Plenary gautum
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Transcript of Plenary gautum
Preventing Burnout
Mamta Gautam,
MD, MBA, FRCPC, CPDC, MOT
Disclosure of Conflict of Interest
Conflicts to Declare:
• No affiliation with a pharmaceutical, medical device or communications organization.
• President and CEO – PEAK MD
Learning Objectives
• Understand why we are vulnerable to stress in medicine
• Recognize the early warning signs of stress
• Define burnout
• Identify strategies to manage stress and prevent burnout
MYTH
Knowing what we should be doing means that we are doing it.
BIOLOGICAL FACTORS
BIOLOGICAL FACTORS
• Lack of Sleep
• Poor Eating Habits
• Poor Level of Fitness
BIOLOGICAL FACTORS -2
• Family history of psychiatric illness
• Overuse of alcohol or drugs
• Anxiety disorders
• Primary Affective Disorder
• Eating Disorders
PSYCHOLOGY OF THE PHYSICIAN
COMMON PERSONALITY TRAITS
• Overly conscientious
• People pleasing
• Sense of Responsibility and Guilt
• Unrelenting perfectionism
• Need to control others
• Chronic self doubts
• Uncomfortable with love, approval
• Ability to delay gratification
THIS IS SOCIALLY VALUABLEBUT
PERSONALLY VERY EXPENSIVE.
ISSUES ARISING FROM PAST EXPERIENCES
• Establish sense of self as children
• Believe three main assumptions
• Develop “Personal Historian”
• Perception: We are not good enough.
We do not measure up.
90:10 Rule
DEFENSES
• Highly intellectual types used.
• Major causes in delay of seeking help.
• Make therapy more difficult.
• ‘Brain-Heart’ Gap
COMMON DEFENSES EMPLOYED
• Reaction Formation
• Denial
• Minimization
• Rationalization
WORKAS A DEFENSE
SOCIAL DEMANDS ON PHYSICIANS
• Work and Career Demands
• Household Responsibilities
• People in Our Lives
• Personal Needs and Wants
“THE DREAM “ OF BECOMING A PHYSICIAN
OUR PATIENTS
OCCUPATIONAL HAZARDS
MEDICINE AS A BUSINESS
MAINTENANCE OF COMPETENCE
ORGANIZATIONAL CHANGES IN HEALTH CARE
ISSUES SPECIFIC TO WOMEN
• Minority status, discrimination still exist
• Isolation
• Life Stage considerations
HOUSEHOLD RESPONSIBILITIES
• Managing the household - shopping, cooking, cleaning
• Finances
• Anxieties about our future
CHILDCARE AND ELDERCARE
RELATIONSHIPS
• Singlehood
• Marital Issues
IN ALL OF THIS, THE PERSONAL NEEDS OF THE
PHYSICIAN ARE LAST, AND OFTEN LOST.
FIVE EARLY DANGER SIGNS
• Increase in physical problems and illnesses.
• More problems with relationships.
• Increase in negative thoughts and feelings.
• Significant increase in bad habits.
• Exhaustion.
BURNOUTA syndrome of emotional exhaustion, chronic overstress.
(Maslach)
-Distinct work-related syndrome – demands exceed individual resources
-Not a psychiatric diagnosis-Most likely to occur in jobs that require extensive care of
others-Common among practicing physicians
BURNOUT
Three Stages (Maslach Burnout Inventory):
• Emotional Exhaustion
• Depersonalization
• Reduced Personal Accomplishment
Review of Burnout Studies
• Emotional exhaustion = 46-80%
• Depersonalization = 22-93%
• Low Personal Satisfaction = 16-79%
Starts early in our training
• Burnout prevalent during medical school• Major US multi-institutional studies estimate at
least half of all medical students may be affected by burnout
• Persists beyond medical school – between 20-60% of practicing physicians
• Highest prevalence reported in residents (40-76%)
Work Related
• Demands of the workplace exceed individual resources – way of life for many physicians
• 2001 CMA PRQ:– 64% have workload too heavy– 58% felt family and personal life suffered– 57% felt patients’ expectations too high– 29% felt on call too often– 33% felt lack of locums and could not take holidays– 64% felt difficulty getting referrals for patients, – 46% felt limited in changing specialty/career path
Possible Risk Factors
• High Workload - demands exceed resources• Age - inverse relation between age and
burnout. ? Survivor bias.• Spousal support – inverse relation between
emotional exhaustion and support from partner
• Personality traits
SERIOUS CONSEQUENCES
1. Impaired job performance and Professional Problems
2. Changing jobs, reducing work hours3. Difficulty with Relationships – home
and work4. Physical Illnesses5. Addictions6. Psychiatric Illnesses – Anxiety,
Depression, Suicide
Even the healthiest and strongest of us can become unhealthy
in an unhealthy environment.
Preventing Burnout
• General Strategy
• Specific Strategies – Work related– Personal
General Strategy
• The number one cause of stress
leading to burnout:
THE PERCEPTION THAT WE HAVE
NO CHOICE, NO CONTROL.
• The number one skill in dealing with stress:
CHALLENGE YOUR PERCEPTION.
STEPS IN MANAGING STRESS
• Identify the stressor
• Recognize that you have more control than you think you do
• Identify what parts you do, and do not, control
• Focus on what you do control, and learn to cope with what you do not control
MAKING CHOICES
• Recognize that you have choices
• Focus on what you can control.
• Set priorities - self, family, work.
• Accept that you will not be perfect. “Good enough is good enough.”
• Phases – A Work in Progress
The Five Balls
• The Work Ball
• The Home and Family Ball
• The Relationships Ball
• The Friends Ball
• The Self Care Ball
Take care of yourself first
Take Away Messages
• The very traits that help us succeed can make us vulnerable to stress and burnout
• None of us are immune• We can look for warning signs of stress in
ourselves and our colleagues• Prevention is key. Take care of yourself first• There are things we can do to be resilient;
stay tuned!