Mark Bolino and Phillip S. Thompson
Harvard Business Review
Originally published March 15, 2018
Here is the conclusion:
Taken together, our studies suggest that employees who are unwilling to accept help when they need it may undermine their own performance and the effectiveness of their team or unit. In light of those potential costs, managers should directly address the negative beliefs that people are harboring. For instance, research shows that employees tend to look to their leaders to determine who is trustworthy and who isn’t. So, to build people’s trust in their coworkers’ motives and competence, managers can demonstrate their faith in those employees by giving them challenging assignments, ownership of certain decisions, direct access to sensitive information or valuable stakeholders, and so on. Further, since giving help and receiving it go hand in hand, managers should create an environment where assisting one another is encouraged and recognized. They can do this by calling attention to successful collaborations and explaining how they’ve contributed to the organization’s larger goals and mission. And they should show their own willingness to help and be helped, since employees are more likely to see the merits of citizenship behaviors when they observe their leaders engaging in such behaviors themselves.
Finally, it’s important not to send mixed messages. If employees who go it alone get ahead more quickly than those who give and receive support, people will pick up on that discrepancy — and they’ll go back to looking out for number one, to their detriment and the organization’s.
The article is here.
Showing posts with label Self-Care. Show all posts
Showing posts with label Self-Care. Show all posts
Friday, April 27, 2018
Saturday, April 21, 2018
A Systematic Review and Meta‐Synthesis of Qualitative Research Into Mandatory Personal Psychotherapy During Training
David Murphy, Nisha Irfan, Harriet Barnett, Emma Castledine, & Lily Enescu
Counseling and Psychotherapy Research
First published February 23, 2018
Abstract
Background
This study addresses the thorny issue of mandatory personal psychotherapy within counselling and psychotherapy training. It is expensive, emotionally demanding and time‐consuming. Nevertheless, proponents argue that it is essential in protecting the public and keeping clients safe; to ensure psychotherapists develop high levels of self‐awareness and gain knowledge of interpersonal dynamics; and that it enhances therapist effectiveness. Existing evidence about these potential benefits is equivocal and is largely reliant on small‐scale qualitative studies.
Method
We carried out a systematic review of literature searched within five major databases. The search identified 16 published qualitative research studies on the topic of mandatory personal psychotherapy that matched the inclusion criteria. All studies were rated for quality. The findings from individual studies were thematically analysed through a process of meta‐synthesis.
Results
Meta‐synthesis showed studies on mandatory psychotherapy had reported both positive and hindering factors in almost equal number. Six main themes were identified: three positive and three negative. Positive findings were related to personal and professional development, experiential learning and therapeutic benefits. Negative findings related to ethical imperatives do no harm, justice and integrity.
Conclusion
When mandatory personal psychotherapy is used within a training programme, courses must consider carefully and put ethical issues at the forefront of decision‐making. Additionally, the requirement of mandatory psychotherapy should be positioned and identified as an experiential pedagogical device rather than fulfilling a curative function. Recommendations for further research are made.
The research is here.
Counseling and Psychotherapy Research
First published February 23, 2018
Abstract
Background
This study addresses the thorny issue of mandatory personal psychotherapy within counselling and psychotherapy training. It is expensive, emotionally demanding and time‐consuming. Nevertheless, proponents argue that it is essential in protecting the public and keeping clients safe; to ensure psychotherapists develop high levels of self‐awareness and gain knowledge of interpersonal dynamics; and that it enhances therapist effectiveness. Existing evidence about these potential benefits is equivocal and is largely reliant on small‐scale qualitative studies.
Method
We carried out a systematic review of literature searched within five major databases. The search identified 16 published qualitative research studies on the topic of mandatory personal psychotherapy that matched the inclusion criteria. All studies were rated for quality. The findings from individual studies were thematically analysed through a process of meta‐synthesis.
Results
Meta‐synthesis showed studies on mandatory psychotherapy had reported both positive and hindering factors in almost equal number. Six main themes were identified: three positive and three negative. Positive findings were related to personal and professional development, experiential learning and therapeutic benefits. Negative findings related to ethical imperatives do no harm, justice and integrity.
Conclusion
When mandatory personal psychotherapy is used within a training programme, courses must consider carefully and put ethical issues at the forefront of decision‐making. Additionally, the requirement of mandatory psychotherapy should be positioned and identified as an experiential pedagogical device rather than fulfilling a curative function. Recommendations for further research are made.
The research is here.
