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3rd Annual DeGroote Interprofessional Health Leadership Conference
Dr. Brian Goldman
October 1, 2011
Doctors open up about their profession
White Coat, Black Art Body and Soul:
Health Professionals at Risk
Objectives
• ‘White Coat, Black Art’ perspective
• Burnout: definition, stats, stories
• Violence against HCPs
• Compassion fatigue: definition, stories
• Some solutions
WHITE, COAT, BLACK ART
•2007-2009: 59 x episodes2007-2009: 59 x episodes•Fifth Season: 2010-11Fifth Season: 2010-11
White Coat’s Mission:
• To reveal the true culture of medicine
• To reveal the inners workings of the health care system (warts and all)
• By telling stories from the POV of health care providers
• We’ve been holding up a mirror to you…
• What you’re about to hear are things you’ve been telling us
• In your own words
Burnout
• A stress syndrome characterized by:– Emotional
exhaustion– Decreased
satisfaction at work– Distancing from
patients and co-workers
Burnout: Stats Among MDs
• 2003 CMA Survey: nearly 50% of MDs in the advanced stages
• 2004 JAMA: analysis of 15 studies found uniformly high rates of burnout among post-graduate residents
• 2006 Mayo Clinic Study: nearly half of med students
An MD’s Story:
• John Aquino is an MD– Early 1990s: trained
in Canada, started FP in the U.S.
– Returned to Canada two years ago for personal reasons
• Since returning, he’s admitted to feeling burned out
Burnout in Nursing
• Even higher rates than MDs
• Over 50% in most studies
• Manitoba Nurses Union: 66% of junior nurses have burnout
A Recent Grad’s Story
• Deb Lowe graduated from U of Victoria in 2004– General wards– ICU
• Four years on, she suffers from burnout
• And, she’s not alone
The View from a Psychotherapist
• Francoise Mathieu• Certified Mental Health
Counselor in Kingston• Specializes in helping
HCPs with burnout• Everyone claims to have
it…– Are HCPs any different?
• “Slammed”• “Inundated”• “Swamped”
Reason #1 For Burnout: The System
A system in which patients are seen as the enemy
Factors We Can’t Control
•Global recession•HCW layoffs
•Seniors: fastest growing population segment in Canada
Statistics Canada
More and More…
AngerUnderstanding
For Those Who Can’t do Anything About It
• Especially true in hospitals – cutbacks mean fewer nurses caring for
more patients– Today’s hospitalized patients are sicker
• A significant amount of that stress is reflected in attitudes towards hospitalized seniors
• Listen to these nursing students
A Great and Paradoxical Divide Between Patients and
HCPs
The View from HCPs in the ED
Dr. John Ross, Head of ED QEII HSC
Jill Lambeth, RN at QEII HSC
So, Who’s to Blame?
• Jill Lambeth, RN, QEII HSC, Halifax: – No advanced directives
Reason #2: Violence
• HC and social service industry accounts for 48% of all non-fatal injuries from acts of violence and workplace assaults
• U.S.: costs billions in security, medical and legal expenses
• Leads to burnout, PTSD, poor job performance• “Healthcare workers are more likely to be
attacked at work that prison guards and police officers.”
Int’l Council of Nurses. Position Statement: Abuse and Violence Against Nursing Personnel
Violence in the ER• Fernandes: 57% of
ER respondents physically assaulted over a 1 year period
• Mayer: 72% assaulted at least once during their career
QuickTime™ and a decompressor
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Violence in the Hospital: Environmental Factors
• Security issues
• Public space - uncontrolled movement
• Delays/wait times
• Crowding, uncomfortable
• Volatile families
Violence in the Hospital: Staff Factors
• Inadequate staffing: working alone
• Violence during patient transport
• Lack of training• Lack of situational
awareness– Dr. Bruce Campana
QuickTime™ and a decompressor
are needed to see this picture.
QuickTime™ and a decompressor
are needed to see this picture.
Violence in the ER: Staff Factors
• Risk factors aren’t unique to the ED
• But the ED has more potential hazards
• Maria Raptis: charge nurse– Recalls a patient
with bipolar brought in by his girlfriend
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QuickTime™ and a decompressor
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Reason #3 for Burnout:Powerlessness in
Relationships• Nurse more likely
than MDs to experience it– Deb Lowe
• ER physicians more likely than other specialists to experience it
• So do students and residents
Compassion Fatigue
• Compassion fatigue, also known as a Secondary Traumatic Stress Disorder, is a term that refers to a gradual lessening of compassion over time. It is common among victims of trauma and individuals that work directly with victims of trauma. It was first diagnosed in nurses in the 1950's.
• Francoise Mathieu is an expert in compassion fatigue
Reason #4: Exposure to Traumatic Events (PTSD)
• a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma
• 50% experience at least 1 traumatic event
• only 8% dx’d with PTSD
• Very high rates among paramedics & veterans
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Vince Savoia, Executive Director of the Tema Conter Foundation
Reason #5:Factors in the Individual
• Dr. Graeme Cunningham– Medical Director, Alcohol
and Drug Treatment Program, Homewood Health Centre, Guelph, Ontario
• In public, he was a respected cardiologist
• In private, he abused alcohol to a deal with a pathological fear of failure
Burnout:The Consequences
• The System– Francoise Mathieu
• The Individual– Dr. Graeme
Cunningham– Donna Paradowski
Solution #1:Get Help
• EAP
• AWARE-NS
• Private counseling
• Other: Tema Conter (for medics)
QuickTime™ and a decompressor
are needed to see this picture.
QuickTime™ and a decompressor
are needed to see this picture.
Solution #2:Advocate
• Francoise Mathieu• Use the ‘low back
pain’ model in nursing– More resources– Less silence
Solution #3:Appreciating Our Limits
• Personal and professional
• System
Sharing the Load
• Roberta Heale and Marilyn Butcher:– 1st NP-led
primary care health clinic in Canada
– 20-30,000 orphan patients in Sudbury
Enlarging the Team
NP’s and PA’s
Family Physicians
Specialists
Enough Business for Everyone?
Three Questions to Ask Yourself
1. When you think about your life at the moment, would you say that by and large you are satisfied with life or are you mostly dissatisfied?
2. If you were asked this question five years ago, what might your answer have been then?
3. What do you think your answer to this question will be five years from now?
Thank You for the Calling You Have Embarked Upon!