Prevention and health promotion programmes for physicians

Transcription

1 Prevention and health promotion programmes for physicians Olaf Gjerløw Aasland Director, The Research Institute Norwegian Medical Association Professor, Institute of health management and health economics University of Oslo III CONGRESO NACIONAL PAIME Barcelona, November 2008

2 Some doctor stereotypes:

3 My definition of a what a doctor is: A doctor is an ordinary human being from whom the extraordinary is expected

4 The good doctor Ample time Loves children Always present ground crew Knows everything and is everybody s friend

5 The master (master/apprentice) Including Patient Professional Inspiring Ample time The Music Maker

6 I am a doctor... The hero... he said quietly, and the crowd let him trough Dr. Jonas Fjeld Hero of 21 Norwegian novels by Øvre Richter Frich in the 1920 s

7 Dr Death or Death s challenger

8 The Disruptive Physician Serious problems with collaboration Not necessarly unpopular among patients A patient safety hazard

9 The self-sacraficing sacraficing doctor Can manage evrything Takes the responsibility for everything

10 In most western countries doctors: Smoke less Exercise more Take less sick leave Eat healthier Drink less alcohol Use less drugs Have a socioeconomically favourable position Have suicide rates that are receding faster than in other segments of the population

11 After the golden age of doctoring (ca ) the role of the patient changed from being a grateful object at the receiving end of a long and hierarchical treatment system to being a conscious subject and a consumer of health services, with legal rights as such.

12 During the golden age doctors who made serious mistakes or showed deviant behaviour seemed immune, like today s diplomats. The modern doctor works in a totally transparent setting where all moves and decisions are documented and accounted for, and personal mistakes or negligence are not tolerated.

13 Burnout-scores (OLBI), Norwegian sample, 2003 Teachers 2,3 2,89 Bus drivers 2,55 2,75 Religious mnisters 1,98 2,74 DOCTORS 2,07 2,74 Advertisement 2,55 2,73 Nurses 2,31 2,69 IT-consultants 2,5 2,63 Lawyers 2,17 2,57 Emotional exhaustion Detachment from work

14 The standing and reputation of the medical profession in our postmodern society is created more by the relatively small group with deviant or unprofessional conduct than by the majority of well functioning doctors.

15 The most important instrument for all doctors are themselves, and their health and behaviour are linked to the patient almost like in a tango dance.

16 The best coping strategy towards the new demands is collectivity to make sure that you as a doctor are always acting in accordance with what is supposed to be professionally right.

17 Caroline B. Thomas et al (1976): What becomes of medical students: The dark side The medical school classes of 1948 through 1964 at the Johns Hopkins University, 1337 individuals, were followed towards three dramatic endpoints: academic failure poor performance (as student or doctor) premature death 49 subjects, 3.1% of the graduates and 11.2% of those who never graduated, died prematurely. Incipient mental illness and emotional disturbance appear to have contributed substantially to academic failure, poor performance during and after medical school, and even to a premature death.

18 Papadakis et al. (2004) at The University of California, San Fransisco (UCSF) Retrospective study of 68 doctors who graduated from the UCSF Medical School between 1943 and 1989 who had been disciplined by the Medical Board of California between 1990 and 2000, Mean age of disciplining: 54 years (range 22 to 77)

19 Reasons for disciplining by The Medical Board of California: (number of cases from the study in parentheses) 1. negligence (38) 2. inappropriate prescribing (12) 3. unlicensed activity (1) 4. sexual misconduct (7) 5. mental illness (3) 6. acts endangering patients through the physician s use of drugs or alcohol (9) *) 7. fraud (3) 8. conviction of a crime (3) 9. unprofessional conduct (8) *) Doctors with alcohol- or drug problems who had not endangered or injured patients, and who had been referred (or self-referred) to the Medical Board s Diversion Program for monitored treatment, were not disciplined.

20 Main findings Students with recorded comments of unprofessional conduct were more than twice as likely to be disciplined by the Medical Board when they became practicing doctors than were students without such comments The more traditional measures of medical school performance, such as grades and passing scores on national standardized tests, did not identify students who later had disciplinary problems as practicing doctors.

21 In a second study from the same goup, three domains of unprofessional behaviour that were of particular importance for later disciplinary actions were identified: poor reliability and responsibility lack of self improvement poor initiative and motivation These findings should provide a good basis for future remediation strategies and policy decisions, as well as better coaching in medical school.

22 1 A program for better prevention and health promotion for doctors selection Selection of students for medical schools should be based with equal weight on three criteria: Academic achievements The ability to deep and strategic learning The ability to communicate, both formally and informally

23 2 A program for better prevention and health promotion for doctors in medical school In medical school, students should regularly be assessed on professional conduct, with special emphasis on: Reliability and responsibility Self improvement Initiative and motivation

24 3 A program for better prevention and health promotion for doctors work life In their work life, doctors should realise that it is no longer considered professional to hide or pretend or work in isolation. Everything they do must be documented and evaluated for the sake of patient safety.

25 4a A program for better prevention and health promotion for doctors professional mirror All doctors must have a professional mirror, where their work, in particular their patient work, is reflected. Such a mirror is usually inherent in a close collegial network with the necessary openness and a possibility to give and receive constructive critique. Sometimes the mirror should be a retreat outside the workplace.

26 4b A program for better prevention and health promotion for doctors professional mirror Doctors and medical students must realise that they are ordinary human beings exposed to the same endogenous and exogenous health hazards as their patients. They must not hesitate to seek help when necessary. Because the patient role is particularly difficult to accept for a doctor, specialised treatment systems and specially trained therapists may be necessary.

27 5 A program for better prevention and health promotion for doctors disciplining and remediation Disciplining or loss of licence for professional misconduct is sometimes necessary measures for the sake of patient safety. All such actions should be accompanied by adequate remediation offers, be it a back on track program or a possibility of rehabilitation outside medicine.

28 Gràcies!