Medical Wellness Flashcards
Burnout:
a state of being that includes emotional exhaustion, depersonalization, and lack of feeing any personal accomplishment despite efforts.
Stress
physical and psychological reaction to ever increasing demands of life;
some stress is normal and can be productive
Some find stress arouses fear, uselessness, guilt, anger and incompetence
Physician Suicide
Suicide rates: approximately 300-400 per year;
that’s over 2 RVU graduating classes, per year
Suicide rates are higher among physicians than their non-physician counterparts, by
40% for men
130% for women
Of note, depression is not necessarily higher, completed suicide attempts are higher
Burn out, quality of life and depressive symptoms predict suicidal ideation
epidemiology of depression
Physicians:
up to 60% report experiencing burn out
up to 30% report being depressed
Medical Residents
Depression/depressive symptoms: 30-40%
75% of first year IM residents went from burnout free to some level of burnout
Burn out rates range: 30%-80%
RVU Epidemiology
Medical Students:
Depression/Anxiety Rates: 40%
Burn out rates: between 45% - 71%
Suicidal ideation: approximately 11% - of those reporting
RVU Students*
Feeling hopeless sometimes, often or always: 23%
Feeling depressed sometimes, always or often: 47%
Feeling emotionally exhausted often or always: 45%
statistics about stress and burnout among physicians
In another survey, only 54% of physicians would choose medicine as a career again
An average of 56% of surveyed physicians report being unsatisfied with their work-life balance
55% of surveyed physicians felt their personal life and family had suffered because they had chosen medicine as a profession.
alcohol abuse
One recent study reported about 13% or males and 21% of females met diagnostic criteria for alcohol abuse or dependence
Variables such as choice of specialty, suicidal ideation and burnout as associate with alcohol abuse or dependence
The same study suggested independent variables such as younger age, being male, unmarried, impulsive, depressed, smoking tobacco, and having a low perception of risk were stronger indicators for at-risk drinking behavior.
contributing factors to wellness
Medical culture
Work place elements
Personal character traits
School variables
medical culture
Rewards unhealthy behavior
Statistics go under reported due to embarrassment, of student, physician, schools and other health care systems
Maintains mental health stigma
Medical student report believing that if they admit being depressed that
faculty would perceive them as “unable to handle their responsibilities”
fellow students would ‘respect (my) professional opinion less.’
Seeking help would make student feel “less intelligent.”
Potential Contributing Factors: Physician Characteristics
Conscientious, hard working, high achievers, self-sacrificing, and self critical (good for being a physician, not so good for well being).
Role bound: Wrap up one’s identity into being a physician; I’m good or bad relative to how I am as a doctor;
Physicians tend to avoid formal healthcare; only a minority have their own primary care physician.
work place variables
Long often unscheduled hours; professional time eats into personal time;
Isolation; decreasing opportunities to connect
Keeping up with an ever-growing body of information (reading)
Finances; business and personal; student debt
Managed care limiting professional freedom
Stress in Medical School
Much research suggests high levels of stress during medical school
Statistics for medical students generally reflect those of physicians
One study showed that mental health worsens throughout medical school
Potential causes of student distress
Adjustment to medical school environment Year 1 & 2: Relocating (away from supports) Increased scholastic workload Concern for academic performance Attempts to master large volumes of information Necessity to join a new peer group Human cadaver experience High stakes exams (boards)
Adjustment to medical school environment Year 3 & 4: Separation from peer group New work environment/different hospital New rotation each month (different knowledge) Unstructured learning environment Lack of free time Long work hours Financial concerns Student abuse
Signs of Burnout:
Feeling overwhelmed in general Critical of self and others Negativity, cynicism Emotional/physical exhaustion It doesn’t feel like fun anymore; lack of personal accomplishment; unmotivated Home feels like a burden due to feeling overwhelmed with commitments outside the home Marital or other relationship problems Feelings of hopelessness or helplessness Tearfulness; crying easily Suicidal ideation Anxiety, depression, sleep difficulties Workaholic; increasing work efforts; ‘it helps patients if I work more, so it should help me’ Concentration difficulty Socially isolated Chronically late for appointments Psychologically absent; difficult deciding what to do, ambivalence Excessive guilt Feelings of worthlessness Family and/or friends notice and comment
Common Signs of Burnout in Medical School
Tearfulness Sense of feeling overwhelmed Feeling paralyzed; don’t know what to do Very tired; poor sleep habits Decreased focus, concentration, retention Chaotic study habits; constant study-school-sleep, repeat Increased isolation Little to no outside activities
benefits of coping strategies
Promote well-being
Engaging coping strategies
Self care
Finding Meaning
Promoting Well-Being
Make an active decision to address your own well being
Learn to recognize your signs of stress
Begin by examining your lifestyle
Deal with stressor proactively rather than reactively, plan for them
Take personal responsibility - the world, or your patients, or our culture will set your agenda for you, if you don’t do it; take control
Strategies to Promote Well-Being: Self-care
Actively cultivating personal interests: have a fulfilling life outside medicine
develop and nurture non-medical interest and relationships; hobbies, activities, friends, family
each day should contain time that is non-medical
stay connected to them
Recharge your battery
Spend quality time alone
Allow transition time between work and home
Take care of your body
Eat right, get sufficient rest, exercise regularly
Watch caffeine, alcohol, tobacco, sugar, recreational drugs
Practice mindfulness
Being fully present and attentive to the moment, to the person and to the task at hand
Seeking professional help for personal physical or psychological illness as needed
Obtain a primary care physician; if you were your own physicians, what would you honestly recommend for about needed lifestyle changes?
