Andrée Rochfort MICGP LFOM Director ICGP Health in Practice Programme ICGP AGM 2012

Transcription

1 Andrée Rochfort MICGP LFOM Director ICGP Health in Practice Programme ICGP AGM 2012

2 Learning Outcomes Reflect on: The impact of your work on your life, and on those who are important to you Your life outside of work. Your relationship with your work. If you want to have nothing else in your life but your work then this workshop is not the place for you now!

3 In this context Let us review and discuss some of the published work on this topic

4 What is Work-Life Balance? Work-life balance is about ensuring work doesn't take up more of your life than it should. WorkSMART: Work-life balance is about ensuring work doesn't take up more of your life than you want it to. Emma Sedgwick. How to achieve a work life balance. BMJ Careers.

5 Developing Healthy Practices During your career you spend your time... with your patients, helping them to cope with the challenges of life with your practice, planning patient care processes and practice organisation activities with your work colleagues, supporting them Don t feel guilty taking a few minutes today, and other days, to reflect on balancing your work with the rest of your life, and preventing or minimising burnout.

6 Nobody on their deathbed ever declared, I wish I'd spent more time at my work!

7 Balancing Act: What are the relative sizes of your jigsaw pieces? self family work community ICGP; HiP 7

8 Assess your own quality of Work Life Balance Time - what do you spend your 24hrs on? Work Family Friends? Money Happiness Physical Exercise Relaxation Hobbies?! Don t become another doctor...who used to... ICGP; HiP 8

9 What is Burnout? Burnout is a state of chronic stress due to workplace problems, in which people become negative, feel they are being controlled by excessive demands and feel they are not exercising choice. They may start to pull away and stay away from colleagues and lose a sense of job satisfaction. It s the opposite of engagement Burnout Syndrome a disease of modern societies? A. Weber and A Jaekel-Reinhard, University of Erlangen-Nuremberg, Germany.

10 Burnout Burnout is a word commonly used to mean anything from being tired to having a nervous breakdown. It can be defined as a work-related syndrome associated with high scores on the Maslach Burnout Inventory (MBI), three domains of EE Emotional Exhaustion DP - Depersonalisation PA Personal Accomplishment decreased

11 UK 2012 Burnout in GPs Orton, Orton & Gray A cross-sectional survey was designed to assess levels of burnout in a census sample of GPs in Essex, UK, and to determine which doctor- or practice-related variables predicted higher levels of burnout. High levels of burnout were reported in the census surveyed 46% doctors reported emotional exhaustion, 42% reported depersonalisation and 34% reported low levels of personal accomplishment.

12 Conclusion of UK Study: Despite experiencing substantial depersonalisation, doctors feelings of burnout were not detected by patients or independent observers. Such levels of burnout are, however, worrying and imply a need for action by doctors themselves, their medical colleagues, professional bodies, healthcare organisations and the Department of Health. Peter Orton, Christopher Orton, Denis Pereira Gray BMJ Open 2012;2: e doi: / bmjopen

13 CMA Burnout Study The 2003 Canadian Medical Association Physician Resource Questionnaire found 45.7 percent of responding Canadian physicians reported symptoms in keeping with advanced stages of burnout F. Joseph Lee, Moira Stewart, Judith Belle Brown Can Fam Physician 2008;54:234-5.e1-5

14 What sort of doctor gets Burnout? Even the strongest and healthiest of physicians can become ill in an unhealthy environment.

15 Pressure to be Superman or Superwoman! Where does this pressure come from? ICGP; HiP 15

16 Acknowledgement for next slides Mamta Gautam, MD, is a psychiatrist in private practice in Ottawa and an assistant professor in the Department of Psychiatry at the University of Ottawa. Physicians make up her entire patient population. She is the founding director of the University of Ottawa faculty Wellness Program. She is the chair of the Expert Advisory Group to the newly launched CMA Centre for Physician Health and Wellness

17 Before Burnout: How Physicians Can Defuse Stress M Gautam, MD Source full text article at: The factors that lead to stress among physicians are many and varied. They can be largely divided into 2 categories: personal factors unique to the physician, and workplace factors

18 Common personality traits that predispose to stress...burnout We are very conscientious and spend a lot of time and energy attending to details and to the needs of others. There is an exaggerated sense of responsibility and a need to fix things even when they are beyond our control and a feeling of guilt if we do not meet these perceived responsibilities. We have unrelenting "perfectionistic" traits, constantly striving to do more and be better. This makes it difficult for us to delegate. M. Gautam

19 Doctors are concerned with OTHERS Physicians have difficulty relaxing and taking care of themselves. Physicians like to be in control and to have control of things and people around them. Much energy is spent in attempts to please everyone, but we are often left with the feeling that we have pleased no one. If we receive positive feedback, approval, love, we are not comfortable with this and dismiss or minimise it. M. Gautam

