THE PRACTICE OF MEDICINE CAN
BE HARZARDOUS TO YOUR
HEALTH
Gary S. Nye, MD
Chair, Physicians ’ Advisory Committee and Committee on Litigation Stress
Alameda Contra Costa County Medical Association

WELLNESS VS. WELL-BEING,
IS THERE A DIFFERENCE?

Some controversy, e.g. MBC WELLNESS COMMITTEE

Some variations in the literature

Historical differences, e.g. ACCMA

Functional institutional differences, e.g
.
Kaiser, UCSF

PHYSICIAN MORALE

HOW IS YOUR MORALE?

DO YOU HAVE A DEFINED COPING STATEGY?

ACPE SURVEY 2006 - 1200+ responses
60% considered leaving medicine
77% fatigue biggest problem
66% burnout
32% family discord & depression
4% suicidal thoughts

MAJOR SOURCES OF STRESS

Lack of Control

Unpredictability

Intense Sense of Responsibility

Change - Rapid change

Finances and Regulation

PRACTICE & BUSINESS ISSUES






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MEDICAL SCHOOL DEBT
ECONOMIC CREDENTIALING
MALPRACTICE
REIMBURSEMENT PROBLEMS
REGULATORY CHANGE
RECORD KEEPING
MBC AND RECREDENTIALING ACTIONS

(ACPE SURVEY)

53% Talk to colleagues

35% Search for jobs outside of health care

27% Lobbying and political activism

26% Personal counseling

1% Substance abuse treatment

GETTING INTO TROUBLE

IMPAIRMENT (Can be anyone at any time)

10 % OF MDs at any one time (soft data)


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6-7% SUBSTANCE ABUSE
3-4 % MENTAL ILLNESS
1-2% PHYSICAL IMPAIRMENTS
3-4% OVERLAP WITH MORE THAN ONE
CATEGORY


PATTERNS OF ILLNESS /
COMPLAINTS
ALABAMA STUDY ’ 91-97, 1000 referrals (PHP)

50% CD

12% Disruptive

12% Quality of care

10% Psychiatric (29% affective illness)

1% Licensure issues

7% Sexual misconduct (boundary issues)


DEMENTIAS AND AGING

LITIGATION STRESS

MARITAL AND FAMILY CONFLICT

BURNOUT

MEDICAL ERRORS

DEPORTMENT

DISRUPTIVE BEHAVIOR

SEXUAL MISCONDUCT

SEXUAL, ETHNIC, OTHER INSENSITIVITY

UNCOOPERATIVENESS


PROFESSIONAL DANGER
ZONES
Fatigue

Isolation

Compulsivity

Self Treatment – Substance Abuse

Curbstone Consultation

Denial – Suppression – Repression

Depression/Anxiety

WHAT PLANET ARE YOU ON?

WHAT IS THE STATE OF YOUR LIFE “ CULTURE ” ?

SELF AWARENESS AND SELF CARE

RELATIONSHIPS- family/professional/personal

SUPPORT FOR AND OF OTHERS

SPIRITUAL AND RECREATIONAL LIFE

CONSTANT PERSONAL INVENTORY / MINDFULNESS

WHAT TO DO OR WHERE TO
GO?

YOUR PERSONAL PHYSICIAN- Don ’ t self treat!

COUNSELOR OR CLERGY

WELL-BEING / WELLNESS COMMITTEE

LITIGATION STRESS COMMITTEE

CMA CONFIDENTIAL LINE

SELF HELP AND SUPPORT GROUPS

California Patient Protection and
Physician Health Program (C3PH)

MBC Diversion vs. C3PH

Regional Workshops