PHYSICIAN BURNOUT DISCLOSURES... A BURNING EPIDEMIC I HAVE NO DISCLOSURES TO REPORT.

Transcription

1 PHYSICIAN BURNOUT A BURNING EPIDEMIC I HAVE NO DISCLOSURES TO REPORT. DISCLOSURES...

2 HISTORICAL DEFINITION. FREUDENBERGER coined the term Burnout. PROCESS One Year Progression Historical term used to refer to the effects of CHRONIC DRUG ABUSE CURRENT DEFINITION.. A SYNDROME OF EMOTIONAL EXHAUSTION, DEPERSONALIZATION AND REDUCED SENSE OF PERSONAL ACCOMPLISHMENT

3 WHY??? WHAT IS THE SIGNIFICANCE OR RELEVANCE OF BURNOUT?? PHYSICIANS NEGATIVE OUTCOMES FOR.. INSTITUTIONS PATIENTS

4 PHYSICIAN OUTCOMES PHYSICAL and EMOTIONAL ILLNESSES. Depression Anxiety Substance abuse Suicide Completion DECREASE WORK-SATISFACTION CASE PRESENTATIONS.. 37 year old dentist.. Chief Complaint.. I just don t want to do anything. Anxiety.stress (financial and emotional) Increased work hours Additional Symptoms... Medications... Pulmonologist...

5 INSTITUTION OUTCOMES.. INCREASED TURNOVER OF PHYSICIANS ABSENTEEISM POOR PERFORMANCE NEGATIVE ATTITUDES PATIENT OUTCOMES. DECREASED QUALITY OF MEDICAL CARE INCREASED MEDICAL ERRORS DECREASED PATIENT SAFETY

6 DO NO HARM PHYSICIAN BURNOUT. MORE THAN HALF OF PHYSICIANS ARE EXPERIENCING SIGNIFICANT SYMPTOMS OF BURNOUT BURNOUT.TWO TIMES MORE PREVALENT THAN COMPARED TO OTHER U.S. WORKERS MOST AFFECTED SPECIALITIES..

7 RISK FACTORS.. DEMANDING WORKLOAD CONFLICTS BETWEEN WORK AND HOME CHILDREN AT HOME ( < 21 YEARS OF AGE) MIDWAY THROUGH MEDICAL CAREER NUMBER OF NIGHTS ON CALL PARTNER WHO IS ALSO A PHYSICIAN MEDICAL ERRORS DECREASED AUTONOMY GENDER 2 MAJOR EFFECTS ON PHYSICIANS. SUICIDE COMPLETION.. SUBSTANCE USE DISORDERS (SUD S).

8 DOCTORS DIE BY SUICIDE ANNUALLY SUICIDE ONE MILLION U.S. PATIENTS LOSE THEIR DOCTORS TO SUICIDE EACH YEAR PERCENT NEVER RECEIVE TREATMENT DR. VERUN S LETTER Dear Pamela, Hi, der. I don t know how thankful I am to you for writing that article on physician s suicide. I really wanted to hug you after reading it. I had really rough day after seeing 130 outpatients and around 60 admission emergency in a 12 hour duty. I work as a final year MD internal medicine resident in one of the busiest hospital in India. I saw a part of myself in every page of your article Just couldn t stop reading the article. It is 3:00 am in the morning here and after a physically and mentally demanding day of work and studies reading your article was the best thing today. It takes me 5 hours by flight to reach my home from my hospital. I have my wife and 6 month old son (whom I been with for 15 days since his birth) at home. I work day in and out just to be with them once in 3 months. I don t see my colleagues smile, I hear my patients misery every day. I smile and crack jokes even when I am sad so that I can bring some joy into my patients sorrowful life. Today I saw this patient who died, married with a son, the only earning member of his family.his widow just wouldn t accept that he was dead. She kept talking to him. I just didn t know what to feel.. I was numb for a minute thinking what if that was me. And the kid is my son..

9 DR. VERUN S LETTER I see deaths everyday in ward..i don t know if you would believe me, but 4 deaths per day in a single ward of 40 beds overcrowded to 125 patients admitted at a time. Two patients on a bed, two lying together on the floor. Poverty, misery and pain all around. I have declared 12 patients dead in a day during one of my duties. I just don t feel death anymore, just don t feel human. My uncle died recently, I felt nothing deep inside just some memories and that is it. I write this mail hoping that the way I survive my day would help you in helping others. I always wish my colleagues and say hi when I see them in the morning. Say hi to everyone from my ward sweeper to the guard in the ward. I never eat alone and always make sure I share my food. I always smile whenever I talk to my patients. I hold their hands when I talk. Listen music whenever possible. And everyday whenever possible I talk to my wife, father, mother, and brother (all of them are doctors). But still this profession demands too much from us. I have thought about giving up and suicide a thousand times the misery was too much for me to see 12 people die in a day. The only thing that keeps me moving forward is my family and friends. I appreciate what you are doing. It took me 4 hours to write this mail. It is 7 am in the morning. But your article was worth it. Thank you. Thanks a lot.. Dr. Varun DR. VERUN S LETTER Varun died by suicide on June 14, The world has lost a beautiful healer. RIP sweet, sweet soul. Dr. Varun s letters published in Physician Suicide Letters and his words recited on the TEDMED stage: Pamela Wible, M.D. is a family doctor who is dedicated to physician suicide prevention. Please be kind to your doctor. The life you save may save you. Photo credit: Dr. Varun (and his newborn son). If you are suffering, please reach out for help. Contact Dr. Wible.

