Professionalism

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Professionalism Professional HealthFaculty
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
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Purpose

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

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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.

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Agenda

1. Professional Wellness
2. Workplace stress, burnout and suicide
3. Distressed behaviors
4. Resources
5. QA and Summary

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Professional Health Spectrum
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Importance Evidence

• MDs suicide gt 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.
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Importance Evidence

• Reduced wellness professional lapses
• Gender differences
• Females gt anxiety, depression, burnout
• FgtM MD suicides
• Reduced use of care by physician
• Stigma anonymity

http//www.aamc.org/members/gwims/statistics/stats
09/start.htm 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
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Professional Wellness

1. Self-care
2. Work-place stress

Mind, Body and Spirit
Balance takes effort, but worth the reward!
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Professional Wellness

• Self-care issues
• Sleep
• Balanced meals
• Physical activity
• Socialization
• Vacations/down times
• Spiritual engagement
• Have a physician

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Work-Place Stress

• Work-place stress
• Manage energy
• Reduce distractions
• Plan appropriately
• Managing failures and successes

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The first wealthishealth. Ralph Waldo
Emerson
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Stress Burnout

• Stress and burnout occurs for different reasons
  in different individuals.
• Work load ? level of stress or burnout in all
  situations.
• Multifactorial

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Stress Productivity
Prolonged Stress
Burnout
Stressed
Situational Stress
Non-Functional
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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
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Risk Factors for Burnout

• Single
• Gender/sexual orientation
• gt 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 20011745-7 Myers MJ
West J Med 200117430-33 Gautam M West J Med
200117437-41
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Six Sources of Burnout

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.
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Symptoms of Burnout

1. Chronic exhaustion
2. Cynical and detached
3. Increasingly ineffective at work
4. Leads to
5. isolation
6. avoidance
7. interpersonal conflicts
8. high turnover

Maslach Leiter, 1997. The Truth About Burnout
How Organizations Cause Personal Stress and What
to Do About It. pg 17
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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

Spickard, Gabbe Christensen. JAMA, September
2002288(12)1447-50
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Protective Factors

• A supportive spouse or partner
• Engage in religious or spiritual activity
• Hobbies
• Mentor (s)

Spickard, Gabbe Christensen. JAMA, September
2002288(12)1447-50
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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

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Preventing Resolving Burnout
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
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Case 1

• Its 1030 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?

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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

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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?

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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
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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.
www.Allanestesia.com
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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.
www.Allanestesia.com
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Addiction

• gt50 residents self-prescribe1
• ETOH most commonly used substance2
• 10 faculty use daily 9 binge2
• 8 use opiates without MD supervision2
• Recovery can be successful ? treatment!

1. Christie et al. 1998 Prescription Drug use and
self-prescription among residents. JAMA
2801253-55)
2. Hughes et al. 1992 Prevalence of substance use
among US physicians. JAMA 2672333-39.
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Inaction is NOT an option. Dr John Lecky
recovering addicted physicianReport
concerns toSuperiorsPhysicians Health Program
confidentialWellness Programs FPWPFPWC
Members
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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?

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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
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Swiggart, Dewey, Hickson, Finlayson. 4/09
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Distressed Colleagues

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

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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

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Resources
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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)
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Vanderbilt Internal Resources
Abbrev. Program Focus Contact Number
FPWC Faculty and Physician Wellness Committee All issues of professional health Charlene Dewey x6-0678
FPWP Faculty and Physician Wellness Program Work/Life Connections EAP Treatment of faculty and employees Mary Yarbrough X6-1327
CPH Center for Professional Health Training physicians Bill Swiggart x6-0678
VCAP Vanderbilt Comprehensive Assessment Program for Professionals Fit for duty assessments and treatment Reid Finlayson X2-4567
CPPA Center for Patient and Professional Advocacy Identification and assistance Jerry Hickson X3-4500
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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

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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

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QA
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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

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More Information

• Please feel free to contact us
• Charlene.dewey_at_vanderbilt.edu
• Wiliam.swiggart_at_vanderbilt.edu

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CPH FPWC Web Pagehttp//www.mc.vanderbilt.edu/c
ph
FPWC
CPH
Center for Professional Health 1107 Oxford
House x6-0678