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 communi...
Learning Objectives
• Understand why we are vulnerable to
stress in medicine
• Recognize the early warning signs of
stress...
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
Prima...
PSYCHOLOGY OF THE
PHYSICIAN
COMMON PERSONALITY TRAITS
•
•
•
•
•
•
•
•

Overly conscientious
People pleasing
Sense of Responsibility and Guilt
Unrelent...
THIS IS SOCIALLY VALUABLE
BUT
PERSONALLY VERY EXPENSIVE.
ISSUES ARISING FROM PAST
EXPERIENCES
•
•
•
•

Establish sense of self as children
Believe three main assumptions
Develop “...
90:10 Rule
DEFENSES
•
•
•
•

Highly intellectual types used.
Major causes in delay of seeking help.
Make therapy more difficult.
‘Bra...
COMMON DEFENSES EMPLOYED
•
•
•
•

Reaction Formation
Denial
Minimization
Rationalization
WORK
AS A DEFENSE
SOCIAL DEMANDS ON
PHYSICIANS
•
•
•
•

Work and Career Demands
Household Responsibilities
People in Our Lives
Personal Need...
“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 n...
BURNOUT
A syndrome of emotional exhaustion, chronic
overstress. (Maslach)
-Distinct work-related syndrome – demands exceed...
BURNOUT
Three Stages (Maslach Burnout Inventory):
• Emotional Exhaustion
• Depersonalization
• Reduced Personal Accomplish...
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 ...
Work Related
• Demands of the workplace exceed individual
resources – way of life for many physicians
• 2001 CMA PRQ:
–
–
...
Possible Risk Factors
• High Workload - demands exceed resources
• Age - inverse relation between age and
burnout. ? Survi...
SERIOUS CONSEQUENCES
1.
2.
3.
4.
5.
6.

Impaired job performance and
Professional Problems
Changing jobs, reducing work ho...
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 w...
MAKING CHOICES
•
•
•
•

Recognize that you have choices
Focus on what you can control.
Set priorities - self, family, work...
The Five Balls
•
•
•
•
•

The Work Ball
The Home and Family Ball
The Relationships Ball
The Friends Ball
The Self Care Bal...
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 im...
Plenary gautum
Plenary gautum
Plenary gautum
Plenary gautum
Plenary gautum
Plenary gautum
Plenary gautum
Plenary gautum
Plenary gautum
Plenary gautum
Plenary gautum
Plenary gautum
Plenary gautum
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2013 Physician Well Being Conference

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Plenary gautum

  1. 1. Preventing Burnout Mamta Gautam, MD, MBA, FRCPC, CPDC, MOT
  2. 2. Disclosure of Conflict of Interest Conflicts to Declare: • No affiliation with a pharmaceutical, medical device or communications organization. • President and CEO – PEAK MD
  3. 3. 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
  4. 4. MYTH Knowing what we should be doing means that we are doing it.
  5. 5. BIOLOGICAL FACTORS
  6. 6. BIOLOGICAL FACTORS • Lack of Sleep • Poor Eating Habits • Poor Level of Fitness
  7. 7. BIOLOGICAL FACTORS -2 • • • • • Family history of psychiatric illness Overuse of alcohol or drugs Anxiety disorders Primary Affective Disorder Eating Disorders
  8. 8. PSYCHOLOGY OF THE PHYSICIAN
  9. 9. 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
  10. 10. THIS IS SOCIALLY VALUABLE BUT PERSONALLY VERY EXPENSIVE.
  11. 11. 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.
  12. 12. 90:10 Rule
  13. 13. DEFENSES • • • • Highly intellectual types used. Major causes in delay of seeking help. Make therapy more difficult. ‘Brain-Heart’ Gap
  14. 14. COMMON DEFENSES EMPLOYED • • • • Reaction Formation Denial Minimization Rationalization
  15. 15. WORK AS A DEFENSE
  16. 16. SOCIAL DEMANDS ON PHYSICIANS • • • • Work and Career Demands Household Responsibilities People in Our Lives Personal Needs and Wants
  17. 17. “THE DREAM “ OF BECOMING A PHYSICIAN
  18. 18. OUR PATIENTS
  19. 19. OCCUPATIONAL HAZARDS
  20. 20. MEDICINE AS A BUSINESS
  21. 21. MAINTENANCE OF COMPETENCE
  22. 22. ORGANIZATIONAL CHANGES IN HEALTH CARE
  23. 23. ISSUES SPECIFIC TO WOMEN • Minority status, discrimination still exist • Isolation • Life Stage considerations
  24. 24. HOUSEHOLD RESPONSIBILITIES • Managing the household - shopping, cooking, cleaning • Finances • Anxieties about our future
  25. 25. CHILDCARE AND ELDERCARE
  26. 26. RELATIONSHIPS • Singlehood • Marital Issues
  27. 27. IN ALL OF THIS, THE PERSONAL NEEDS OF THE PHYSICIAN ARE LAST, AND OFTEN LOST.
  28. 28. 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.
  29. 29. BURNOUT A 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
  30. 30. BURNOUT Three Stages (Maslach Burnout Inventory): • Emotional Exhaustion • Depersonalization • Reduced Personal Accomplishment
  31. 31. Review of Burnout Studies • Emotional exhaustion = 46-80% • Depersonalization = 22-93% • Low Personal Satisfaction = 16-79%
  32. 32. 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 (4076%)
  33. 33. 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
  34. 34. 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
  35. 35. SERIOUS CONSEQUENCES 1. 2. 3. 4. 5. 6. Impaired job performance and Professional Problems Changing jobs, reducing work hours Difficulty with Relationships – home and work Physical Illnesses Addictions Psychiatric Illnesses – Anxiety, Depression, Suicide
  36. 36. Even the healthiest and strongest of us can become unhealthy in an unhealthy environment.
  37. 37. Preventing Burnout • General Strategy • Specific Strategies – Work related – Personal
  38. 38. General Strategy • The number one cause of stress leading to burnout: THE PERCEPTION THAT WE HAVE NO CHOICE, NO CONTROL.
  39. 39. • The number one skill in dealing with stress: CHALLENGE YOUR PERCEPTION.
  40. 40. 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
  41. 41. 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
  42. 42. The Five Balls • • • • • The Work Ball The Home and Family Ball The Relationships Ball The Friends Ball The Self Care Ball
  43. 43. Take care of yourself first
  44. 44. 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!
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