20 Chronic self-doubt There can be chronic self-doubt and insecurity, with a sense of being an imposter and having fooled people so far. Thus, we fear having our cover blown; losing our power and authority, and being "found out." Someday somebody might discover we don t know something. Feeling inadequate and delaying our own gratification prevents us from doing the very things we need to do to better manage our stress. M. Gautam

21 Striving for perfection Additionally, we are masters of self-denial and delayed gratification. We put off meeting our own needs until everything else is done, or everyone else s needs have been met. Often, our own needs go unmet. Being perfect, conscientious, responsible, and in control requires time and energy. These personality characteristics are part of the reason we succeed. However, they also make us more vulnerable to stress. M. Gautam

22 How Toxic is your workplace? Factors in the workplace add to our stress. The workplace is full of pressure to do more with less, as doctors struggle to maintain a high standard of patient care in a changing health care system with fewer financial and personnel resources. Our working day extends into our evenings, nights and weekends...administration, paperwork, planning. Out of hours care. We do not get enough sleep. We do not feel fully equipped to run the business side of our practice on top of the clinical responsibilities. M. Gautam

23 Demands on us The patients are demanding. We may feel their expectations are unrealistic. We cannot meet everyone's expectations. We are constantly exposed to illnesses, problems and distress. There is a risk of aggression and violence. Concerns about potential litigation and complaints are real. We do not always feel we have control over how we have to practice medicine. We have little time to stay up to date with information, read journals, and attend conferences. We lack time for our families or loved ones. Even less time remains for ourselves. M. Gautam

24 Peer supports at work? Not only are GPs and other doctors feeling stressed, they are working with colleagues and health care personnel who may also be feeling the same way and who therefore cannot provide support M. Gautam

25 Warning signs of Burnout Initially, we feel emotionally exhausted. We manage to get through the day at work, but have little else to give. Later, we are exhausted, irritable, and impatient. It can be so difficult to be with others we withdraw and prefer to isolate ourselves. We begin to feel negative about people and work we used to enjoy. We develop a reduced sense of accomplishment and satisfaction from our work and can become cynical and distant. M. Gautam

26 Possible effects of burnout Practicing physicians who are burnt out may be subject to complaints or litigation. Emotional illnesses can result such as anxiety disorders, eating disorders, addictions, depression, and suicide Physicians at this stage often consider leaving the profession of medicine. M. Gautam

27 Solutions? There are a range of solutions to this multifaceted issue Here I will list some areas to tackle as illustrated in M. Gautams featured article. The main approach to dealing with stress is to remember the cause of stress.

28 Focus on what you control Regardless of the source, stress comes down to one thing: in a given situation, we feel stressed because we do not feel we have any choice or control. Yet, this is only our perception. In reality, we have more control than we think. We focus on controlling and changing things around us, and so, appropriately, feel we have no control. The only factor we control is us, our thoughts, feelings, expectations, behaviors, strengths, and weaknesses. We must learn to identify what part of the situation is under our control and focus on that. M. Gautam

29 Some specific strategies that can prevent burnout: First and foremost, take care of yourself well. Make time for yourself. Eat regular healthy meals daily. Develop good sleep habits. Don t bring work to bed. Exercise regularly and stay fit. Walking is free and does not need an appointment or up front membership fee. Learn relaxation techniques. Get a GP and consult him or her yearly or as needed. M. Gautam

30 Manage YOUR time Learn to manage your time efficiently at work. Be organised, be creative, schedule commitments realistically, and try not to over-commit yourself. Recognise and accept that you cannot do everything, be everything, know everything. Set priorities that include yourself, and your family and friends. Set and maintain limits. Learn to say "No." Stop trying to please everyone. M.Gautam

31 More time management Take regular breaks and holidays. Do not wait for a crisis to force this. Day trips work wonders. Picnics in nice places. Walk by water, river, lake or the sea. Drive without radio or music. Sometimes, do something you want to do, not something you have to do. It s okay to sit or walk and to do NOTHING. M.Gautam

32 Good enough is good enough Anticipate and prepare for situations, both at home and at work. Don t spend time trying to do things "the way it has always been done," or the "perfect" way. Look for options. Set realistic expectations of yourself. Accept that good enough is good enough. M.Gautam

33 Make space for non-work Make it a rule not to take your work home. If you have to do this, it should be the rare exception to the rule. At home, define when and where you will work, and stick to these parameters. Give your family and friends your full attention when you are with them. Laugh more often. Look for and enjoy humour on a regular basis. Share a laugh with family, friends, and colleagues. Add fun to work, hobbies, family. M.Gautam

34 Value of time well spent Guilt is the main reason why physicians do not make changes to manage their stress. Take time for yourself and your family and friends without feeling guilt. Acknowledge your guilt, and let it go. See this time as an investment that strengthens you and allows you to be better available for all your other responsibilities. M.Gautam

35 Supports Seek and use supports. Make your family a priority. Have at least 1 good friend. Share concerns with trusted colleagues. Reach out and get a mentor or confidante. Ask for help if needed. Foster a team spirit at work to create supports there. M.Gautam

36 Money Being financially overcommitted is the second most common reason that physicians do not make changes to decrease their level of stress. Create a financial plan. Stick to basic principles, and reduce non-deductible debts. Learn to say no to extravagance. Keep it simple. Do not live beyond your means. M.Gautam

37 Life goes on...all around us While the stress of medicine will always be present, we can make it work for us by making an effort to keep it positive, motivating, and enriching.

