Physician Wellness
How to Protect our “Emotional Bank Account”
by Connie Ruffo
A couple of readings inspired me to ponder this dilemma: how does a doctor protect their Emotional Bank Account? The concept of an “Emotional Bank Account” was borrowed from Dike Drummond, a guru of physician burnout.
In their professional work-life doctors juggle 2 inescapable challenges: EMRs and compassion fatigue.
It is common knowledge that EMRs have become an administrative burden for physicians and are linked to burnout. It is estimated that physicians spend an average 3 hours/day of “pajama time” clicking away on their EMRs.
TIP OF THE MONTH: READ A GREAT BOOK
Attending – Medicine, Mindfulness, and Humanity
Author: Ronald Epstein MD
“At a time when physicians are being replaced by algorithms and AI, Attending reveals the true roots of healing.” - Dean Ornish, MD
The knack for reflecting on our thoughts is often viewed as a hallmark of the human mind. It is a vital survival skill. This book is engaging to read and should rattle your metacognition. As a physician one cannot help but reflect on what it means to truly be the attending physician.
“In medicine, the senior physician responsible for a patient’s care is called the attending physician, or just “the attending”. The attending’s responsibility is to direct the clinical team’s attention to the most important things, take charge, make the patient feel attended to and provide attentive care. Attending means showing up, being present, listening, and accompanying patients when it matters most. Attending is also a moral imperative: by being attentive, doctors not only provide the best care, they also honor each patient’s humanity.”
Neuroscience has revealed what happens in our heads when we read a detailed description, an evocative metaphor or an emotional dialogue. Reading stimulates the brain and even changes how we act in life. So, drop your squawking, pinging digital device for a few hours and read this landmark book on being a physician. And spend some time reflecting on the message, and remember why you went into medicine.
Connie Ruffo
Buckle up kids, 2019 is here!
“The unexamined life may not be worth living, but the life too closely examined may not be lived at all.” – Mark Twain
Right off the bat on New Year’s Eve, my husband sat me down and asked what was on our calendar for 2019. The “play-and-have-fun” calendar that is. What are we doing in January? Ski- perfect! And February – oh, Hello Good-bye, great! And skiing. March? Cross country skiing? What about April? And onward we planned the bucket list for 2019!
Once the calendar was filled with adventures, I asked what New Year’s Resolutions he had in mind. “Those were OUR New Year’s resolutions”, he said. “What were you thinking of for resolutions?”
I was feeling introspective the last eve of 2018. So, I shared with my dear husband these questions:
1. What 3 new skills would make a big difference in the year ahead?
2. Who are the people most important in my life with whom I want to have a closer relationship?
3. What are 3 things I came to understand about myself in 2018 that I want to change or build on?
What are the benefits of “looking within” at one’s conscious thoughts, feelings, and sensations?
Self-reflection has been shown to strengthen emotional intelligence. When you spend time asking yourself important questions you gain clarity on your values, priorities and strengths. This helps you make better choices, decisions and build new connections. Sometimes you will uncover hidden dreams and undiscovered potential. It can lead you to respond calmly and more effectively to challenges that might otherwise hinder your life. It is an opportunity to create your life on purpose.
So, add a touch of introspection/self-reflection to your New Year’s resolutions and get to know yourself a bit better. Your “play list” might hold some new insights.
Happy New Year to All!
Footnote: Check out Effective Thinker by Adam Sicinski
Why the triple aim of health care systems is not enough
We live in a time where the gap between societal expectations and professional reality is widening. Patient-centred care means we give them what they want, exactly when they want it, with empathy provided by a high-quality physician of their choice with whom they have a long-term relationship…but without resources or support. I am surprised a mere 50% of physicians are burned out!
Organizations and governments refer to Triple Aim - enhancing patient experience, improving population health and reducing costs. But the stressful work life of clinicians and staff limits the ability to achieve these 3 goals. The Quadruple Aim is now acknowledged by many organizations, adding in improving the work life of all healthcare workforce. With a healthy workforce the Triple Aim will naturally happen.
While we are pressured to do more for less, there are ways to create space for joy in our work. This is a selection of opportunities that have been gleaned from a variety of studies.
1. The physician is the team-leader. Learn some leadership skills. Listen to your team members. They have a good ideas too.
2. Know your job description. Your job is to build a relationship with your patients and make diagnosis and treatment plans. You are not a data manager or data entry clerk. You need to be able to use your data to modify treatment plans but data managers should extract that information not you.
3. All team members document in the same chart (we are working on this one). Also, someone other than you can be the scribe during the patient visit entering some or all documentation, prescription processing, plan. Team documentation is associated with greater physician and staff satisfaction and the capacity to manage a larger panel of patients and going home earlier.
4. Pre-visit planning and pre-appointment lab testing cuts down on follow-up phone calls and visits and saves hours. Delegate to the team.
5. Twice daily team huddles to sort out managing fit-ins, difficult patients. Take time for each team member to check in and share how they feel each day (?tired, stressed, angry). If you are tired they will help out.
6. Expand roles of MOAs and nurses to do preventative care and chronic care coaching under physician’s direction.
7. Standardize workflow for rx refills- saves up to 5 hrs per week of physician time.
8. Co-locate teams in physician’s offices- increases efficiency and saves 30 min per day of physician time.
9. Don’t shift burnout from physician to staff- train them well and acknowledge them as team members.
10. Have clear boundaries between your personal time and work hours. Don’t work on holidays. Find a new passion- other than medicine. Have a social network of like-minded people.
11. If something in the system (ie. Office) is not working, team huddle and change it.
12. Recognize that work schedules are under your control. Why can’t you sleep in, attend morning yoga or exercise class, read the paper, and instead work afternoon and evenings? You will be less resentful of always being too tired for the things you enjoy. Try it once as an experiment.
Being positively engaged in both your office and system transformation and continuing to exercise the wisdom and knowledge we have cultivated is the only hope for building joy in our work life.
Happy to hear your ideas! Connie Ruffo cjruffo@gmail.com
