Roadmap The Science of Burnout What Is It, What Causes It, and What Makes It Go Away Define burnout and discuss its impact Describe risk factors and protective factors Define compassion fatigue, secondary traumatic stress, and compassion satisfaction Discuss strategies for preventing burnout and promoting compassion satisfaction Diana Coffa, MD Residency Program Director, Family and Community Medicine UCSF, San Francisco General Hospital Herbert Freudenberger s original conception of burnout 1. Compulsion to prove oneself 2. ing harder 3. Neglecting needs 4. Displacement of conflicts 5. Revision of values 6. Denial of emerging problems Herbert Freudenberger s original conception of burnout 7. Withdrawal 8. Obvious behavioral changes 9. Depersonalization 10.Inner emptiness 11.Depression 12.Burnout syndrome physical and emotional collapse 1
The concept was refined by Christina Maslach, developer of the Maslach Burnout Inventory Emotional exhaustion Cynicism and depersonalization Loss of sense of efficacy Impact of Burnout 25-75% of practicing physicians have burnout at any given time. Over a career, periodic episodes of burnout are virtually inevitable Impact of Burnout Increased rates of Depression Anxiety Suicidality Increased inflammatory markers Possible association with cardiovascular disease Increased sick calls Attrition from medicine Increased Adverse impacts spread Errors, both medical and surgical Patient dissatisfaction Postoperative recovery times Wound infections Patient nonadherance 2
Related Factors Lack of control Heavy workload Exposure to trauma Related Protective Factors Lack of control Heavy workload Exposure to trauma Shared mission Flexible schedule Teamwork friends Supportive culture Teaching and administrative roles Opportunity for sense of effectiveness in the short to mid term 3
Factors Lack of control Heavy workload Exposure to trauma Shared mission Flexible schedule Teamwork friends Supportive culture Teaching and administrative roles Temperament and personality features Alexithymia Life stress history of trauma Approach to work Surface organized Must be just so Surface disorganized Overwhelmed Deep approach Approach to work Interested and engaged by complexity, problem solving McMannus IC et al. Stress, burnout and doctors attitudes to work are determined by personality and learning style: A twelve year longitudinal study of UK medical graduates. BMC Medicine 2004. 2:29 4
Protective Factors Relationships with patients Relationships with colleagues Social support Empathetic concern Openness to new experience Deep approach to work Lack of control Heavy workload Exposure to trauma Shared mission Flexible schedule Teamwork friends Supportive culture Teaching and administrative roles Temperament and personality features Alexithymia Life stress history of trauma Approach to work Relationships with patients Relationships with colleagues Social support Empathetic concern Openness to new experience Deep approach to work Self-care practices Meditation Exercise Outside interests Psychological practices Therapy Special training Micro-breaks Vacations Meditation Increased attentional control Increased ability to notice and accurately label emotions Decreased impulsive reaction to negative emotion Shift from brooding or perseverative style to compassionate noting style of awareness Increased positive affective states Happiness, joy, love, gratitude, contentment, hope, interest, amusement, awe Increased internal resources: greater purpose in life, improved resilience, enhanced optimism, greater mindfulness, more self-acceptance, more hope 5
Gratitude list Psychological Practices Taking in the good Perspective taking Deep breath Visualization Micro-breaks Short, dispersed throughout day -related Conversations with colleagues Physical Walk down the hall Stretch Relaxing Deep breath Visualization Words Vacations Other Models Reduced work related stress and burnout for 1-2 months Shorter if high workload upon return Consider shorter, more frequent vacations Secondary Traumatic Stress Compassion Fatigue Compassion Satisfaction 6
What is Compassion Satisfaction? The satisfaction derived from being able to help others. Incentivizing with money is a self-fulfilling prophecy of cynicism. We must promote compassion, courage, and wisdom among our physicians before we make a sordid business of this high and sacred calling. The Impact of Compassion Satisfaction Studies on the impact of emotional attunement and engagement Higher adherence to medications and recommendations Increased patient satisfaction Increased placebo response Describe a time when you felt compassion satisfaction at work What were the conditions that promoted it? Your assignment Notice the moments when you experience compassion satisfaction. Can you build those conditions in to your work more? Feel it when it happens. Look for ways to build more in. 7