1102017

1

Physician Burnout A Prescription for Wellness

William J Sanders DO MSBoard Certified General Adult and Forensic Psychiatry ABNP and AOBNP

Pine RestMichigan State University Psychiatry Residency Director

Michigan Psychiatric Society Vice President

Assistant Professor Michigan State University

Disclosures

bull NONE

Dr Joseph Burtka MD

1102017

2

Coping Strategies

bull Working in Prison

1102017

2

Coping Strategies

bull Working in Prison

1102017

3

Todayrsquos Talk

bull Define Burnout

bull Identify components of burnout and its impact on the physician their families and the health system

bull Identify screening tools useful in identifying stressors and burnout

bull Discuss methods to promote wellness

1102017

4

BURNOUT

bull Commonly 3 Dimensions

ndash Emotional Exhaustion (lack of energy or enthusiasm)

ndash Detachment (feeling of cynicism)

ndash Feeling that nothing is being accomplished (low sense of personal accomplishment)

bull Primarily Effects the Work Place

ndash This is not depression

ndash Depression effects all realms of life

bull 12 Male Physicians

bull 20 Female Physicians

1102017

5

Physician Suicide

bull The statistics on physician suicide are frightening

ndash Physicians are more than twice as likely to kill themselves as nonphysicians (and female physicians three times more likely than their male counterparts)

ndash Approximately 400 doctors commit suicide every year

Physician Suicide

bull Young physicians at the beginning of their training are particularly vulnerable In a recent study published in the Journal of Academic Medicine 94 percent of fourth-year medical students and interns reported having suicidal thoughts in the previous year

BURNOUT

bull Introduced in 1974 by a German-born American Psychologist named Herbert Freudenberger

bull Coined due to the increasing number of cases he encountered of ldquophysical or mental collapse caused by overwork or stressrdquo

bull The relationship to stress and anxiety is crucial as it distinguishes burnout from simple exhaustion (ie running a long race)

1102017

4

BURNOUT

bull Commonly 3 Dimensions

ndash Emotional Exhaustion (lack of energy or enthusiasm)

ndash Detachment (feeling of cynicism)

ndash Feeling that nothing is being accomplished (low sense of personal accomplishment)

bull Primarily Effects the Work Place

ndash This is not depression

ndash Depression effects all realms of life

bull 12 Male Physicians

bull 20 Female Physicians

1102017

5

Physician Suicide

bull The statistics on physician suicide are frightening

ndash Physicians are more than twice as likely to kill themselves as nonphysicians (and female physicians three times more likely than their male counterparts)

ndash Approximately 400 doctors commit suicide every year

Physician Suicide

bull Young physicians at the beginning of their training are particularly vulnerable In a recent study published in the Journal of Academic Medicine 94 percent of fourth-year medical students and interns reported having suicidal thoughts in the previous year

BURNOUT

bull Introduced in 1974 by a German-born American Psychologist named Herbert Freudenberger

bull Coined due to the increasing number of cases he encountered of ldquophysical or mental collapse caused by overwork or stressrdquo

bull The relationship to stress and anxiety is crucial as it distinguishes burnout from simple exhaustion (ie running a long race)

1102017

5

Physician Suicide

bull The statistics on physician suicide are frightening

ndash Physicians are more than twice as likely to kill themselves as nonphysicians (and female physicians three times more likely than their male counterparts)

ndash Approximately 400 doctors commit suicide every year

Physician Suicide

bull Young physicians at the beginning of their training are particularly vulnerable In a recent study published in the Journal of Academic Medicine 94 percent of fourth-year medical students and interns reported having suicidal thoughts in the previous year

BURNOUT

bull Introduced in 1974 by a German-born American Psychologist named Herbert Freudenberger

bull Coined due to the increasing number of cases he encountered of ldquophysical or mental collapse caused by overwork or stressrdquo

bull The relationship to stress and anxiety is crucial as it distinguishes burnout from simple exhaustion (ie running a long race)

