compassion fatigue and burnout: not if but when 1 compassion fatigue and burnout: not if but when...
TRANSCRIPT
2/21/2016
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Compassion Fatigue and Burnout:
Not If But When
Rodney Tucker, MD MMM
Chief Experience Officer
Associate Professor and Director
UAB Center for Palliative and Supportive Care
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Disclosures
No financial disclosures but I am a part of the
Studer Group Speakers bureau
Acknowledge and thanks to members of the UAB Office
of Patient Experience and Engagement for assistance
with slides and content.
Rodney O. Tucker, MD MMM
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Identify and recognize signs of compassion fatigue
and burnout
Design and prepare an individualized plan for
resiliency
Objectives:
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•So why this topic and
why now?
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Question One: The Why
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No one is experiencing more change
than physicians.
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Quint Studer
Founder of the Studer Group
Years of experience working with Healthcare systems
and physicians in culture change and making medicine a
better place
Shares personal side of his family healthcare experiences
and concerns about physician burnout
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December JAMA Article
Prevalence of Depression and Depressive
Symptoms
Among Resident Physicians
A Systematic Review and Meta-analysis
Douglas A. Mata, MD, MPH; Marco A. Ramos, MPhil, MSEd;
Narinder Bansal, PhD; Rida Khan, BS;
Constance Guille,MD, MS; Emanuele Di Angelantonio,MD, PhD;
Srijan Sen, MD, PhD
JAMA.2015;314(22):2373-2383
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Impact of Burnout on Self-Reported Patient Care
Among Emergency Physicians
Lu, Dave; Dresden, Scott; McCloskey, Colin, et al.
Volume XVI, No. 7: December 2015
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Western Journal of Emergency Medicine
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Now is the time to engage and partner with
physicians
Change in Payment
System Change in Technology
Change in Employment
EXTERNAL ENVIRONMENT
W H Y ?
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• “Moving from volume to value is
monumental and the transition to
getting there is schizophrenic at
best.”
• R. Tucker, December 2015
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Change in Payment System
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Acute Care Medicare Payment at Risk
Press Ganey Assoc.
Page 12 Press Ganey Assoc.
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Now is the time to engage and partner with
physicians
Change in Payment System
Change in Technology
Change in Employment
EXTERNAL ENVIRONMENT
W H Y ?
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Healthcare Consumers Want Choice
72% of US adult internet users who look for health
information online
35% of adults that have tried to diagnose a medical
condition online
60% of 18 – 24yo who prefer tele-health over an office visit.
71% of 18 – 24yo interested in using a mobile app
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The Digital Age of Review
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How Consumers are Choosing Their Healthcare
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Can we engage consumers and compete?
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How Consumers are Accessing Healthcare
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Beleaguered by Electronic Medical Record
Mandates, Some Doctors Burning Out
John Russell
Chicago Tribune
December 12, 2015
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Chicago Tribune
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Now is the time to engage and partner with
physicians
Change in Payment System
Change in Technology
Change in Employment
EXTERNAL ENVIRONMENT
W H Y ?
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Providers (Physicians)
Healers
Crafts(people)
Guides
Counselors
Prescribers
Scribes
Billers
Managers
Coders
Most of all, leaders of
subcultures
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What Do Physicians Want?
Physician Drivers
QUALITY Physicians want to know their patients are receiving quality care and a great patient experience.
EFFICIENCY
Physicians want to work with team members who have the information needed at hand to discuss their patients. Over the course of a day this efficiency will save the physician 30 minutes or more.
INPUT
Physicians need a seat at the table to provide input when decisions are being made that affect clinical outcomes. Round on physicians and consistently ask them, “Do you have everything you need to provide excellent care to your patient?”
APPRECIATION Physicians value a “thank you” and acknowledgment when things are going well. They also want to see follow-up on their input in the form of tangible change.
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INTERNAL ENVIRONMENT
Source: Abraham Maslow; 1940; “Four Stages for Learning Any New
Skill””; Gordon Training International by Noel Burch; 1970
Unconsciously
skilled
Consciously
skilled
Unconsciously
unskilled
Consciously
unskilled
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•So what is compassion
fatigue and how does it
look?
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Question Two: The What
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Associate Professor
of Medicine
Bellevue Hospital
Editor in Chief, co-
founder of Bellevue
Literary Review
Writes about life in
medicine
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• Grief
• Empathy
• Fear
• Guilt and Shame
• Disillusionment
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What Doctors Feel
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• Considered a symptom, physical and/or mental
• Ranges from a general state of lethargy to a specific induced
muscle tiredness
• Reported by self rather than others
• Inability to continue functioning at the level of ones normal
abilities
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Fatigue
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• “A more user friendly term for secondary
traumatic stress disorder which is almost
identical to Post-traumatic Stress Disorder,
except that it applies to those emotionally
affected by the trauma of another (usually a
client or family member)”
-Figley CR, ed. Treating Compassion Fatigue. New York: Brunner-
Routledge,2002.
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Compassion Fatigue
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“Progressive loss of
idealism, energy, and
purpose.”
