Jane Lemaire MD FRCPC - University of Alberta · CMAJ.2013;185:649-653. * * * Our work is rich but...
Transcript of Jane Lemaire MD FRCPC - University of Alberta · CMAJ.2013;185:649-653. * * * Our work is rich but...
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Jane Lemaire MD FRCPC
Health and Wellness Rounds
Department of Anesthesiology
University of Alberta
Edmonton, AlbertaMarch 21, 2014
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*
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*Dr Jean Wallace
Department of Medicine
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*
* To discuss why physicians are at risk of
burnout
* To review the personal and professional
impacts of burnout
* To consider how physicians can shift from
burnout to wellness with some simple
strategies
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*
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*
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*
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*Patient demographics
*Technology
*Advancements in health care
*Gender and generational shifts
*Expectations
*
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Prepared by
Jean E. Wallace
Jane Lemaire
Alyssa Jovanovic
Prepared for the Alberta Heritage Foundation for Medical Research
and the Calgary Health Region
All physicians within the Calgary
Health Region
Stage One:• Physician interviews (N=42)
• Physician job observations (N=44)
• Spouse interviews (N=32)
Stage Two:• Survey to all physicians in the CHR
• Received 1178 surveys (40% RR)
Jean E Wallace, Jane Lemaire, William Ghali,
Dave Megran, Todd Watkins, Maeve Obeirne,
Alyssa Borkosky
Determinants of Physician Well Being
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Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374:1714-1721.
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*
* Workload
* Long hours
* Emotional and
cognitive
demands
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*
*Depression
*Suicide
*Substance abuse
*Relationship difficulties
*Job or career change
*Coronary artery disease
*Decreased immunity
*Accelerated aging
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*
* Emotional
exhaustion
* Depersonalization
* Reduced sense of
accomplishment
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*
* Individual factors
* Profession–related
factors
* Workplace factors
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Workaholic vs. not
• Emotional exhaustion
• Depression
• Job satisfaction
• Rewarding patient experiences
• Career commitment
Type A vs. not
• Emotional exhaustion
• Depression
• Anxiety
Control Freak vs. not
• Emotional exhaustion
• Depression
• Anxiety
• Poor mental health
Wallace JE, Lemaire JB. Physicians’ personality traits: sound familiar? Abstracts. Doctors’ Health Matters-
Finding the Balance. 2008 BMA-AMA-CMA International Conference on Doctors’ Health.
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*
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*Negative peer pressure
33
42
21
4
0
10
20
30
40
Not Important at All Not Very Important Somewhat Important Very Important
% o
f R
esp
onse
s
Negative Peer Pressure Affects my Ability to Improve my own Health and Well Being
Source: 2009 Determinants of Physician Well Being: Stage Two Report (n=1178)
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0
20
40
60
80%
of
Res
po
nse
s
Oft
en o
r m
ost
of
the
tim
e
Family
Medical
Surgical
2009 Determinants of Physician Well-Being: Stage Two Report (n=1178)
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* Job and career turnover
* Productivity/efficiency
* Patient encounters
* Job satisfaction/patient
compliance
* Role modeling for
patients
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Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374:1714-1721.
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*
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*
0
50
100
150
200
250
300
350
400
450
500
1972-1981 1982-1991 1992-2001 2002-2012
Nu
mb
er
of
Sear
ch R
esu
lts
Years Searched
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*“But I’m not sure that the link between their (physicians’) own health and patient care is probably very clear. Because you can’t believe that right? You can’t believe if you’re having a bad day that you’re going to provide poor patient care ‘cause that’s just not what you do.”
*
Wallace JE, Lemaire JB. Physician well being and quality of patient care: an exploratory study of the missing link. Psychol Health Med.
2009;14:545-52.
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*
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*
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How does workplace nutrition affect
physicians?
Well Doc? Module 1
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Nutrition and cognition
Lemaire, Wallace et al. Physician nutrition and cognition during work hours:effect of a nutrition based
intervention. BMC Health Serv Res. 2010;10:241.
. Lemaire, Wallace et al. Food for thought: an exploratory study of how physicians experience poor workplace
nutrition. Nutr J. 2011;10:18.
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Does a portablebiofeedback tool help
reduce physician stress?
Well Doc? Module 2
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Regulating the endocrine and autonomic
nervous system response to stress
Lemaire JB, Wallace JE, Lewin AM, de Grood J, Schaefer JP. The effect of a biofeedback-based stress
management tool on physician stress: a randomized controlled clinical trial. Open Med. 2011;5(4):e154–e163.
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What physician coping strategies are
most effective against burnout?
Well Doc? Module 3
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0
20
40
60
80
100
Concentrate on what to do
next
Make a plan of action
Use humour to lighten situation
Keep it to myself
Talk with colleagues
Go on as nothing has happened
Take a time out
% o
f Res
pons
es
Most of the Time
Often
Sometimes
Frequency of use of physician coping strategies at work (n=1151)
Lemaire JB, Wallace JE. Not all coping strategies are created equal: a mixed methods study exploring physicians’ self reported coping strategies. BMC Health Serv Res. 2010;10:208.
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0
20
40
60
80
Spend time with family
Talk to spouse Find time to exercise Leave work at work Make quiet time outside of work
% o
f Res
pons
es
Most of the Time
Often
Sometimes
Frequency of use of physician coping strategies outside of work (n=1151)
Lemaire JB, Wallace JE. Not all coping strategies are created equal: a mixed methods study exploring physicians’ self reported coping strategies. BMC Health Serv Res. 2010;10:208.
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Coping styles and affect
High positive
affectN=493
• More problem solving
• More seeking support
• More time outs
High negative
affectN=281
• More denial
• More keeping to self
Wallace JE, Lemaire JB. Physician coping styles and emotional exhaustion. Indus relations. 2013;68;187-209.
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*
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*Use humor
*Take a time out
*Eat and drink
*Make a plan of action
*Talk with colleagues
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*
*Time off
*Quiet time
*Family
*Friends
*Exercise
*Hobbies
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• Time outs
• Some work free nights/weekends
• Real vacations
• Sabbatical leaves
• Nature
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*
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*
*Positive psychology
*Mindfulness/gratitude
*Relaxation techniques
*Narratives
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*“Wellness goes beyond merely the absence of distress and includes being challenged, thriving, and achieving success in various aspects of personal and professional life” (Shanafelt et al 2003)
*
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*
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*Frank E, Dresner Y, Shani M, Vinker S. The association between physicians’ and patients’ preventive health practices.
CMAJ.2013;185:649-653.
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*
*Our work is rich but difficult
*We are at risk for burnout
*We can learn to prevent and mitigate poor stress-related health outcomes
*We can message and role model mental health for our patients
*We can target wellness
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Well Doc?
Physician Wellness:
Fundamental for Doctors.Vital for Patients.
Jane Lemaire MD
Jean E Wallace PhD
William A Ghali MD MPH
Jeffrey P Schaefer MD
Delia Roberts PhD
Jill de Grood MA
Kelly Dinsmore MSc
Adriane Lewin MSc
Alyssa Jovanovic PhD
Judy Boychuk Duchscher RN PhD
Alicia Polachek MA
Debbie Gray BSw MSc
Krista Warners BN MSc
Teri Dingwell BN
Mamta Gautam MD
Peter Sargious MD
Maria Bacchus MD
Kelly Zarnke MD
David Ward MD
Sonja Morrison RN
Rhonda Niebrugge RN
Jennifer Cowles RN
Susan Campeau RN
Mary Widas RN
Katherine Bright RN
Kristen Desjarlais-deKlerk ABD
Jaya Dixit MA