Ron Salomon MD

Faculty and Housestaff Wellness Programs

Thanks to V. Flynn, MD

Managing

Workplace Workplace AnxietyAnxiety

Conflicts • No conflicts of interest

related to this talk • No IRB disclosures • No IACUC involvement

Goals Anxiety and stressAnxiety and stress, actually, ARE things to worry about.

Besides taking control of your energy and attitude, it can affect your career and your general health.

There are ways to help bring it under control .

Participants will be able to- Recognize: stress and anxiety at work is common - Understand: symptom severity changes with

- Challenges – number and intensity - Internal and external support – availability and qualities

- Appreciate: psychological perspectives, separating - Personal coping

- Pressures of managing illnesses in patients

- Find: resources for self-help and professional assistance

Some stress is good.

Maslach Burnout Inventory*

7 point scale: “Never” to “Daily” •“….emotionally drained…”•“used up at the end of the day”•“fatigued … have to face another day”•“… understand how my patients feel about things …”

*Highly used and cited Burnout scale: Maslach 1981, 2005 Nixon 1979 Transactional Model of Stress

Emotional Health

Personal Issues• Stress, Depression, Anger, Anxiety• Grief/Loss• Conflict with S.O./Divorce • Parenting/Emotional Health of

Child • Child with challenges/illness• Elder care• Drugs/Alcohol

Work-Related Issues • Professional Burnout• No sense of personal

accomplishment • Work/Life Balance • Problems with supervisor• Problems with supervisee

Prince William weighs inStressed the importance of emotional well-being to business leaders

-workplace stress can take a toll on a person’s overall mental health

-psychological conditions should be met with the same compassion in the office as physical health.

“I’ve also seen how an employer can createan environment where it is as unremarkableto talk about feeling a bit down as it is to admit to having a cold,” he said.

His experience as an air ambulance pilot has shown him that employers can make it OK to admit feeling down.

Even Leucocytes …

…get reactive when they face challenges!!

Gras et al., J Leuoocyte Biol 2006

The LEAST Stressful Income Growth Stress

Score

Diagnostic Medical Sonographer

$64K 24% 4

Compliance Officer $66K 3% 5.7

Hair Stylist $23K 10% 5.8

Audiologist $24K 29% 7.3

University Professor $75K 13% 8.2

Medical Records Technician $37K 15% 8.6

Jeweler $37K 11% 8.9

Operations Research Analyst $78K 30% 9

Pharmacy Technician $30K 9% 9.1

Medical Laboratory Technician

$50K 9% 10.3

↑ Challenges ↑ Symptom Severity

Rating Factors:• Travel • Career Growth Potential • Physical Demands• Environmental Conditions • Hazards Encountered • Meeting the Public• Competition • Risk of Death or Grievous Injury • Immediate Risk of Another’s Life

• Deadlines• Working in the Public Eye

Top Five: •Firefighter•Industrial engineer•Aerospace engineer •Mechanic foreman •Vehicle and railway equipment repair worker

ADAA, 2016

It’s common. By State:Of the best places to practice –

Arkansas

is somewhere in the lower half.

Medscape, 2016Paul Barrows

It’s common. Especially in Healthcare and Public sectors• Workload• Less managerial support • Rapid organizational changes • 50% of physicians • Stress, depression, anxiety • 37% of work-related ill health • 45% of days lost in 2015-16 (N=38,000 interviews)

• High stress, depression, anxiety Prevalence: 1.5 per 1000 Incidence (2015-16): .7 per 1000 Work loss per case: 24 days

IsHak et al., 2009Health and Safety Executive Report 2016

It’s common across occupations and age groups. But not equal by sex. In men: Peak is at 45 – 54 years – but not significantly higher than for younger men

• Maslach Depersonalization Scores: • Teaching: 11.0 • Social Services: 7.5 • Medicine: 7.12

• Elevated stress is seen in the first five years of practice for physicians

Health and Safety Executive Report 2016Maslach et al. 1996, 2005 Szigethy 2017

It’s common, but not equal by sex. In women:

• Higher levels of work-related stress, anxiety, and depression than men. Some suggested problems:• Inequalities in pay• Inadequate accommodations • Sexist environments and sexism in hiring/promotion

• Age – differences in stress seen from 25 to 54 • Peak at 35 – 44 years, when juggling family issues

(children, parents)

Mohring J, Health and Safety Executive 2016Priory’s Wellbeing Center in the City of London

“Burnout” rated from

1 = no interference

to

7 = I’m thinking of

leaving medicine

It’s common in Doctors. By Specialty:

Medscape, 2016

ED work: Mental and physical health of doctors is critical to patient care

ProblemsHigh job stress and work volume

Quick decisions under pressure

Limited prospect for improvement

Limited stress interventions

High burden of responsibility

↓↓

↓ ↓ Physical and psychological health

Loss of job satisfaction

Lower productivity

More staff turnover

Data25 studies reviewed. Confirmed: -High work volume and long hours,-Little control over work, -Poor support at work, -Low pay -Inadequate recognition-Compassion fatigue

Work “targets,” e.g. requirements to see patients within four hours, could add greatly to job stress.

