Burnout -dr. brian goldman


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  • Burnout -dr. brian goldman

    1. 1. 3rd Annual DeGroote Interprofessional Health Leadership Conference Dr. Brian Goldman October 1, 2011 Doctors open up about their profession White Coat, Black Art Body and Soul: Health Professionals at Risk
    2. 2. Objectives <ul><li>‘ White Coat, Black Art’ perspective </li></ul><ul><li>Burnout: definition, stats, stories </li></ul><ul><li>Violence against HCPs </li></ul><ul><li>Compassion fatigue: definition, stories </li></ul><ul><li>Some solutions </li></ul>
    3. 3. Dr. Goldman’s CV: 1982-2007
    4. 4. WHITE, COAT, BLACK ART <ul><li>2007-2009: 59 x episodes </li></ul><ul><li>Fifth Season: 2010-11 </li></ul>
    5. 5. White Coat’s Mission: <ul><li>To reveal the true culture of medicine </li></ul><ul><li>To reveal the inners workings of the health care system (warts and all) </li></ul><ul><li>By telling stories from the POV of health care providers </li></ul>
    6. 6. <ul><li>We’ve been holding up a mirror to you… </li></ul><ul><li>What you’re about to hear are things you’ve been telling us </li></ul><ul><li>In your own words </li></ul>
    7. 7. Burnout <ul><li>A stress syndrome characterized by: </li></ul><ul><ul><li>Emotional exhaustion </li></ul></ul><ul><ul><li>Decreased satisfaction at work </li></ul></ul><ul><ul><li>Distancing from patients and co-workers </li></ul></ul>
    8. 8. Burnout: Stats Among MDs <ul><li>2003 CMA Survey: nearly 50% of MDs in the advanced stages </li></ul><ul><li>2004 JAMA: analysis of 15 studies found uniformly high rates of burnout among post-graduate residents </li></ul><ul><li>2006 Mayo Clinic Study: nearly half of med students </li></ul>
    9. 9. An MD’s Story: <ul><li>John Aquino is an MD </li></ul><ul><ul><li>Early 1990s: trained in Canada, started FP in the U.S. </li></ul></ul><ul><ul><li>Returned to Canada two years ago for personal reasons </li></ul></ul><ul><li>Since returning, he’s admitted to feeling burned out </li></ul>
    10. 10. Burnout in Nursing <ul><li>Even higher rates than MDs </li></ul><ul><li>Over 50% in most studies </li></ul><ul><li>Manitoba Nurses Union: 66% of junior nurses have burnout </li></ul>
    11. 11. A Recent Grad’s Story <ul><li>Deb Lowe graduated from U of Victoria in 2004 </li></ul><ul><ul><li>General wards </li></ul></ul><ul><ul><li>ICU </li></ul></ul><ul><li>Four years on, she suffers from burnout </li></ul><ul><li>And, she’s not alone </li></ul>
    12. 12. The View from a Psychotherapist <ul><li>Francoise Mathieu </li></ul><ul><li>Certified Mental Health Counselor in Kingston </li></ul><ul><li>Specializes in helping HCPs with burnout </li></ul><ul><li>Everyone claims to have it… </li></ul><ul><ul><li>Are HCPs any different? </li></ul></ul>
    13. 13. <ul><li>“ Slammed” </li></ul><ul><li>“ Inundated” </li></ul><ul><li>“ Swamped” </li></ul>Reason #1 For Burnout: The System A system in which patients are seen as the enemy
    14. 14. Factors We Can’t Control <ul><li>Global recession </li></ul><ul><ul><li>HCW layoffs </li></ul></ul><ul><li>Seniors: fastest growing population segment in Canada </li></ul><ul><ul><li>Statistics Canada </li></ul></ul>
    15. 15. More and More… Anger Understanding 
    16. 16. For Those Who Can’t do Anything About It <ul><li>Especially true in hospitals </li></ul><ul><ul><li>cutbacks mean fewer nurses caring for more patients </li></ul></ul><ul><ul><li>Today’s hospitalized patients are sicker </li></ul></ul><ul><li>A significant amount of that stress is reflected in attitudes towards hospitalized seniors </li></ul><ul><li>Listen to these nursing students </li></ul>
    17. 17. A Great and Paradoxical Divide Between Patients and HCPs
    18. 18. The View from HCPs in the ED Dr. John Ross, Head of ED QEII HSC Jill Lambeth, RN at QEII HSC
    19. 19. So, Who’s to Blame? <ul><li>Jill Lambeth, RN, QEII HSC, Halifax: </li></ul><ul><ul><li>No advanced directives </li></ul></ul>
    20. 20. Reason #2: Violence <ul><li>HC and social service industry accounts for 48% of all non-fatal injuries from acts of violence and workplace assaults </li></ul><ul><li>U.S.: costs billions in security, medical and legal expenses </li></ul><ul><li>Leads to burnout, PTSD, poor job performance </li></ul><ul><li>“ Healthcare workers are more likely to be attacked at work that prison guards and police officers.” </li></ul>Int’l Council of Nurses. Position Statement: Abuse and Violence Against Nursing Personnel
