view Dr. Finkelstein's presentation


Strategies to Build Resilience in Medical Practice

Thurston-Mason County Medical Society Meeting

Claudia Finkelstein MD [email protected]


Financial none

Slight Epic meltdown in progress- challenging personal resilience

Learning Objectives:

Define burnout

Name evidence based strategies to promote resilience

Be aware of existing Resources

Current State : Burnout


Three spheres

MBI vs Single Item Measure

In our world: a syndrome characterized by

Three Spheres

emotional exhaustion - being emotionally overextended and exhausted by one's work

depersonalization - unfeeling and impersonal response toward recipients of one's service

decreased sense of personal accomplishment – lack of feelings of competence and successful achievement in one's work

Maslach Burnout Inventory

Single Item Measure

I feel emotionally burned out or emotionally depleted from my work

I have become more callous toward people since I took this job — treating patients and colleagues as objects instead of humans.

Single item measures of emotional exhaustion and depersonalization are useful for assessing burnout in medical professionals. West CP, Dyrbye LN, Sloan JA, Shanafelt TD.J Gen Intern Med. 2009 Dec;24(12):1318-


Burnout Prevalence

Students 50 % burnout, 11 % suicidal ideation

Dyrbe,LN Ann Intern Med. 2008 Sep



GME varies w specialty 25-75% burnout

Ishak WW J Grad Med Educ. 2009 Dec;1(2):236-42

1/3 all docs experiencing burnout at any given time

Shanafelt,JAMA. 2009 Sep 23;302(12):1338-40

Besides Burnout

Substance abuse

Disruptive behavior

Mood disorders


Not to mention




How Can We Make It Better?

Examine Causes

Personality traitsidealism, high sense of personal responsibility, perfectionism career characteristics: sense of control, appreciation, meaningful work, fair workload, aligned values

Risk factors for burnout>60, especially >80 hours/week, young kids, 2 careers,

What works to make things better?

What works: Individual

Maslow hierarchy

Happiness practices


Gratitude Journal

Peer group support


Spiritual practice

Gratitude Journal

There is not only one right way (frequency, time of day)

Do it and mean it

Quality more than quantity

Add some details

Savor it

Change it up


Peer Group

Peer group support


Finding Meaning in Medicine

Mind Body groups

Faculty meeting time w/o agenda


Narrative exercises

Emotional regulation

Perspective taking

Compassion Cultivation training

Medical improve

Connection w meaning/purpose

Spiritual practice

Group Interventions

Peer support

Practice transformation

Peer Support -What is it?

Option for colleague or self needing support (but not necessarily a psychiatrist/lawyer/etc.)

Peer to peer service offering- an ear, resources, empathy, confidentiality*

*unless “duty to report” supersedes

Talking points

• safe way for clinicians impacted by adverse events, medical errors, litigation or other workplace stressors to talk about their experiences and emotions

• does not offer therapy, provides a network of faculty clinicians who offer a listening ear to colleagues experiencing stressful situations.

Peer supporters receive training in how to listen and respond as well as information about resources.

Organizational: 2 studies

Quality of Patient Care Drives Physician Satisfaction; Doctors Have

Concerns About Electronic Health Records-

In Search of Joy in Practice: A Report of 23 High-Functioning Primary

Care Practices

Ann Fam Med. May 2013; 11(3): 272–278.Christine A. Sinsky et al

Rand Study: Primary driver of MD satisfaction?

The quality of care one can deliver (with an element of control)

Rand Study: Primary driver of MD dissatisfaction?


Too much clerical time per task

“death by a thousand clicks”

Poor note quality

Eye contact

In what other business model are the highest paid employees doing the data entry?

What are they doing in practices where things are good?

Resources-flyers available

WPHP- not just for when you are in trouble!