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Professionalism & Professional Health: Faculty Overview. Charlene M. Dewey, M.D., M.Ed., FACP Associate Professor of Medical Education and Administration Associate Professor of Medicine Co-Director & Chair William H. Swiggart, M.S.,LPC/MHSP Assistant in Medicine Co-Director.

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Professionalism & Professional Health:Faculty Overview

Charlene M. Dewey, M.D., M.Ed., FACP

Associate Professor of Medical Education and Administration

Associate Professor of Medicine

Co-Director & Chair

William H. Swiggart, M.S.,LPC/MHSP

Assistant in Medicine

Co-Director

Center for Professional Health, Faculty and Physician Wellness Committee, Vanderbilt University School of Medicine


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Purpose

  • To raise awareness of issues related to professionalism and professional health and to provide an overview of key resources in/outside of Vanderbilt.


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Participant Objectives

  • List ways to improve your professional health.

  • Compare and contrast workplace stress and burnout.

  • Describe distressed behaviors and how to report them.

  • State resources available for faculty and physicians in/out of Vanderbilt.


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Agenda

  • Professional Wellness

  • Workplace stress, burnout and suicide

  • Distressed behaviors

  • Resources

  • Q&A and Summary


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Fair Functioning

Reduced Productivity

Relationships Suffer

Fair-Not Functioning

Fair-Not Productive

Institution & Family Loses

High Functioning

High Productivity

Fair Functioning

Decreasing Productivity

Coping Mechanisms

Risk of MH issues and suicide

Faculty vitality

Stress & Burnout

Professional Health Spectrum


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Importance & Evidence

  • MDs suicide > other prof. & gen pop.

  • One physician per day; PhD – unclear

  • Grossly underestimated

  • Little education on topic

  • 30-60% MD have distress and burnout

  • Depression/bipolar & substance abuse = suicide risk

“Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressure of Success.” Cole, Goodrich & Gritz, 2009.


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Importance & Evidence

  • Reduced wellness professional lapses

  • Gender differences:

    • Females > anxiety, depression, burnout

    • F>M MD suicides

  • Reduced use of care by physician

  • Stigma & anonymity

  • http://www.aamc.org/members/gwims/statistics/stats09/start.htm

    Lin et al.1985. Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty. JAMA 254(19):2775-82. (Schindler et al 2006)

    “High physician suicide rates suggest lack of treatment for depression.” - MD Consult News June 11, 2008


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    Professional Wellness

    • Self-care

    • Work-place stress

    Mind, Body and Spirit

    Balance takes effort, but worth the reward!


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    Professional Wellness

    Mind

    Body

    • Self-care issues:

      • Sleep

      • Balanced meals

      • Physical activity

      • Socialization

      • Vacations/down times

      • Spiritual engagement

      • Have a physician

    Soul


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    Work-Place Stress

    Manage

    Energy

    Reduce

    Distractions

    Work-place stress:

    • Manage energy

    • Reduce distractions

    • Plan appropriately

    • Managing failures and successes

    Planning


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    “The first wealthishealth.”~ Ralph Waldo Emerson


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    Stress & Burnout

    Stress and burnout occurs for different reasons in different individuals.

    Work load ≠ level of stress or burnout in all situations.

    Multifactorial


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    Productive Stress

    No Prolonged Stress

    Declining Function

    Stress & Productivity

    Prolonged Stress

    Situational Stress

    Stressed

    Burnout

    Non-Functional


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    Burnout

    “In the current climate, burnout thrives in the workplace. Burnout is always more likely when there is a major mismatch between the nature of the job and the nature of the person who does the job.”

    ~Christina Maslach

    The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. Maslach & Leiter pg 9; 1997


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    Single

    Gender/sexual orientation

    ># of children at home

    Family problems

    Mid-late career

    Previous mental health issues (depression)

    Fatigue & sleep deprivation

    General dissatisfaction

    Alcohol and drugs

    Minority/international

    Teaching & research demands

    Potential litigation

    Risk Factors for Burnout

    Puddester D. West J Med 2001;174:5-7

    Myers MJ West J Med 2001;174:30-33

    Gautam M West J Med 2001;174:37-41


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    Work overload

    Lack of control

    Insufficient reward

    Unfairness

    Breakdown of community

    Value conflict

    Six Sources of Burnout

    Maslach & Leiter, 1997. “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.”


