3rd Annual DeGroote Interprofessional Health Leadership Conference

Dr. Brian Goldman

October 1, 2011

Doctors open up about their profession

White Coat, Black Art Body and Soul:

Health Professionals at Risk

Objectives

• ‘White Coat, Black Art’ perspective

• Burnout: definition, stats, stories

• Violence against HCPs

• Compassion fatigue: definition, stories

• Some solutions

WHITE, COAT, BLACK ART

•2007-2009: 59 x episodes2007-2009: 59 x episodes•Fifth Season: 2010-11Fifth Season: 2010-11

White Coat’s Mission:

• To reveal the true culture of medicine

• To reveal the inners workings of the health care system (warts and all)

• By telling stories from the POV of health care providers

• We’ve been holding up a mirror to you…

• What you’re about to hear are things you’ve been telling us

• In your own words

Burnout

• A stress syndrome characterized by:– Emotional

exhaustion– Decreased

satisfaction at work– Distancing from

patients and co-workers

Burnout: Stats Among MDs

• 2003 CMA Survey: nearly 50% of MDs in the advanced stages

• 2004 JAMA: analysis of 15 studies found uniformly high rates of burnout among post-graduate residents

• 2006 Mayo Clinic Study: nearly half of med students

An MD’s Story:

• John Aquino is an MD– Early 1990s: trained

in Canada, started FP in the U.S.

– Returned to Canada two years ago for personal reasons

• Since returning, he’s admitted to feeling burned out

Burnout in Nursing

• Even higher rates than MDs

• Over 50% in most studies

• Manitoba Nurses Union: 66% of junior nurses have burnout

A Recent Grad’s Story

• Deb Lowe graduated from U of Victoria in 2004– General wards– ICU

• Four years on, she suffers from burnout

• And, she’s not alone

The View from a Psychotherapist

• Francoise Mathieu• Certified Mental Health

Counselor in Kingston• Specializes in helping

HCPs with burnout• Everyone claims to have

it…– Are HCPs any different?

• “Slammed”• “Inundated”• “Swamped”

Reason #1 For Burnout: The System

A system in which patients are seen as the enemy

Factors We Can’t Control

•Global recession•HCW layoffs

•Seniors: fastest growing population segment in Canada

Statistics Canada

More and More…

AngerUnderstanding

For Those Who Can’t do Anything About It

• Especially true in hospitals – cutbacks mean fewer nurses caring for

more patients– Today’s hospitalized patients are sicker

• A significant amount of that stress is reflected in attitudes towards hospitalized seniors

• Listen to these nursing students

A Great and Paradoxical Divide Between Patients and

HCPs

The View from HCPs in the ED

Dr. John Ross, Head of ED QEII HSC

Jill Lambeth, RN at QEII HSC

So, Who’s to Blame?

• Jill Lambeth, RN, QEII HSC, Halifax: – No advanced directives

Reason #2: Violence

• HC and social service industry accounts for 48% of all non-fatal injuries from acts of violence and workplace assaults

• U.S.: costs billions in security, medical and legal expenses

• Leads to burnout, PTSD, poor job performance• “Healthcare workers are more likely to be

attacked at work that prison guards and police officers.”

Int’l Council of Nurses. Position Statement: Abuse and Violence Against Nursing Personnel

Violence in the ER• Fernandes: 57% of

ER respondents physically assaulted over a 1 year period

• Mayer: 72% assaulted at least once during their career

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Violence in the Hospital: Environmental Factors

• Security issues

• Public space - uncontrolled movement

• Delays/wait times

• Crowding, uncomfortable

• Volatile families

Violence in the Hospital: Staff Factors

• Inadequate staffing: working alone

• Violence during patient transport

• Lack of training• Lack of situational

awareness– Dr. Bruce Campana

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Violence in the ER: Staff Factors

• Risk factors aren’t unique to the ED

• But the ED has more potential hazards

• Maria Raptis: charge nurse– Recalls a patient

with bipolar brought in by his girlfriend

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Reason #3 for Burnout:Powerlessness in

Relationships• Nurse more likely

than MDs to experience it– Deb Lowe

• ER physicians more likely than other specialists to experience it

• So do students and residents

Compassion Fatigue

• Compassion fatigue, also known as a Secondary Traumatic Stress Disorder, is a term that refers to a gradual lessening of compassion over time. It is common among victims of trauma and individuals that work directly with victims of trauma. It was first diagnosed in nurses in the 1950's.

• Francoise Mathieu is an expert in compassion fatigue

Reason #4: Exposure to Traumatic Events (PTSD)

• a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma

• 50% experience at least 1 traumatic event

• only 8% dx’d with PTSD

• Very high rates among paramedics & veterans

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Vince Savoia, Executive Director of the Tema Conter Foundation

Reason #5:Factors in the Individual

• Dr. Graeme Cunningham– Medical Director, Alcohol

and Drug Treatment Program, Homewood Health Centre, Guelph, Ontario

• In public, he was a respected cardiologist

• In private, he abused alcohol to a deal with a pathological fear of failure

Burnout:The Consequences

• The System– Francoise Mathieu

• The Individual– Dr. Graeme

Cunningham– Donna Paradowski

Solution #1:Get Help

• EAP

• AWARE-NS

• Private counseling

• Other: Tema Conter (for medics)

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Solution #2:Advocate

• Francoise Mathieu• Use the ‘low back

pain’ model in nursing– More resources– Less silence

Solution #3:Appreciating Our Limits

• Personal and professional

• System

Sharing the Load

• Roberta Heale and Marilyn Butcher:– 1st NP-led

primary care health clinic in Canada

– 20-30,000 orphan patients in Sudbury

Enlarging the Team

NP’s and PA’s

Family Physicians

Specialists

Enough Business for Everyone?

Three Questions to Ask Yourself

1. When you think about your life at the moment, would you say that by and large you are satisfied with life or are you mostly dissatisfied?

2. If you were asked this question five years ago, what might your answer have been then?

3. What do you think your answer to this question will be five years from now?

Thank You for the Calling You Have Embarked Upon!