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Professionalism & Professional Health: Faculty Overview Charlene M. Dewey, M.D., M.Ed., FACP Associate Professor of Medical Education and Administration.

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Presentation on theme: "Professionalism & Professional Health: Faculty Overview Charlene M. Dewey, M.D., M.Ed., FACP Associate Professor of Medical Education and Administration."— Presentation transcript:

1 Professionalism & Professional Health: Faculty Overview Charlene M. Dewey, M.D., M.Ed., FACP Associate Professor of Medical Education and Administration Associate Professor of Medicine Co-Director & Chair William H. Swiggart, M.S.,LPC/MHSP Assistant in Medicine Co-Director Center for Professional Health, Faculty and Physician Wellness Committee, Vanderbilt University School of Medicine

2 Purpose To raise awareness of issues related to professionalism and professional health and to provide an overview of key resources in/outside of Vanderbilt.

3 Participant Objectives 1.List ways to improve your professional health. 2.Compare and contrast workplace stress and burnout. 3.Describe distressed behaviors and how to report them. 4.State resources available for faculty and physicians in/out of Vanderbilt.

4 Agenda 1.Professional Wellness 2.Workplace stress, burnout and suicide 3.Distressed behaviors 4.Resources 5.Q&A and Summary

5 Professional Health Spectrum High Functioning High Productivity Fair Functioning Decreasing Productivity Fair Functioning Reduced Productivity Relationships Suffer Fair-Not Functioning Fair-Not Productive Institution & Family Loses Coping MechanismsRisk of MH issues and suicide Faculty vitalityStress & Burnout

6 Importance & Evidence MDs suicide > other prof. & gen pop. One physician per day; PhD – unclear Grossly underestimated Little education on topic 30-60% MD have distress and burnout Depression/bipolar & substance abuse = suicide risk Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressure of Success. Cole, Goodrich & Gritz, 2009.

7 Importance & Evidence Reduced wellness professional lapses Gender differences: Females > anxiety, depression, burnout F>M MD suicides Reduced use of care by physician Stigma & anonymity 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 2006) High physician suicide rates suggest lack of treatment for depression. - MD Consult News June 11, 2008

8 Professional Wellness 1.Self-care 2.Work-place stress Balance takes effort, but worth the reward! Mind, Body and Spirit

9 Professional Wellness Self-care issues: –Sleep –Balanced meals –Physical activity –Socialization –Vacations/down times –Spiritual engagement –Have a physician Mind Body Soul

10 Work-Place Stress Work-place stress: –Manage energy –Reduce distractions –Plan appropriately –Managing failures and successes Manage Energy Reduce Distractions Planning

11 The first wealth is health. ~ Ralph Waldo Emerson

12 Stress & Burnout Stress and burnout occurs for different reasons in different individuals. Work load level of stress or burnout in all situations. Multifactorial

13 Stress & Productivity Declining Function Productive Stress No Prolonged Stress BurnoutStressed Situational Stress Non-Functional Prolonged Stress

14 Burnout In the current climate, burnout thrives in the workplace. Burnout is always more likely when there is a major mismatch between the nature of the job and the nature of the person who does the job. ~Christina Maslach The Truth About Burnout: How Organizations cause Personal Stress and What to Do About It. Maslach & Leiter pg 9; 1997

15 Risk Factors for Burnout Single Gender/sexual orientation ># of children at home Family problems Mid-late career Previous mental health issues (depression) Fatigue & sleep deprivation General dissatisfaction Alcohol and drugs Minority/international Teaching & research demands Potential litigation Puddester D. West J Med 2001;174:5-7 Myers MJ West J Med 2001;174:30-33 Gautam M West J Med 2001;174:37-41

16 1.Work overload 2.Lack of control 3.Insufficient reward 4.Unfairness 5.Breakdown of community 6.Value conflict Maslach & Leiter, 1997. The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It. Six Sources of Burnout

17 Symptoms of Burnout 1.Chronic exhaustion 2.Cynical and detached 3.Increasingly ineffective at work 4.Leads to: 1. isolation 2. avoidance 3. interpersonal conflicts 4. high turnover Maslach & Leiter, 1997. The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It. pg 17