Seek professional counseling as needed
Engaging Coping Strategies
Utilizing those with positive consequences or reaching out, such as: Problem solving Positive reinterpretation Reliance on social support Expression of emotions
Leads to productive outcomes, such as:
Skills to adapt easier,
Minimize anxiety and depression
Lower mental and physicals health risks
Increased self-awareness
Increased self awareness is an engaging coping mechanism that can minimize negative outcomes and increase overall well being
Personal journaling is one of the most accessible ways to facilitate self awareness and
emotional intelligence
Journal #1
Goal: make you think about yourself
Allow you to look back and articulate who you are and what you see in your character
Ideally find ways to assist in utilizing this information to enhance your well-being
Disengaging Coping Strategies
Utilizing those with negative consequences or withdrawing or internalizing, such as: Problem avoidance Wishful thinking Self criticism Isolation
Leads to:
Increased depression and anxiety
Lowered mental and physical health
Self-Care: Stress reducing strategies
Relaxation techniques Meditation Guided Imagery Tai chi/yoga Exercise
Deep breathing
Close your eyes
Take three deep breaths
Inhale slowly for a count of three, hold for a count of three and exhale for a count of three
Mindfulness
Paying attention on purpose to the present with a non-judgmental attitude
Eyes closed, listen and feel the breathing, count your breaths
If your mind wanders, its ok, just come back and count again.
Progressive muscle relaxation
The goal is to physically teach you to relax your muscles
Deliberately apply tension to a certain muscle/muscle group
Then release the tension and focus on the relaxation and how the tension flows away
Autogenic training
Sit in a comfortable position, focus your mind
Use visual imagination and verbal cues to relax your body
“My left leg is feeling heavy” “My breathing is very calm”
Meditation
Intentional self-regulation of attention conducted without judgment and focused on observation of the present moment
When we are able to focus on just what is happening in the present moment, our minds cannot be anxious, worried or distressed about other issues
When your mind starts to wander, without judgment gently bring it back to the calm centered place
Establish and frequently utilize pathways from chaos to calm
Benefits of Meditation
Physiological Benefits: Decrease in hypertension Decrease in heart rate Decreased levels of cortisol Reduced sympathetic arousal Strengthened immune system Reduced levels of pain
Psychological Benefits: Reduced stress level Decreased anxiety Decreased depression Improved confidence and concentration Increased peace of mind, optimism and self-worth
Finding Meaning at Work
Much of mental health is based upon our attitude; what is the meaning of our work?
Actively choosing and limiting type of medical practice
Reflect - why are you becoming a physician?
Keep a collection of positive notes/cards from patients/faculty, review them occasionally
Regain focus: create a contact zone:
Choose a few individuals daily and create a contact zone; make a special effort to be curious about some part of their lives other than medicine
Religion/Spirituality
Personal attentiveness to and nurturing of the spiritual aspects of the self can help you feel centered and in control of your life
Recognition, reminder, and appreciation for the bigger picture can put daily tasks in perspective
Reflect on meaning; much of our well being is based upon our philosophy of living and the meaning we make of our lives
Life Philosophies
Develop a philosophic approach to life that incorporates a positive outlook
Identifying and acting on values
If you don’t set them, they will get set for you
Prioritizing values - which may mean a modification of career goals
Acknowledge your priorities and build your life around them
Spend time wisely “how well will this align with my values and priorities?”
Live your values
Identifying Values and Priorities
Values: what are your personal goals?
What do I want out of my life?
What do I want to be remembered for?
What are the most important things in my life?
Priorities:
What is most important to me?
What are my priorities for time, money, and energy?