1102017

6

BURNOUT

bull Rates vary from 30-65 across medical specialties

bull Nearly 1 in 2 physicians will suffer from ldquoBurnoutrdquo

bull Burnout is not unique to physicians

bull Physicians are uniquely vulnerablesusceptible to burnout as they have been trained to be strong independent and invulnerable

Burnout effects Patients

1102017

7

What is BURNOUTbull Fatigue

bull Exhaustion

bull Anhedonia

bull Loss of Motivation

bull Feelings of Detachment

bull Sense of Ineffectiveness

bull Hypervigilance

bull Sleep Problems

bull Perfectionism

bull Frequent Illness

bull Loss of Sense of Purpose

bull Weary Indifference

bull Lack of Engagement

bull Chronic Indecisiveness

bull Over Identification

bull Irritability

bull Personal and Professional Boundary Violations

bull Avoiding Emotionally Difficult Situations

Do you Believe in Stress

bull How to make stress your friend

The worst thing you can do is look the other way Watch out for colleagues

bull Physical exhaustion

bull Repetitive cynicism

bull Guilt

bull Ineffectiveness

bull A sense of depersonalization in relationships with coworkers or patients

1102017

7

What is BURNOUTbull Fatigue

bull Exhaustion

bull Anhedonia

bull Loss of Motivation

bull Feelings of Detachment

bull Sense of Ineffectiveness

bull Hypervigilance

bull Sleep Problems

bull Perfectionism

bull Frequent Illness

bull Loss of Sense of Purpose

bull Weary Indifference

bull Lack of Engagement

bull Chronic Indecisiveness

bull Over Identification

bull Irritability

bull Personal and Professional Boundary Violations

bull Avoiding Emotionally Difficult Situations

Do you Believe in Stress

bull How to make stress your friend

The worst thing you can do is look the other way Watch out for colleagues

bull Physical exhaustion

bull Repetitive cynicism

bull Guilt

bull Ineffectiveness

bull A sense of depersonalization in relationships with coworkers or patients

1102017

8

The Scream

bull Sickness insanity and death were the angels that surrounded my cradle and they have followed me throughout my lifeldquo- EdvardMunch

The ldquoPhysician Personalityrdquo and ldquoThe Physician Culturerdquo

bull Diagnostic rigor

bull Thoroughness

bull Commitment to patients

bull Desire to stay current

bull Recognize responsibility of patientsrsquo trust

bull Hectic schedule

bull Strong achievement orientation

bull An inability to say ldquonordquo

1102017

9

1102017

10

The Maslach Burnout Inventory (MBI)

bull The Gold Standard for Assessing Burnout

bull 22-item inventory that emphasizes 3 dimensions

ndash Emotional exhaustion

ndash Depersonalization

ndash Low Personal Accomplishment

Managing Burnoutbull Reduce its effect- try rest and relaxation health

and fitness personal coping strategies and social support

bull Deal with sources- be realistic and establish priorities use time management lobby for change and use assertiveness

bull Improve your attitude- look for the good highlight the positive and reflect and take control

bull LET THINGS GO

1102017

11

Preventing Burnout

bull Mental- meditationmindfulness seminar process group

bull Social- get together with friends find a peer group

bull Intellectual- promote opportunities for scholarly activity

bull Physical- healthy snacks cook a new meal hike swim physical activity

bull Financial- debt management financial advisor

ndash myth that more money makes you happy

Do Prevention Strategies Workbull Initial step of all programs was enhanced

recognitionIdentify the problem Whats the problem

bull In a comprehensive systematic review and meta-analysis of studies evaluating the effect of physician burnout interventions investigators identify multiple individual and organizational-based programs that produced significant improvements in the prevalence and severity of overall burnout emotional exhaustion and depersonalization

Do Prevention Strategies Work

bull The majority of the studies used the MaslachBurnout Inventory

bull The pooled mean of 15 randomized control trials and 37 observational studies that met the review criteria and addressed outcomes and approaches to physician burnout demonstrated a reduction of 54 to 44 (difference 10 95 confidence interval [CI] 5-14 Plt0001I^2=15)

bull It was noted that structural or organizational interventions were more effective than individual focused ones

