Physician burnout: An emotionally malignant disease with an … · 2020. 2. 11. · PHYSICIAN BURNOUT: AN EMOTIONALLY MALIGNANT DISEASE WITH AN INNATE CURE HCMS East Branch Naim El-Aswad,

PHYSICIAN BURNOUT: AN EMOTIONALLY MALIGNANT DISEASE WITH AN INNATE CURE

HCMS East Branch

Naim El-Aswad, MD, FACP

Chief Medical Officer

Vital Signs Vital Skills, L.L.C.

March 24th, 2020

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WHY WE ARE HERE?

www.vitalsignsvitalskills.com

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“Life does not get

easier or more

forgiving, we get

stronger and

more resilient”Steve Maraboli

“Medicine arose out

of the primal

sympathy of man

with man; out of the

desire to help those

in sorrow, need and

sickness.”Sir William Osler.

The price of

anything is the

amount of life

you exchange for

it.Henry David Thoreau

CHANGE

WHERE CHANGE NEEDS TO HAPPEN


3

Healthcare Environment

Healthcare Organizations

Healthcare Individuals

…Intrinsic motivation-performing a task primarily for its own sake is the most

powerful way to change behavior…Jay Kimiecik

LEARNING MODALITY

BURNOUT DEFINITION

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It is now a DISEASE. (WHO: ICD 11)

“Syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. 3 dimensions:

1- Feelings of energy depletion;

2- Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job;

3- Reduced professional efficacy.

It is an occupational phenomenon.


BURNOUT CAUSES


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Burnout

Unmet Expectations

Lack of Control

Insufficient Rewards

Leadership

Pressure

Personal characteristics

Purpose and Need

Self-care and wellness

UNMET EXPECTATIONS, LACK OF CONTROL INSUFFICIENT REWARDS,


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THE PURPOSE OF MEDICINE

Connect, diagnose

Diagnose, Treat, Help

Connect and Treat Patients

Emotions

Behavior

P

Cognition

“Medicine arose out

of the primal

sympathy of man

with man; out of the

desire to help those

in sorrow, need and

sickness.”Sir William Osler.

PURPOSE AND NEED

Engaged: Best

physician/patient

satisfaction/outcome


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E

B

P

C

PURPOSE AND NEED


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Connecting to Purpose

Physician’s Self

Determination Theory:

Empathetically Connected

Clinically Competent

Professionally Autonomous

Behavior

P

Cognition

Emotions

Behavior

P

Cognition

I-THOU I-ITMedical Training


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Emotions“A resident’s views (own learning and practice)

and the modeling they receive (faculty)

produce a deep shift of emotions and

compassion, to self and others, from assets to

liabilities...” (Philips and Dalgarno, 2017)

COGNITION: WHAT ARE WE THINKING?


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Government

regulations

Insurance

companies

Law suits

Feedbacks,

evaluations

Personal

demands

Business

demands. Non-

medical

responsibilities

Cognitive

Scarcity

Leads to

counter-

productive

behaviors

and mistakes

Draws cognitive

resources to

urgent demands

Induces

impairments

in other

domains

Behavior

P

BEHAVIOR: WHAT ARE WE DOING?

• “How Do Residents Spend Their Shift Time? A Time and Motion Study With a Particular Focus on the Use of Computers”, Mamykina L et al, Academy of Medicine, 2016

• In a single day, residents spent 364.5 minutes (50.6%) of their shift time using computers, compared with 67.8 minutes (9.4%) interacting with patients.


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To study the phenomenon of

disease without books is to sail

unchartered sea, while to study

books without patients is not to go

to sea at all.William Osler

P

BEHAVIOR: WHAT ARE WE DOING?

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• In April 2013, researchers at Denver-based Vanguard Communications analyzed 3617 online reviews of 300 internists and Ob/Gyn’s.

• Patients who posted negative reviews were 4 times more likely to complain about a healthcare provider's indifference, bedside manner, or customer service than about his or her medical skills:

• 43.1% included complaints about poor bedside manner;

• 21.5% included complaints about medical skills, such as false diagnoses and surgical mistakes.


