Burnout - UW Obstetrics and Gynecology
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Transcript Burnout - UW Obstetrics and Gynecology
Faculty Development Committee
Department of Obstetrics and Gynecology
Professional Development Series
October 16th, 2014
Avoiding Burnout: Recovering the Joy of Medical Practice
Professor Emeritus Norman M Jensen, MD,
Department of Medicine
American Academy on Communication in Healthcare
President, 2007-2009
Board Chair, 2011-2013
Faculty Guide for Distance Fellows
Faculty for Clinical Skills Enhancement Courses:
- Philadelphia, PA in June, 2015
Avoiding Burnout: Recovering the Joy of
Medical Practice
Our Aims today are:
1. Understand contribution of physician personal wellbeing to good clinical practice
2. What is burnout?
3. Score our own Ob/Gyn Well-Being Index (clicker
questions)
4. What are the best counter measures for physicians?
5. Resolve to undertake one measure to ward off or
diminish burnout (will be mailed to you in 2 months)
“In a culture where work can be a
religion, burnout is its crisis of faith.”
Jennifer Senior, November 26, 2006, New Yorker Magazine
Burnout
“The cost of caring”
Norm Jensen MD MS
Professor (CHS) Emeritus
Department of Medicine
[email protected]
Personal Bio
Rural Wisconsin, public schools
UW college and med school
Harvard - Boston City residency
Drafted Navy doctor, Viet Nam Years
UW Grad school - social psychology
Fellowship - clinical communication
Teacher - Clinician 44+ years
Academic focus: clinical skills
No conflict of interest with this talk
Intended Learning Outcomes
Cognitive
What’s
burnout
How am I doing?
What helps?
What hurts?
Attitudinal: just a touch of
Self
awareness
The Story Begins
What is Professional Burnout?
Why is it important?
Burnout, professional (MH)
An
excessive stress reaction to work.
manifest by feelings of
– emotional and physical exhaustion
– & sense of frustration and failure.
(NLM-MESH)
Burnout defined
Work-related
distress that combines
– Emotional exhaustion
– Depersonalization
treating
people in an unfeeling,
impersonal way
– Sense of low personal accomplishment
• Ramirez. Lancet 1996;347:724-28.
ICD-10: "Problems related to lifemanagement difficulty".
Research concept
1970
Maslach & Jackson
– Maslach Burnout Inventory
exhaustion,
Maslach
cynicism, inefficacy
& Leiter
– Burnout antithesis = “engagement”
energy,
involvement, efficacy
7395 Medline Publications
Burnout, professional (MH)
600
500
400
300
# Pub
200
100
0
1977 1982 1987 1992 1997 2002 2007 2012 2017
Updated September 29, 2014
MESH: STRESS, PSYCHOLOGICAL 1983-89, STRESS, PSYCHOLOGIC 1969-72
Burnout: What’s the big deal?
It’s prevalent
It harms the clinician personally
It harms the clinician’s clinical skill
It risks harm to patients
It is costly to the healthcare system
Inefficiency and waste
Professional workforce attrition
Physician’s Well-Being Index
Dyrbye LN, et. al. J Gen Intern Med 2012;28:421-27.
DURING THE PAST MONTH
1. Have you felt burned out from work?
2. Have you worried that your work is
hardening you emotionally?
3. Have you often been bothered by feeling
down, depressed, or hopeless?
4. Have you fallen asleep while stopped in traffic
or driving?
5. Have you felt that all the things you had to do
were pilling up so high that you could not
overcome them?
6. Have you been bothered by emotional
problems, such as feeling anxious, depressed, or
irritable?
7. Has your physical health interfered with your
ability to do your daily work at home or away
from home?
A Personal Inventory
• Each of the next 7 slides has one
personal question.
• Please answer “yes” or “no”, quickly,
the first response that comes to mind.
• Keep a personal count of the number
of “yes” answers.
• Use your “clicker” for anonymous
group prevalence.
Clickers:
press A = yes
press B = no
DURING THE PAST MONTH
1. Have you felt burned out
from work?
Clickers:
press A = yes
press B = no
DURING THE PAST MONTH
2. Have you worried that
your work is hardening
you emotionally?
Clickers:
press A = yes
press B = no
DURING THE PAST MONTH
3. Have you often been
bothered by feeling down,
depressed, or hopeless?
Clickers:
press A = yes
press B = no
DURING THE PAST MONTH
4. Have you fallen asleep
while stopped in traffic or
driving?
Clickers:
press A = yes
press B = no
DURING THE PAST MONTH
5. Have you felt that all the
things you had to do were
pilling up so high that you
could not overcome them?
