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Daniel Friedland, MD
Medical Director, Barney and Barney
Founder & CEO, SuperSmartHealth
© 2012 SuperSmartHealth
Roadmap & Objectives
1) Factors predicting burnout
1) Recognizing burnout
2) The 4 in 4 Framework™
to navigate burnout
Burnout
Prevalence of Burnout
• Approximately 50% of students experience burnout and 10%
experience suicidal ideation during medic...
Prevalence of Burnout
• Survey of 27,276 U.S. physicians, 7288 (26.7%) completed surveys.
• 45.8% of physicians reported a...
Effects of Physician Stress
• 1200 practicing physicians surveyed
• 6 in 10 have considered leaving medicine
• 77% experie...
Effects of Physician Stress
• 1200 practicing physicians surveyed
• 6 in 10 have considered leaving medicine
• 77% experie...
Factors Contributing to Burnout
Work-related stress:
• Excessive workloads
• Balancing personal and professional life
• De...
Factors Contributing to Burnout
• Cross-sectional national survey of 2,000
randomly selected physicians in the U.S. with
9...
Results from Canadian Medical Association Physician Resource Questionnaire (PRQ) November 2003
http://www.cma.ca/multimedi...
Burnout by Specialty
Shanafelt TD et al. Arch Intern Med. 2012 Aug20:1-9.Copyright © 2012 American Medical Association.
Personality and Burnout
• Escape-Avoidance (Self-directedness & Cooperativeness protective)1
• Low sense of stability and ...
Maslach Burnout Inventory
1. Emotional exhaustion
2. Depersonalization
3. Reduced personal accomplishment
Maslach, C. & Ja...
Freudenberger’s 12 Phases of Burnout
1. The compulsion to prove oneself
2. Working harder
3. Neglecting one‟s needs
4. Dis...
“Burnout is the index of the dislocation
between what people are and what they have
to do.
It represents an erosion in
val...
Swank and Marchland 1946;
redrawn from Mind-Body Medicine, Watkins 1997
0 10 20 30 40 50 60
Degreeofcombat
Days in combat
...
Consequences of Burnout
• Increased medical errors
• Decreased empathy
• Plans to retire early
• Job dissatisfaction
Dyrby...
Physician satisfaction matters
• Strongly linked to patient satisfaction1
• Affects patients‟ perception of quality of car...
Ten factors enhancing physician satisfaction
• Relationships with
colleagues
• Relationships with
patients
• Relationships...
• Relationships with
colleagues
• Relationships with
patients
• Relationships with staff
• Community involvement.
• Autono...
• Relationships with
colleagues
• Relationships with
patients
• Relationships with staff
• Community involvement.
• Autono...
Values, Workload and Efficacy
(in women)
Leiter MP, Frank E, Mathison TJ. Canadian Family Physician December 2009 vol. 55 ...
„„If all of the knowledge and advice
about how to beat burnout could be
summed up in one word,
that word would be balance ...
If burnout involves
exhaustion,
depersonalization
and decreased personal efficacy,
how can we become more resilient to
bet...
P
e
r
f
o
r
m
a
n
c
e
Arousal/Stress
?
Yerkes–Dodson Law
P
e
r
f
o
r
m
a
n
c
e
Arousal/Stress Yerkes RM, Dodson JD (1908). Journal of Comparative
Neurology and P...
The Foundation
Neuroplastic Transformation
P
e
r
f
o
r
m
a
n
c
e
Arousal / Stress
The 4 in 4 Framework™
Integrating
Mental Emotional
Social Spiritual
Intelligence
Make the Turn into
What’s Truly Important
Cultivate Creativity
By Reflecting on
What’s Truly Important
Reappraise Stress
a...
Recognize
Reactivity
Reactivity
Fight & Flight
Creativity
Fulfillment
The 4 in 4 Framework™
1
Recognize
Reactivity:
1. Physical Sensations
2. Feelings
3. Thoughts
4. Behaviors
1
Is it doing more harm than good?
Recognize
Reactivity:
1
Reappraise Stress
and Self-Doubt
Reactivity
Fight & Flight
Creativity
Fulfillment
The 4 in 4 Framework™
2Recognize
Reactiv...