“Physician Misery Index Survey,” Geneia, March 5, 2015,
http://www.geneia.com/news-and-events/geneia-survey/
Burnout
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Burnout Rates by Specialty
37% 38%
39% 41% 41%
43% 43%
44% 44% 44%
45% 45% 45% 45%
46% 47%
48% 49% 49% 49%
50% 50% 50% 50%
52% 53%
Dermatology
Psychiatry & Mental Health
Pathology
Gastroentrerology
Ophthalmology
Allergy & Clinical Immunology
Rheumatology
Anesthesiology
Oncology
Pediatrics
Plastic Surgery
Nephrology
Orthopedics
Diabetes & Endocrinology
Cardiology
Pulmonary Medicine
Urology
Neurology
OB/Gyn & Women's Health
Radiology
HIV/Infectious Diseases
General Surgery
Internal Medicine
Family Medicine
Emergency Medicine
Critical Care
The 2015 Medscape survey results reflect the highest burnout rates found in critical care (53%) and emergency medicine (52%), and with half of all family physicians, internists, and general surgeons
reporting burnout
Peckham, C., “Physician Burnout: It Just Keeps Getting Worse,”
Medscape Physician Lifestyle Report January 26, 2015.
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Does Burnout Matter?
Medical Errors Medical Malpractice
Suits • Williams ES et al, Health Care Manage
Rev. 2007;32:203-212 • Firth-Cozens J & Greenhalgh J. Soc Sci
Med. 1997; 44:1017-1022 • Shanafelt TD et al. Ann Intern Med.
2002;136:358-67
• Jones JW et al. J Appl Psychol, 1988; 73:727-35
• Hickson, et al
Patient Compliance Patient Satisfaction
• DiMatteo MR et al. Health Psychol. 1993; 12:93-102
• Linn LS et al. Med Care. 1985;23. 1171-78
• Haas JS et al. J Gen Intern Med. 2000;15:122-128
Choosing Resilience; Wayne M. Sotile, Ph.D.; Founder of Center for
Physician Resilience, Davidson, NC
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Compassion Fatigue and Burnout Syndromes
Cognitive
Emotional
Behavioral
Spiritual
Personal relations
Somatic
Work Performance
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Lowered
concentration
Decreased self
esteem
Apathy
Rigidity
Disorientation
Perfectionism
Minimalization
Preoccupation with
trauma
Thoughts of self harm
or harm to others
Cognitive
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Powerlessness
Anxiety
Guilt
Anger and rage
Survivor guilt
Shutdown
Numbness
Fear
Helplessness
Sadness
Depression
Emotional roller
coaster
Depleted
Overly sensitive
Emotional
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Impatient
Irritable
Withdrawn
Moody
Regression
Sleep disturbance
Nightmares
Appetite changes
Hypervigilance
Elevated startle
response
Accident proneness
Losing things
Behavioral
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Questioning
meaning of life
Loss of purpose
Lack of self
satisfaction
Pervasive
hopelessness
Anger at God
Questioning prior
religious beliefs
Loss of faith in a higher
power
Greater skepticism
about religion
Spiritual
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Withdrawal
Decreased interest in
intimacy
Mistrust
Isolation from others
Overprotection as a
parent
Protection of anger or
blame
Intolerance
Loneliness
Increased
interpersonal conflicts
Personal relations
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Shock
Sweating
Rapid heartbeat
Breathing difficulties
Aches and pains
Dizziness
Increased number of
medical maladies
Other somatic
complaints
Impaired immune
system
Somatic
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Low morale
Low motivation
Avoiding tasks
Obsession about
details
Apathy
Negativity
Lack of appreciation
Detachment
Poor work
commitments
Staff conflicts
Absenteeism
Exhaustion
Irritability
Withdrawal from
colleagues
Work Performance
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•So how do we combat
compassion fatigue
internally and
externally?
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Question Three: The How
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Organizational
psychologist
CEO of Healthy
Companies
International
Physical Health
Emotional Health
Intellectual Health
Social Health
Vocational Health
Spiritual Health
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New Culture Assumptions
Adapt to a new era of accountability,
engagement and communication
Adopt flexible practices of evidence based
leadership
Accept that the physicians and providers of
yesterday and today will not look the same as
those of tomorrow
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• Individualized
• Consider where gaps or opportunities may exist (boost exercise,
examine diet and sleep habits, etc.)
• Clinically:
• Consider a step back in humanizing our patients before we
medicalize
• Set boundaries
• Work as a team in meeting patient expectations
• Reward and recognize; Celebrate positive feedback
• Debrief with colleagues
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Designing a Personal Plan
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• Refocus on solutions rather than reiterating the problems
• Technology has to become friend not enemy; Volunteer for
enhancement teams around the EHR
• Couple process improvement with standardized communication
skills (AIDET)
• Round and engage colleagues differently:
• What is working well?
• Who is doing a good job and what is the behavior?
• Where can we improve policies or procedures?
• What resources do you need to take better care of our patients?
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Personal Leadership Plan
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Rodney Tucker, MD MMM
Chief Experience Officer- UAB Medicine
205-975-4011
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