Sustaining your practice: - PowerPoint Presentation

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Sustaining your practice: Using mindfulness as an everyday tool to promote compassion

Cora Collette Breuner, MD, MPH, FAAP

Professor Department of Pediatrics  Adolescent

Medicine

Adjunct Professor Orthopedics and Sports Medicine

Seattle Childrens Hospital  University of Washington

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Faculty Disclosure Information

In the past 12 months, I have not had a significant financial interest or other relationship with the manufacturer(s) of the product(s) or provider(s) of the service(s) that will be discussed in my presentation.

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Objectives1.Recognize possible signs of physician burnout.

2. Identify strategies for preventing and addressing burnout.

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Definition: Provider Fatigue// BurnoutLoss of emotional, mental, and physical energy due to continued job-related stress.

Symptoms include:

Depersonalization

Emotional exhaustion

Low personal accomplishment

Burnout is more common among physicians than among other professionals.

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Burnout and satisfaction with work/life balance among US physicians 

Burnout among physicians was measured using the Maslach Burnout Inventory (MBI)

45.8% of physicians reported at least one symptom of burnout

The MBI has three subscales to evaluate each domain of burnout:

Emotional exhaustion

Depersonalization

Low personal accomplishment

Arch Intern Med

2012; DOI:10.1001/archinternmed.2012.3199.

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Six in 10 physicians would quit today

Doctors are working less, seeing fewer patients, and many would quit if they could, a sweeping survey of 13 575 physicians from across the nation shows.

A survey of American’s physicians: practice patterns and perspectives was commissioned by the Physicians Foundation. It is the latest and perhaps the largest and most comprehensive of a number of surveys that have identified wide, deep, and increasing discontent among the nation's physicians regardless of their age, gender, specialty, location, or employment status.

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Depression

Katherine J Gold MD, MSW, MS, Ananda

Sen,PhD

, and Thomas L.

Schwenk

, MD Details on suicide among U.S. physicians: Data from the National Violent Death Reporting System. Gen

Hosp

Psychiatry 2013 Jan 35 (1) 45-49.

Collier R. Physician suicide too often “brushed under the rug”. CMAJ. 2017 Oct 2; 189(39): E1240–E1241.

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Why is it happening?

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Shortage of physicians

"By 2015, the US will be 62 900 doctors short, and the future looks even worse,"

Archambault

said. "By 2025, the estimated shortage of doctors will more than double, as baby boomers require more care. Seeing a doctor in a reasonable amount of time may be a thing of the past, unless meaningful consumer-directed reform is passed soon."

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Changing Patient-Physician Interaction

EMR distances us from our patients

More patient autonomy

More focus on patient satisfaction

Less focus on provider satisfaction

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EMR

Time consuming

More oversight in the office

Redundant

Inefficient

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Individual issues

Entitled (I've worked really hard and got all As)?

Anxiety from transition, change, and uncertainty? "Broken contract"

Addicted to affirmation—less appreciation shown by patients

More deep rooted? “This is not what I signed up for, this is not my calling, these are not my values”

Is it because physicians' values are being compromised?

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How do we fix it?

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Doctors who view medicine as a calling are more satisfied

They feel better about caring for patients with complex conditions such as obesity and alcohol addiction than other physicians, research shows.

The reasons that drive doctors to practice medicine can have an impact on how satisfied they are caring for patients with challenging conditions, says an 

Archives of Internal Medicine

 research letter published online August 27.

Researchers analyzed data from a national survey of 1504 primary-care physicians. They found that doctors who see medicine as a calling are more likely than other physicians to be satisfied treating patients who are obese or addicted to nicotine or alcohol.

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Interventions

Reducing

dissatisfiers

Reduce stressors by cutting back on working hours, relaxing intrusive oversight, and finding ways to lift the burden of "busywork" from the shoulders of physicians.

Fair pay

Enhance fulfillment

Focus on the work itself.