1102017

10

The Maslach Burnout Inventory (MBI)

bull The Gold Standard for Assessing Burnout

bull 22-item inventory that emphasizes 3 dimensions

ndash Emotional exhaustion

ndash Depersonalization

ndash Low Personal Accomplishment

Managing Burnoutbull Reduce its effect- try rest and relaxation health

and fitness personal coping strategies and social support

bull Deal with sources- be realistic and establish priorities use time management lobby for change and use assertiveness

bull Improve your attitude- look for the good highlight the positive and reflect and take control

bull LET THINGS GO

1102017

11

Preventing Burnout

bull Mental- meditationmindfulness seminar process group

bull Social- get together with friends find a peer group

bull Intellectual- promote opportunities for scholarly activity

bull Physical- healthy snacks cook a new meal hike swim physical activity

bull Financial- debt management financial advisor

ndash myth that more money makes you happy

Do Prevention Strategies Workbull Initial step of all programs was enhanced

recognitionIdentify the problem Whats the problem

bull In a comprehensive systematic review and meta-analysis of studies evaluating the effect of physician burnout interventions investigators identify multiple individual and organizational-based programs that produced significant improvements in the prevalence and severity of overall burnout emotional exhaustion and depersonalization

Do Prevention Strategies Work

bull The majority of the studies used the MaslachBurnout Inventory

bull The pooled mean of 15 randomized control trials and 37 observational studies that met the review criteria and addressed outcomes and approaches to physician burnout demonstrated a reduction of 54 to 44 (difference 10 95 confidence interval [CI] 5-14 Plt0001I^2=15)

bull It was noted that structural or organizational interventions were more effective than individual focused ones

1102017

11

Preventing Burnout

bull Mental- meditationmindfulness seminar process group

bull Social- get together with friends find a peer group

bull Intellectual- promote opportunities for scholarly activity

bull Physical- healthy snacks cook a new meal hike swim physical activity

bull Financial- debt management financial advisor

ndash myth that more money makes you happy

Do Prevention Strategies Workbull Initial step of all programs was enhanced

recognitionIdentify the problem Whats the problem

bull In a comprehensive systematic review and meta-analysis of studies evaluating the effect of physician burnout interventions investigators identify multiple individual and organizational-based programs that produced significant improvements in the prevalence and severity of overall burnout emotional exhaustion and depersonalization

Do Prevention Strategies Work

bull The majority of the studies used the MaslachBurnout Inventory

bull The pooled mean of 15 randomized control trials and 37 observational studies that met the review criteria and addressed outcomes and approaches to physician burnout demonstrated a reduction of 54 to 44 (difference 10 95 confidence interval [CI] 5-14 Plt0001I^2=15)

bull It was noted that structural or organizational interventions were more effective than individual focused ones

1102017

12

Physician Burnout Strategiesbull Both Individual-focused and structured

organizational strategies are likely required

bull Mindfulness stress management and small group discussions were all common effective strategies

bull Mindfulness training can help individuals be aware of burnout in the early phases-noting changes in the body (headaches or muscle tension) emotions (irritability or sarcasm) or thoughts (blaming self or others)

Prevention Strategiesbull 1) Evaluate

ndash Evaluate a typical weekly schedule and reduce or eliminate non-essential tasks

ndash Prioritize the remaining tasks into doable lists

ndash Early recognition of the burnout process and factors

ndash Often there is self denial (work harder and longer)

bull 2) Assess

ndash Complete a periodic assessment and realignment of goals skills and work passions

Prevention Strategies

bull 3) Sleep

ndash Get enough Sleep 7-8 hours

ndash Learn about good sleep hygiene

bull 4) Take Breaks

ndash Include enjoyable ldquotimeoutsrdquo

bull Yoga

bull Hobbies

bull HUMOR

bull Meditation

bull Cultivate Relaxation

1102017

13

Neurobiology of Mindfulness in Military Training

Background

bull Military deployment can have a profound effect on physical and mental health

bull Limited data regarding interventions prior to deployment

bull Population studies of military personal serving in combat indicate prevalences of stress-related mental health disorders between 113 and 191 (1)

bull Research suggestion neural network disruption (5)