Friday, March 2, 2018
Burnout in mental health providers
Practice Research and Policy Staff
American Psychological Association Practice Organization
Originally published January 25, 2018
Burnout commonly affects individuals involved in the direct care of others, including mental health practitioners. Burnout consists of three components: emotional exhaustion, depersonalization of clients and feelings of ineffectiveness or lack of personal accomplishment (Maslach, Jackson & Lieter, 1997). Emotional exhaustion may include feeling overextended, being unable to feel compassion for clients and feeling unable to meet workplace demands. Depersonalization is the process by which providers distance themselves from clients to prevent emotional fatigue. Finally, feelings of ineffectiveness and lack of personal accomplishment occur when practitioners feel a negative sense of personal and/or career worth.
Studies estimate that anywhere between 21 percent and 61 percent of mental health practitioners experience signs of burnout (Morse et al., 2012). Burnout has been associated with workplace climate, caseload size and severity of client symptoms (Acker, 2011; Craig & Sprang, 2010; Thompson et al., 2014). In contrast, studies examining burnout prevention have found that smaller caseloads, less paperwork and more flexibility at work are associated with lower rates of burnout (Lent & Schwartz, 2012). Burnout results in negative outcomes for both practitioners and their clients. Symptoms of burnout are not solely psychological; burnout has also been linked to physical ailments such as headaches and gastrointestinal problems (Kim et al., 2011).
The following studies examine correlates and predictors of burnout in mental health care providers. The first study investigates burnout amongst practitioners working on posttraumatic stress disorder clinical teams in Veterans Affairs (VA) health care settings. The second study examines correlates of burnout in sexual minority practitioners, and the third study investigates the impact of personality on burnout. Finally, the fourth study examines factors that may prevent burnout.
The information is here.
American Psychological Association Practice Organization
Originally published January 25, 2018
Burnout commonly affects individuals involved in the direct care of others, including mental health practitioners. Burnout consists of three components: emotional exhaustion, depersonalization of clients and feelings of ineffectiveness or lack of personal accomplishment (Maslach, Jackson & Lieter, 1997). Emotional exhaustion may include feeling overextended, being unable to feel compassion for clients and feeling unable to meet workplace demands. Depersonalization is the process by which providers distance themselves from clients to prevent emotional fatigue. Finally, feelings of ineffectiveness and lack of personal accomplishment occur when practitioners feel a negative sense of personal and/or career worth.
Studies estimate that anywhere between 21 percent and 61 percent of mental health practitioners experience signs of burnout (Morse et al., 2012). Burnout has been associated with workplace climate, caseload size and severity of client symptoms (Acker, 2011; Craig & Sprang, 2010; Thompson et al., 2014). In contrast, studies examining burnout prevention have found that smaller caseloads, less paperwork and more flexibility at work are associated with lower rates of burnout (Lent & Schwartz, 2012). Burnout results in negative outcomes for both practitioners and their clients. Symptoms of burnout are not solely psychological; burnout has also been linked to physical ailments such as headaches and gastrointestinal problems (Kim et al., 2011).
The following studies examine correlates and predictors of burnout in mental health care providers. The first study investigates burnout amongst practitioners working on posttraumatic stress disorder clinical teams in Veterans Affairs (VA) health care settings. The second study examines correlates of burnout in sexual minority practitioners, and the third study investigates the impact of personality on burnout. Finally, the fourth study examines factors that may prevent burnout.
The information is here.
Thursday, February 8, 2018
What I’ve learned from my tally of 757 doctor suicides
Pamela Wible
The Washington Post
Originally published January 13, 2018
Here are two excerpts:
Physician suicide is a public health crisis. One million Americans lose their doctors to suicide each year.
Many doctors have lost a colleague to suicide. Some have lost up to eight during their career — with no opportunity to grieve.
We lose way more men than women. For every female physician on my suicide registry, there are seven men. Suicide methods vary by region and gender. Women prefer to overdose and men choose firearms. Gunshot wounds prevail out West. Jumping is popular in New York City. In India, doctors have been found hanging from ceiling fans.
(cut)
Patient deaths hurt doctors. A lot. Even when there’s no medical error, doctors may never forgive themselves for losing a patient. Suicide is the ultimate self-punishment. In several cases, the death of a patient seemed to be the key factor in pushing them over the edge.
Malpractice suits can be devastating. Humans make mistakes. Yet when doctors make mistakes, they’re publicly shamed in court, on TV and in newspapers (that live online forever). Many continue to suffer the agony of harming someone else — unintentionally — for the rest of our lives.
