Transcript Managing Stress - Nova Scotia Health Authority

Dr. Carolyn Thomson
Professional Support Program,
Doctors Nova Scotia
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To identify key areas of stress in a physician’s life and
understand its effect on performance
To understand the influence of the physician personality
on the interpretation of potentially stressful events
To discuss the warning signs of burnout
To identify and develop tools to manage stress and
enhance resilience
To appreciate key components of life balance and develop
skills to enhance it
No
affiliation with industry
“I am more and more convinced that
our happiness or unhappiness
depends more on the way we meet the
events of life than on the nature of
those events themselves”
Alexander Humboldt
The Royal College values physician
wellness: CANMEDS Professional Role:
“Physicians’ maintenance of their own
health and well-being is an essential
component of their professional role.”
CanMEDS Physician Health Guide, 2009
When
did you first feel drawn to
medicine?
What did it feel like?
Has that feeling grown or diminished
over time?
How does your life in clinical practice
differ from your expectations upon
entering medical school?
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> 90% of physicians report good health
Majority comply with Canadian personal health screening
guidelines, but:
 Only 57% report good work-life balance
 25% have chronic physical or mental health
condition that impacts their ability to work as
they otherwise would
 >60% will work when ill
8,000 practicing physicians revealed that:
23% of physicians feel depressed
33% admit their work day causes stress
60% have so much work that it prevents them from
pursuing personal and family interests
Canadian Physician Health Survey 2008
4,501
female physicians surveyed
31%
would not choose to be a
physician again
38%
would prefer to change their
specialty
• Erica Frank et al, Arch Inter Med. 1999; 159: 1417 - 1426
 Lack
of work control
o Those with unpredictable hours had more stress
o Those with an unhappy practice environment had
more stress
 Work
stress
o 44% reported working too much
 Home
stress
 Lack of religious or spiritual life
 Fewer children
o Those with an imbalance between family and home
had more stress
2144
physicians surveyed, aged 35-54
What decreased stress & increased
work satisfaction:
o Participation in community activities
o Leadership roles & control
o Collegial support
o Factors Explaining Career Satisfaction Among Psychiatrists and Surgeons in
Canada, Rein Lepnurm, DrPH, Roy Dobson, PhD, Allen Backman, PhD,
David Keegan, MD, Canadian J Psychiatry, March 2006
Do
you experience joy in your
work?
Do others experience joy as a
result of your work?
Controllable
hours
Balance between family and work
life
Less stress
Income that equals our effort
Fun!
Love
Health
care reimbursement?
Hospital administration?
Colleagues?
Families?
Patients?
Ourselves?
We
Are:
o Intelligent
o Caring
o Sensitive
o Inquisitive
Type
A
Competitive
Perfectionistic
Safety seeking
Developing an ability
to emotionally
dissociate because…
“A physician in
training sees more
trauma in one month
that most others see
in a lifetime.”
Exhausted
Isolated
from
friends and
family
In debt
Ego-centric
as an
expression of
insecurity
Emotionally
dissociated
Emotional
fatigue
Stress
Resentment
Stress: How the body reacts to a stressor,
real or imagined
Stressor: Anything external that knocks the
body out of homeostasis forcing the body
to take action
Eustress: Where stress enhances function
(physical or mental)
Distress: Persistent stress that is not
resolved through coping or adaptation
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Increased physical problems & illness
Increased problems with relationships
Increased negative thoughts & feelings
Increased unhealthy behaviours
Inability to continue pushing oneself
Directly linked
 Heart
disease
 Stroke
 Injury
 Suicide
 Homicide
Indirectly linked
 Cancer
 Chronic
liver
disease
 Emphysema
 Chronic bronchitis
Disruptive
behaviours
Intimidation/harassment at work
Difficult interactions with patients
and colleagues
Unexpected outcomes – error,
complaint, litigation
Personal health issues
#1 Cause of stress:
sense of lack of control
#1 Solution:
Challenge this perception
Sense of self arises from experiences we had as a
child
 Draw conclusions (often concrete) based on how we
were treated
 Not reality but perception of reality
 History is the “ultimate” distortion and concrete
thinking persists
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10% of your reaction is due to that
particular situation
 90%
is what you automatically assume
from past experience (your “historian”).