Conclusion

bull 1) MT altered heart rate and breathing rate recovery following stressful training

bull 2) MT modulated a strongly correlated set of peripheral biomarkers before during and after exposure to a stressful training session

bull 3) The neuroimaging results support the hypothesis that MT affects brain structure that are important in integrating information about the internal physiological state and the bodyrsquos response to stress

1102017

14

Conclusion

bull MT demonstrated beneficial effects across multiple domains

bull Effects were observed even in nonclinical samples

bull Evidence for the prevention and treatment of stress related pathology

bull Cardiorespiratory fitness is associated with greater reactivity to stress followed by enhanced recovery

Conclusion

bull Changes were found in insula function via fMRI

bull Evidence suggests individuals who adapt well to stress have more efficient deployment of neural processing resources and autonomic response to stress

bull MT group showed lower sympathetic activation during recovery from stressful immersive training

Neurobiology of Mindfulnessbull The eight brain regions consistently altered included

the following

bull Rostrolateral prefrontal cortex A region associated with meta-awareness (awareness of how you think) introspection and processing of complex abstract information

bull Sensory cortices and insular cortex The main cortical hubs for processing of tactile information such touch pain conscious proprioception and body awareness

bull Hippocampus A pair of subcortical structures involved in memory formation and facilitating emotional responses

1102017

15

Neurobiology of Mindfulness

bull Anterior cingulate cortex and mid-cingulate cortex Cortical regions involved in self-regulation emotional regulation attention and self-control

bull Superior longitudinal fasciculus and corpus callosum Subcortical white matter tracts that communicate within and between brain hemispheres

Amygdala

Hippocampus

(Deep in

temporal lobe)

(contextual

memory)

Prefrontal

Cortex

Medial Prefrontal

Cortex (Inhibitory

regulation of

amygdala)

Anterior Cingulate (Interpreting

SignalsResolving Conflict)

Hypothalamus (HPA)

neuroendocrine response

Amygdala

Periaquaductal Gray

(freezeresponse)

Basal GangliaStriatum

(Coordinated Muscle

Response

Ventral

Tegmental Area

(dopamine)

Locus

Coeruleus

(Norepinephrine)

1102017

16

Prevention Strategies

bull 5) Get Support

ndash Build up professional and personal support system

ndash Dedicated family time

ndash Supervision Groups

ndash Meeting with mentors to discuss management

ndash Organizations can help establish defined roles job characteristics help build interpersonal relationships and improve work environment and morale

Prevention Strategies

bull 6) Invest in a vacation

ndash Cultivate an ability to self-reflect

ndash Pause to attend to personal needs

ndash Use time to realign goals and expectations

ndash Exhaustion is easier to treat than depersonalization and a sense of ineffectiveness

ndash Take a vacation

Prevention Strategies

bull 7) Optimize meaning in work

ndash Healer

ndash Expert

ndash Teacher

ndash Building a practice

ndash Advancing Researchbull Physicians who spend less

than 20 of their time in meaningful activities are at a higher risk of burnout

1102017

13

Neurobiology of Mindfulness in Military Training

Background

bull Military deployment can have a profound effect on physical and mental health

bull Limited data regarding interventions prior to deployment

bull Population studies of military personal serving in combat indicate prevalences of stress-related mental health disorders between 113 and 191 (1)

bull Research suggestion neural network disruption (5)

Conclusion

bull 1) MT altered heart rate and breathing rate recovery following stressful training

bull 2) MT modulated a strongly correlated set of peripheral biomarkers before during and after exposure to a stressful training session

bull 3) The neuroimaging results support the hypothesis that MT affects brain structure that are important in integrating information about the internal physiological state and the bodyrsquos response to stress

1102017

14

Conclusion

bull MT demonstrated beneficial effects across multiple domains

bull Effects were observed even in nonclinical samples

bull Evidence for the prevention and treatment of stress related pathology

bull Cardiorespiratory fitness is associated with greater reactivity to stress followed by enhanced recovery

