Post on 24-Aug-2020
1©Jay Kaplan, M.D. 2013
Wellness and Well-Being:Avoiding Burnout and
Staying Resilient
Jay Kaplan, MD, FACEP
Member, ACEP Board of Directors
Practicing Clinician and Director, Service/Operational Excellence, CEP America
Upfront Questions
What do you want?
Are you getting it?
If yes, how do you plan on keeping it?
If no, how do plan on getting it?
2©Jay Kaplan, M.D. 2013
Emergency Medicine
Gen Internal Medicine
Int Medicine Subsp
General Pediatrics
General Surgery
Mean
Orthopedic Surgery
Family Medicine
Ob/GYN
Gen Surgery Subsp
Preventive Med/Occ Health
Burnout and Satisfaction with Work-Life Balance – Arch Int Med August 2012Physicians who reported burnout: 45.8%
3©Jay Kaplan, M.D. 2013
Medical Residents & Burnout Journal of Medicine 09/12
Residents who reported burnout symptoms
Feelings of depersonalization
Quality of Life “as bad as it could be”
51.5%
28.9%
14.8%
Nursing Morale Survey 2007
Feel they are too busy to provide the care they would like
Would recommend nursing as a career:
Would leave nursing if they could:
55%
49%
28%
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Real-Time Professional Sources of StressReal-Time Professional Sources of Stress
Work at all hours of the day and night
Malpractice litigation
Risk of infectious disease exposure
Risk of violence
Illness/impairment
Loss of connection to purpose
Stress (Day to Day)Stress (Day to Day)
Unpredictability of each day
Constant pressure for perfection
diagnosis (risk of malpractice complaint)
service (risk of patient complaint)
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More Specifically . . .
Critically ill patients, one after another
“Difficult” Patients (Intoxicated, Angry, Entitled, Drug-Seeking)
Staffing shortages
EHR/Computer anything
Limited resources of facility
Drug shortages
How much of it will
there be?
How Quickly It
Does Burn?
Add to all that, Living in the real world . . .
6©Jay Kaplan, M.D. 2013
“Well-Being” “Burnout”“Well-Being” “Burnout”
Involvement and Engagement
Patience and Compassion
Feeling of Fit and being a part of a greater whole
Exhaustion, Cynicism, Indifference
Anger, Bitterness, Frustration
Alienation and Isolation
StressStress
Stress = a nonspecific response of the body to any demand.
Stressors may be pleasant or unpleasant.
One system is the weakest and first affected by stressors.
Stress = a nonspecific response of the body to any demand.
Stressors may be pleasant or unpleasant.
One system is the weakest and first affected by stressors.
7©Jay Kaplan, M.D. 2013
Neuroendocrine-NeuroimmuneStress Response SystemNeuroendocrine-NeuroimmuneStress Response System
Immune systemImmunocyte behaviore.g., cytokine release
Limbic SystemHypothalamus
PituitaryAdrenals
Sympathetic nervoussystem
Aminergic Changes
Stress
Stress - Cannon & SelyeStress - Cannon & Selye
Homeostasis - the body’s balancing act
General Adaptation Syndrome (3 stages)
1) Alarm– Shock phase
– Countershock phase
2) Resistance
3) Exhaustion/Renewal
Homeostasis - the body’s balancing act
General Adaptation Syndrome (3 stages)
1) Alarm– Shock phase
– Countershock phase
2) Resistance
3) Exhaustion/Renewal
8©Jay Kaplan, M.D. 2013
Homeostasis
Waking
Excitement
RelaxingDigesting
Sleeping
Running
Perceived Threat Sympathetic Outflow
Perceived threat
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Parasympathetic Outflow Renewal
Cause and Effect
Causes:
Difficult patients
Difficult families
Difficult consultants
Circadian disruption
Litigation fears
Reimbursement fears
Job security fears
EHR
Staffing shortages
Effects:
Cynicism
Negativity
Difficulty sleeping
Substance use
Anxiety
Marital problems
Depression
Exhaustion
Alienation
Past Learning
Past Learning
PerceivedThreat
PerceivedThreat