Reappraise Stress
and Self-Doubt:
• SCARF
1
• What if…
• If only...
• Judgment and Criticism
• Rejection and Abandonment
•...
Reappraise Stress
and Self-Doubt:
2
Appraise Reappraise
1) What happened (just the facts)?
2) What is my belief about what...
Reappraise Stress
and Self-Doubt:
• What if…
• If only…
• Judgment and Criticism
• Rejection and Abandonment
• Neglect and...
In a survey of 314 people at San Francisco International Airport
how many acknowledged they experience doubts of self-wort...
Self-doubt
is nothing more
than psychic gas!
Reappraise Stress
and Self-Doubt:
2
Reactivity
Fight & Flight
Creativity
Fulfillment
The 4 in 4 Framework™
Recognize
Reactivity
Is it doing more
harm than goo...
Cultivate Creativity
By Reflecting on
What’s Truly Important
What is your
definition of
optimal health?
3
Cultivate Creativity
By Reflecting on
What’s Truly Important
• Learning
• Connecting
• Expressing Potential
• Being of Ser...
Cultivate Creativity
By Reflecting on
What’s Truly Important
3
Health Relationships Productivity
V
S
I
R
V=Vision S=Strate...
Reactivity
Fight & Flight
Creativity
Fulfillment
The 4 in 4 Framework™
Recognize
Reactivity
Is it doing more
harm than goo...
1
3
Find
Frame
Apply
Evaluate
1
3
24
Make the Turn into
What’s Truly Important
4
Frame-Find-Evaluate-Apply Spiral of Growth™
Cultivate Creativity
By Reflecting on
What’s Truly Important
Reappraise Stress
and Self-Doubt
Recognize
Reactivity
Reactiv...
Fight
Flight Trigger
1 2
Fight
Flight
Trigger
Give Receive
1 2
GiveReceive
Cycle of
Reactivity
Cycle of
Creativity
Cultivate Creativity
By Reflecting on
What’s Truly Important
Reappraise Stress
and Self-Doubt
Recognize
Reactivity
Reactiv...
Achieve and Enhance
Peak Performance
P
e
r
f
o
r
m
a
n
c
e
Arousal / Stress
Online Program
+
The 4 in 4 Framework™ to
Achieve Peak Performance
Workbook
• 1 Module per week for 8 weeks, each 45-90 mi...
Contact Information
Daniel Friedland, MD
Medical Director, Barney and Barney
Founder & CEO, SuperSmartHealth
daniel@supers...
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Friedland burnout plenary 1

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Friedland burnout plenary 1

  1. 1. Daniel Friedland, MD Medical Director, Barney and Barney Founder & CEO, SuperSmartHealth © 2012 SuperSmartHealth
  2. 2. Roadmap & Objectives 1) Factors predicting burnout 1) Recognizing burnout 2) The 4 in 4 Framework™ to navigate burnout
  3. 3. Burnout
  4. 4. Prevalence of Burnout • Approximately 50% of students experience burnout and 10% experience suicidal ideation during medical school1 • Between 25-75% of medical residents experience burnout depending on the specialty2 • Approximately 1 in 3 doctors (both medical and surgical) are experiencing physician burnout at any given time3 1. Dyrbye LN, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149:334. 2. Ishak WW, Lederer S. J Grad Med Educ. 2009 Dec;1(2):236-42. 3. Shanafelt T, et al. JAMA. 2009;302(12):1338.
  5. 5. Prevalence of Burnout • Survey of 27,276 U.S. physicians, 7288 (26.7%) completed surveys. • 45.8% of physicians reported at least 1 symptom of burnout. • Compared with a sample of over 3442 working US adults, physicians were more likely to have symptoms of burnout (37.9% vs 27.8%) and to be dissatisfied with work-life balance (40.2% vs 23.2%). Shanafelt TD et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012 Aug20:1-9.
