Faculty/Presenter Disclosure Turning Burnout Into Joy: • Faculty: Dr. Mamta Gautam • Disclosure: President and CEO, PEAK MD Inc Addressing Practitioner Stress and Burnout • Relationships with commercial/pharma interests: NONE • Disclosure of commercial support: NONE • Potential for conflict of interest: NONE Mamta Gautam, • Mitigating potential bias: NOT REQUIRED MD, MBA, FRCPC, CCPE, CPE, MOT • The content of this discussion is not related to the services of commercial interest. • No therapeutic recommendations for medications will be made. Learning Objectives BURNOUT A syndrome of emotional exhaustion, chronic overstress. (Maslach) • What is burnout? • What is the scope of the problem? • Distinct work-related syndrome – demands exceed • What is causing clinician burnout? individual resources • Why should we care? • Most likely to occur in jobs that require extensive care of others • What can we do about it? • Common among practicing clinicians • Not a psychiatric diagnosis, but can lead to serious consequences 1
BURNOUT Review of Burnout Studies • Nearly half of all physicians (46%) experience Three stages of burnout: burnout, more than any other type of workers. • 2011 – 45.8% of US physicians • 2015 – 54% of US physicians • Emotional Exhaustion • 2019 – 44% of US physicians • Depersonalization • Emergency care (52%), critical care (53%), • Reduced Personal Accomplishment and family medicine (50%) experience the highest rates of burnout among health care providers. Obs/Gyn (45%) Medscape clinician LifeStyle Reports Possible Risk Factors • Nursing: Up to 70% of nurses report burnout • High Workload - demands exceed resources in current position (CareerBuilder, 2017) • Incentive Based Pay • Less is known about other members of the • Age - inverse relation between age and burnout. health care team, although existing data Survivor bias. suggest a similar prevalence of burnout • Gender – higher (2X) in women than men among nurse practitioners and physician • Children – higher if young children under 21 yo assistants (Dyrbye and Shanafelt, 2017) • Spousal support – inverse relation between emotional exhaustion and support from partner 2
Cultural Drivers Individual Drivers • Intellectual Defenses: Denial, minimization, rationalization, • Attitudes: The patient comes first. Never show sublimation weakness or emotion. “Tough it out”. • Sets high expectations, perfectionism, self denial • Personality traits: perfectionistic, self-critical, guilt, need for control • Lack of control • High expectations of ourselves and others • Doing things that are not ‘doctoring’ or clinical • Concerns dismissed, not taken seriously by • Sign of weakness; associated sense of shame and guilt colleagues • Fear of failure, judgment, exposure • Unsupportive or judgmental colleagues • Fear of loss of control, concerns re. future prognosis • Stigma in the culture of medicine Stigma as a Major Challenge Systems Drivers • Workplace issues: Long hours, frequent call, frustration with administrative burden, paperwork, EMR, feeling undervalued, frustrations with referral networks, difficult “ Nowhere is the stigma of mental health greater patients, medicolegal issues than within medicine.” • Challenges in finding work-life balance • Withdrawal from practice – time away from patients and work, with increasing workloads M. Gautam, 2008 • Lack of confidentiality and privacy – loss of autonomy • Regulatory concerns – hospital privileges, practice restrictions, limitations of licensing/privileges • Insurance – discrimination or inability in obtaining insurance 3
Consequences to the Clinician Consequences to our Patients • Quality of Care: patient safety and quality of 1. Impaired job performance and Professional care - increased rates of medical errors, riskier Problems prescribing patterns, and lower patient 2. Changing jobs, reducing work hours adherence to chronic disease management 3. Difficulty with Relationships plans 4. Physical Illnesses 5. Addictions • Quality of Caring – communication, empathy, 6. Psychiatric Illnesses – Anxiety, Depression, Suicide patient satisfaction Consequences to the System • Impact on morale and satisfaction Even the healthiest and strongest of • Recruitment and Retention: dissatisfaction, us can become unhealthy making them more likely to leave clinical in an unhealthy environment. practice, retire early • Leadership: Interest, energy and ability to lead changes in the practice or health care system 4