Conclusion

bull Changes were found in insula function via fMRI

bull Evidence suggests individuals who adapt well to stress have more efficient deployment of neural processing resources and autonomic response to stress

bull MT group showed lower sympathetic activation during recovery from stressful immersive training

Neurobiology of Mindfulnessbull The eight brain regions consistently altered included

the following

bull Rostrolateral prefrontal cortex A region associated with meta-awareness (awareness of how you think) introspection and processing of complex abstract information

bull Sensory cortices and insular cortex The main cortical hubs for processing of tactile information such touch pain conscious proprioception and body awareness

bull Hippocampus A pair of subcortical structures involved in memory formation and facilitating emotional responses

1102017

15

Neurobiology of Mindfulness

bull Anterior cingulate cortex and mid-cingulate cortex Cortical regions involved in self-regulation emotional regulation attention and self-control

bull Superior longitudinal fasciculus and corpus callosum Subcortical white matter tracts that communicate within and between brain hemispheres

Amygdala

Hippocampus

(Deep in

temporal lobe)

(contextual

memory)

Prefrontal

Cortex

Medial Prefrontal

Cortex (Inhibitory

regulation of

amygdala)

Anterior Cingulate (Interpreting

SignalsResolving Conflict)

Hypothalamus (HPA)

neuroendocrine response

Amygdala

Periaquaductal Gray

(freezeresponse)

Basal GangliaStriatum

(Coordinated Muscle

Response

Ventral

Tegmental Area

(dopamine)

Locus

Coeruleus

(Norepinephrine)

1102017

16

Prevention Strategies

bull 5) Get Support

ndash Build up professional and personal support system

ndash Dedicated family time

ndash Supervision Groups

ndash Meeting with mentors to discuss management

ndash Organizations can help establish defined roles job characteristics help build interpersonal relationships and improve work environment and morale

Prevention Strategies

bull 6) Invest in a vacation

ndash Cultivate an ability to self-reflect

ndash Pause to attend to personal needs

ndash Use time to realign goals and expectations

ndash Exhaustion is easier to treat than depersonalization and a sense of ineffectiveness

ndash Take a vacation

Prevention Strategies

bull 7) Optimize meaning in work

ndash Healer

ndash Expert

ndash Teacher

ndash Building a practice

ndash Advancing Researchbull Physicians who spend less

than 20 of their time in meaningful activities are at a higher risk of burnout

1102017

14

Conclusion

bull MT demonstrated beneficial effects across multiple domains

bull Effects were observed even in nonclinical samples

bull Evidence for the prevention and treatment of stress related pathology

bull Cardiorespiratory fitness is associated with greater reactivity to stress followed by enhanced recovery

Conclusion

bull Changes were found in insula function via fMRI

bull Evidence suggests individuals who adapt well to stress have more efficient deployment of neural processing resources and autonomic response to stress

bull MT group showed lower sympathetic activation during recovery from stressful immersive training

Neurobiology of Mindfulnessbull The eight brain regions consistently altered included

the following

bull Rostrolateral prefrontal cortex A region associated with meta-awareness (awareness of how you think) introspection and processing of complex abstract information

bull Sensory cortices and insular cortex The main cortical hubs for processing of tactile information such touch pain conscious proprioception and body awareness

bull Hippocampus A pair of subcortical structures involved in memory formation and facilitating emotional responses

1102017

15

Neurobiology of Mindfulness

bull Anterior cingulate cortex and mid-cingulate cortex Cortical regions involved in self-regulation emotional regulation attention and self-control

bull Superior longitudinal fasciculus and corpus callosum Subcortical white matter tracts that communicate within and between brain hemispheres

Amygdala

Hippocampus

(Deep in

temporal lobe)

(contextual

memory)

Prefrontal

Cortex

Medial Prefrontal

Cortex (Inhibitory

regulation of

amygdala)

Anterior Cingulate (Interpreting

SignalsResolving Conflict)

