2013 Physician Well Being Conference

1. Preventing Burnout
Mamta Gautam,
MD, MBA, FRCPC, CPDC, MOT

4. Disclosure of Conflict of Interest
Conflicts to Declare:
• No affiliation with a pharmaceutical,
medical device or communications
organization.
• President and CEO – PEAK MD

5. 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

6. MYTH
Knowing what we should be doing
means that we are doing it.

7. BIOLOGICAL FACTORS

8. BIOLOGICAL FACTORS
• Lack of Sleep
• Poor Eating Habits
• Poor Level of Fitness

10. BIOLOGICAL FACTORS -2
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Family history of psychiatric illness
Overuse of alcohol or drugs
Anxiety disorders
Primary Affective Disorder
Eating Disorders

11. PSYCHOLOGY OF THE
PHYSICIAN

12. COMMON PERSONALITY TRAITS
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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

13. THIS IS SOCIALLY VALUABLE
BUT
PERSONALLY VERY EXPENSIVE.

14. ISSUES ARISING FROM PAST
EXPERIENCES
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Establish sense of self as children
Believe three main assumptions
Develop “Personal Historian”
Perception: We are not good enough.
We do not measure up.

15. 90:10 Rule

16. DEFENSES
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Highly intellectual types used.
Major causes in delay of seeking help.
Make therapy more difficult.
‘Brain-Heart’ Gap

17. COMMON DEFENSES EMPLOYED
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Reaction Formation
Denial
Minimization
Rationalization

18. WORK
AS A DEFENSE

19. SOCIAL DEMANDS ON
PHYSICIANS
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Work and Career Demands
Household Responsibilities
People in Our Lives
Personal Needs and Wants

20. “THE DREAM “
OF BECOMING A PHYSICIAN

22. OUR PATIENTS

24. OCCUPATIONAL HAZARDS

25. MEDICINE AS A BUSINESS

26. MAINTENANCE OF COMPETENCE

28. ORGANIZATIONAL CHANGES
IN HEALTH CARE

32. ISSUES SPECIFIC TO WOMEN
• Minority status, discrimination still exist
• Isolation
• Life Stage considerations

33. HOUSEHOLD RESPONSIBILITIES
• Managing the household - shopping,
cooking, cleaning
• Finances
• Anxieties about our future

34. CHILDCARE AND ELDERCARE

36. RELATIONSHIPS
• Singlehood
• Marital Issues

37. IN ALL OF THIS,
THE PERSONAL NEEDS OF THE
PHYSICIAN ARE LAST, AND
OFTEN LOST.

38. 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.

39. 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

40. BURNOUT
Three Stages (Maslach Burnout Inventory):
• Emotional Exhaustion
• Depersonalization
• Reduced Personal Accomplishment

41. Review of Burnout Studies
• Emotional exhaustion = 46-80%
• Depersonalization = 22-93%
• Low Personal Satisfaction = 16-79%

42. 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%)

43. Work Related
• Demands of the workplace exceed individual
resources – way of life for many physicians
• 2001 CMA PRQ:
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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

44. 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

45. SERIOUS CONSEQUENCES
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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

46. Even the healthiest and strongest of
us can become unhealthy
in an unhealthy environment.

47. Preventing Burnout
• General Strategy
• Specific Strategies
– Work related
– Personal

48. General Strategy
• The number one cause of stress
leading to burnout:
THE PERCEPTION THAT WE HAVE
NO CHOICE, NO CONTROL.

49. • The number one skill in dealing with stress:
CHALLENGE YOUR PERCEPTION.

50. 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

53. MAKING CHOICES
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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

55. The Five Balls
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The Work Ball
The Home and Family Ball
The Relationships Ball
The Friends Ball
The Self Care Ball

56. Take care of yourself first

57. 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!