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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

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

purpose
Purpose
  • To raise awareness of issues related to professionalism and professional health and to provide an overview of key resources in/outside of Vanderbilt.
participant objectives
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.
agenda
Agenda
  • Professional Wellness
  • Workplace stress, burnout and suicide
  • Distressed behaviors
  • Resources
  • Q&A and Summary
professional health spectrum

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
importance evidence
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.

importance evidence7
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

professional wellness
Professional Wellness
  • Self-care
  • Work-place stress

Mind, Body and Spirit

Balance takes effort, but worth the reward!

professional wellness9
Professional Wellness

Mind

Body

  • Self-care issues:
    • Sleep
    • Balanced meals
    • Physical activity
    • Socialization
    • Vacations/down times
    • Spiritual engagement
    • Have a physician

Soul

work place stress
Work-Place Stress

Manage

Energy

Reduce

Distractions

Work-place stress:

  • Manage energy
  • Reduce distractions
  • Plan appropriately
  • Managing failures and successes

Planning

stress burnout
Stress & Burnout

Stress and burnout occurs for different reasons in different individuals.

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

Multifactorial

stress productivity

Productive Stress

No Prolonged Stress

Declining Function

Stress & Productivity

Prolonged Stress

Situational Stress

Stressed

Burnout

Non-Functional

burnout
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

risk factors for burnout
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

six sources of burnout
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.”

symptoms of burnout
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

protective factors
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

protective factors19
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

protective factors20
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
preventing resolving burnout

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

case 1
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?
suicide
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

case 2
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?
suicide25
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

signs of addiction
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

addiction
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

addiction28
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.

slide29

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

case 3
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?
distressed physicians
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

slide33

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

distressed colleagues
Distressed Colleagues
  • Focus on behaviors
  • Document behaviors
  • Discuss with leadership
  • Report in VERITAS
  • Re-training can be successful
distressed physicians35
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

faculty and physician wellness committee fpwc
Faculty and Physician Wellness Committee (FPWC)

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

vanderbilt internal resources40
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
other resources
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
summary
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
more information
More Information
  • Please feel free to contact us:
    • Charlene.dewey@vanderbilt.edu
    • Wiliam.swiggart@vanderbilt.edu
cph fpwc web page http www mc vanderbilt edu cph
CPH & FPWC Web Pagehttp://www.mc.vanderbilt.edu/cph

CPH

FPWC

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