Hypothalamus (HPA)

neuroendocrine response

Amygdala

Periaquaductal Gray

(freezeresponse)

Basal GangliaStriatum

(Coordinated Muscle

Response

Ventral

Tegmental Area

(dopamine)

Locus

Coeruleus

(Norepinephrine)

1102017

16

Prevention Strategies

bull 5) Get Support

ndash Build up professional and personal support system

ndash Dedicated family time

ndash Supervision Groups

ndash Meeting with mentors to discuss management

ndash Organizations can help establish defined roles job characteristics help build interpersonal relationships and improve work environment and morale

Prevention Strategies

bull 6) Invest in a vacation

ndash Cultivate an ability to self-reflect

ndash Pause to attend to personal needs

ndash Use time to realign goals and expectations

ndash Exhaustion is easier to treat than depersonalization and a sense of ineffectiveness

ndash Take a vacation

Prevention Strategies

bull 7) Optimize meaning in work

ndash Healer

ndash Expert

ndash Teacher

ndash Building a practice

ndash Advancing Researchbull Physicians who spend less

than 20 of their time in meaningful activities are at a higher risk of burnout

1102017

15

Neurobiology of Mindfulness

bull Anterior cingulate cortex and mid-cingulate cortex Cortical regions involved in self-regulation emotional regulation attention and self-control

bull Superior longitudinal fasciculus and corpus callosum Subcortical white matter tracts that communicate within and between brain hemispheres

Amygdala

Hippocampus

(Deep in

temporal lobe)

(contextual

memory)

Prefrontal

Cortex

Medial Prefrontal

Cortex (Inhibitory

regulation of

amygdala)

Anterior Cingulate (Interpreting

SignalsResolving Conflict)

Hypothalamus (HPA)

neuroendocrine response

Amygdala

Periaquaductal Gray

(freezeresponse)

Basal GangliaStriatum

(Coordinated Muscle

Response

Ventral

Tegmental Area

(dopamine)

Locus

Coeruleus

(Norepinephrine)

1102017

16

Prevention Strategies

bull 5) Get Support

ndash Build up professional and personal support system

ndash Dedicated family time

ndash Supervision Groups

ndash Meeting with mentors to discuss management

ndash Organizations can help establish defined roles job characteristics help build interpersonal relationships and improve work environment and morale

Prevention Strategies

bull 6) Invest in a vacation

ndash Cultivate an ability to self-reflect

ndash Pause to attend to personal needs

ndash Use time to realign goals and expectations

ndash Exhaustion is easier to treat than depersonalization and a sense of ineffectiveness

ndash Take a vacation

Prevention Strategies

bull 7) Optimize meaning in work

ndash Healer

ndash Expert

ndash Teacher

ndash Building a practice

ndash Advancing Researchbull Physicians who spend less

than 20 of their time in meaningful activities are at a higher risk of burnout

1102017

16

Prevention Strategies

bull 5) Get Support

ndash Build up professional and personal support system

ndash Dedicated family time

ndash Supervision Groups

ndash Meeting with mentors to discuss management

ndash Organizations can help establish defined roles job characteristics help build interpersonal relationships and improve work environment and morale

Prevention Strategies

bull 6) Invest in a vacation

ndash Cultivate an ability to self-reflect

ndash Pause to attend to personal needs

ndash Use time to realign goals and expectations

ndash Exhaustion is easier to treat than depersonalization and a sense of ineffectiveness

ndash Take a vacation

Prevention Strategies

bull 7) Optimize meaning in work

ndash Healer

ndash Expert

ndash Teacher

ndash Building a practice

ndash Advancing Researchbull Physicians who spend less

than 20 of their time in meaningful activities are at a higher risk of burnout

1102017

17

Positive Psychology

bull The Happy Secret to Better Workbull Positive Psychology

ndash Positive psychologist seek to find and nurture genius and talent and to make normal life more fulfilling

ndash Scientific study of optimal human functioning and what makes life worth living

ndash Psychology of the characteristics conditions and processes which lead to flourishing

ndash Researching what goes right for individuals communities and organizations

Prevention Strategies

bull 8) Avoid Over Commitment

ndash Say ldquoyesrdquo with intention

bull ldquowhatrsquos meaningful to merdquo

ndash Identify personal and professional values and goals which will help guide decisions

ndash Setting Limits

Prevention Strategiesbull 9) Physical Activity

ndash Individuals who follow the CDC guidelines for exercise were less likely to have burnout and more likely to have a high quality of life

bull 150 minutes per week of moderately intense exercise of 75 minutes of vigorous exercise in addition to strength training each major muscle group at least twice per week

