STRESS AND COPING FOR TODAY’S PHYSICIAN

1. STRESS AND COPINGFORTODAY’S PHYSICIAN ACP Maryland Chapter Kim K. Solberg, MD Feb 9, 2008

2. The road to becoming a physician is COMPETITIVE and INTENSE

3. WHAT IT TAKES • OBSESSIVENESS • COMPULSIVENESS • EXAGGERATED SENSE OF RESPONSIBILITY • CHRONIC FEELINGS OF NOT DOING ENOUGH • DIFFICULTY SETTING LIMITS

4. TYPE APERSONALITY TRAITS

5. DELAYED GRATIFICATION • The ability to delay personal and pleasurable self interests until more important goals are achieved • DOCTORS are MASTERS of this • The ability to delay attending to significant relationships and other sources of renewal until all the work is done BUT

6. PHYSICANSare prone to marital and relationship problems

7. THEN VS NOW Traditionally, doctors were men who were often married to a homemaker Today: 1/3 of doctors are women ½ of medical students are women Women struggle more with balancing home and work responsibilities

8. What is distressful to one is exhilarating to another

9. THE PRACTICE OF MEDICINE IS CHANGING • LONGER HOURS • MORE PAPERWORK • DECREASING COMPENSATION • STRINGENT GOVERNMENT AND INSURANCE REGULATIONS • MALPRACTICE ACCUSATIONS

10. AUTONOMY?

11. WE TRAINED TO BECOME PHYSICIANS WHO CARE FOR PATIENTS • WE ARE INCREASINGLY SEEN AS PROVIDERS WHO SERVICE CLIENTS WITH A GROWING SENSE OF MISTRUST

12. STRESS

13. STRESS • difficult to define • Physical, mental or emotional strain or tension • BMJ 1951-”stress is itself, is the cause of itself and is the result of itself • Good stress-eustress • Bad stress-distress

14. STRESS • ACUTE STRESS- immediate response to a threat or stressor • CHRONIC STRESS: -long term acute stress -More subtle but lasting -Nagging -Unrelenting

15. STRESS • A CONDITION EXPERIENCED WHEN A PERSON PERCEIVES THAT DEMANDSEXCEED THEIR PERSONAL AND SOCIAL RESOURCES • UNABLE TO COPE • HAVING LITTLE OR NO CONTROL IS ALWAYS DISTRESSFUL

16. BURNOUT • The cumulative result of unaddressed stress • A state of physical, emotional and mental exhaustion • “an erosion of the soul” • “silent anguish of the healers” • A relationship gone bad

17. BURNOUT • Grows gradually over time • Perhaps beginning in medical school or residency • Disillusioned • Cynical • It becomes very difficult to do a competent job

18. COSTS OF BURNOUT • Personal and family losses • Decreased productivity • Medical mistakes • Physician turnover

19. HEADLINES “Frustrated physicians find careers outside of medicine” “Suicide rate of women doctors in US is twice that of other working women” “Suicide rate high in female doctors” “Many doctors prone to stress”

20. ADDRESSING STRESS AND PREVENTING BURNOUT Putting out the fire!

21. BURNOUT PREVENTION • 1)Physician’s personal responsibility (INTRINSIC) but should include 2)help from the workplace (EXTRINSIC) • Should start in medical school! and continue through retirement • In 2001, the Joint Commission mandated that hospitals address physician well-being

22. “PHYSICIAN HEAL THYSELF”

23. HEALTH AND HAPPINESS INVENTORY -Listen to your SELF TALK -Are you content and satisfied? -Are you always complaining to yourself? -What causes you to feel stressed? -What makes you happy? Are you happy? Are you irritable? Anxious? Depressed?

24. HEALTH AND HAPPINESS INVENTORY • How are your relationships going? • Is your practice going well? Is it what you expected? • What is your body telling you? -Are you tired? -Do you get enough sleep? -Do you have headaches? Back pain?

25. SET GOALS • Set attainable personal and professional GOALS • Periodically re-evaluate your priorities • Choose a partner and others who support your goals • Make time for your family and friends

26. SET GOALS • TAKE CARE OF YOURSELF! -Eat right -Exercise -Get enough sleep -Relax often

27. GOALS • Work on self acceptance-let go of perfection as a goal • Autonomy-internallocus of self-evaluation • Always work towards personal growth

28. PERSONAL GROWTH AND RENEWAL -Not only for life outside of work -Work does not have to be merely a domain of energy expenditure but also of energy renewal -Learn to receive support, healing and meaning while giving

29. STRESS MANAGEMENT • Decrease level of arousal and moderate the stress response • Decrease feelings of tension and arousal • Increase sense of well-being and peacefulness • Increase sense of personal control • EASY to learn. EASY to do.

30. GET ENOUGH SLEEP

31. Nix Coffee?

32. Massage

33. YOGA

34. WALKING

35. RESISTANCE TRAINING

36. VENTING

37. MINDFULNESS • Fostered by MEDITATION • Being fully presentin the moment, to the person and the task at hand • COUNTERBALANCE for all the interrupted tasks and competing demands common to most work days

38. CHANGES IN THE WORKPLACE • Establish a Physician Health Committee • Mentor program • Confidential support groups • Annual well-being retreat

39. CHANGES IN THE WORKPLACE • Look at a physicians sense of meaning in their work and not just productivity • Membership to fitness clubs • CME on topics related to well-being • Flexible schedules • Decrease paperwork

40. THANK YOU!GO GET ‘EM!