  6. 6. Effects of Physician Stress • 1200 practicing physicians surveyed • 6 in 10 have considered leaving medicine • 77% experience fatigue • 67% experience burnout • 33% depression & family discord ACPE Survey 2006 November-December The Physician Executive © Lee Lipsenthal 2009
  7. 7. Effects of Physician Stress • 1200 practicing physicians surveyed • 6 in 10 have considered leaving medicine • 77% experience fatigue • 67% experience burnout • 33% depression & family discord • Contributing causes; – Low reimbursement – Low autonomy – Patient overload – Lack of respect ACPE Survey 2006 November-December The Physician Executive © Lee Lipsenthal 2009
  8. 8. Factors Contributing to Burnout Work-related stress: • Excessive workloads • Balancing personal and professional life • Deterioration in work conditions • Autonomy • Meaning in the work Dyrbye LN, Shanafelt TD. Physician burnout: a potential threat to successful health care reform. JAMA. 2011 May 18;305(19):2009-10.
  9. 9. Factors Contributing to Burnout • Cross-sectional national survey of 2,000 randomly selected physicians in the U.S. with 935 respondents • The strongest predictor of burnout was having little control over schedule and hours worked (P<.001) Keeton K, et al. Predictors of physician career satisfaction, work-life balance, and burnout. Obstet Gynecol. 2007Apr;109(4):949-55.
  10. 10. Results from Canadian Medical Association Physician Resource Questionnaire (PRQ) November 2003 http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/PhysicianHealth/news/pdf/Burn-out.pdf
  11. 11. Burnout by Specialty Shanafelt TD et al. Arch Intern Med. 2012 Aug20:1-9.Copyright © 2012 American Medical Association.
  12. 12. Personality and Burnout • Escape-Avoidance (Self-directedness & Cooperativeness protective)1 • Low sense of stability and increased vigilance and anxiety traits2 • Low self-esteem, feelings of inadequacy, dysphoria and obsessive worry, passivity, social anxiety, and withdrawal from others3 • Higher levels of neuroticism and introversion and lower levels of agreeableness4 • (Higher self-rated Emotional Intelligence protective)5 1. Pejušković B, et al. Burnout syndrome among physicians - the role of personality dimensions and coping strategies. Psychiatr Danub. 2011 Dec;23(4):389-95. 2. Cebrià et al. Personality traits and burnout in family doctors. Aten Primaria. 2001 Apr 30;27(7):459-68. 3. McCranie EW, Brandsma JM. Personality antecedents of burnout among middle-aged physicians. Behav Med. 1988 Spring;14(1):30-6. 4. McManus IC, et al. Stress, burnout and doctors' attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Med. 2004 Aug 18;2:29. 5. Weng HC, et al. Associations between emotional intelligence and doctor burnout, job satisfaction and patient satisfaction. Med Educ. 2011 Aug;45(8):835-42.
  13. 13. Maslach Burnout Inventory 1. Emotional exhaustion 2. Depersonalization 3. Reduced personal accomplishment Maslach, C. & Jackson, S.E. The measurement of experienced burnout. Journal of Occupational Behavior. 1981;2:99-113.
  14. 14. Freudenberger’s 12 Phases of Burnout 1. The compulsion to prove oneself 2. Working harder 3. Neglecting one‟s needs 4. Displacement of conflicts 5. Revision of values 6. Denial of emerging problems 7. Withdrawal 8. Obvious behavioral changes 9. Depersonalization 10. Inner emptiness 11. Depression 12. Burnout Syndrome
 Freudenberger H.J. & North G. Women's Burnout: How to Spot It, How to Reverse It, and How to Prevent It. (1985). New York: Doubleday.
  15. 15. “Burnout is the index of the dislocation between what people are and what they have to do. It represents an erosion in value, dignity, spirit, and will – an erosion of the human soul. It is a malady that spreads gradually and continuously over time, putting people into a downward spiral from which it‟s hard to recover.” Maslach, C. & Leiter, M. P. (1997). The truth about burnout. San Francisco: Jossey Bass. In summary…
  16. 16. Swank and Marchland 1946; redrawn from Mind-Body Medicine, Watkins 1997 0 10 20 30 40 50 60 Degreeofcombat Days in combat Soldier becomes "battlewise" Period of maximum efficiency Combat exhaustion Hyper-reactive stage Emotional exhaustion stage Period of overconfidence Vegetative phase Battle Stress / Efficiency and Exhaustion © Lee Lipsenthal 2007
  17. 17. Consequences of Burnout • Increased medical errors • Decreased empathy • Plans to retire early • Job dissatisfaction Dyrbye LN, Shanafelt TD. Physician burnout: a potential threat to successful health care reform. JAMA. 2011 May 18;305(19):2009-10.