THE EROSION OF PURPOSE/NEED

Connect, diagnose

Diagnose, Treat, Help

Connect and Treat

Emotions

Behavior

P

Cognition

• Step I: Remove the essence of medicine by inhibiting emotions and decreasing empathy

• Step II: Occupy the cognition with non-medical tasks and responsibilities

• Step III: Evaluate behavior NOT based on medical and clinical judgement and performance but on CUSTOMER service, pay for performance, and metric attainment

Empathetically Connected

Clinically Competent

Professionally Autonomous

PURPOSE AND NEED

Engaged: Best

physician/patient


Burnout: Worst

physician/patient



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E

B

P

C

Loss of purpose in the New

World of Medicine:

What are we feeling?

What are we thinking?

What are we doing?

The New Challenge

of Medicine:

Recognize

obstacles, Bypass

obstacles, Protect

against obstacles,

Reconnect with

purpose and satisfy

need

Burnout Cannot Exist Where

Purpose LivesMatt Manero

PRESSURE VERSUS STRESS

Copyright 2016 Relly Nadler, Psy.D., MCC

Pressure is where the outcome is

important to you, it is uncertain, and

you are accountable and judged for

the results. You must deliver the

goods or suffer dire consequences.

Adversely impacts cognitive success,

downgrades behavioral skills, we

perform below our capability, often

camouflaged and is continually

increasing. Weisenger and Pawliw-Fry, (2015) Performing Under Pressure

PERSONAL CHARACTERISTICS

• Personal characteristics associated with burnout include:

• Being self-critical

• Matching the personality to the specialty

• Engaging in unhelpful coping strategies

• Perfectionism

• Idealism

• Certain personality types can affect positively or negatively


Patel S. et al, 2018. Factors Related to Physician Burnout and Its Consequences: A Review. Behavioral Sciences.

BURNOUT AND PHYSICIAN PERFORMANCE

• Observation, Reason, Human Understanding, Courage; these make the physician. ~Martin H. Fischer (1879–1962)

• Observation: Disconnected, unrealistic, can’t read clues and “checked out”

• Reason: Decreased ability to analyze, assess and think. Loss of clinical skills, and abilities.

• Human Understanding: Can’t understand or relate to others, loss of empathy

• Courage: Distant, insecure, blaming others, explosive, unpredictable and aggressive


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50 % of MD’s are

burned out at 4.2/5

severity

From: Stress and Burnout Among Surgeons: Understanding and Managing the Syndrome and Avoiding the Adverse Consequences

Arch Surg. 2009;144(4):371-376. doi:10.1001/archsurg.2008.575Vital Signs Vital Skills, L.L.C.

Resiliency/Coping

Abilities

Humanity and

empathy

Purpose/Meaning

BURNOUT MALIGNANCY MODEL

Environmental and Genetic

FactorsTime

Negative cumulative

Effects


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Lack of defenses and

ability to detect

Intervene:

Resiliency, coping,

EQ/Self-care mindset,

momentum

Use it to our advantage

Develop detection and

defense capabilities:

EQ/Self-care

Positive cumulative CHANGE

CREATE A NEW REALITY

BURNOUT AND PHYSICIAN PERFORMANCE

• Observation, Reason, Human Understanding, Courage; these make the physician. ~Martin H. Fischer (1879–1962)

• Observation: Disconnected, unrealistic, can’t read clues and “checked out”

• Reason: Decreased ability to analyze, assess and think. Loss of clinical skills, and abilities.

• Human Understanding: Can’t understand or relate to others, loss of empathy

• Courage: Distant, insecure, blaming others, explosive, unpredictable and aggressive


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Intervention

WHAT HAS WORKED SO FAR ON AN INDIVIDUAL LEVEL?

