STRESS MANAGEMENT FOR DOCTORS

Dr.KMH-IMA

Dr.Jaikumar(Psychiatrist)

IMPORTANCE & EVIDENCE

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.

IMPORTANCE & EVIDENCE Academic faculty:

Worked longer hoursTook 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.

TYPE A PERSONALITY TRAITS

WHAT IT TAKES OBSESSIVENESS COMPULSIVENESS EXAGGERATED SENSE OF RESPONSIBILITY CHRONIC FEELINGS OF NOT DOING ENOUGH DIFFICULTY SETTING LIMITS

DELAYED GRATIFICATION

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

PHYSICANS ARE PRONE TO MARITAL AND RELATIONSHIP PROBLEMS

THEN VS NOWTraditionally, doctors were men who were

often married to a homemakerToday:1/3 of doctors are women½ of medical students are womenWomen struggle more with balancing

home and work responsibilities

THE PRACTICE OF MEDICINE IS CHANGING

LONGER HOURS MORE PAPERWORK DECREASING COMPENSATION STRINGENT GOVERNMENT AND INSURANCE

REGULATIONS MALPRACTICE ACCUSATIONS

COMMON STRESS ASSOCIATED DISEASES Diminished Immunity Headache Fatigue Weight gain Dyslipidemia Hypertension Heart Disease Psoriasis/Eczema Digestive problems

Depression Alcoholism Substance abuse Anxiety Insomnia Irritable bowel

syndrome Fibromyalgia Decreased sex

drive

OVERVIEW OF TERMINOLOGY Stress: A state of disharmony or a threat to

homeostasisPhysiological changes increase alertness, focus,

and energyPerceived 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

OVERVIEW OF TERMINOLOGY

STRESS ACUTE STRESS- immediate response to

a threat or stressor CHRONIC STRESS: -long term acute stress -More subtle but lasting -Nagging -Unrelenting

CAUSES OF STRESS External causes

Family, work, economics, work, school,

major life changes, unforeseen events,

etc.

Internal causes

Worry, uncertainty, fear, attitudes,

unrealistic expectations, etc.

STAGES OF THE STRESS RESPONSEGENERAL ADAPTATION SYNDROME OF HANS SELYE (1907-1982)

Alarm—when one feels threatenedActivation of the fight or flight reaction

Resistance—mobilization of resources to solve the problemContinued stress causes adaptation

ExhaustionAdaptation fails and level of function

decreases

BURNOUT 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

BURNOUT Grows gradually over time Perhaps beginning in medical school or residency

Disillusioned Cynical It becomes very difficult to do a competent job

COSTS OF BURNOUT Personal and family

losses

Decreased productivity

Medical mistakes

Physician turnover

HEADLINES“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”

COPINGAdaptive Coping

Contribute to resolution of the stress response

Maladaptive Coping

Strategies that cause further problems

Active Coping

Actively seeking resolution to the stress

BURNOUT PREVENTION 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

HEALTH AND HAPPINESS INVENTORY-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?

HEALTH AND HAPPINESS INVENTORY 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?

PROMOTE ADAPTIVE COPING

TrainingPrepares for stressful events

NutritionEat healthy, avoid skipping meals

Exercise Include regular exercise

SleepGet adequate sleep—avoid fatigue

AVOID MALADAPTIVE COPING Blurring of

boundaries Avoidance/

withdrawal Negative attitude Anger outbursts Alcohol/Drugs Hopelessness Negative self-talk Resentment Violence

PROMOTE RESILIENCE FACTORS Positive Role

Models Optimism Humor Moral Compass Altruism Religion &

Spirituality Social Support

GOALS Work on self

acceptance-let go of perfection as a goal

Autonomy-internal locus of self-evaluation

Always work towards personal growth

PERSONAL GROWTH AND RENEWAL

-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

STRESS MANAGEMENT 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.

PROMOTE ADAPTIVE COPING 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 problemUtilize existing social supports to problem solve

HUMOR 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

MORAL COMPASS 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

ALTRUISM Unselfish regarding the welfare of

others

Believe in a meaningful cause

Mutual cooperation

Activates of the brain’s reward center

RELIGION & SPIRITUALITY Associated with psychological and

physical well being

Guards against despair

Provides social support

Provides positive role models

Provides a positive mission

SOCIAL SUPPORT 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”

OPTIMISM Positive Beliefs

Associated with well beingCognitive reframingPositive thinkingRefute the negative thinkingBelieve in a meaningful cause

It is important to acknowledge relevant negative factors

GET ENOUGH SLEEP

NIX COFFEE?

MASSAGE

YOGA

WALKING

RESISTANCE TRAINING

VENTING

MINDFULNESS 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

CHANGES IN THE WORKPLACE

Establish a Physician Health Committee

Mentor program Confidential

support groups Annual well-being

retreat

CHANGES IN THE WORKPLACE

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

THANK YOU!

GO GET ‘EM!