18 Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50 Protective Factors Personal: –Tend to self care issues first –Address Maslachs 6 sources of burnout –Influence happiness through personal values and choices –Adapt a healthy philosophy/outlook –Spend time with family & friends

19 Protective Factors –A supportive spouse or partner –Engage in religious or spiritual activity –Hobbies –Mentor (s) Spickard, Gabbe & Christensen. JAMA, September 2002:288(12):1447-50

20 Protective Factors Work: –Address Maslachs 6 sources of burnout –Gain control over environment & workload –Find meaning in work –Set limits and maintain balance –Have a mentor –Obtain adequate administrative support systems

21 Individual ApproachOrganizational Approach Starts with person Becomes group project Connects to organization Outcomes affects related mismatches Outcome is a process Starts with management Becomes organizational project Connects to people Figure 5.1 (pg 80) Maslach, C & Leiter, MP. The Truth About Burnout: How Organizations Cause Personal Stress and What to do About It. 1997 Preventing & Resolving Burnout

22 Case 1: Its 10:30 PM and you pass your colleague in the hall. She is a 48 yo female physician, recently divorced with one kid. You can tell she was crying. When you ask what is wrong she shapes up and replies, Nothing really. I am so frustrated with the system! You offer to talk and she declines. What are your concerns? What are her risk factors for stress & burnout?

23 Suicide Friends who work with people in medicine need to be aware that, if they see something that concerns them, they need to transmit the message to the powers that be. Dr. W. Gerald Austen, surgeon-in-chief emeritus Massachusetts General Hospital

24 Case 2: Dr S has struggled for the last year to fit in. He often seems emotionless and flat. He has been considered unsocial because he does not participate in any of the faculty gatherings. He has missed several deadlines and often calls in sick. His students say he doesnt teach and is erratic at times. Once on his day off you saw him leaving a bar possibly drunk and on his post call day he was not responding to emails or pages for several hours. Just after the holidays he was found dead after a single vehicle MVA. What are you concerned with here? What barriers may play a role in this case?

25 Suicide However, hard and stressful work alone does not result in suicide. Those who do commit suicide almost always have significant identifiable underlying mental illnesses, such as major depression and/or bipolar disorders, usually coupled with alcoholism and major drug use. ~Eugene V. Boisaubin Faculty Health in Academic Medicine: Physicians, Scientists, and the Pressures of Success. Pg 32; 2009

26 Signs of Addiction Unprofessional behaviors Decreased performance Diverting drugs Unusual pharmacy orders PE signs of either intoxication or withdrawal Isolation & withdrawal from friends Mood changes Overreactions to criticism Long sleeves Frequent restroom stops Asks for extra calls Wearing Masks II. 1993 rainbow productions.

27 Addiction Residents are more prone (especially anesthesia) than faculty Increases accidental and intended deaths Denial, cover-ups, easy access History of addiction – individual or family Tried it just once or twice. Wearing Masks II. 1993 rainbow productions.

28 Addiction >50% residents self-prescribe 1 ETOH most commonly used substance 2 10% faculty use daily; 9% binge 2 8% use opiates without MD supervision 2 Recovery can be successful treatment! 2. Hughes et al. 1992 Prevalence of substance use among US physicians. JAMA 267:2333-39. 1. Christie et al. 1998 Prescription Drug use and self-prescription among residents. JAMA 280:1253-55 )

29 Inaction is NOT an option. ~Dr John Lecky – recovering addicted physician Report concerns to: Superiors Physicians Health Program – confidential Wellness Programs – FPWP FPWC Members


31 Case 3: Dr D is an OB/GYN who was fired from one residency program. She joined the faculty 6 mo ago. Since then, she has had five pt and staff generated complaints about her aggressive, loud behavior. In stressful situations, she becomes loud, forceful and rude. She slammed the door after a heated discussion with a nurse in front of a patient. She has also changed OR times without team permission to take care of VIP patients. She is quoted as saying, This is how I get things done. What do her behaviors tell us? Are her behaviors ok if her skills are outstanding?