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    Symptoms of Burnout

    Chronic exhaustion

    Cynical and detached

    Increasingly ineffective at work

    Leads to:

    isolation

    avoidance

    interpersonal conflicts

    high turnover

    Maslach & Leiter, 1997. “The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It.” pg 17


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    Protective Factors

    • Personal:

      • Tend to self care issues first

      • Address Maslach’s 6 sources of burnout

      • Influence happiness through personal values and choices

      • Adapt a healthy philosophy/outlook

      • Spend time with family & friends

    Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50


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    Protective Factors

    • A supportive spouse or partner

    • Engage in religious or spiritual activity

    • Hobbies

    • Mentor (s)

    Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50


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    Protective Factors

    • Work:

      • Address Maslach’s 6 sources of burnout

      • Gain control over environment & workload

      • Find meaning in work

      • Set limits and maintain balance

      • Have a mentor

      • Obtain adequate administrative support systems


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    Individual Approach

    Organizational Approach

    Starts with person

    Starts with management

    Becomes organizational project

    Becomes group project

    Connects to organization

    Connects to people

    Outcomes affects related mismatches

    Outcome is a process

    Preventing & Resolving Burnout

    Figure 5.1 (pg 80) Maslach, C & Leiter, MP. “The Truth About Burnout: How Organizations Cause Personal Stress and What to do About It.” 1997


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    Case 1:

    It’s 10:30 PM and you pass your colleague in the hall. She is a 48 yo female physician, recently divorced with one kid. You can tell she was crying. When you ask what is wrong she shapes up and replies, “Nothing really. I am so frustrated with the system!” You offer to talk and she declines.

    • What are your concerns?

    • What are her risk factors for stress & burnout?


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    Suicide

    • “Friends who work with people in medicine need to be aware that, if they see something that concerns them, they need to transmit the message to the powers that be.”

      Dr. W. Gerald Austen, surgeon-in-chief emeritus

      Massachusetts General Hospital


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    Case 2:

    Dr S has struggled for the last year to “fit in.” He often seems emotionless and flat. He has been considered “unsocial” because he does not participate in any of the faculty gatherings. He has missed several deadlines and often calls in sick. His students say he doesn’t teach and is erratic at times. Once on his day off you saw him leaving a bar possibly drunk and on his post call day he was not responding to emails or pages for several hours. Just after the holidays he was found dead after a single vehicle MVA.

    • What are you concerned with here?

    • What barriers may play a role in this case?


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    Suicide

    • “However, hard and stressful work alone does not result in suicide. Those who do commit suicide almost always have significant identifiable underlying mental illnesses, such as major depression and/or bipolar disorders, usually coupled with alcoholism and major drug use.”

      ~Eugene V. Boisaubin

    Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressures of Success. Pg 32; 2009


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    Unprofessional behaviors

    Decreased performance

    Diverting drugs

    Unusual pharmacy orders

    PE signs of either intoxication or withdrawal

    Isolation & withdrawal from friends

    Mood changes

    Overreactions to criticism

    Long sleeves

    Frequent restroom stops

    Asks for extra calls

    Signs of Addiction

    Wearing Masks II. 1993 rainbow productions. www.Allanestesia.com


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    Addiction

    • Residents are more prone (especially anesthesia) than faculty

    • Increases accidental and intended deaths

    • Denial, cover-ups, easy access

    • History of addiction – individual or family

    • “Tried it just once or twice.”

    Wearing Masks II. 1993 rainbow productions. www.Allanestesia.com


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    Addiction

    • >50% residents self-prescribe1

    • ETOH most commonly used substance2

    • 10% faculty use daily; 9% binge2

    • 8% use opiates without MD supervision2

    • Recovery can be successful  treatment!