10 ANOTHER MAJOR EFFECT ON PHYSICIANS SUBSTANCE USE DISORDERS

11 DEFINITION OF SUD S. TWO OR MORE OF THE FOLLOWING SYMPTOMS (12 MONTH PERIOD) Taking more substances than intended Unsuccessful efforts to cut down Significant time spent using or recovering Cravings Failure to perform major role obligations Continued use despite interference with social/occupational activities Use in hazardous situations Use despite negative impact on health Tolerance/Withdrawal DEFINITION. PHYSICIAN IMPAIRMENT.. THE INABILITY TO PRACTICE MEDICINE WITH REASONABLE SKILL AND SAFETY TO PATIENTS BY REASON OF PSYCHIATRIC OR GENERAL- MEDICAL CONDITION.. SUD S MOST COMMON CONDITION LEADING PHYSICIANS TO BECOME IMPAIRED.

12 SUBSTANCES. ALCOHOL MOST FREQUENTLY ABUSED SUBSTANCE IN PHYSICIANS WITH SUD S PRESCRIPTION OPIOIDS.2 ND MOST FREQUENTLY ABUSED SUBSTANCE HIGHER RATES OF PRESCRIPTION DRUG MISUSE RESTROSPECTIVE STUDY. BETWEEN RETROSPECTIVE STUDY OF 3,604 PHYSICIANS.. DRUG OF CHOICE (DOC).. ETOH 25% OPIOIDS 25% MJ 12% COCAINE 11% SEDATIVES 10% AMPHETAMINES 4% OTHER 8% LITERATURE SUGGESTS THAT RATES ARE INCREASING

13 COMORBIDITIES HIGH RATES OF MENTAL HEALTH COMBORBITIES.. MDD 33.0% BIPOLAR DO 11.0% ASPD 7.0% GAD 7.1% MENTAL HEALTH COMBORBIDITIES ASSOCIATED WITH HIGHER RATES OF RELAPSE ON SUBSTANCES. CHARACTERISTICS/RISK FACTORS.. GREATER ACCESS TO RX DRUGS HIGH WORK STRESS PHYSICIANS TRAITS STRONG DRIVE FOR ACHIEVMENT TENDENCY TO DENY PERSONAL PROBLEMS ABILITY TO PERFORM UNDER STRESS SOPHISTICATED DENIAL PROCESSES DIFFICULTY TAKING INPUT/DIRECTIONS FROM OTHERS (AUTONOMY) GENDER (FEMALES REFERRED LESS FOR SUD TREATMENT)

14 EMERGENCY MEDICINE MEDICAL SPECIALTIES.. ANESTHESIOLOGY HIGHEST RISK SPECIALTIES.. PREVENTION OF BURNOUT SELF-CARE.. CONNECTIONS ARE VITAL MODEL WELLNESS.. SEEK HELP OTHER MODALITIES

15 BIBLIOGRAPHY... Arora, Manit, et al. Review Article: Burnout in Emergency Medicine Physicians. Emergency Medicine Australasia, vol. 25, no. 6, Sept. 2013, pp , doi: / Arora, Manit, et al. Review Article: Burnout in Emergency Medicine Physicians. Emergency Medicine Australasia, vol. 25, no. 6, Sept. 2013, pp , doi: / Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care. National Academy of Medicine, National Academy of Medicine, 5 Feb. 2018, nam.edu/burnout-amonghealth-care-professionals-a-call-to-explore-and-address-this-underrecognizedthreat-to-safe-high-quality-care/. BIBLIOGRAPHY... Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care. National Academy of Medicine, National Academy of Medicine, 5 Feb. 2018, nam.edu/burnout-among-health-careprofessionals-a-call-to-explore-and-address-this-underrecognized-threat-to-safe-highquality-care/. Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care. National Academy of Medicine, National Academy of Medicine, 5 Feb. 2018, nam.edu/burnout-among-health-careprofessionals-a-call-to-explo Maslach, Christina. Historical and Conceptual Development of Burnout, 560C42F8D27627C7A6136&rd=1&h=dabBICRYH-LHSsNwN13UhakIu- kuxnlxafogrxyv-- k&v=1&r=