What can we do to prevent burnout? Quit Multiplying By Zero We need to stop blaming the clinicians and see this H = I x C x S as a shared responsibility of: • Individual clinicians • Culture of medicine Where H = Health • Healthcare systems I = Individual C = Culture S = System Gautam, M. Mar 2019. CJPL You cannot give what you do not have • The gifts of hope, confidence, and safety can only come from a workforce that feels hopeful, “Instead of framing our challenge as confident, and safe. ‘reducing burnout’, we should focus • Joy in work is an essential resource for the on the objective of enhancing joy.” enterprise of healing • Joy in work is a consequence of systems; quality IHI Framework for Improving Joy in Work improvement methods and tools have a role in its Institute for Healthcare Improvement White Paper pursuit. Cambridge, MA, 2017 Perlo J et al • Joy is possible, important, effective 5
THE FIVE C’s of RESILIENCE CLINICIAN RESILIENCE 1. Being prepared CONTROL for the event 2. Coping with the CARE COMMITMENT situation – skills FOR SELF and strategies RESILIENCE 3. Bouncing back and growing further CALMNESS CONNECTION 1. Control and Confidence COMMON PERSONALITY TRAITS • Overly conscientious One needs a sense of: • People pleasing • Self awareness that will lead to • Sense of Responsibility and Guilt – Confidence • Unrelenting perfectionism – Control • Need to control others • Chronic self doubts • Uncomfortable with love, approval • Ability to delay gratification 6
FIVE EARLY DANGER SIGNS 2. Commitment • What initially drew me to this work? • Increase in physical problems and • Values clarification exercise illnesses. • More problems with relationships. • Appreciative Inquiry • Increase in negative thoughts and • Reflection and Journaling – how is my feelings. work meaningful to me? • Significant increase in bad habits. • My best moment at work – Rubik’s Cube • Exhaustion. moment The Five Balls 3. Caring Connections 1. Work • We often feel alone and lonely, with our 2. Home and Family workload and responsibilities 3. Relationships • Holding Environment – how would you 4. Friends create this? 5. Self Care 7
Personal Relationships Relationships in the workplace • Create a sense of community – personal How do we nurture and support these touch With our partner? • Emotional Bank Account With our children? • Add fun to work With our parents and siblings? • Use peers/colleagues for support With our friends? • Encourage mentoring • Build teams – communicate, resolve conflicts USE SUPPORT SYSTEMS 4. Calmness • Recognize when you are not calm • Have at least one good friend • Learn skills to manage during that time • Friends- good for you physically, emotionally • People who are “good for you” • Pets 8
RELAXATION TECHNIQUES Strategies for Calmness: The ABC’s A llow feelings: Vent Buddy Journaling – acknowledge and let go • Many methods available Four-letter technique – write at least 4 letters; do NOT send • Spiritual relaxation, meditation B urn it off: Exercise – long run, hard workout, punching bag • ‘Rehearse’ for the ‘performance’ C alm down: Deep Breathing Gratitude, Forgiveness Spirituality Yoga Relaxation Exercises – Visualization, active & passive Mindfulness Meditation TAKE REGULAR TIME OFF SHARE YOUR STORIES • Planned : The Tarzan Rule • Unplanned : A Gift of Time 9
5. Care for Self • Healthy sex life • Take care of yourself first • Get your own family doctor • Make time for yourself – Almost everything • Indulge yourself will work again if you unplug it for a few • Sleep minutes, including you. • Exercise • Nutrition FINANCIAL MANAGEMENT • Stick to basic financial principles • Reduce non-deductible debt LAUGH MORE OFTEN. • Avoid “Christopher Columbus” Syndrome • Do not overextend financially 10
LET GO OF THE GUILT • Acknowledge it; let go of it DON’T JUST TRY. • My Rule for Colleagues 11
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