Do physicians recognize what they find most fulfilling?

What does their best work look like?

Are they making full use of their knowledge, skills, and innate abilities?

Are they growing and developing as human beings?

Do they feel that they are making a real difference in the lives of their patients and communities?

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Three Domains of the Stanford Wellness Framework

Culture of Wellness

: Creation of work environment with a set of normative values, attitudes, and behaviors that promote self care, personal and professional growth, and compassion for colleagues, patients, and self

Efficiency of Practice

: Value added clinical work accomplished divided by the time and energy spent

Personal Resilience

: Set of individual skills, behaviors, and attitudes that contribute to personal physical, emotional, and social well-being, including the prevention of burnout

©2016 Stanford Medicine

 

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Culture of Wellness: Creation of work environment with a set of normative values, attitudes, and behaviors that promote self care, personal and professional growth, and compassion for colleagues, patients, and self

Ways to Implement:

Define professional wellness as a priority

Utilize the different survey instruments to regularly assess physician well-being

Create a toolkit of interventions such as forums and engagement groups to foster community support

Develop a communication platform for physicians to address daily work challenges

Culture of Wellness-Stanford Well MD

©2016 Stanford Medicine

 

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Efficiency of Practice: Value added clinical work accomplished divided by the time and energy spent

Ways to Implement:

Re-engineer the way work is done and by whom (ex. EHR documentation)

Utilize the Practice Assessment Tool to assess your practice’s current state

Undergo a LEAN event

Engage clinical and operations leadership teams

Efficiency of Practice

©2016 Stanford Medicine

 

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Personal Resilience

Personal Resilience

: Set of individual skills, behaviors, and attitudes that contribute to personal physical, emotional, and social well-being, including the prevention of burnout

Ways to Implement:

Provide assistance for physicians in accomplishing basic life tasks

Establish a quiet, refresh, and recharge room for physicians

Provide on-site exercise facilities

Offer peer support programs and off-site psychological counseling services

©2016 Stanford Medicine

 

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Institute for Health Care Improvement

Perlo

J,

Balik

B,

Swensen

S,

Kabcenell

A, Landsman J,

Feeley

D. 

IHI Framework for Improving Joy in Work

. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017

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Experiential

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Grepmair

L,et

al.

Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: a randomized, double-blind, controlled study.

Psychother

Psychcom

. 2007;76(6):332-8.

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Experiential

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What can you do for your patient/ for yourself?Experiential

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Resources

Calm, Headspace

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AAP Section on Integrative Medicine : SOIM

Mission

: to support the mission of the AAP "to attain optimal physical, mental, and social health and well being for all infants, children, adolescents, and young adults" by:

promoting polices to enhance patient-centered care;

integrating evidence-based, safe and effective complementary therapies into high quality pediatric practice;

educating clinicians and families; advocating for appropriated payment for safe and effective services; and

respectfully collaborating with diverse health professionals dedicated to enhancing the health of infants, children, and adolescents.

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Conclusions

Burnout is real and has both qualitative and quantitative risks for healthcare delivery and our profession

The systemic changes that contributed to this had noble intent but have diminished physician autonomy to such an extent that following the rules and feeling "excessively scrutinized" and avoiding criticism is becoming the chief professional motivation

There are many ways to approach this and definitely include institutional and efficiency changes but mindfulness is a proven and thoughtful intervention that may help promote a culture of wellness and personal resilience

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Websiteshttps://pediatrics.aappublications.org/content/134/4/830

https://www.ama-assn.org/topics/physician-burnout

https://mindfulnessnorthwest.com

w

ww.stepsforward.org

https://nccih.nih.gov/health/

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Questions? Reflections?cora.breuner@seattlechildrens.org

(206) 999- 1208

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David Whyte - Enough

Enough. These few words are enough.

If not these words, this breath.

If not this breath, this sitting here.

This opening to the life

we have refused

again and again

until now.

Until now.