Sympathetic DominanceSympathetic Dominance
10©Jay Kaplan, M.D. 2013
Parasympathetic v. Sympathetic
Sympathetic Dominance• Compromised Cognitive and
Motor Functioning
• Reactive
• Repeating Same Mistakes
• Coercive or Hesitant Leader
Parasympathetic Dominance• Maximal Cognitive & Motor Functioning
• Intentional
• Creative Problem Solving
• Transformative Leader*Slide courtesy of CEP America Resiliency Course
Optimal Performance:
p
11©Jay Kaplan, M.D. 2013
PNI - Effects of StressPNI - Effects of Stress
Increased cortisol and epinephrine
Higher number and NK cell activity
Decrease in % of helper to inducer cells, helper to suppressor-cell ratios
Lower levels of S-Ig A, Ig A, Ig G, Ig M
Increased illness and morbidity
Avoiding Burnout: Tactics for WellnessAvoiding Burnout: Tactics for Wellness
A painting by Edward Hicks (1780)–1849))
12©Jay Kaplan, M.D. 2013
1. Don’t miss the boat.
2. Remember we are all in the same boat.
3. Plan ahead. It wasn’t raining when Noah built the Ark.
4. Stay fit. When you’re 600 years old, someone may ask you to do something very big.
5. Don’t listen to critics. Just get on with the job that needs to be done.
6. Build your future on high ground.
Tactics for Wellness Learned From NoahTactics for Wellness Learned From Noah
Lessons
7. For safety’s sake, travel in pairs.
8. Speed isn’t always an advantage. The snails were on board with the cheetahs.
9. When you’re stressed, float a while.
10. Remember the Ark was built by amateurs, the Titanic by professionals.
11. When you’re in a storm, if you feel connected, there will always be a rainbow after the storm.
13©Jay Kaplan, M.D. 2013
1. Don’t Miss the Boat
This life is not a dress rehearsal
Identify who you want to be, what is important to you, what you want to do, the legacy you want to leave
Tactic: Personal Mission Statement (Write down what is important to you)
I am:A student of lifeA teacher by exampleA feeler of feelingsA devoted fatherA grateful husbandConnected to people
to spirit andto myself
Willing to love and be lovedAnd to use mind heart and soulTo make a differenceSeeking guidance, inspiration and joy
JAK Mission Statement
14©Jay Kaplan, M.D. 2013
2. Remember We’re All in the Same Boat
It is about the people who surround you, and choosing those who will support your strengths and help you with
your opportunities . . . It is about everyone on
board, paddling together . . .
Tactic: Choose carefully who you spend time with and who you surround yourself with.
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3. Plan Ahead . . . It Wasn’t Raining When Noah Built the Ark
Determine your key metrics
Define where you are/Set goals for where you want to be
Tactic - Do a Self-Assessment –How Is Your Balance?
16©Jay Kaplan, M.D. 2013
The Adult Apgar
– Shay Bintliff, M.D., FACEP
Write out a “Joy List”
Create a formal “Renewal Investment Plan”
1000 Marbles Exercise
Tactics
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Treat your body as your temple.
Get enough rest.
Eat whatever diet works for your body.
Exercise is a great drug.
4. Stay Fit – When You’re 600 years Old, Someone May Ask You To Do Something Really Big . . . 4. Stay Fit – When You’re 600 years Old, Someone May Ask You To Do Something Really Big . . .
TacticsTactics
Rest/SleepSet a goal for rest timeAvoid alcohol, caffeine, meals close to bedtimeShift work – family cooperation, heavy curtains, white noise, blindfoldsSet alarm for when to go to bed
Note: If you get < 6 hours of sleep a night, your risk of coronary heart disease is increased 48% and risk of stroke 15%
FoodBreakfast is an important meal.Different strokes for different folks.
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Exercise, andregularly.
