (3 programs) o Measures: o Emotional exhaustion o Depersonalization o Personal achievement o Rates of burn out decreased from 75% to 57% with work hour restrictions Landrigan 2008 30 Part A: Understanding Grief and Loss in Children and Their Families

What is Burn-Out? o Emotional exhaustion o Depersonalization o Decreased feelings of personal accomplishment Maslach, C. and Jackson, S. E. 1981 . 31 Part A: Understanding Grief and Loss in Children and Their Families

Burnout is an Occupational Hazard for Physicians o Estimates of physician burnout range from 25%-75%. o Onset is linked to residency training. o Physicians have a higher rate of depression, anxiety, substance abuse and suicide when compared to the general population. 32 Part A: Understanding Grief and Loss in Children and Their Families

Why such a problem? o Social isolation o Self-blame for negative outcomes o Lack of attention to emotional needs Why such a problem? o Inadequate attention to personal medical care o Strong emotional responses to the care of complex patients Eckleberry-Hunt J 2009 33 Part A: Understanding Grief and Loss in Children and Their Families

Factors Related to Burnout? What do you think they would be? 34 34 Part A: Understanding Grief and Loss in Children and Their Families Part A: Understanding Grief and Loss in Children and Their Families

Factors Related to Burnout o Perfectionism o Lack of coping skills o Personal bad habits (smoking and recreational drug use) o Lack of control over office processes o Lack of control over schedule Eckleberry-Hunt, 2009 35 Part A: Understanding Grief and Loss in Children and Their Families