    1. Christie et al. 1998 Prescription Drug use and self-prescription among residents. JAMA 280:1253-55)

    2. Hughes et al. 1992 Prevalence of substance use among US physicians. JAMA 267:2333-39.


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    “Inaction is NOT an option.”~Dr John Lecky – recovering addicted physicianReport concerns to:SuperiorsPhysician’s Health Program – confidentialWellness Programs – FPWPFPWC Members


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    Case 3:

    Dr D is an OB/GYN who was fired from one residency program. She joined the faculty 6 mo ago. Since then, she has had five pt and staff generated complaints about her aggressive, loud behavior. In stressful situations, she becomes loud, forceful and rude. She slammed the door after a heated discussion with a nurse in front of a patient. She has also changed OR times without team permission to “take care of VIP patients.” She is quoted as saying, “This is how I get things done.”

    • What do her behaviors tell us?

    • Are her behaviors ok if her skills are outstanding?


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    Internal Factors:

    Alcohol and drug addiction

    Compulsive behavior around sexual acting out, compulsive gambling, eating, working, etc.

    Little or no training in conflict resolution, leadership skills, communication and teaching skills

    Psychiatric disorders

    Narcissistic personality disorder

    Depression/bipolar

    Dementia etc.

    External Factors:

    High system demands and low system support

    Disruptive behavior is reinforced by the system

    Bully doc gets preferential operating time

    Masking ineffective managers

    Failure to act

    The system fails to provide physician with complaints and/or feedback

    Life cycle events (i.e. death in the family, children leaving home, divorce, etc.)

    Distressed Physicians

    Swiggart, Dewey, Hickson, Finlayson. 4/09


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    Figure 1

    Spectrum of Disruptive Behaviors

    Passive

    Aggressive

    Passive

    Aggressive

    Chronically late

    Failure to return calls

    Inappropriate/

    inadequate chart notes

    Avoiding meetings & individuals

    Non-participation

    Ill-prepared, not prepared

    Inappropriate anger,

    threats

    Yelling, publicly degrading

    team members

    Intimidating staff,

    patients, colleagues, etc.

    Pushing, throwing objects

    Swearing

    Outburst of anger &

    physical abuse

    Hostile notes, emails

    Derogatory comments about institution, hospital, group, etc.

    Inappropriate joking

    Sexual

    Harassment

    Complaining,

    Blaming

    Swiggart, Dewey, Hickson, Finlayson. 4/09


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    Distressed Colleagues

    • Focus on behaviors

    • Document behaviors

    • Discuss with leadership

    • Report in VERITAS

    • Re-training can be successful


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    Distressed Physicians

    “This leadership course has brought about change in the way I perceive others and how I am perceived as a professional, husband and father. This intervention should have occurred earlier.”

    ~CPH participant 07-08


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    Resources


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    Faculty and Physician Wellness Committee (FPWC)

    Charlene M. Dewey, M.D., M.Ed., FACP (chair)


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    Vanderbilt Internal Resources


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    Vanderbilt Internal Resources

    • Center for Integrated Health (CIH)

    • Health Plus

    • Go for the Gold program

    • Center for Professional Health Educational Resource web page/on-line classroom (in development)

    • Dayani center & ortho exercise facility

    • VERITAS


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    Other Resources

    • Primary care provider

    • Centerstone, Elam Center or other private counseling services

    • Cumblerland Heights & Evelyn Fry for substance use related issues

    • 1-800-273-TALK: suicide prevention hotline

    • YMCA/YWCA

    • State physician health programs


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    Q&A


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    Summary

    • Good professional health protects both you and your career

    • Workplace stress and burnout are common in AMC – be aware of the risks and try to prevent it when possible

    • Seek assistance when needed

    • Vanderbilt has several resources to assist


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    More Information

    • Please feel free to contact us:

      • Charlene.dewey@vanderbilt.edu

      • Wiliam.swiggart@vanderbilt.edu


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    CPH & FPWC Web Pagehttp://www.mc.vanderbilt.edu/cph

    CPH

    FPWC

    Center for Professional Health * 1107 Oxford House * x6-0678


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