1102017

18

Prevention Strategiesbull 10) Build Relationships

ndash Nurturing relationships leads to a greater quality of life

ndash Social support builds resiliency

ndash Find a Peer Group

ndash Build relationships at work and at homebull Can be as simple as sending

thank you notes

Prevention Strategies

bull 11) Avoid Delayed Gratification

ndash Consider what activities you enjoy outside of work

ndash What steps can you take to add that activity to your life

bull 12) Reduce hours

ndash It can affect your salary and the number of patients you see but it does help

Prevention Strategies

bull 13) Gratitude

ndash Gratitude Diary

bull ldquo3 things Irsquom Grateful for Todayrdquo

ndash 5 minutes for Reflection

ndash Notes of Gratitude

bull 14) Set Realistic Goals

ndash The Sabanization of College Football

bull 15) Evaluate WorkHome Life Balance

1102017

19

Prevention Strategiesbull 1)Evaluate

bull 2)Assess

bull 3)Sleep

bull 4)Take Breaks

bull 5)Get Support

bull 6)Invest in a vacation

bull 7)Optimize meaning in work

bull 8)Avoid Over Commitment

bull 9)Physical Activity

bull 10)Building Relationships

bull 11)Avoid delayed gratification

bull 12)Reduce Hours

bull 13)Gratuity

bull 14)Set Realistic Goals

bull 15)ReevalauteHomeLife balance

Obstacles to Reducing Stress

bull Holding onto perfectionism

bull Rigidity

bull Isolation

bull Over commitment

bull Undiagnosed addictions-addiction to substances reward appreciation andor substances

1102017

20

GETTING HELP

bull National Suicide Prevention Hotline

ndash 1-800-273-8255

bull Pine Rest

ndash 616-455-5000

Referencesbull httpwwwcdcgovviolencepreventionsuicideconsequenceshtml

bull Lindeman S Laara E Hakko H Lonnqvist J Br J Psychiatry 1996 Mar168(3)274-9 A systematic review on gender-specific suicide mortality in medical doctors

bull Louise B Andrew MD JD Chief Editor Barry E Brenner MD PhD FACEP Medscape Physician Suicide Author

bull Goebert Deborah DPH Thompson Diane MD Takeshita Junji MD Beach Cheryl PhD Bryson Philip LCSW Ephgrave Kimberly MD Kent Alan PhD Kunkel Monique MD Schechter Joel PhD Tate Jodi MD Academic Medicine Depressive Symptoms in Medical Students and Residents A Multischool Study

bull Center for Disease Control httpwwwcdcgovnchsfastatsleading-causes-of-deathhtm

References

bull Christine Y Lu et al BMJ 2014348bmjg3596

bull Jong-Min Woo Olaoluwa Okusaga Teodor T Postolache Seasonality of Suicidal Behavior Int J Environ Res Health 2012 February 9(2) 531-547

bull Frank E Biola H Burnett CA Mortality Rates and Causes Among US Physicians Am J Prev Med 2000 Oct 19(3) 155-9

bull Linzer M et al ldquo10 Bold Steps To Prevent Burnout In General Internal Medicinerdquo J Gen Intern Med 20142918-20

bull Peckham C ldquoPhysician Burnout It Just Keeps Getting Worserdquo Medscape Physician Lifestyle Report january 26 2015

bull Cohen J ldquoMinds Turned to Ashrdquo The Economist 1843 magazine AugustSeptember 2016

bull Holy Bible NV version Ecclesiastes 12-3

bull Galen As quoted in Robson D ldquoThe reasons why exhaustion and burnout are so commonrdquo BBC Future July 22 2016 on-line reference accessed on october29 2016 at httpwwwbbccomfuturestory20160721-the reason-why-exhaustion-and-burnout-are-so-common

