Stress management for docs
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The document discusses the mental health challenges faced by physicians, including high rates of distress, burnout, and suicide, especially among women doctors. It examines the impact of chronic stress, maladaptive coping strategies, and the importance of support systems in managing these issues. Solutions are proposed, such as promoting physician well-being through training, mentorship, and changes in the workplace culture.
Stress management for docs
- 2. Little education; evidence building 30-60% MD have distress and burnout MDs suicide > other prof. & gen pop. One physician per day; PhD – unclear Grossly underestimated Depression/bipolar & substance abuse = suicide risk “Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressure of Success.” Cole, Goodrich & Gritz, 2009.
- 3. Academic faculty: Worked longer hours Took less vacation 10% with mild depression 27% with elevated anxiety No sig difference clinical vs. academic Litigation/named in law suite Lin et al.1985. Health status, job satisfaction, job stress, and life satisfaction among academic and clinical faculty. JAMA 254(19):2775-82. Schindler et al. The Impact onof the changing Health Care Environment on the Health and Well-being of faculty at Four Medical Schools. Academ Med 2006 81(1):27-34.
- 5. OBSESSIVENESS COMPULSIVENESS EXAGGERATED SENSE OF RESPONSIBILITY CHRONIC FEELINGS OF NOT DOING ENOUGH DIFFICULTY SETTING LIMITS
- 6. The ability to delay personal and pleasurable self interests until more important goals are achieved DOCTORS are MASTERS of this The ability to delay attending to significant relationships and other sources of renewal until all the work is done BUT
- 8. Traditionally, doctors were men who were often married to a homemaker Today: 1/3 of doctors are women ½ of medical students are women Women struggle more with balancing home and work responsibilities
- 9. LONGER HOURS MORE PAPERWORK DECREASING COMPENSATION STRINGENT GOVERNMENT AND INSURANCE REGULATIONS MALPRACTICE ACCUSATIONS
- 10. Diminished Immunity Headache Fatigue Weight gain Dyslipidemia Hypertension Heart Disease Psoriasis/Eczema Digestive problems
- 11. Depression Alcoholism Substance abuse Anxiety Insomnia Irritable bowel syndrome Fibromyalgia Decreased sex drive
- 12. Stress: A state of disharmony or a threat to homeostasis Physiological changes increase alertness, focus, and energy Perceived demands may exceed the perceived resources Coping: The ability to maintain control, think rationally, and problem solve Resilience: Resistant quality that permits a person to recovery quickly and thrive in spite of adversity
- 13. ACUTE STRESS- immediate response to a threat or stressor CHRONIC STRESS: -long term acute stress -More subtle but lasting -Nagging -Unrelenting
- 14. External causes Family, work, economics, work, school, major life changes, unforeseen events, etc. Internal causes Worry, uncertainty, fear, attitudes, unrealistic expectations, etc.
- 15. Alarm—when one feels threatened Activation of the fight or flight reaction Resistance—mobilization of resources to solve the problem Continued stress causes adaptation Exhaustion Adaptation fails and level of function decreases
- 16. The cumulative result of unaddressed stress A state of physical, emotional and mental exhaustion “an erosion of the soul” “silent anguish of the healers” A relationship gone bad
- 17. Grows gradually over time Perhaps beginning in medical school or residency Disillusioned Cynical It becomes very difficult to do a competent job
- 18. Personal and family losses Decreased productivity Medical mistakes Physician turnover
- 19. “Frustrated physicians find careers outside of medicine” “Suicide rate of women doctors in US is twice that of other working women” “Suicide rate high in female doctors” “Many doctors prone to stress”
- 20. Adaptive Coping Contribute to resolution of the stress response Maladaptive Coping Strategies that cause further problems Active Coping Actively seeking resolution to the stress
- 21. 1)Physician’s personal responsibility (INTRINSIC) but should include 2)help from the workplace (EXTRINSIC) Should start in medical school! and continue through retirement In 2001, the Joint Commission mandated that hospitals address physician well-being
- 22. -Listen to your SELF TALK -Are you content and satisfied? -Are you always complaining to yourself? -What causes you to feel stressed? -What makes you happy? Are you happy? Are you irritable? Anxious? Depressed?
- 23. How are your relationships going? Is your practice going well? Is it what you expected? What is your body telling you? -Are you tired? -Do you get enough sleep? -Do you have headaches? Back pain?
- 24. Training Prepares for stressful events Nutrition Eat healthy, avoid skipping meals Exercise Include regular exercise Sleep Get adequate sleep—avoid fatigue
- 25. Blurring of boundaries Avoidance/withdraw al Negative attitude Anger outbursts Alcohol/Drugs Hopelessness Negative self-talk Resentment Violence
- 26. Positive Role Models Optimism Humor Moral Compass Altruism Religion & Spirituality Social Support
- 27. Work on self acceptance-let go of perfection as a goal Autonomy-internal locus of self- evaluation Always work towards personal growth
- 28. -Not only for life outside of work -Work does not have to be merely a domain of energy expenditure but also of energy renewal -Learn to receive support, healing and meaning while giving
- 29. Decrease level of arousal and moderate the stress response Decrease feelings of tension and arousal Increase sense of well-being and peacefulness Increase sense of personal control EASY to learn. EASY to do.
- 30. Realistic expectations Set realistic goals Planning Anticipate problems, have a backup plan Reframing Change the way you look at things Relaxation Learn relaxation techniques, take time-out for leisure Discuss the problem Utilize existing social supports to problem solve
- 31. Highly effective Mature coping mechanism “Another of the souls’ weapons for the fight for self-preservation, it is well known that humor, more then anything else in the human makeup, can provide an aloofness and the ability to rise above any situation, even for a few seconds.” Viktor Frankl
- 32. Conduct a moral inventory “Look not for any greater harm then this, destroying the trustworthy, self-respecting, well-behaved man within you.” Epicetus Maintain your integrity “Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” Viktor Frankl
- 33. Unselfish regarding the welfare of others Believe in a meaningful cause Mutual cooperation Activates of the brain’s reward center
- 34. Associated with psychological and physical well being Guards against despair Provides social support Provides positive role models Provides a positive mission
- 35. Social support has a profound effect on life expectancy Patients have better outcomes with strong social support Isolation and poor social support are associated with a poor stress response Few hardy individuals “go it alone”
- 36. Positive Beliefs Associated with well being Cognitive reframing Positive thinking Refute the negative thinking Believe in a meaningful cause It is important to acknowledge relevant negative factors
- 44. Fostered by MEDITATION Being fully present in the moment, to the person and the task at hand COUNTERBALANCE for all the interrupted tasks and competing demands common to most work days
- 45. Establish a Physician Health Committee Mentor program Confidential support groups Annual well-being retreat
- 46. Look at a physicians sense of meaning in their work and not just productivity Membership to fitness clubs CME on topics related to well-being Flexible schedules Decrease paperwork