Exercise is a great drugExercise is a great drug
Get a Heart-Rate Monitor Watch.
19©Jay Kaplan, M.D. 2013
5. Don’t Listen to Critics . . . Just Get On with the Job that Needs to be Done
There’s a difference between being a “Winner” and a “Whiner”
Glass Half-Full v. Half-Empty
It’s a choice we make every day, or several times a dayDr. Whiner, c. 2000
No one is going to
create a great place for us to
work or for our patients to receive care unless we
participate . . .
“Where’s There’s No Gardener, There’s No Garden”
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“It had long since come to my attention
that people of accomplishment rarely
sat back and let things happen to them.
They went out and happened to things.”
Leonardo De Vinci
Tactic
Do more than just your job.
Attend your department meetings.
Become a medical staff leader in your hospital.
Get involved with your state medical society or with the AMA
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6. Build Your Future on High Ground
Integrity
Always act in the best interest of the patient.
We need to be willing to be honest with ourselves and hold ourselves accountable to standards.
Courageous humility – acknowledge and apologize when appropriate . . . and quickly . . .
Make Your Workplace
A Family A School
7. For Safety’s Sake, Travel in Pairs
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Colleague as Customer
“What can I do to help you have a great day in working with me today?”
The Simplest Recognition: Saying “Thank you” at the
end of the day (shift)
Say Thank You More
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8. Speed Isn’t Always an Advantage . . . The Snails Were On Board with the Cheetahs
“There is more to life than merely increasing its speed.”
--Gandhi
Tactic: Electronics Free Days Off
Turn off your smartphone
Do not feel guilty if you do not answer text messages.
Automatic reply for emails – “I am taking an electronics-free day off . . . Please contact me on _____.
24©Jay Kaplan, M.D. 2013
Schedule time off . . . just for you . . .Electronics Free
Time Aloneand
Time Together
9. When You’re Stressed, Float a While
“Burnout is the chronic condition of perceived demands outweighing perceived resources.”- Gentry & Baranowsky 1998
“Compassion fatigue is burnout + secondary traumatization.” - Figley 1995
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Tactic - “We are human beings,not human doings.”
Tactic - “We are human beings,not human doings.”
No one ever went to his/her deathbed wishing to have gone to work more.
“Work” harder on yourself/your family than you do on your job.
A Key Tactic to Avoid Overwhelm
Practice saying “NO”
If you can’t say “No,” say “Oh”
Look for the big “YES”
Remember Bob Dylan
26©Jay Kaplan, M.D. 2013
Real-Time On-The-Job Self-Regulation Skills
Awareness of the body’s physiologic responses to stress
Intentionality/Mindfulness
Self-regulation
Breathing
Relaxation
Community support
Laugh . . . Have Fun
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When you first start doing anything, you are not going to do it well.
Experts become experts through practice.
Tactic: Write down the sayings that help you through difficult times.
10. Remember . . . The Ark was Built by Amateurs, the Titanic by Professionals.
What Are the Sayings That Guide You?
“I’m always doing things I can’t do. That’s how I get to do them.”
Pablo Picasso
“Progress, not perfection; one step at a time.” 12 Step Program
“No one ever learned anything by beating themselves over the head with a mistake.” JAK
28©Jay Kaplan, M.D. 2013
11. When You’re in a Storm, if You Feel Connected . . . There’s Always a Rainbow Waiting
Gratitude
Gratitude Journal
5 things for which you feel grateful
One sentence for each
Do once a week
Gratitude visit
Write a 300 word letter to someone who changed your life for the better
Deliver it in person preferably without advanced notice
When you get there, read the whole thing
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Passion
“The greatest force on earth is the human soul on
fire”-Foche
“The antidote to exhaustion is not
necessarily rest . . . It’s whole-
heartedness”-Brother David Steindl-Rast
Know How Special You Are . . .
“We work in the dark.
We do what we can.
We give what we have.
Our doubt is our passion.
Our passion is our task.
The rest is the madness of art.”
- Henry James