1102017

20

GETTING HELP

bull National Suicide Prevention Hotline

ndash 1-800-273-8255

bull Pine Rest

ndash 616-455-5000

Referencesbull httpwwwcdcgovviolencepreventionsuicideconsequenceshtml

bull Lindeman S Laara E Hakko H Lonnqvist J Br J Psychiatry 1996 Mar168(3)274-9 A systematic review on gender-specific suicide mortality in medical doctors

bull Louise B Andrew MD JD Chief Editor Barry E Brenner MD PhD FACEP Medscape Physician Suicide Author

bull Goebert Deborah DPH Thompson Diane MD Takeshita Junji MD Beach Cheryl PhD Bryson Philip LCSW Ephgrave Kimberly MD Kent Alan PhD Kunkel Monique MD Schechter Joel PhD Tate Jodi MD Academic Medicine Depressive Symptoms in Medical Students and Residents A Multischool Study

bull Center for Disease Control httpwwwcdcgovnchsfastatsleading-causes-of-deathhtm

References

bull Christine Y Lu et al BMJ 2014348bmjg3596

bull Jong-Min Woo Olaoluwa Okusaga Teodor T Postolache Seasonality of Suicidal Behavior Int J Environ Res Health 2012 February 9(2) 531-547

bull Frank E Biola H Burnett CA Mortality Rates and Causes Among US Physicians Am J Prev Med 2000 Oct 19(3) 155-9

bull Linzer M et al ldquo10 Bold Steps To Prevent Burnout In General Internal Medicinerdquo J Gen Intern Med 20142918-20

bull Peckham C ldquoPhysician Burnout It Just Keeps Getting Worserdquo Medscape Physician Lifestyle Report january 26 2015

bull Cohen J ldquoMinds Turned to Ashrdquo The Economist 1843 magazine AugustSeptember 2016

bull Holy Bible NV version Ecclesiastes 12-3

bull Galen As quoted in Robson D ldquoThe reasons why exhaustion and burnout are so commonrdquo BBC Future July 22 2016 on-line reference accessed on october29 2016 at httpwwwbbccomfuturestory20160721-the reason-why-exhaustion-and-burnout-are-so-common

1102017

21

Referencesbull Beard G ldquoNeurasthenia or nervous exhaustionrdquo Boston Medical and Surgical

Journal 1869(3)217-221 As referenced in Taylor RE ldquoDeath of neurasthenia and its psychological reincarnation A study of neurasthenia at the National Hospital for the Relief and Cure of the Paralysed and Epileptic Queen Square London 1870-1932rdquo Brit J of Psychiatry December 2001179(6)550-557

bull Jauhar S ldquoWhy Doctors Are Sick of Their Professionrdquo The Wall Street Journal August 29 2014

bull Smith RP Physician burnout Oral presentation Grand Rapids MI october 18 2016

bull Studer Q Healing physician Burnout Pensacola Fire Starter Publishing 201555-69 82-86

bull Carlson R Donrsquot Sweat the Small Stuffhellipand itrsquos All Small Stuff New York Hyperion 199719-20

bull Phillips D Physician Burnout Can Be Reduced by Targeted Interventions October 11 2016 Medscape

bull Szigethy E MD PhD Burnout Strategies to Prevent and Overcome a Common-and Dangerous-Problem

Referencesbull Adapted from Kearney MK Self-

Care of Physicians Caring forPatients at the End Of Life JAMA20093011155-1164

bull Krasner MS Epstein RM et al JAMA 2009 302 1284-1293

bull TED talks ldquoHow to make stress your friendrdquo httpswwwyoutubecomwatchv=RcGyVTAoXEU

bull TED talks ldquoThe Happy Secret to Better Workrdquo httpswwwyoutubecomwatchv=fLJsdqxnZb0