Event
+ Response = Outcome
o Eliminate the cause
o Change our perception of the stress
What you can change
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Perceptions of ourselves and the
situation
Recognise learned behaviours and
assumptions that do not help us
Attain a +ve attitude
Become more assertive and set
limits and boundaries
More confident at reaching out and
connecting with others
ID aspects that we value in all parts
of our lives- work, relationships,
family, home, self- and decide what
we are going to do to maintain these
priorities
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What you can’t change
Parents
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Childhood experiences
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Upbringing
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Genetics
Dwelling
on a single negative detail
If you made an error with a patient this
will override all the good things you’ve
done with and for that individual
If you do something embarrassing an
entire experience can be ruined
This can negate the benefit of a great
relationship or life experience
Of
cognitive distortions
oAll or nothing thinking
Perfectionism
o“Anything worth doing is worth
doing half-assed”
• Rachael Naomi Remen
Lower
catecholamines
Lower cortisol
Enhance cortical function
Meditation
Yoga
Tai
Chi
Prayer
Exercise
Hobbies
Yankee Rose
Common
cause of early retirement
Job dissatisfaction
Poor working relationships
Mayo Clinic:
Almost half of American physicians are
emotionally exhausted, suffering from
depersonalization, and struggling with a low
sense of personal accomplishment
Shanafelt, T et al. Arch Intern Med
Top three:
 Emergency physicians
 General Internal Medicine
 Family Physicians
“Gradual erosion of the person”
 Emotional
Exhaustion
 Depersonalization
 Loss of professional satisfaction
Are you at risk?
 We
lose perspective and blame others
 We judge others harshly
 We begin to externalize our frustrations and feel
bad about it
 Our type A tendencies are running at max
 We become hyper-irritable
 Our personal lives crash
 We hit survival mode
o Numbness
o Loss of creativity
o Reflex behaviors predominate
Burnout is easier
to prevent than
to treat
 Commitment,
self-efficacy,
resourcefulness and hope
 May have to address at organizational
level
 Cognitive – behavioural strategies
 Exhaustion more easily treated
The “3R” Approach:
Recognize
Reverse
Resilience
Why do some people cope better than others?
American Psychological Association:
“The ability to adapt well in the face of adversity,
trauma, tragedy, threats and from sources of stress
such as work pressures, health, family and
relationship problems.”
The ability to bounce back
 Optimism
& hope
 Confidence
 Learn lessons from experience
 Assume things will work out well
 Focus on learning and coping rather than
blaming and being a victim
If you don’t design your own life
plan, chances are you fall into
someone else’s plan. And guess
what they have planned for you?
Not much.
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Mental
Physical
Emotional
Spiritual
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Physical capacity
o Builds endurance and promotes
mental and physical recovery
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Emotional capacity
o Creates the internal climate that
drives performance
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Mental capacity
o Focuses mental and emotional
energy on the task at hand
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Spiritual capacity
o Provides powerful source of
motivation, determination
and endurance
I’ll
exercise for one hour a day
Then, I’ll tell all my friends and family
that I love them
Maybe I’ll call then while I’m on the
treadmill
Then, I’ll pray for 30 minutes, meditate
for 20 minutes and read the literature
for an hour
Spiritual
Mental
Emotional
Physical
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Identify personal and professional values and priorities
Enhance areas of work that are most personally
meaningful
Identify and nurture personal wellness strategies that are
important to you
Self care
Hobbies and personal interests
Shanafelt, TD. J Support Oncol 2005;3(2):157-62
Identify
the things that bring you joy
and do more of them
Identify the things that drain you
and do less of them
Make choices about what you can
and can’t do
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General Health:
o www.Ephysicianhealth.com
o CanMeds Physician Health Guide: A Practical Handbook for
Physician Health and Well-Being
• Puddester, Flynn, Cohen
• Available on line
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The Resilient Physician
o Sotile and Sotile
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Finding Balance in a Medical Life
o Lipsenthal
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Family, friend or colleague you can trust – find one!
Family Physician-get one
Provincial Physician Health Program
o Listed with contact information on CMA.ca wesite
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Substance Use Concerns:
o AA, NA
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CMPA Physician Wellness Resources
o http://www.cmpa-acpm.ca