Clickers:
press A = yes
press B = no
DURING THE PAST MONTH
6. Have you been bothered by
emotional problems, such as
feeling anxious, depressed,
or irritable?
Clickers:
press A = yes
press B = no
DURING THE PAST MONTH
7. Has your physical health
interfered with your ability to
do your daily work at home
or away from home?
Clickers:
press A = yes
press B = no
If you responded “YES” to
four or more, click
“Yes”
now
Clickers:
press A = yes
press B = no
Physician’s Well-Being Index
Dyrbye LN, et. al. J Gen Intern Med 2012;28:421-27.
Likelihood of Low Physician Well Being
=>
4 “yes”
– Likelihood ratio 3.85
– Specificity 86%
<
4 “yes”
– Likelihood ratio .033
The Story Develops
Prevalence
Profession
By specialty
Life cycle
Consequences
Personal
Healthcare
Risk Correlates
Personal
Work conditions
Moral Injury concept
Physician Burnout Prevalence
Practicing physicians
– 30 – 65%
Hospitalists 30%
Ann Intern Med 2008
Highest mid-career
BMJ. 2008 Mar 1;336(7642):488-91.
Med Students 50%, > 6% suicide thoughts
JGIM 2011
Pediatric residents 74%
Lancet 2009, JAMA 2009, Mayo Clin Proc 2013, JAMA Intern
Med 2012
Mayo Clinic Proceedings 2013
Difference among specialties …
USA Physician Burnout Survey, Arch Intern Med 2012;172;1381
Burn out %
USA Physician Burnout Survey, Arch Intern Med 2012;172;1381
Work-Life Balance
Mayo Clinic Proceedings 2013;88:1363
Personal correlates
Personal suffering
Stress Hormone excess
YALE J BIOL MED 2002;75:199-205.
Coronary artery disease +
Lancet 1996;347:724-8 (Hospital consultants)
Psych Bulletin 2006;132:327–353
+ metabolic syndrome, HPA dysreg, sympathetic
activation, sleep disturbance, systemic inflammation,
and impaired immunity, blood coagulation, and
fibrinolysis, and poor health behaviors.
Mental health
Anxiety, mood, adjustment, AODA, Suicide
ICD-10: "Problems related to life-management
difficulty"
Healthcare Correlates
On the job error
Ann Surg 2010 Jun;251(6):995-1000 (surgeons)
BMJ. 2008 Mar 1;336(7642):488-91. (Peds res)
Clinician empathy – compassion fatigue
Career & job dissatisfaction - disability
– Sick leave, early retirement, job turnover
Patient dissatisfaction / adherence
€ 20 Billion economic loss (Awa 2010)
– $115 - 587,000 to replace a physician
Threat to & from healthcare reform?
Correlating factors
Work
load
Meaning in work
Work conditions
Feeling
poorly managed and resourced
– Effort : reward
– Work demands : skills
– Low autonomy & control
Patient
suffering – “moral injury”
Intellectual stimulation
Work variety
“Work place bullying”
Correlating factors
Work-life
Life
balance
style
Lack
of life partner
Personal
Woman
Personal
management skill
Communication skills
Self care – resiliency
Mid-career
Multivariate Analysis
Mayo Clinic Proc 2013;88:1364
Factor
Odds Ratio
Work hours / week
1.02 / hour
Call nights / week
1.03 / night
Recent home & work conflict 2.47
Resolution favored work
2.13
Have children
0.63
Academic practice
0.63
The Story Develops
What helps?
Work focused
Person focused (resilience)
Work - Person Interaction
State of the art review of evidence
Burnout prevention: A review of
intervention programs. Patient Education
and Counseling 2010;78:184-190.
What helps?
Work Focused
How
days are organized
– Modulate pace of work
– Minimize hassles, interruptions &
paperwork
– Support staff share tasks requiring
little / no professional judgment
What helps?
Work
control improvements
– ↑ clinician participation in
management – decentralize control
– Monitoring work load
– Promoting teamwork
– Orientation of the new to set
reasonable job expectations
– Management by goal setting &
feedback
What helps?
Person focused
Right
job for the right person
Sabbaticals, vacations, breaks
Work-home-life balance
Self care
– AMA book, The Resilient Physician
What helps?
Personal & professional learning
Mindfullness
training
Advanced communication skills
– JAMA 2009;302:1284-92.
Stress
Management skills
– CBT vs Yoga (RCT)
– Cog Behav Therapy
– Physical Exercise
Conflict
management skills
Personal Management, life coach
Concept of Resilience
“The long-term ability to survive in and thrive
on adversity.” Med Ed 2012;46:349-356.
