Clarke abbotsford rounds 2009-02-11

connecting physicians to health

Physician Heal Thyself
Andrew Clarke, MD
Executive Director, Physician Health Program of BC
Presentation at Abbotsford Regional Hospital
2009-02-11
This work is licensed under the Creative Commons Attribution-Noncommercial-Share Alike 2.5 Canada License. To view a
copy of this licence, visit http://creativecommons.org/licenses/by-nc-sa/2.5/ca/


Physician Healthy Self
Andrew Clarke, MD
2009-02-11


Physicians Heal Thyselves
Andrew Clarke, MD
2009-02-11

Agenda

• Do physicians work too much?
• What is burnout and what are its signs and symptoms?
• When and how should I get help?

How do I get help?

Imagine someone stopping you after this session and saying:
• John, I’ve been hearing rumors about your behavior lately. When I
hear gossip like that, I feel concerned. I’d really like some
reassurance that you’re doing ok. Would you be willing to sit for a
while and check in with me about how things are going for you?
• Jane, when notice you falling asleep during the presentation, I wonder
if you’re feeling tired and needing some rest. Could we take a few
minutes and catch up on how you’re doing these days?
What would your likely reaction be?
Could anyone say this to you without provoking a defensive reaction?

Your trusted network might include…

•
•
•
•
•

A spouse or partner
A friend, or “über-friend”
A colleague, or mentor (either official or unofficial)
A family doctor*
A counsellor

What if your answer is “no one”?

Then please call us
at the Physician Health Program.
We’ll help connect you to people who
can be in this role for you.
+1 800 663 6729
* If you don’t have a formal relationship with a family doctor of your own, please call us
and let us help you find one.

Agenda

• Do physicians work too much?
• What is burnout and what are its signs and symptoms?
• When and how should I get help?

What do you mean by help?

When you need help depends on what help means to you

• Help can mean a stable network of long-term, trusted relationships you
can rely on for inspiration, reflection and support.
Everyone needs this first kind of help. All the time.
You need this now. Get this kind of help immediately.
• Or it can mean someone to give you advice about what to do, when
you can’t seem to figure it out for yourself.
The trouble with this second kind of help is that the more you need it, the
less likely you are to recognize your need. You need a trusted network
to help you recognize WHEN to get this kind of help.

Signs of trouble in physicians

• Signs that you are having trouble
• Signs that a colleague might be having trouble

Mamta Gautam’s signs of trouble (for you personally)

•
•
•
•
•

more physical problems
more trouble in relationships
more negative thoughts and feelings
more bad habits - whatever your personal ones are
more exhaustion

Gautam M. IRONDOC: Practical Stress Management Tools for
Physicians. Book Coach Press; 2004.

Jenny Firth-Cozens’ signs of trouble (in a colleague)

•
•
•
•
•
•
•

rigidity (lack of flexibility)
anger (openly expressed in the workplace)
difficulty in prioritizing (knowing which corners can be cut, and when)
unexplained absences (“I lost my pager”)
bypass syndrome – people are avoiding dealing with your colleague
lack of confidence in judgment
unwillingness or inability to recognize limitations

Firth-Cozens J. Improving the health of psychiatrists.
Advances in Psychiatric Treatment. 2007;13(3):161-168.

Burnout vs. psychiatric illness

• Burnout is a specific syndrome, but not a DSM-IV diagnosis. Think of
it as disillusionment with a career in a helping profession. It’s related
to, but not the same as, chronic overstress.
• It has three independently measurable1 characteristics:
– emotional exhaustion
– depersonalization (treating other people as objects / diseases)
– decreased sense of personal accomplishment

• It has four stages:2
–
–
–
–

enthusiasm (“I love this job – I’m doing great things, with more to come!”)
stagnation (“Well, it’s not exactly all I hoped for.”)
frustration (“This system is seriously broken, but I’m trapped in it.”)
apathy (“It’s a job. I’m just putting in my time until I can get out of here.”)

1

1. Maslach C, Jackson SE. The measurement of experienced burnout. J Occup Behav. 1981;2:99-113.

2

1. Edelwich J, Brodsky A. Burn-out: Stages of Disillusionment in the Helping Professions. Human Sciences Press New York; 1980.

Burnout

• Unlike psychiatric illness, burnout seems to be contagious.
• It has very high prevalence among physicians (20% – 75%) with a lot
of local variation, just like an infectious disease.
– This is probably because cynical attitudes tend to spread in workplaces.

• It can co-occur with depression, but isn’t the same thing
– does not respond to anti-depressant medications
– does not generally respond to CBT, although other types of counselling are
effective
• guided life reflection
• reality therapy

– does not have the same effect on objective work performance as depression
• has as great or greater effect on SUBJECTIVE work performance

Maybe

• Studies show that reducing working hours is not by itself enough to
alleviate burnout.
• Others show that people who do get over burnout usually wind up
working fewer hours.
• Reduced working hours seem to be an outcome of effective burnout
treatment, but not an effective single intervention for burnout.


Time check
Next four slides: current health issues for physicians

What are important health issues for docs these days?

• Focus groups in 2007: ~20 physicians from all over the province
• Made a long wish list of items that are of concern
• Three themes emerged:
– Collegiality
– Advocacy
– Wellness

Collegiality theme

CONCERNS RAISED BY PHYSICIANS
• What do I do when I notice a colleague
who may be in distress, or vulnerable?
• What are some reasons why
physicians don’t “get along”?

•
•

•
•

FACTORS UNDERLYING THE CONCERNS
Physicians value autonomy highly: their
own and their patients’.
Entry to medical school is granted on the
basis of success in a competitive,
individualistic education system.
Teamwork is not a strong component of
medical education.
Teamwork is, however, a reality of modern
medical practice in most settings.

Advocacy Theme

• How can I effectively advocate for
changes to the systems in which I
practice?
• Why am I not consulted on decisions
that affect me, and my patients?

• Physicians are used to seeing a
problem, and fixing it. Immediately.
• Effective advocacy for social change
requires several intermediate steps.
• Physicians can be perceived by others
as “bullies” or “not team players”
when they use their usual action
strategies to advocate for social
change.
• Decision-makers respond defensively
by alienating and excluding physicians.

Wellness Theme

•
•

•

•

How do I take what I know about
health and apply it to my own life?
What are the barriers to finding and
keeping a family physician if you are a
physician?
Is there anything special to keep in
mind when I have another physician as
my patient?
If there are things about physicianpatients that are unique, how are they
ethically justified?

• I should be able to manage this on my
own.
• I don’t want to seem like a “whiner”
to a colleague.
• If I consult a colleague for this
problem, I’ll be using up a scarce
resource.
• I don’t have the time, motivation, or
permission to improve my health
• Meaning of terms like: health,
wellness, sustainability


Thanks!

800-663-6729
andrew@physicianhealth.com

Clarke abbotsford rounds 2009-02-11

Clarke abbotsford rounds 2009-02-11

Recommandé

Contenu connexe

Tendances

Tendances(20)

En vedette

En vedette(20)

Similaire à Clarke abbotsford rounds 2009-02-11

Similaire à Clarke abbotsford rounds 2009-02-11(20)

Plus de Ihsaan Peer

Plus de Ihsaan Peer(20)

Dernier

Dernier(20)

Clarke abbotsford rounds 2009-02-11