Academic distress kills medical students’ dreams. Failing medical-board exams and not getting a post-medical-school assignment in a specialty of choice has led to suicides. Doctors can be shattered if they fail to gain a residency: Before his suicide, Robert Chu, unmatched to residency, wrote a letter to medical officials and government leaders calling out a system that he said ruined his career.
The information is here.
The Washington Post
Originally published January 13, 2018
Here are two excerpts:
Physician suicide is a public health crisis. One million Americans lose their doctors to suicide each year.
Many doctors have lost a colleague to suicide. Some have lost up to eight during their career — with no opportunity to grieve.
We lose way more men than women. For every female physician on my suicide registry, there are seven men. Suicide methods vary by region and gender. Women prefer to overdose and men choose firearms. Gunshot wounds prevail out West. Jumping is popular in New York City. In India, doctors have been found hanging from ceiling fans.
(cut)
Patient deaths hurt doctors. A lot. Even when there’s no medical error, doctors may never forgive themselves for losing a patient. Suicide is the ultimate self-punishment. In several cases, the death of a patient seemed to be the key factor in pushing them over the edge.
Malpractice suits can be devastating. Humans make mistakes. Yet when doctors make mistakes, they’re publicly shamed in court, on TV and in newspapers (that live online forever). Many continue to suffer the agony of harming someone else — unintentionally — for the rest of our lives.
Academic distress kills medical students’ dreams. Failing medical-board exams and not getting a post-medical-school assignment in a specialty of choice has led to suicides. Doctors can be shattered if they fail to gain a residency: Before his suicide, Robert Chu, unmatched to residency, wrote a letter to medical officials and government leaders calling out a system that he said ruined his career.
The information is here.
Wednesday, January 24, 2018
Top 10 lies doctors tell themselves
Pamela Wible
www.idealmedicalcare.org
Originally published December 27, 2017
Here is an excerpt:
Sydney Ashland: “I must overwork and overextend myself.” I hear this all the time. Workaholism, alcoholism, self-medicating. These are the top coping strategies that we, as medical professionals, use to deal with unrealistic work demands. We tell ourselves, “In order to get everything done that I have to get done. In order to meet expectations, meet the deadlines, then I have to overwork.” And this is not true. If you believe in it, you are participating in the lie, you’re enabling it. Start to claim yourself. Start to claim your time. Don’t participate. Don’t believe that there is a magic workaround or gimmick that’s going to enable you to stay in a toxic work environment and reshuffle the deck. What happens is in that shuffling process you continue to overcompensate, overdo, overextend yourself—and you’ve moved from overwork on the face of things to complicating your life. This is common. Liberate yourself. You can be free. It’s not about overwork.
Pamela Wible: And here’s the thing that really is almost humorous. What physicians do when they’re overworked, their solution for overwork—is to overwork. Right? They’re like, “Okay. I’m exhausted. I’m tired. My office isn’t working. I’ll get another phone line. I’ll get two more receptionists. I’ll add three more patients per day.” Your solution to overwork, if it’s overwork, is probably not going to work.
The interview is here.
www.idealmedicalcare.org
Originally published December 27, 2017
Here is an excerpt:
Sydney Ashland: “I must overwork and overextend myself.” I hear this all the time. Workaholism, alcoholism, self-medicating. These are the top coping strategies that we, as medical professionals, use to deal with unrealistic work demands. We tell ourselves, “In order to get everything done that I have to get done. In order to meet expectations, meet the deadlines, then I have to overwork.” And this is not true. If you believe in it, you are participating in the lie, you’re enabling it. Start to claim yourself. Start to claim your time. Don’t participate. Don’t believe that there is a magic workaround or gimmick that’s going to enable you to stay in a toxic work environment and reshuffle the deck. What happens is in that shuffling process you continue to overcompensate, overdo, overextend yourself—and you’ve moved from overwork on the face of things to complicating your life. This is common. Liberate yourself. You can be free. It’s not about overwork.
Pamela Wible: And here’s the thing that really is almost humorous. What physicians do when they’re overworked, their solution for overwork—is to overwork. Right? They’re like, “Okay. I’m exhausted. I’m tired. My office isn’t working. I’ll get another phone line. I’ll get two more receptionists. I’ll add three more patients per day.” Your solution to overwork, if it’s overwork, is probably not going to work.
The interview is here.
Friday, December 22, 2017
Professional Self-Care to Prevent Ethics Violations
Claire Zilber
The Ethical Professor
Originally published December 4, 2017
Here is an excerpt:
Although there are many variables that lead a professional to violate an ethics rule, one frequent contributing factor is impairment from stress caused by a family member's illness (sick child, dying parent, spouse's chronic health condition, etc.). Some health care providers who have been punished by their licensing board, hospital board or practice group for an ethics violation tell similar stories of being under unusual levels of stress because of a family member who was ill. In that context, they deviated from their usual behavior.