• Individual targeted approaches

• Focused small group discussions

• Providing physicians with some degree of choice

and control over their lives

• Building comradery

• Opportunity for excellence

• Developing physician leadership

• Culture change within the institution

• Coaching

• Resilience development/training

• Emotional intelligence and self-care


THE REVISED DECLARATION OF GENEVA: A MODERN-DAY

PHYSICIAN’S PLEDGE

“I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;”


HOW WELL AND HOW OFF BALANCE ARE YOU INDIVIDUALLY?


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Wellness and

life/work

balance

protect

against and

treat burnout

https://www.google.ca/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjZp9TAi8XLAhUCyYMKHdZFA1gQjRwIBw&url=https://www.flickr.com/photos/61056899@N06/5751301741&bvm=bv.116954456,d.amc&psig=AFQjCNGaTUU3AdaKrJI_Jqyt8daRIZu0Hw&ust=1458213653017743

THE ART AND SCIENCE OF MEDICINE


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IQ for Hard Skills (Science of Medicine):

Specific teachable abilities (20 %)

EQ for Soft Skills (Art of Medicine): Leadership,

teamwork, communication, problem solving,

work ethic, flexibility/adaptability and

interpersonal. (80%)

“Illustrious doctors might

have graduated from

books, but books made

not a single physician”.

Sir William Osler quoting

Paracelsus

Success in Medicine

DEFINITION OF EMOTIONAL INTELLIGENCE

Understanding ourselves,

managing ourselves,

understanding others,

managing others

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EMOTIONAL INTELLIGENCE REALMS


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UNDERSTANDING AND MANAGING SELF

Pain


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Physical

endurance

EQ/IQ

endurance

UNDERSTANDING AND MANAGING OTHERS


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EMOTIONAL INTELLIGENCE IN MEDICINE

• Decreasing/diagnosing/preventing Burnout

• Needed for the skills of the 21st century physician

• Needed for personal and professional development

• Needed in the ACGME competencies

• Tied to physician satisfaction and mission

• Tied to physician wellness

• Tied to patient satisfaction

• At the core of LEADERSHIP


PHYSICIAN PERFORMANCE

Resiliency

Coping

abilities

Adaptive

mechanisms

Humanity

and empathy

Physician

Physician-Patient InteractionDecision Making

Engaged Burnout

Emotional Intelligence

Wellness

Institutional

Political

Social

Governmental

Professional


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AAA APPROACH

• A: Awareness

• A: ACKNOWLEDGEMENT and ASSESSMENT

• A: ACTION


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TIME TO CHANGE…BUT


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EMBRACING THE NEW CHANGE

MINDSET

WELLNESS

COACHING


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MOMENTUMEOMTIONAL

INTELLIGENCE

WHERE CHANGE NEEDS TO HAPPEN


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Healthcare Environment

Healthcare Organizations

Healthcare Individuals

MINDSET38


“A set of beliefs

or a way of

thinking that

determines one’s

behavior,

outlook, and

mental attitude”

“Those who

cannot change

their minds

cannot change

anything”George Bernard Shaw

4 MINUTE MILE - MOTIVATION If Someone Else Has Done it You Can Do It! MUST SEE Best motivation Les Brown.mp4

SIGNS YOU NEED TO CHANGE YOUR MINDSET

✓ You continuously focus on what is wrong

✓ You mourn your failures without celebrating your success

✓ You don’t want to face the truth

✓ You get angry when your expectations are not met

✓ You feel unsatisfied or unhappy with everything you have

✓ You are constantly fighting with the ones you care about

✓ You think about what you have to do and not what you get to

do

✓ You see yourself as a victim

✓ You hold on to other people’s dreams

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TIPS TO WORK ON YOUR EMOTIONAL INTELLIGENCE

•ACKNOWLEDGE EMOTIONS!!!!!!• Take an assessment test (EQi, MSCEIT,…). Find out where you are, where you

are strong and where you need help.

• Make a mental memory of your own reactions. Self analyze.

• Few times a day, STOP, and observe your emotions. Listen to your own mind.

