MEDICAL DISCOVERIES: Impact on the health of the patient and the physician

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MEDICAL DISCOVERIESImpact on the health of the
patientand the physician

• MAMTA GAUTAM
• MD, FRCPC, MOT

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Medical Discoveries

• Medical knowledge and technology evolving rapidly
• Advances vaccines and immunization, cardiac
  imaging and care, infertility treatments,
  diabetes care and guidelines, hormonal
  contraceptives, evidence based medicine

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Impact on health of the Patient

• Highly Positive
• Improved medical understanding and knowledge
  about illnesses and disease
• New skills, tools in delivery of medicine
• Improved technology
• Improved patient care records, retrieval, and
  communication between physicians
• Overall Improved medical care

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Impact on health of the physician

• Greater need to be up to date on knowledge
• Requires more time and energy to attend
  conferences, read journals, study on-line
• Managing more ill and more complex patients than
  ever before
• Overall Greater workload and stress

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Greater reason to maintain healthy work-life
balanceGreater challenges to maintaining such a
balance
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BURNOUT

• A syndrome of emotional exhaustion, chronic
  overstress. (Maslach)
• -Distinct work-related syndrome demands exceed
  individual resources
• -Not a psychiatric diagnosis
• -Most likely to occur in jobs that require
  extensive care of others
• -Very common among practicing physicians

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FIVE EARLY DANGER SIGNS

• Increase in physical problems and illnesses.
• More problems with relationships.
• Increase in negative thoughts and feelings.
• Significant increase in bad habits.
• Exhaustion.

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Components of Burnout

• Emotional Exhaustion
• Depersonalization
• Reduced Personal Accomplishment

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Review of Burnout Studies

• Emotional exhaustion 46-80
• Depersonalization 22-93
• Low Personal Satisfaction 16-79
• Residents similar to practicing clinicians
• US OBS Academic chairs 56-26-31

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In Canada

• 2002 Study of Alberta MDs showed 48.6 in
  advanced stages
• CMA Physician Resource Questionnaire in August
  2003, showed 45.7 Canadian physicians in
  advanced stages of burnout
• -Female physicians 60 more likely to report
  burnout juggling more
• Likelihood increases 12-15 for each added hour
  worked over 40/week.

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Work Related

• Demands of the workplace exceed individual
  resources way of life for many physicians
• 2001 CMA PRQ
• 64 have workload too heavy
• 58 felt family and personal life suffered
• 57 felt patients expectations too high
• 29 felt on call too often
• 33 felt lack of locums and could not take
  holidays
• 64 felt difficulty getting referrals for
  patients,
• 46 felt limited in changing specialty/career path

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Possible Risk Factors

• High Workload - demands exceed resources
• Age - inverse relation between age and burnout.
  ? Survivor bias.
• Spousal support inverse relation between
  emotional exhaustion and support from partner

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SERIOUS CONSEQUENCES

1. Impaired job performance and Professional
   Problems
2. Changing jobs, reducing work hours
3. Difficulty with Relationships home and work
4. Physical Illnesses
5. Addictions
6. Psychiatric Illnesses Anxiety, Depression,
   Suicide

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Preventing Burnout

• General Strategy
• Specific Strategies
• Work related
• Personal

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General Strategy

• The number one cause of stress
• leading to burnout
• THE PERCEPTION THAT WE HAVE
• NO CHOICE, NO CONTROL.

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• The number one skill in dealing with stress
• CHALLENGE YOUR PERCEPTION.

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STEPS IN MANAGING STRESS

• Identify the stressor
• Recognize that you have more control than you
  think you do
• Identify what parts you do, and do not, control
• Focus on what you do control, and learn to cope
  with what you do not control

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MAKING CHOICES

• recognize that you have choices
• focus on what you can control.
• set priorities - self, family, work.
• accept that you will not be perfect. Good enough
  is good enough.
• Phases A Work in Progress

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The Five Balls

• The Work Ball
• The Home and Family Ball
• The Relationships Ball
• The Friends Ball
• The Self Care Ball

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Work Strategies
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Control Work Environment

• Working hours, breaks, start time, stop time,
  days per week.
• Power nap.
• Type of work - vary, keep interesting.
• Change your environment at least once.
• Personalize office or workspace, enjoy working in
  it.

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TEAM BUILDING

• Choose coworkers carefully.
• Staff relations, team building.
• Shared call
• Flexible time

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TIME MANAGEMENT

• Get organized.
• Prioritize things to be done.
• Keep up with paperwork.
• Handle each paper only once - file, toss, reply
  and send it right back.
• Set aside specific time for phone calls.
• Schedule. Dont overcommit.

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WARNINGDates on this calendar are closer than
you think.
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SET PRIORITIES

• Delegate
• Include yourself and your family in your list of
  priorities

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• Energy Creating vs Energy Depleting Activities.
• - Decide what of all that you do goes in each
  category. Do more of what creates energy less
  of what drains you.

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NETWORK MANAGEMENT

• Add fun to work.
• Use colleagues for support.
• Seek mentors, and reach out to them. Look for
  people with similar challenges.
• Take People Breaks daily.
• Express appreciation of colleagues and
  co-workers. Immediate, specific, simple. Catch
  someone doing something right.

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• Ask Do I want to do this?
• Am I the only one who can do this?
• Whats in it for me?
• Learn to say No.

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TRANSITION TIME

• Stop before you start.
• Prepare to be home. Consciously see what is
  ahead.
• Say Hello when you arrive.

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BALANCING WORK AT HOME

• Dont take your work home
• If you need to do so with their input and
  support
• Set and observe limits
• Give family your undivided attention

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Personal Strategies
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SELF CARE

• Take care of yourself first
• Make time for yourself
• Exercise
• Nutrition

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• Healthy sex life
• Get your own family doctor
• Indulge yourself
• Sleep

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ANTICIPATE AND PREPARE FOR SITUATIONS

• Professionally
• Personally

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TAKE REGULAR TIME OFF

• Planned The Tarzan Rule
• Unplanned A Gift of Time

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USE SUPPORT SYSTEMS

• Have at least one good friend
• People who are good for you
• Pets

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SHARE YOUR STORIES.
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LAUGH MORE OFTEN.
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RELAXATION TECHNIQUES

• Many methods available
• Spiritual relaxation, meditation
• Rehearse for the performance

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FINANCIAL MANAGEMENT

• Stick to basic financial principles
• Reduce non-deductible debt
• Avoid Christopher Columbus Syndrome
• Do not overextend financially

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LET GO OF THE GUILT

• Acknowledge it let go of it
• RULE OF THUMB

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YEAH, SOUNDS GREAT...BUT HOW DO I INCORPORATE
THISINTO MY DAILY LIFE?
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DONT JUST TRY.