This document discusses physician well-being and resilience. It notes that physicians are often compelled perfectionists who face stress from their work environments and cultures that discourage acknowledging vulnerabilities. This can lead to burnout characterized by emotional exhaustion, reduced personal accomplishment, and depersonalization. The document recommends developing self-awareness, balance, supportive relationships, and a personal philosophy to build resilience. Actions include maintaining boundaries, prioritizing balance, mindfulness, self-care, and asking for help.

1. Physician Well-Being:
Creating an Oasis for You
Foundation for Medical Excellence
October 6, 2012
Alderbrook
Dr. Paul Farnan
farnan@mail.ubc.ca

3. Physicians & their
Temperaments

4. 4
“The most important quality of a physician is
compulsiveness.”
The Triad of Compulsiveness
Self-Doubt
Guilt feelings
Exaggerated sense of responsibility
Compulsiveness

5. ‘Perfectionism’
• Contains an element of pressure associated with
a sense of helplessness and hopelessness.
• Perfectionism is a vulnerability factor for burnout,
and anxiety.
• The desire to excel must be differentiated from the
desire to be perfect.
• Believing that others will value you only if you are
perfect is associated with both depression and
suicide.
- Flett & Hewitt, 2002

6. Individuals with compulsive and
perfectionistic traits are attracted to
medical careers
Stressors in the environment of an
academic setting do not create these
personality features – they exacerbate
pre-existing traits

7. Internally driven Compulsiveness
• Challenging the external environment ignores
the inner demands & doesn’t help the discomfort
• By believing these internal demands are natural
it allows us to avoid looking at ourselves and our
own behaviours as part of the problem
• Our outward focus on the patient, the disease,
the diagnosis, the procedure, the treatment
reinforces our reluctance to look inwards
Menninger

8. Culture of Medicine
Competitive, Controlling,
Perfectionistic
OverWork is the norm
Blurred boundaries
Neglect health and relationships
‘Psychology of Postponement’

9. Physicians and Intimate
Relationships
• “In many physicians, the character armour that
enables them to do their daily work becomes
hypertrophied and is carried from the workplace
into the home”
• “Hence, giving and receiving love in the medical
‘marriage’ becomes a challenge”
Myers M. The medical ‘marriage’. Paper presented at the
American Psychiatric Association Annual Scientific Meeting,
San Francisco, May 22, 2003

10. ‘If I work hard(er),
I will be loved’
Roots of Physician
Stress Explored
Lynne Lamberg JAMA
1999;282:13-14

11. Myth of Invincibility
Medical profession does not encourage physicians to
admit health vulnerabilities or seek help
- Levine & Bryant,
2000
‘Illness doesn’t belong to us. It belongs to them, the
patients. Doctors need to be taught to be ill. We
need permission to be ill and to acknowledge that
we are not superhuman’
McKevitt C, Morgan M.
Illness doesn’t belong to us
J R Soc Med 1997;90: 491 -495

12. Definitions of Stress
Automatic non-specific response
'Relationship between the person and the
environment that is appraised as taxing or
exceeding his or her resources and endangering
his or her well-being'
The response is mediated by the autonomic
nervous system.

13. 
Emotional Exhaustion – feeling emotionally
overrun/exhausted by one’s work – little left to give

Reduced Personal Accomplishment – perception
of clinical ineffectiveness, dissatisfaction with achievement

Depersonalization – Becoming distant and cynical,
view others as objects, avoidance of people. Negative
attitude towards others and self
Maslach
‘Burnout’ – 3 dimensions

14. Burnout produces feelings of
Hopelessness,
Powerlessness,
Cynicism,
Stagnation
Reduced productivity
Resentment

15. How Can We Become More
Resilient?
“capable of recoiling from pressure or
shock unchanged or undamaged.”
Funk & Wagnalls

16. Difficulty balancing personal
and professional life is a major
contributor to physician
distress
Unbalanced lives in terms of:

Work

Relationships

Play

Personal Time

17. Six-Category Framework

Workload(Too much work, Not enough resources)

Control(Micromanagement, Lack of influence,
Accountability without power)

Reward(Not enough pay, acknowledgement or
satisfaction)

Community(Isolation, Conflict, Disrespect)

Fairness( Discrimination, Favouritism)

Values(Ethical Conflicts, Meaningless Tasks)
Maslach & Leiter

18. 
Both individuals and organizations can use
this framework to diagnose which
catagories are especially troublesome for
them, and then to design interventions that
target these problem areas.

Narrow the gap between your expectations
and your work reality

19. 1.Self-Awareness
2.Self-Care
3.Sharing of feelings and responsibilities
4.Developing a personal philosophy
5.Non-traditional coping skills
A physician's personal growth and
development – 5 areas of focus
Williamson

20. 4 main aspects of Physician
Resilience

1) Attitudes and Perspectives

2) Balance and Prioritization

3) Practice Management Style

4) Supportive Relations
Jensen, Trollope-Kumar, Waters, Everson

21. Happiness
The man who thinks he can live without others is
mistaken; the one who thinks others can't live
without him is even more deluded.
~ Hasidic Saying”
‘The areas that contributed most to doctor’s happiness
with their lives as physicians seem to focus on the
people they work with, the people they live with, and
most of all the people for whom they provide medical
care’.
• ‘Interpersonal relationships are the number one
predictor of well-being’ Tal Ben-Shahar

22. Burnout
'Joyless Striving'
Holmes & Rahe

23. 
Positive change doesn't just happen

We must take action and well-informed
action at that.

24. When there is balance in my life I am
more resilient
Check-in:
Getting overloaded by taking on too much
Procrastination
Take a step back - I need to regroup & get organized!
GOALS:
To be healthy emotionally, spiritually and physically
To be happy and excited about the work that I am doing
To not feel overwhelmed, unsatisfied, angry or resentful

25. ACTIONS
Believe that I can change - Being Proactive is about
not being Reactive
Maintain positive philosophy with sense of optimism
Loving-Kindness Meditation - regularly
Inventory – Mad, Sad, Glad or Afraid?
Daily Gratitude List
Keep a sense of humour, daily

26. ACTIONS
Define my limits & boundaries, and share them
with others - appropriate assertiveness
Work on balance between work, home and self -
small steps... A Sanctuary, 'Sabbath'..
Work on friendships, focus on two special people
Be mindful for the moments of wonder

27. ACTIONS
Incorporate physical fitness, and more plant based
diet as part of my wellbeing
Get enough sleep
Do something I like outside medicine - Give myself
permission for leisure time – e.g.15 mins rule
Plan for retirement
Ask for help when I need it
REMEMBER:
My job is what I do, not who I am
We have more control than we think