• Know your positive and negative triggers. Enhance positive reactions, modify negative reactions.

• Identify the emotion: name it to tame it


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WELLNESS/SELF-CARE

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• Rules of wellness:• At the heart of wellness: Self-love,

Self-compassion, and Self-care

• Four steps to successful wellness:• Deciding (Develop the mindset) • Taking control (Take control from what life

robs you off. Take it!)• Taking time (Take time from what prevents

you to do so. Take it!). Your time for your wellness is SACRED

• Creating a habit


WELLNESS ACTIVITY: WHEEL OF WELLNESS

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• Use a scale of 0 to 10 (0 being the least and 10 being the most) to write down your personal wellness score for each realm using the wheel below.

• Identify one activity that you can do to improve your score along each realm.

• Set a plan of action to achieve that activity.

• Complete the activity.


BUILDING RESILIENCE*

• Make connections

• Avoid seeing crises as insurmountable problems

• Accept that change is a part of living

• Move toward your goals

• Take decisive actions

• Look for opportunities for self-discovery

• Nurture a positive view of yourself

• Keep things in perspective

• Maintain a hopeful outlook

• Take care of yourself APA: American Psychological Association


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COACHING

SUCCESS


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Assessments:

BurnoutEQ

Personality

Resilience

GritOthers

INNATE CUREwww.vitalsignsvitalskills.com

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Stress/Burnout

Factors

Training

Practice of

medicine

Positive

Emotions/

Mood

Negative

Emotions/Mood

Mindfulness/Wellness/

EI training/Coaching

Cognitive abilities, self-

control, Emotional

Intelligence, IQ

P/P Satisfaction

Hijack, loss of IQ, loss

of will power, Lower

EQ

Problem solving and

creativity

Choose how to

respond to stressInstitutional

Changes/Outside

Factors

Purpose/Need of

medicine

BECOME A RED FISH!


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Knowing is not

enough. We mustapply.

Willing is not enough.

We must do.Johann Wolfgang von Goethe

ADDING THE MISSING INGREDIENT


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Change Should Do Into Must Do And Be Extraordinary.mp4

WHAT’S NEXT?

• Identify: Your burnout, your abilities, your assets, your limitations

• Mindset: Decide not only that you SHOULD change, but that you MUST and WILL change

• Enhance: Your EQ, self-care, and resilience

• Plan: With or without a coach, outline a plan of action based on your parameters.

• Assess and adjust: “Adapt what is useful, reject what is useless, and add what is specifically your own.” Bruce Lee


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SOME PRACTICAL TIPS: ON AN INSTITUTIONAL LEVEL

• Identify a “champion”. A leader for the cause needs to emerge and take charge.

• Identify the needs (Survey, open communications and discussions, suggestions)

• Outline your goals

• Identify resources (available and needed)

• Develop an action plan

• Assess and reevaluate

• Fine tune, and re-commit

• Involve management


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• “In a battle all you need to make you fight is a little hot blood and the knowledge that it’s more dangerous to lose than to win.” George Bernard Shaw

• “No matter how great the talent or efforts, some things just take time. You can’t produce a baby in one month by getting nine women pregnant.” Warren Buffet

• 21 days to create a habit, 60 days to fix it, 90 days to anchor it


SOME REFLECTIONS

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To know even one life has

breathed easier because

you have lived, this is to

have succeeded. -Ralph Waldo Emerson

“He who has a Why to

live for can bear almost

any How”Nietzsche

Momentum=(Focus +

Action)*ConsistencyMichael McQueen

Contact Information:

Naim El-Aswad, MD, FACP

[email protected]

[email protected]

mailto:[email protected]:[email protected]://www.vitalsignsvitalskills.com/

Documents

Physician burnout: An emotionally malignant disease with an … · 2020. 2. 11. · PHYSICIAN BURNOUT: AN EMOTIONALLY MALIGNANT DISEASE WITH AN INNATE CURE HCMS East Branch Naim El-Aswad,