Goals Intervention studies (only 2)

-aromatherapy and massage sessions reduced anxiety.

-Mindfulness and other emotional skills didn’t reduce job stress.

Proposed but unstudied: -“buddy system,” -exercise programs -increasing workers’ contact with their families

Emergency Medicine Journal, 2014

Burnout!!

Shanafelt and Noseworth, 2017

Consequences: • Stroke? • Holmes&Rahe>150 OR=3.84

• Cancer? (weak evidence)• Sleep disruption faster tumor

growth• Bmal1, Per2 KO’s faster tumor

growth

• Neurotoxic? • Loss of dendritic spines, poor

function in mPFC, amygdala, anterior cingulate ctx

http://dx.doi.org/10.1136/jnnp-2012-302420 Hunter et al., 2009 Roozendall et al., 2014 Papagiannoakopoulos et al., 2017

Wrong Solution!!

↑Support ↓Symptoms• Family • Friends• Coworkers • Religious affiliation or spirituality • Therapist • Leisure activity peers • Hobby enthusiasts• Peer support group (AA, …)

Stress Solutions

• Therapies • Mindfulness • CBT

• Exercise • Yoga • Walking

• Skills • Relaxation• Positive Psychology • Communication • Time management • Team building • Setting and achieving goals

Kilpatrick, et al., 2011, NeuroImage Salyers, et al., 2011Quoidbach et al., 2010, Personality and Individual Differences Krasner, et al., 2009 Davidson, McEwen, 2012, Nature Neuroscience Hayes et al., 2004

Stress relievers

115 men surveyed •27% - Sex •29% - Playing video games•31% - Comfort eating•74% - Talking with friends•Male bonding •Therapy for work issues

250 women surveyed•11% - Sex •>50% - Comfort eating •Read self-help book •Talk to friends •Arts and Crafts •Therapy for relationship issues

Russoniello et al., 2009Barry, J, 2017

Video games: $25bn in the United States in 2016

Interventions• Enhance sense of capacity to influence organizational policies

• Personalized responses • Stressors tend to be individual, and relatively unique • Burnout reduction programs with universal solutions generally don’t work.

• SLEEP!! Leiter et al., 2014Halbesleben et al., 2006

Timing is everything

• It’s all about YOU! • Be mindful of yourself and your environment• Decide when to send that email – will the recipient be likely to have

• Time to respond – is it the end of the day? • A weekend coming up – is it Friday before a long

weekend?

DECIDE WHEN AND HOW TO GET HELP!

Burnout Reduction Resources: ACGME

• ACGME Symposium on Physician Well-Being: Commitment to ACGME Symposium on Physician Well-Being: Commitment to Change :Change :– SMART (Stress Management And Resiliency Training)SMART (Stress Management And Resiliency Training)• Protected time for mindfulness meditation, stress awareness, and Protected time for mindfulness meditation, stress awareness, and

opportunity for experience sharingopportunity for experience sharing

– Positive Psychology CoachingPositive Psychology Coaching• Focus on positives, self reflection, and guidance led personal and professional Focus on positives, self reflection, and guidance led personal and professional

growthgrowth

ACGME, 2016: http://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/2016-ACGME-Symposium-on-Physician-Well-Being

Resources: Employee Assistance Program – Therapy focus • Anger management• Eldercare• Grief/bereavement• Individual life skills training• Life/Career coaching• Personal/emotional concerns• Referral/resource assistance

http://eap.uams.edu/ 686-2588

• Relationships• Short-term, individual and family

counseling• Stress management• Substance Abuse• Wellness training• Work-related issues

Resources: Employee Assistance Program – Therapy focus • Free and confidential • Email a counselor at

www.uams.edu/eap• Appointments in 72 hrs• 24 h crisis counseling • Group assistance for workgroups

http://eap.uams.edu/ 686-2588

Resources: Wellness Programs• Urgent and Rapid Evaluation and Diagnosis• Treatment planning

FACULTY: http://faculty.uams.edu/wellness/ 526 – 8140

HOUSE STAFF: http://medicine.uams.edu/current-residents/resident-handbook/

526 – 8286

STUDENTS: http://studentwellness.uams.edu/ 686 – 8408

• Initial medication management • Referral/resource assistance

Goals

This introductory talk should have helped to:

-Identify workplace stress and anxiety issues, -Recognize signs of excessive anxiety, and-Understand helpful ways to cope with stress, -Obtain information on how and where to seek additional help.

Questions?