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Self Care: Maintaining Your Balance

S. Lawrence Librach MD,CCFP,FCFPProfessor Family & Community Medicine

Sun Life Financial Chair in Bioethics

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Objectives

• Define burnout, compassion fatigue• Recognize signs, symptoms• Know risk factors• Contrast with depression• Identify techniques to achieve work-life

balance

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What is Burnout?

• Psychological syndrome• Response to chronic interpersonal stressors

on the job

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Key Dimensions

• Overwhelming exhaustion• Cynicism, detachment from job• Sense of ineffectiveness, lack of

accomplishment

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Signs of Burnout

• PhysicalFatigue, physical exhaustionHeadachesGI disturbancesWeight loss

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Signs of Burnout

• EmotionalInsomniaDepressionBoredomEmotional exhaustionFrustrationLow morale

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Signs of Burnout

• FunctionalJob turnoverImpaired job performanceQuality of care declines

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What is Compassion Fatigue?

• “Cost of caring”• Evolves from relationship with patients’

traumatic experiences• Similar to PTSD• May lead to burnout

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Signs of Compassion Fatigue

• Hyperarousal• Avoidance• Re-experiencing

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Nature of Burnout

• Journal of Clinical Oncology:oncologist subscribersSense of failure: 56%Depression: 34%Disinterest in practice: 20%Boredom: 18%Almost 50% felt burnout inherent to

oncology

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Survey of ENT Surgeons

• Frustration withDisease: 27%Government: 67%Economics: 58%

IS THIS FAMILIAR?

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Cancer Care Ontario

• ExhaustionPhysician: 53.3%Allied health professionals: 37.1%Support staff: 30.5%

• DepersonalizationPhysician: 22.1%Allied health professionals: 4.3%Support staff: 5.5%

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Risk Factors

• Individual• Cultural• Personality• Social support, spirituality, religion• Work life

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Burnout vs. Depression

BURNOUT• Work specific• “In the battle”

DEPRESSION• Pervasive• “Given up”

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Lifestyle Management Techniques

• Recognize, monitor symptoms• Good nutrition, exercise• Meditation, spiritual life, energy work• Grieve losses• Reduce overtime• Discuss stresses, seek support• Seek new solutions

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Preventive Approaches

• Address emotions that affect patient care• Physician, situation, patient

risk factors• Changes in managerial/organizational

practice• Educational interventions• Improved communications

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Summary

• Burnout, compassion fatigue prevalent• Recognize burnout, compassion fatigue early

to minimize associated distress• Monitor for signs, symptoms• Manage lifestyle issues• Address managerial issues