Thurston-Mason County Medical Society Meeting
Claudia Finkelstein MD claudiaf@uw.edu

Disclosures
• 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
• Definition
• 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-
21

Burnout Prevalence
• Students 50 % burnout, 11 % suicidal ideation
Dyrbe,LN Ann Intern Med. 2008 Sep
2;149(5):334-41
.
• 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
• Suicide

Not to mention
• Joy
• Creativity
• Compassion

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
• MBSR
• Gratitude Journal
• Peer group support
• Compassion/empathy/meaning
• 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

MBSR

Peer Group

Peer group support
• Balint
• Finding Meaning in Medicine
• Mind Body groups
• Faculty meeting time w/o agenda

Compassion/empathy/meaning
• 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-
• http://www.rand.org/news/press/2013/10/09.html
• 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?
• EHR
• Too much clerical time per task
• “death by a thousand clicks”
• Poor note quality
• Eye contact

What are they doing in practices where things are good?

Resources-flyers available
WPHP- not just for when you are in trouble!