For example, a surgeon whose son was mentally ill prescribed psychotropic medications to him because he refused to go to a psychiatrist. This surgeon was entering into a dual relationship with her child and prescribing outside of her area of competence, but felt desperate to help her son. Another physician, deeply unsettled by his wife’s diagnosis with and treatment for breast cancer, had an extramarital affair with a nurse who was also his employee. This physician sought comfort without thinking about the boundaries he was violating at work, the risk he was creating for his practice, or the harm he was causing to his marriage.
Physicians cannot avoid stressful events at work and in their personal lives, but they can exert some control over how they adapt to or manage that stress. Physician self-care begins with self-awareness, which can be supported by such practices as mindfulness meditation, reflective writing, supervision, or psychotherapy. Self-awareness increases compassion for the self and for others, and reduces burnout.
The article is here.
The Ethical Professor
Originally published December 4, 2017
Here is an excerpt:
Although there are many variables that lead a professional to violate an ethics rule, one frequent contributing factor is impairment from stress caused by a family member's illness (sick child, dying parent, spouse's chronic health condition, etc.). Some health care providers who have been punished by their licensing board, hospital board or practice group for an ethics violation tell similar stories of being under unusual levels of stress because of a family member who was ill. In that context, they deviated from their usual behavior.
For example, a surgeon whose son was mentally ill prescribed psychotropic medications to him because he refused to go to a psychiatrist. This surgeon was entering into a dual relationship with her child and prescribing outside of her area of competence, but felt desperate to help her son. Another physician, deeply unsettled by his wife’s diagnosis with and treatment for breast cancer, had an extramarital affair with a nurse who was also his employee. This physician sought comfort without thinking about the boundaries he was violating at work, the risk he was creating for his practice, or the harm he was causing to his marriage.
Physicians cannot avoid stressful events at work and in their personal lives, but they can exert some control over how they adapt to or manage that stress. Physician self-care begins with self-awareness, which can be supported by such practices as mindfulness meditation, reflective writing, supervision, or psychotherapy. Self-awareness increases compassion for the self and for others, and reduces burnout.
The article is here.
Wednesday, October 25, 2017
Physician licensing laws keep doctors from seeking care
Bab Nellis
Mayo Clinic New Network
Despite growing problems with psychological distress, many physicians avoid seeking mental health treatment due to concern for their license. Mayo Clinic research shows that licensing requirements in many states include questions about past mental health treatments or diagnoses, with the implication that they may limit a doctor's right to practice medicine. The findings appear today in Mayo Clinic Proceedings.
“Clearly, in some states, the questions physicians are required to answer to obtain or renew their license are keeping them from seeking the help they need to recover from burnout and other emotional or mental health issues,” says Liselotte Dyrbye, M.D., a Mayo Clinic physician and first author of the article.
The researchers examined the licensing documents for physicians in all 50 states and Washington, D.C., and renewal applications from 48 states. They also collected data in a national survey of more than 5,800 physicians, including attitudes about seeking mental health care.
Nearly 40 percent of respondents said they would hesitate in seeking professional help for a mental health condition because they feared doing so could have negative impacts on their medical license.
The article is here.
The target article is here.
Mayo Clinic New Network
Despite growing problems with psychological distress, many physicians avoid seeking mental health treatment due to concern for their license. Mayo Clinic research shows that licensing requirements in many states include questions about past mental health treatments or diagnoses, with the implication that they may limit a doctor's right to practice medicine. The findings appear today in Mayo Clinic Proceedings.
“Clearly, in some states, the questions physicians are required to answer to obtain or renew their license are keeping them from seeking the help they need to recover from burnout and other emotional or mental health issues,” says Liselotte Dyrbye, M.D., a Mayo Clinic physician and first author of the article.
The researchers examined the licensing documents for physicians in all 50 states and Washington, D.C., and renewal applications from 48 states. They also collected data in a national survey of more than 5,800 physicians, including attitudes about seeking mental health care.
Nearly 40 percent of respondents said they would hesitate in seeking professional help for a mental health condition because they feared doing so could have negative impacts on their medical license.
The article is here.
The target article is here.