38 How often should we make Time to self assess our own work situation? Time to reappraise our goals? Time to reflect on helping colleagues in difficulty?

39 Recognition and Appreciation As humans, we need to feel appreciated for what we do. The medical workplace is not generally known for praise and encouragement. As a group, you can explore ways to make someone feel appreciated and encourage doing this more often. Some ideas include writing a short thank you note on a Post-it and sticking it to paperwork, celebrating birthdays and special events as a group, and sending flowers or small gifts. M.Gautam

40 Workplace dynamics Being busier than ever before, we may not have the time to promote a sense of community and connection in our workplace. We are too busy to take the time to get together to eat lunch or go for a walk. It is now easier and quicker to send off a quick text or than to take the time to seek out a colleague to talk with them. Thus, we feel increasingly isolated. Find ways to communicate in person, stay connected and work as a group in the practice. Relate to colleagues as people, not just someone with whom you work. M.Gautam

41 Help all practice team members to feel more appreciated Some groups suffer from a sense of lack of fairness and respect for each other's contributions. It is best when your group can accept that the value of work is dependent on the time it takes to do it. That is, an hour of clinical work is as valuable as administrative work, teaching or research. Take time to address it. Take time to listen to and understand each other,. Issues and goals can be raised. This must be followed by regular updates to maintain the relationships and priorities. Expressing appreciation is a good way to connect and restore morale. M.Gautam

42 Take back some control If you feel there is a sense of lack of control and choice over issues at work. It helps to address this openly, and identify as a group what you can and cannot control. You can't control that resources are limited; but you can control some aspects, such as what you have available to care for patients, how you work together and how much you work. M.Gautam

43 Tips from Palliative Care Specialists Self-care of Physicians Caring for Patients at the End of Life : Being Connected... A Key to My Survival JAMA, March 18, 2009 Vol 301, No. 11 Michael K. Kearney, MD Radhule B. Weininger, MD, PhD Mary L. S. Vachon, RN, PhD Richard L. Harrison, PhD Balfour M. Mount, MD

44 Surgeons and burnout? All surgeons deal with stressful times in their personal and professional life and must cultivate habits of personal renewal, emotional self-awareness, connection with colleagues, adequate support systems, and the ability to find meaning in work to combat these challenges As surgeons, we also need to set an example of good health to our patients and future generations of surgeons Combating stress and burnout in surgical practice: a review. Adv Surg. 2010;44:29-47 (John Hopkins University, USA)

45 Surgeons review the meaning of their work... The practice of surgery offers the potential for tremendous personal and professional satisfaction... but with significant challenges, which can lead to substantial personal distress for the individual surgeons and their family By identifying the priorities of their personal and professional life, surgeons can identify values, choose the optimal practice type, manage the stressors unique to that career path, determine the optimal personal work-life balance, and nurture their personal wellness. Adv Surg. 2010;44:29-47 (John Hopkins University, USA)

46 Tips from the surgeons It helps doctors to know that they are not alone and that many of their colleagues face similar issues. It is important that surgeons do not make the mistake of thinking: "I must not be tough enough," or "no one could possibly experience what I am going through." Those surgeons most dedicated to their profession and their patients may very well be most susceptible to burnout Being proactive is better than reacting to burnout after it has damaged one's professional life or personal wellness Adv Surg. 2010;44:29-47 (John Hopkins University, USA)

47 Recognising and Intervening Surgeons must also be able to recognise how and when their personal distress affects the quality of care they provide (both in the delivery of care and in the emotional support of patients and their families). Additional research in these areas is needed to elucidate evidence-based interventions to address physician distress at both the individual and organizational level to benefit the individual surgeon and the patients they care for. Silence on career distress, as a strategy, simply does not work among professionals whose careers, well-being, and level of patient care may be in jeopardy. Adv Surg. 2010;44:29-47 (John Hopkins University, USA)

48 Maintaining these values and healthy habits is the work of a lifetime...and an important part of continuous professional development Balch CM & Shanafelt T., Johns Hopkins Department of Surgery, Baltimore, MD

49 It s your Life - to balance ICGP; HiP 49