Docs underutilize resources for emotional stress

With research showing that burnt-out hospital staff is more prone to unprofessional patient care, a new study in the Archives of Surgery finds that 79 percent of surveyed physicians experienced either a serious adverse patient event and/or a traumatic personal event during the previous year.

But despite the frequency of such stressful occurances–the common predecessor to burnout–physicians fail to use established support resources, according to the study conducted at a large tertiary care academic hospital.

Most physicians (89 percent) said a lack of time prevented them from seeking support, while 68 percent had concerns about confidentiality, and 68 percent thought it would negatively affect their career

With 88 percent of survey respondents choosing fellow physicians as their preferred source of support, the researchers suggest hospitals implement one-on-one peer physician support programs to help physicians effectively manage on-the-job stress.

Similarly, physicians in Ottawa found group counseling eased stress, FierceHealthcare previously reported. The physicians meet every two weeks to talk about stressful experiences at work, such as a difficult patient or a challenging diagnosis.

Hospitals also can use a physician health committee that offers support, emphasizing discussion as a committee, evaluation and treatment to professionals and the use of voluntary medical leave of absence, rather than the punitive culture that physicians worry about.

In addition to peers, support also can come from the top. According to a survey conducted by Physician Wellness Services (PWS) and Cejka Search last fall, healthcare administrators can offer flexible or reduced work hours to help physicians achieve better work/life balance, as well as address conflicts promptly to alleviate disruptive situations.

Many see integrity as a description reserved for morally upstanding individuals.  However, integrity is like a T.V. dinner.  Remember T.V. dinners?  The word integrity stems from integer which literally means whole.  Now T.V. dinners have the peas, mystery meat, and potatoes each separated from one another by little boxed partitions.  We do not show integrity when we put each part of us and how we behave in separate containers aka we act differently depending on whether we are at work or with our family etc.  To have integrity is to behave the same no matter whether we are at work, at play, at home, etc.  So integrity is when we behave like a T.V. dinner with the meat, potatoes, and peas all mixed together in one big pile.

Why Emotions Matter: Age, Agitation, and Burnout Among Registered Nurses

In today’s encore excerpt – practice. Rather than being the result of genetics or inherent genius, truly outstanding skill in any domain is rarely achieved with less than ten thousand hours of practice over ten years’ time. “For those on their way to greatness [in intellectual or physical endeavors], several themes regarding practice consistently come to light: 1. Practice changes your body. Researchers have recorded a constellation of physical changes (occurring in direct response to practice) in the muscles, nerves, hearts, lungs, and brains of those showing profound increases in skill level in any domain. 2. Skills are specific. Individuals becoming great at one particular skill do not serendipitously become great at other skills. Chess champions can remember hundreds of intricate chess positions in sequence but can have a perfectly ordinary memory for everything else. Physical and intellectual changes are ultraspecific responses to particular skill requirements. 3. The brain drives the brawn. Even among athletes, changes in the brain are arguably the most profound, with a vast increase in precise task knowledge, a shift from conscious analysis to intuitive thinking (saving time and energy), and elaborate self-monitoring mechanisms that allow for constant adjustments in real time. 4. Practice style is crucial. Ordinary practice, where your current skill level is simply being reinforced, is not enough to get better. It takes a special kind of practice to force your mind and body into the kind of change necessary to improve. 5. Short-term intensity cannot replace long-term commitment. Many crucial changes take place over long periods of time. Physiologically, it’s impossible to become great overnight. “Across the board, these last two variables — practice style and practice time — emerged as universal and critical. From Scrabble players to dart players to soccer players to violin players, it was observed that the uppermost achievers not only spent significantly more time in solitary study and drills, but also exhibited a consistent (and persistent) style of preparation that K. Anders Ericsson came to call ‘deliberate practice.’ First introduced in a 1993 Psychological Review article, the notion of deliberate practice went far beyond the simple idea of hard work. It conveyed a method of continual skill improvement. ‘Deliberate practice is a very special form of activity that differs from mere experience and mindless drill,’ explains Ericsson. ‘Unlike playful engagement with peers, deliberate practice is not inherently enjoyable. It … does not involve a mere execution or repetition of already attained skills but repeated attempts to reach beyond one’s current level which is associated with frequent failures.’ … “In other words, it is practice that doesn’t take no for an answer; practice that perseveres; the type of practice where the individual keeps raising the bar of what he or she considers success. … “[Take] Eleanor Maguire’s 1999 brain scans of London cabbies, which revealed greatly enlarged representation in the brain region that controls spatial awareness. The same holds for any specific task being honed; the relevant brain regions adapt accordingly. … “[This type of practice] requires a constant self-critique, a pathological restlessness, a passion to aim consistently just beyond one’s capability so that daily disappointment and failure is actually desired, and a never-ending resolve to dust oneself off and try again and again and again. … “The physiology of this process also requires extraordinary amounts of elapsed time — not just hours and hours of deliberate practice each day, Ericsson found, but also thousands of hours over the course of many years. Interestingly, a number of separate studies have turned up the same common number, concluding that truly outstanding skill in any domain is rarely achieved in less than ten thousand hours of practice over ten years’ time (which comes to an average of three hours per day). From sublime pianists to unusually profound physicists, researchers have been very hard-pressed to find any examples of truly extraordinary performers in any field who reached the top of their game before that ten-thousand-hour mark.” Author: David Shenk Title: The Genius in All of Us Publisher: Anchor Date: Copyright 2010 by David Shenk Pages: 53-57

Physician meditation, communication improve care

May 1, 2012 | By Debra Beaulieu

Learning “mindful meditation and communication” skills may sound to some doctors like a luxury for which they don’t have time, but new research from the University of Rochester confirms it may be well worth the investment for physicians and their patients.

The study, published in Academic Medicine, is a follow-up to a paper the researchers published in the Journal of the American Medical Association in 2009. For the initial study, Howard Beckman, M.D., clinical professor of Medicine and Family Medicine at the University of Rochester Medical Center, and colleagues enrolled 70 physicians in a mindfulness training program that involved eight weekly sessions, followed by 10 monthly sessions. They found that participants were better equipped to handle psychological distress, fend off burnout and improve their well-being. For the follow-up, the team interviewed 20 of the physicians about their experience with the training.

Highlights from their feedback are as follows:

• 60 percent said the training helped them become more attentive listeners
• 50 percent said they were more self-aware and less judgmental in conversations at work and home
• 75 percent found strong benefits in being able to discuss their personal medical experiences with other doctors in the training program in a setting they felt was safe and free of judgment
• 70 percent placed a high value on the mindfulness course having a well-defined curriculum that designated time and space to pause and reflect

But to truly improve primary care, the researchers suggested training individual physicians in mindfulness doesn’t go far enough.

“Programs focused on personal awareness and self-development are only part of the solution,” the researchers stated. “Our healthcare delivery systems must implement systematic change at the practice level to create an environment that supports mindful practice, encourages transparent and clear communication among clinicians, staff, patients and families, and reduces professional isolation.”