    21. 21. Violence in the ER <ul><li>Fernandes: 57% of ER respondents physically assaulted over a 1 year period </li></ul><ul><li>Mayer: 72% assaulted at least once during their career </li></ul>
    22. 22. Violence in the Hospital: Environmental Factors <ul><li>Security issues </li></ul><ul><li>Public space - uncontrolled movement </li></ul><ul><li>Delays/wait times </li></ul><ul><li>Crowding, uncomfortable </li></ul><ul><li>Volatile families </li></ul>
    23. 23. Violence in the Hospital: Staff Factors <ul><li>Inadequate staffing: working alone </li></ul><ul><li>Violence during patient transport </li></ul><ul><li>Lack of training </li></ul><ul><li>Lack of situational awareness </li></ul><ul><ul><li>Dr. Bruce Campana </li></ul></ul>
    24. 24. Violence in the ER: Staff Factors <ul><li>Risk factors aren’t unique to the ED </li></ul><ul><li>But the ED has more potential hazards </li></ul><ul><li>Maria Raptis: charge nurse </li></ul><ul><ul><li>Recalls a patient with bipolar brought in by his girlfriend </li></ul></ul>
    25. 25. Paramedics <ul><li>Your home = their office </li></ul><ul><li>Little advance intel of the situation </li></ul><ul><li>Little training to handle potential violence </li></ul><ul><li>Ill-equipped </li></ul><ul><ul><li>Tom Janatos & Sandra Laughlin </li></ul></ul>
    26. 26. Paramedics: Solutions & Dilemmas <ul><li>Staging: </li></ul><ul><ul><li>Jim Hearst death </li></ul></ul><ul><ul><li>Tom Janatos and Sandra Laughlin </li></ul></ul><ul><li>To arm, or not to arm: </li></ul><ul><ul><li>Fred Galvan </li></ul></ul>
    27. 27. Reason #3 for Burnout: Powerlessness in Relationships <ul><li>Nurse more likely than MDs to experience it </li></ul><ul><ul><li>Deb Lowe </li></ul></ul><ul><li>ER physicians more likely than other specialists to experience it </li></ul><ul><li>So do students and residents </li></ul>
    28. 28. Compassion Fatigue <ul><li>Compassion fatigue, also known as a Secondary Traumatic Stress Disorder, is a term that refers to a gradual lessening of compassion over time. It is common among victims of trauma and individuals that work directly with victims of trauma. It was first diagnosed in nurses in the 1950's. </li></ul><ul><li>Francoise Mathieu is an expert in compassion fatigue </li></ul>
    29. 29. Reason #4: Exposure to Traumatic Events (PTSD) <ul><li>a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma </li></ul><ul><li>50% experience at least 1 traumatic event </li></ul><ul><ul><li>only 8% dx’d with PTSD </li></ul></ul><ul><li>Very high rates among paramedics & veterans </li></ul>Vince Savoia, Executive Director of the Tema Conter Foundation
    30. 30. Reason #5: Factors in the Individual <ul><li>Dr. Graeme Cunningham </li></ul><ul><ul><li>Medical Director, Alcohol and Drug Treatment Program, Homewood Health Centre, Guelph, Ontario </li></ul></ul><ul><li>In public, he was a respected cardiologist </li></ul><ul><li>In private, he abused alcohol to a deal with a pathological fear of failure </li></ul>
    31. 31. Burnout: The Consequences <ul><li>The System </li></ul><ul><ul><li>Francoise Mathieu </li></ul></ul><ul><li>The Individual </li></ul><ul><ul><li>Dr. Graeme Cunningham </li></ul></ul><ul><ul><li>Donna Paradowski </li></ul></ul>
    32. 32. Solution #1: Get Help <ul><li>EAP </li></ul><ul><li>AWARE-NS </li></ul><ul><li>Private counseling </li></ul><ul><li>Other: Tema Conter (for medics) </li></ul>
    33. 33. Solution #2: Advocate <ul><li>Francoise Mathieu </li></ul><ul><li>Use the ‘low back pain’ model in nursing </li></ul><ul><ul><li>More resources </li></ul></ul><ul><ul><li>Less silence </li></ul></ul>
    34. 34. Solution #3: Appreciating Our Limits <ul><li>Personal and professional </li></ul><ul><li>System </li></ul>
    35. 35. Sharing the Load
    36. 36. Sharing the Load <ul><li>Roberta Heale and Marilyn Butcher: </li></ul><ul><ul><li>1st NP-led primary care health clinic in Canada </li></ul></ul><ul><ul><li>20-30,000 orphan patients in Sudbury </li></ul></ul>
    37. 37. Enlarging the Team NP’s and PA’s Family Physicians Specialists
    38. 38. Enough Business for Everyone?
    39. 39. Three Questions to Ask Yourself <ul><li>1. When you think about your life at the moment, would you say that by and large you are satisfied with life or are you mostly dissatisfied? </li></ul><ul><li>2. If you were asked this question five years ago, what might your answer have been then? </li></ul><ul><li>3. What do you think your answer to this question will be five years from now? </li></ul>
    40. 40. Thank You for the Calling You Have Embarked Upon!