32 Distressed Physicians Internal Factors: –Alcohol and drug addiction –Compulsive behavior around sexual acting out, compulsive gambling, eating, working, etc. –Little or no training in conflict resolution, leadership skills, communication and teaching skills –Psychiatric disorders Narcissistic personality disorder Depression/bipolar Dementia etc. External Factors: –High system demands and low system support –Disruptive behavior is reinforced by the system –Bully doc gets preferential operating time –Masking ineffective managers –Failure to act –The system fails to provide physician with complaints and/or feedback –Life cycle events (i.e. death in the family, children leaving home, divorce, etc.) Swiggart, Dewey, Hickson, Finlayson. 4/09

33 Aggressive Passive Aggressive Figure 1 Spectrum of Disruptive Behaviors Inappropriate anger, threats Yelling, publicly degrading team members Intimidating staff, patients, colleagues, etc. Pushing, throwing objects Swearing Outburst of anger & physical abuse Hostile notes, emails Derogatory comments about institution, hospital, group, etc. Inappropriate joking Sexual Harassment Complaining, Blaming Chronically late Failure to return calls Inappropriate/ inadequate chart notes Avoiding meetings & individuals Non-participation Ill-prepared, not prepared Swiggart, Dewey, Hickson, Finlayson. 4/09

34 Distressed Colleagues Focus on behaviors Document behaviors Discuss with leadership Report in VERITAS Re-training can be successful

35 Distressed Physicians This leadership course has brought about change in the way I perceive others and how I am perceived as a professional, husband and father. This intervention should have occurred earlier. ~CPH participant 07-08


37 Resources

38 Faculty and Physician Wellness Committee (FPWC) Rahn K. Bailey, M.D. – MMC Chad Boomershine, M.D. Donald W. Brady, M.D. Ildiko Csiki, M.D. (resident) Larry Churchill, Ph.D. Roy Elam, M.D. A.J. Reid Finlayson, M.D. Kimberly Garcia, M.D. (resident) Stephan Heckers, M.D. Gerald B. Hickson, M.D. Jerry Jaboin, M.D. (resident) Tracy Jackson, M.D. Peter Martin, M.D. Jeanette J. Norden, Ph.D. James ONeill, Jr., M.D. Paul W. Ragan, M.D. David S. Raiford, M.D. Scott M. Rodgers, M.D. Debbie Smith, M.A. William Swiggart, M.S., LPC/MHSP Donna Seger, M.D. Anderson Spickard, Jr., M.D. Mary Yarbrough, M.D., MPH Charlene M. Dewey, M.D., M.Ed., FACP (chair)

39 Vanderbilt Internal Resources Abbrev.ProgramFocusContactNumber FPWCFaculty and Physician Wellness Committee All issues of professional health Charlene Deweyx6-0678 FPWPFaculty and Physician Wellness Program – Work/Life Connections EAP Treatment of faculty and employees Mary YarbroughX6-1327 CPHCenter for Professional Health Training physiciansBill Swiggartx6-0678 VCAPVanderbilt Comprehensive Assessment Program for Professionals Fit for duty assessments and treatment Reid FinlaysonX2-4567 CPPACenter for Patient and Professional Advocacy Identification and assistance Jerry HicksonX3-4500

40 Vanderbilt Internal Resources Center for Integrated Health (CIH) Health Plus Go for the Gold program Center for Professional Health Educational Resource web page/on-line classroom (in development) Dayani center & ortho exercise facility VERITAS

41 Other Resources Primary care provider Centerstone, Elam Center or other private counseling services Cumblerland Heights & Evelyn Fry for substance use related issues 1-800-273-TALK: suicide prevention hotline YMCA/YWCA State physician health programs

42 Q&AQ&A

43 Summary Good professional health protects both you and your career Workplace stress and burnout are common in AMC – be aware of the risks and try to prevent it when possible Seek assistance when needed Vanderbilt has several resources to assist

44 More Information Please feel free to contact us: – –

45 FPWC CPH & FPWC Web Page CPH Center for Professional Health * 1107 Oxford House * x6-0678

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