1. Strategies to Build Resilience in Medical Practice Thurston-Mason County Medical Society Meeting Claudia Finkelstein MD claudiaf@uw.edu

2. Disclosures Financial none Slight Epic meltdown in progress- challenging personal resilience

3. Learning Objectives: Define burnout Name evidence based strategies to promote resilience Be aware of existing Resources

4. Current State : Burnout Definition Three spheres MBI vs Single Item Measure

5. In our world: a syndrome characterized by Three Spheres emotional exhaustion - being emotionally overextended and exhausted by one's work depersonalization - unfeeling and impersonal response toward recipients of one's service decreased sense of personal accomplishment – lack of feelings of competence and successful achievement in one's work

6. Maslach Burnout Inventory

7. Single Item Measure I feel emotionally burned out or emotionally depleted from my work I have become more callous toward people since I took this job — treating patients and colleagues as objects instead of humans. Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. West CP, Dyrbye LN, Sloan JA, Shanafelt TD.J Gen Intern Med. 2009 Dec;24(12):1318- 21

8. Burnout Prevalence Students 50 % burnout, 11 % suicidal ideation Dyrbe,LN Ann Intern Med. 2008 Sep 2;149(5):334-41. GME varies w specialty 25-75% burnout Ishak WW J Grad Med Educ. 2009 Dec;1(2):236-42 1/3 all docs experiencing burnout at any given time Shanafelt,JAMA. 2009 Sep 23;302(12):1338-40

9. Besides Burnout Substance abuse Disruptive behavior Mood disorders Suicide

10. Not to mention Joy Creativity Compassion

11. How Can We Make It Better? Examine Causes Personality traits- idealism, high sense of personal responsibility, perfectionism Risk factors for burnout>60, especially >80 hours/week, young kids, 2 careers, career characteristics: sense of control, appreciation, meaningful work, fair workload, aligned values

12. What works to make things better?

14. What works: Individual Maslow hierarchy Happiness practices MBSR Gratitude Journal Peer group support Compassion/empathy/meaning Spiritual practice

16. Gratitude Journal There is not only one right way (frequency, time of day) Do it and mean it Quality more than quantity Add some details Savor it Change it up

17. MBSR

18. Peer Group

19. Peer group support Balint Finding Meaning in Medicine Mind Body groups Faculty meeting time w/o agenda

20. Compassion/empathy/meaning Narrative exercises Emotional regulation Perspective taking Compassion Cultivation training Medical improve Connection w meaning/purpose

21. Spiritual practice

22. Group Interventions Peer support Practice transformation

23. Peer Support -What is it? Option for colleague or self needing support (but not necessarily a psychiatrist/lawyer/etc.) Peer to peer service offering- an ear, resources, empathy, confidentiality* *unless “duty to report” supersedes

24. Talking points safe way for clinicians impacted by adverse events, medical errors, litigation or other workplace stressors to talk about their experiences and emotions does not offer therapy, provides a network of faculty clinicians who offer a listening ear to colleagues experiencing stressful situations. Peer supporters receive training in how to listen and respond as well as information about resources.

25. What 1:1 Peer Support is Not Critique of care Psychotherapy Reassurance of what they did An assessment of the individual or situation Conflict resolution

26. Organizational: 2 studies Quality of Patient Care Drives Physician Satisfaction; Doctors Have Concerns About Electronic Health Records- http://www.rand.org/news/press/2013/10/09.html In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices Ann Fam Med. May 2013; 11(3): 272–278.Christine A. Sinsky et al

27. Rand Study: Primary driver of MD satisfaction? The quality of care one can deliver (with an element of control)

28. Rand Study: Primary driver of MD dissatisfaction? EHR Too much clerical time per task “death by a thousand clicks” Poor note quality Eye contact

29. In what other business model are the highest paid employees doing the data entry?

30. What are they doing in practices where things are good?

31. Resources-flyers available WPHP- not just for when you are in trouble!