Find Happiness as a Physician
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Transcript of Find Happiness as a Physician
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Helping People Live and Work Well - by Design
Coastal Area Health Education Center
Is It Even POSSIBLEto Find Happiness
as a Physician Today?
Kernan Manion, MD
Internal Medicine Grand Rounds Lecture SeriesSeptember 13th, 2006
Keys to Preventing Burnout andFinding Well-being in Medicine Today
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Is It Even POSSIBLEto Find Happiness
as a Physician Today?
Kernan Manion, MD
Keys to Preventing Burnout andFinding Well-being in Medicine Today
Kernan Manion, MD does nothave any conflicting
financial interest from
commercial entities.
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"To find health should bethe object of the doctor.
Anyone can find disease."
Dr. A.T. Still
Founder of Osteopathic Medicine, 1874
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Maintaining ones own health
& well-being should be asimportant a concern of the
physician as treating patients.
Otherwise, the doctor
becomes the patient."Kernan Manion, MD 2006
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Physicianhood is not justa job.
It is an often high intensityhuman service focused on thetreatment of illness,
the prevention of deathand the alleviation of suffering.
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TIME
EMOTIONALRESP
ONSE
-RESILIENCY
StressorEvent 1
StressorEvent 2
EMOTIONAL INTENSITY(think "energy")
RESILIENCY(Affect Reserve Pool)
(think "elasticity")
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STRESS DURATION
EMOTIONALRESERV
E/RESILIENCY
Stressor2nd
Stressor
Recovery
Phase
Think "Muscle Physiology"
TIME"X"
Work Phase
"Strengthening" & Resiliency=>> "Endurance"
Recovery
Phase
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STRESS OCCURANCE / TIME
EMOTIONALRESER
VE
-RESILIENCY
MAJORSTRESSOR
2ndStressor
RecoveryPhase
(Inadequate)
3rdStressor 4th
Stressor
STRESS RESPONSE DEPLETION
i.e. Cognitive / Emotional Exhaustioni.e. BURNOUT
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The Stress Response
Fight( Anger) Flight(= Fear [Anxiety])OR
Traditional Understanding
The Relaxation Response
Non Fight(= Non Anger) Non Flight(= Non Fear)
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The Stress ResponseAnger Anxiety Sadness Shame Pain
Through the MindSense Perspective
(Turmoil)
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Love
Peace
Joy
Pride
Delight
Anger
Anxiety
Sadness
Shame
Pain
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Love
Peace
Joy
Pride
Delight
Anger
Anxiety
Sadness
Shame
Pain
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Affect Pool
An
ger
Anx
iety
Sadness
Sha
me
Pain
Lo
ve
Peace
Joy
Pride
Delight
Event / Issue
Internal Dialog(s)
Affect(s)
Soma
Behavior(s)
(Theme)
The MindSenseModel
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Emotion Pastels of Primary TurmoilAffects
ANGER
SADNESS
SHAME
PAIN
Irritation Rage
ANXIETYWorry Panic
Glum Grief
MortifiedEmbarrassed
Hurt Misery
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Emotion Pastels of Primary BlissAffects
LOVE
JOY
PRIDE
DELIGHT
Fondness Enamored
PEACECalm Serene
Content Euphoric
Self-respectSatisfied
Pleasure Ecstasy
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Antidotes for dismantling and for replenishment
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Anatomy & Physiologyof a Single Stress Event
using the MindSense model
(For those wishing to learn more about the MindSensemodel, visit the contact page at
www.WorkLifeDesign.organd request that I send you the MindSense audiooverview.)
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Affect Pool
Anger
Anxiety
Sadnes
s
Shame
Pain
Love
Peace
Joy
Pride
Delight
Event / Issue
Internal Dialog(s)
Affect(s)
Soma
Behavior(s)
(Theme)
The Model
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CHAOS:
the entire array of issues, events
and situations within our
perceived sphere of concern thatmay be acting upon us
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CACOPHONY:
the array of internal dialogs(conscious and pre-conscious)
one has regarding each of theevents / issues / situations in
ones CHAOS layer
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TURMOIL:
the concurrent negative
emotions associated withCHAOS & CACOPHONY
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The Triad of Symptoms(adapted from Maslach and modified)
Fatigue/Exhaustion
DetachmentReduced Accomplishment
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Fatigue/Exhaustion
Physical
Cognitive
Emotional
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The work of healing requires
cognitive, physical andemotional energy. Energy
needs to be replenished.
We do NOT have an
inexhaustible resource ofemotional energy.
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DetachmentFrom Family & Friends, Colleagues, Patients
Cognitive
Physical
Emotional
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ReducedAccomplishment
Productivity
Quality
Keep in mind that one can maintain
productivity & quality,
but at significant cost to Energy
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Meltdown Burnout Weardown Functional/Operational Engagement
Fatigue Energy
Detachment Involvement
Accomplishment: Reduced Increased
WorkLife Health Continuum
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But its not just:Doing okay vs. Not doing okay
In reality, theres a continuum
of adaptation / maladaptation:
EngagedOK/ FunctionalWeardownBurnout Meltdown
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Remember
Burnout is an Occupational Stress Syndromeand it can manifest in MANY WAYS.
But
Burnout Depression
P t ti l O t
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MELTDOWN - the Worklife "Code Blue"
(Clinical performance impairment)Simmering Burnout ("Slow Burn)
Emotional Illness & Addiction
Compassion Fatigue (+ Vicarious
Traumatization / 2ndry PTSD)
Behavioral Issues (e.g. disruptive)Relational Strain
Physical Manifestations of Chronic
Stress Exposure (HTN, MI, CVA )
Detrimental Impact On Organization
Loss of job / career
Fortuitous Job change / Career modification
Renewal & Transformation
- Potential Outcomes
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I find it helpful to divide the matrix ofcontributing causes into 4 majordomains of influence:
Individual
Role & Career
Organizational
Systemic & Environmental
Contributing Causes in Burnout
Domains of Influence and Recurring Themes
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There are innumerable stress issues that may
contribute to ones Burnout (and each persons
stress array is unique.)
Clustering these into theme categories not only
helps get a handle on the predominant issues; it
also helps highlight some common areas that need
to be addressed (e.g. interpersonal communication;
dealing with difficult patients.)
Domains of Influence and Recurring Themes
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The key challenge:
Dismantling ourChaos &TurmoilRealizing our LONGING
and finding our Bliss!
Insert slides here with focus ondismantling burnout / changingenvironment / setting sights onhealthy culture
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Remedies: Overall
Treat the illness.
Dismantle the contributors to your stressand turmoilon an ongoing basis.
Replenish your emotional energy.
Craft your career intentionally.
Aim for thrival, not just survival !
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(Organizational)
EngagementBurnout(Disengagement ) ("Flow")
Burnout Wellbeing
(Individual)
("Ill-being") ("Vitality")
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Unhealthy systems stayunhealthy until they change orare changed.
(If nothing changes
nothing changes.)
I b l k h h
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Kernan Manion,M.D.
Its been an pleasure to speak with you this
morning.
Please consider Work/Life Design a ready
resource for coaching, group practice consulting,
workshops and retreats.
Should you have any questions or wish to
receive specific materials mentioned, pleasecontact me at www.WorkLifeDesign.org.
Please also visit our new resource pagewww.WorkLifeDesign.org/forum/
Wishing you abundant success & happiness !
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Johann Wolfgang von GoetheMasonboro Sound
Wrightsville Beach, NC