farnan plenary

Physician Well-Being:Creating an Oasis for You

Foundation for Medical ExcellenceOctober 6, 2012

Alderbrook

Dr. Paul Farnanfarnan@mail.ubc.ca

2000’s

1990’s

1980’s

1970’s 1960’s

‘Impairment’ Substance Use

Disorders

Depression, Other Mental Health

Disorders

Other Potentially ‘Impairing’ Conditions

‘Disruptive Doctor’, Behavioral Issues, Stress & Burnout,

Physician Well-Being

Prevention, Health Promotion, Renewal, Career Counselling,

Coaching

Scope of problems presented to Physician Health Programs

Physicians & their Temperaments

4

“The most important quality of a physician is compulsiveness.”

The Triad of Compulsiveness

Self-Doubt

Guilt feelings

Exaggerated sense of responsibility

Gabbard, 1985

Compulsiveness

‘Perfectionism’

• Contains an element of pressure associated with a sense of helplessness and hopelessness.

• Perfectionism is a vulnerability factor for burnout, and anxiety.

• The desire to excel must be differentiated from the desire to be perfect.

• Believing that others will value you only if you are perfect is associated with both depression and suicide.

- Flett & Hewitt, 2002

Individuals with compulsive and perfectionistic traits are attracted to medical careers

Stressors in the environment of an academic setting do not create these personality features – they exacerbate pre-existing traits

Internally driven Compulsiveness

• Challenging the external environment ignores the inner demands & doesn’t help the discomfort

• By believing these internal demands are natural it allows us to avoid looking at ourselves and our own behaviours as part of the problem

• Our outward focus on the patient, the disease, the diagnosis, the procedure, the treatment reinforces our reluctance to look inwards

Menninger

Culture of Medicine

Competitive, Controlling, PerfectionisticOverWork is the normBlurred boundariesNeglect health and relationships‘Psychology of Postponement’

Physicians and Intimate Relationships

• “In many physicians, the character armour that enables them to do their daily work becomes hypertrophied and is carried from the workplace into the home”

• “Hence, giving and receiving love in the medical ‘marriage’ becomes a challenge”

Myers M. The medical ‘marriage’. Paper presented at the American Psychiatric Association Annual Scientific Meeting, San Francisco, May 22, 2003

‘If I work hard(er),

I will be loved’

Roots of Physician Stress Explored Lynne Lamberg

JAMA 1999;282:13-14

Myth of Invincibility

Medical profession does not encourage physicians to admit health vulnerabilities or seek help

- Levine & Bryant, 2000

‘Illness doesn’t belong to us. It belongs to them, the patients. Doctors need to be taught to be ill. We need permission to be ill and to acknowledge that we are not superhuman’

McKevitt C, Morgan M.Illness doesn’t belong to us

J R Soc Med 1997;90: 491 -495

Definitions of Stress

Automatic non-specific response 'Relationship between the person and the

environment that is appraised as taxing or exceeding his or her resources and endangering his or her well-being'

The response is mediated by the autonomic nervous system.

Emotional Exhaustion – feeling emotionally overrun/exhausted by one’s work – little left to give

Reduced Personal Accomplishment – perception of clinical ineffectiveness, dissatisfaction with achievement

Depersonalization – Becoming distant and cynical, view others as objects, avoidance of people. Negative attitude towards others and self

Maslach

‘Burnout’ – 3 dimensions

Burnout produces feelings of

Hopelessness,

Powerlessness,

Cynicism,

Stagnation

Reduced productivity

Resentment

How Can We Become More Resilient?

“capable of recoiling from pressure or shock unchanged or undamaged.” Funk & Wagnalls

Difficulty balancing personal and professional life is a major

contributor to physician distress

Unbalanced lives in terms of: Work Relationships Play Personal Time

Six-Category Framework

Workload(Too much work, Not enough resources) Control(Micromanagement, Lack of influence,

Accountability without power) Reward(Not enough pay, acknowledgement or

satisfaction) Community(Isolation, Conflict, Disrespect) Fairness( Discrimination, Favouritism) Values(Ethical Conflicts, Meaningless Tasks)

Maslach & Leiter

Both individuals and organizations can use this framework to diagnose which catagories are especially troublesome for them, and then to design interventions that target these problem areas.

Narrow the gap between your expectations and your work reality

1.Self-Awareness

2.Self-Care

3.Sharing of feelings and responsibilities

4.Developing a personal philosophy

5.Non-traditional coping skills

A physician's personal growth and development – 5 areas of focus

Williamson

4 main aspects of Physician Resilience

1) Attitudes and Perspectives 2) Balance and Prioritization 3) Practice Management Style 4) Supportive Relations

Jensen, Trollope-Kumar, Waters, Everson

Happiness

The man who thinks he can live without others is mistaken; the one who thinks others can't live without him is even more deluded.

~ Hasidic Saying”

‘The areas that contributed most to doctor’s happiness with their lives as physicians seem to focus on the people they work with, the people they live with, and most of all the people for whom they provide medical care’.

• ‘Interpersonal relationships are the number one predictor of well-being’ Tal Ben-Shahar

Burnout

'Joyless Striving'

Holmes & Rahe

Positive change doesn't just happen We must take action and well-informed

action at that.

When there is balance in my life I am more resilient

Check-in:

Getting overloaded by taking on too much

Procrastination

Take a step back - I need to regroup & get organized!

GOALS:

To be healthy emotionally, spiritually and physically

To be happy and excited about the work that I am doing

To not feel overwhelmed, unsatisfied, angry or resentful

ACTIONS

Believe that I can change - Being Proactive is about not being Reactive

Maintain positive philosophy with sense of optimism

Loving-Kindness Meditation - regularly

Inventory – Mad, Sad, Glad or Afraid?

Daily Gratitude List

Keep a sense of humour, daily

ACTIONS

Define my limits & boundaries, and share them with others - appropriate assertiveness

Work on balance between work, home and self - small steps... A Sanctuary, 'Sabbath'..

Work on friendships, focus on two special people

Be mindful for the moments of wonder

ACTIONSIncorporate physical fitness, and more plant based

diet as part of my wellbeing

Get enough sleep

Do something I like outside medicine - Give myself permission for leisure time – e.g.15 mins rule

Plan for retirement

Ask for help when I need it

REMEMBER:

My job is what I do, not who I am

We have more control than we think