  18. 18. Physician satisfaction matters • Strongly linked to patient satisfaction1 • Affects patients‟ perception of quality of care1 • Enhances patient confidence2 • Enhances patient adherence with therapies3 1. Haas J, et al. “Is the professional satisfaction of general Internists associated with patient satisfaction?” J Gen Intern Med. 2000;15:122-128. 2. Grembowski D, et al. “Managed care, physician job satisfaction, and the quality of primary care.” J Gen Intern Med.2005;20:271-277. 3. DiMatteo MR, et al. Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol. 1993 Mar;12(2):93-102.
  19. 19. Ten factors enhancing physician satisfaction • Relationships with colleagues • Relationships with patients • Relationships with staff • Community involvement. • Autonomy • Income • Resources • Administrative support • Free time away from work • Intrinsic satisfaction Konrad T, et al. “Measuring physician job satisfaction in a changing workplace and a challenging environment.” Med Care. 1999;37:1174-1182. © Lee Lipsenthal 2009
  20. 20. • Relationships with colleagues • Relationships with patients • Relationships with staff • Community involvement. • Autonomy • Income • Resources • Administrative support • Free time away from work • Intrinsic satisfaction Ten factors enhancing physician satisfaction Konrad T, et al. “Measuring physician job satisfaction in a changing workplace and a challenging environment.” Med Care. 1999;37:1174-1182. © Lee Lipsenthal 2009
  21. 21. • Relationships with colleagues • Relationships with patients • Relationships with staff • Community involvement. • Autonomy • Income • Resources • Administrative support • Free time away from work • Intrinsic satisfaction  The nature of the work  Achievement  Recognition  Responsibility  Growth Ten factors enhancing physician satisfaction Konrad T, et al. “Measuring physician job satisfaction in a changing workplace and a challenging environment.” Med Care. 1999;37:1174-1182. © Lee Lipsenthal 2009
  22. 22. Values, Workload and Efficacy (in women) Leiter MP, Frank E, Mathison TJ. Canadian Family Physician December 2009 vol. 55 no. 12 1224-1225.e6
  23. 23. „„If all of the knowledge and advice about how to beat burnout could be summed up in one word, that word would be balance – balance between giving and getting, balance between stress and calm, balance between work and home.‟‟ Maslach C. Burnout: The Cost of Caring. Englewood Cliffs, NJ: Prentice-Hall;1982. - Christina Maslach
  24. 24. If burnout involves exhaustion, depersonalization and decreased personal efficacy, how can we become more resilient to better navigate stress and reengage so that we can experience greater vitality, more fully connect with others, ourselves and our source of inspiration, as well as thrive with peak performance?
  25. 25. P e r f o r m a n c e Arousal/Stress ?
  26. 26. Yerkes–Dodson Law P e r f o r m a n c e Arousal/Stress Yerkes RM, Dodson JD (1908). Journal of Comparative Neurology and Psychology 18: 459–482.
  27. 27. The Foundation
  28. 28. Neuroplastic Transformation P e r f o r m a n c e Arousal / Stress
  29. 29. The 4 in 4 Framework™ Integrating Mental Emotional Social Spiritual Intelligence
  30. 30. Make the Turn into What’s Truly Important Cultivate Creativity By Reflecting on What’s Truly Important Reappraise Stress and Self-Doubt Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ 1 2 34
  31. 31. Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ 1
  32. 32. Recognize Reactivity: 1. Physical Sensations 2. Feelings 3. Thoughts 4. Behaviors 1
  33. 33. Is it doing more harm than good? Recognize Reactivity: 1
  34. 34. Reappraise Stress and Self-Doubt Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ 2Recognize Reactivity Is it doing more harm than good? 1
  35. 35. Reappraise Stress and Self-Doubt: • SCARF 1 • What if… • If only... • Judgment and Criticism • Rejection and Abandonment • Neglect and Abuse • Standards and Expectations • Loss • Transition Triggers of Stress and Self-Doubt: 2 1. Rock, D., Managing with the Brain in Mind. Oxford Leadership Journal. 1(1): p. 1-10.