Self – efficacy
Self – control
– Cognitive: plan and act
– Emotional intelligence
Self aware & modulation
– Learn from difficulty
– Persistence
Social intelligence
– Engage help & support
What helps?
Work - Person Interaction
Employers
/ supervisors must
– Understand sources of work-home
interference & help manage
Cross
coverage
Child care
Part-time practice
Flexible work hours
Advocacy
c. 1970s
The Story Continues
ACTIONABLES
Resilience Plan
•
Burnout meter awareness
• How’s the energy supply?
•
Mindfulness skills
• Awareness of me
•
Revise priorities regularly
• Really, is this what you want?
•
Personal maintenance
• “Keep the saw sharp”
Check Burnout Meter Monthly
1. burned out from work?
2. emotionally hardened?
3. mood down, hopeless?
4. daytime sleepiness?
5. overwhelmed by work?
6. emotional problems?
7. physical symptoms?
Enhancing Mindfulness Skills
•
Reading
•
•
•
Training classes, UWHealth
•
•
•
http://www.psychiatry.wisc.edu/uwpMindfulness.html
https://www.uwhealth.org/onlineservices/classes/class/viewClass/21
CME courses
•
•
Jon Kabat-Zinn, Wherever You Go, There You Are. Hyperion, New York,
1994
Zinn J-K, Davidson RJ, The Mind’s Own Physician. New Harbinger
Publications, Oakland, CA, 2011
http://www.urmc.rochester.edu/family-medicine/mindfulpractice/presentations-workshops.aspx
Personal practice
Revise Priorities Annually
•
•
•
•
•
Personal
Family
Professional
Keep dynamic record
Revise New Year’s Day
• Share with significant others
Personal Maintenance
Social life
Personal physician / clinician
Optimize personal health
–
–
–
–
–
–
Emotional intelligence
Food intelligence
Weight control
Physical activity
Sleep, R, R, & R
Disease screening
Continue learning
Assess your risk at
http://www.mind
tools.com/stress/B
rn/BurnoutSelfTes
t.htm
AMA book store,
$35, $30 for
members.
CHAPTERS
• Defining & Exploring Personal Assessment
& Management Strategies
• What really stresses physicians?
• Self-Assessment: How are you doing?
• The psychology of physicians
• Stress resilience
• The balancing act
• Understanding & Managing Relationships in
the Medical Workplace
• Conflict self-assessment
• Anger management
• Negotiating conflict
• The disruptive physician
• Listening & communication skills
• Coping with change
• Understanding & managing the stress of
medical training
• Making your workplace a positive
interpersonal culture
Continue learning
•
•
•
•
•
Chapters
Beyond Expertise
• The New Yardstick
• Competencies of the Stars
• Hard case for soft skills
Self Mastery
• The Inner Rudder
• Self Control
• What moves us
People Skills
• Social Radar
• The Arts of Influence
• Collaboration, teams, group IQ
A New Learning Model
• The Billion-Dollar Mistake
• Best Practices
Emotionally Intelligent
Organization
• Taking Organizational Pulse
• The Heart of Performance
Continued learning
A great first read on mindfulness,
especially for one who wants learn it
on their own, or at least begin that
way.
3 Parts -270 pages
1. In the bloom of the present
moment
1. 31 chapters
2. The Heart of Practice
1. 18 chapters
3. In the Spirit of Mindfulness
1. 24 chapters
4. Practice MP3s available
Clinical Skills CME
MINDFUL PRACTICE:
Enhancing Quality of Care, Quality of
Caring, and Resilience April 27 - May 1,
2015
Hosted by: The Center for Experiential
Learning, University of Rochester Medical
Center
http://www.urmc.rochester.edu/familymedicine/mindful-practice/presentationsworkshops.aspx
Clinical Skills CME
ENRICH: Communicating in highly
effective healthcare systems
June 18-21, 2015 at Drexel University
College of Medicine in Philadelphia.
American Academy on Communication in
Healthcare –www.aachonline.org/
N Y Times, July 8, 2003
ERICA GOODE
Doctors' Toughest Diagnosis:
Own Mental Health
Intended Learning Outcomes
Cognitive
What’s
burnout
How am I doing?
What helps?
What hurts?
Attitudinal: just a touch of
Self
awareness
I have enjoyed being with you.
•References
available on request
•[email protected]
•If
you wish to share a story please
contact me by email and we’ll
arrange a time to talk.
The lecture ends here!
Questions?
Answers
$0.25
Answers requiring thought $1.00
Correct answers
$2.50
Comments?