  36. 36. Reappraise Stress and Self-Doubt: 2 Appraise Reappraise 1) What happened (just the facts)? 2) What is my belief about what happened? 3) Is my belief true or what is the evidence this should be so? 4) How could I view this differently? Adapted from Albert Ellis et al. Rational Emotive Behavior Therapy. Amer Psychological Assn; 3 edition 2011.
  37. 37. Reappraise Stress and Self-Doubt: • What if… • If only… • Judgment and Criticism • Rejection and Abandonment • Neglect and Abuse • Standards and Expectations • Loss • Transition Reappraising the Triggers: 2
  38. 38. In a survey of 314 people at San Francisco International Airport how many acknowledged they experience doubts of self-worth? a) 76 b) 187 c) 235 d) 283 e) 311 Reappraise Stress and Self-Doubt: 2 Friedland D, SFO Self-Doubt Study 2001, unpublished data
  39. 39. Self-doubt is nothing more than psychic gas! Reappraise Stress and Self-Doubt: 2
  40. 40. Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ Recognize Reactivity Is it doing more harm than good? 1 Reappraise Stress and Self-Doubt It‟s nothing more than Psychic gas! 2 Cultivate Creativity By Reflecting on What’s Truly Important 3
  41. 41. Cultivate Creativity By Reflecting on What’s Truly Important What is your definition of optimal health? 3
  42. 42. Cultivate Creativity By Reflecting on What’s Truly Important • Learning • Connecting • Expressing Potential • Being of Service • Creating Opportunity • Experiencing Significance • Leaving a Legacy 3
  43. 43. Cultivate Creativity By Reflecting on What’s Truly Important 3 Health Relationships Productivity V S I R V=Vision S=Strategy I=Implementation R=Results
  44. 44. Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ Recognize Reactivity Is it doing more harm than good? 1 Reappraise Stress and Self-Doubt It‟s nothing more than Psychic gas! 2 Cultivate Creativity By Reflecting on What’s Truly Important Learning Connecting Expressing Potential Being of Service Creating Opportunity Experiencing Significance Leaving a Legacy 3 Make the Turn into What’s Truly Important 4
  45. 45. 1 3 Find Frame Apply Evaluate 1 3 24 Make the Turn into What’s Truly Important 4
  46. 46. Frame-Find-Evaluate-Apply Spiral of Growth™
  47. 47. Cultivate Creativity By Reflecting on What’s Truly Important Reappraise Stress and Self-Doubt Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ Is it doing more harm than good? It‟s nothing more than Psychic gas! Learning Connecting Expressing Potential Being of Service Creating Opportunity Experiencing Significance Leaving a Legacy Make the Turn into What’s Truly Important Frame 1 2 3 4Apply Evaluate Find 1 2 34
  48. 48. Fight Flight Trigger 1 2 Fight Flight Trigger Give Receive 1 2 GiveReceive Cycle of Reactivity Cycle of Creativity
  49. 49. Cultivate Creativity By Reflecting on What’s Truly Important Reappraise Stress and Self-Doubt Recognize Reactivity Reactivity Fight & Flight Creativity Fulfillment The 4 in 4 Framework™ Is it doing more harm than good? It‟s nothing more than Psychic gas! Learning Connecting Expressing Potential Being of Service Creating Opportunity Experiencing Significance Leaving a Legacy Make the Turn into What’s Truly Important Frame 1 2 3 4Apply Evaluate Find 1 2 34
  50. 50. Achieve and Enhance Peak Performance P e r f o r m a n c e Arousal / Stress
  51. 51. Online Program + The 4 in 4 Framework™ to Achieve Peak Performance Workbook • 1 Module per week for 8 weeks, each 45-90 minutes long • 30 minutes of workbook exercises per week • 10-20 minutes of mindfulness practice per day For more information go to: http://danielfriedland.com/programs
  52. 52. Contact Information Daniel Friedland, MD Medical Director, Barney and Barney Founder & CEO, SuperSmartHealth daniel@supersmarthealth.com Office: 858.481.2393 Cell: 858.229.0875

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