Wednesday, September 27, 2017
How to Recognize Burnout Before You’re Burned Out
Kenneth R. Rosen
The New York Times
Originally published September 5, 2017
Here is an excerpt:
In today’s era of workplace burnout, achieving a simpatico work-life relationship seems practically out of reach. Being tired, ambivalent, stressed, cynical and overextended has become a normal part of a working professional life. The General Social Survey of 2016, a nationwide survey that since 1972 has tracked the attitudes and behaviors of American society, found that 50 percent of respondents are consistently exhausted because of work, compared with 18 percent two decades ago.
Where once the term burnout was applied exclusively to health care workers, police officers, firefighters, paramedics or social workers who deal with trauma and human services — think Graham Greene’s novel “A Burnt-Out Case,” about a doctor in the Belgian Congo, a book that gave rise to the term colloquially — the term has since expanded to workers who are now part of a more connected, hyperactive and overcompensating work force.
But occupational burnout goes beyond needing a simple vacation or a family retreat, and many experts, psychologists and institutions, including the Centers for Disease Control and Prevention, highlight long-term and unresolvable burnout as not a symptom but rather a major health concern. (Though it does not appear in the Diagnostic and Statistical Manual of Mental Disorders, which outlines psychiatric disorders, it does appear in the International Statistical Classification of Diseases and Related Health Problems, a classification used by the World Health Organization.)
“We’re shooting ourselves in the foot,” Ms. Seppala told me. “Biologically we are not meant to be in that high-stress mode all the time. We got lost in this idea that the only way to be productive is to be on the go-go-go mode.”
The article is here.
The New York Times
Originally published September 5, 2017
Here is an excerpt:
In today’s era of workplace burnout, achieving a simpatico work-life relationship seems practically out of reach. Being tired, ambivalent, stressed, cynical and overextended has become a normal part of a working professional life. The General Social Survey of 2016, a nationwide survey that since 1972 has tracked the attitudes and behaviors of American society, found that 50 percent of respondents are consistently exhausted because of work, compared with 18 percent two decades ago.
Where once the term burnout was applied exclusively to health care workers, police officers, firefighters, paramedics or social workers who deal with trauma and human services — think Graham Greene’s novel “A Burnt-Out Case,” about a doctor in the Belgian Congo, a book that gave rise to the term colloquially — the term has since expanded to workers who are now part of a more connected, hyperactive and overcompensating work force.
But occupational burnout goes beyond needing a simple vacation or a family retreat, and many experts, psychologists and institutions, including the Centers for Disease Control and Prevention, highlight long-term and unresolvable burnout as not a symptom but rather a major health concern. (Though it does not appear in the Diagnostic and Statistical Manual of Mental Disorders, which outlines psychiatric disorders, it does appear in the International Statistical Classification of Diseases and Related Health Problems, a classification used by the World Health Organization.)
“We’re shooting ourselves in the foot,” Ms. Seppala told me. “Biologically we are not meant to be in that high-stress mode all the time. We got lost in this idea that the only way to be productive is to be on the go-go-go mode.”
The article is here.
Thursday, September 14, 2017
Over half of doctors have symptoms of burn-out: survey
Lynn Desjardins
Radio Canada International
Originally published August 28, 2017
A recent survey suggests that 54 per cent of Canadian doctors have symptoms of burn-out and it’s a problem that physicians themselves don’t like to talk about. This was a topic much discussed at the annual meeting of the Canadian Medical Association which represents more than 80,000 doctors.
‘Very frustrating and annoying’ interventions required
“First and foremost, it’s about the inability that physicians have sometimes to get what the patient actually needs in a timely way,” says Dr. Granger Avery, immediate past president of the Canadian Medical Association.
“So, that’s whether looking for a consultation, following up on an operation, whether it’s transferring a patient from one level of service to another, these things often require the doctor to make repeated phone calls, repeated interventions to get what should be a relatively simple piece of work done. So, that’s very frustrating and annoying for a physician who’s been brought up and trained and focused on helping people, not doing that administrative work.”
The article and the podcast are here.
Radio Canada International
Originally published August 28, 2017
A recent survey suggests that 54 per cent of Canadian doctors have symptoms of burn-out and it’s a problem that physicians themselves don’t like to talk about. This was a topic much discussed at the annual meeting of the Canadian Medical Association which represents more than 80,000 doctors.
‘Very frustrating and annoying’ interventions required
“First and foremost, it’s about the inability that physicians have sometimes to get what the patient actually needs in a timely way,” says Dr. Granger Avery, immediate past president of the Canadian Medical Association.
“So, that’s whether looking for a consultation, following up on an operation, whether it’s transferring a patient from one level of service to another, these things often require the doctor to make repeated phone calls, repeated interventions to get what should be a relatively simple piece of work done. So, that’s very frustrating and annoying for a physician who’s been brought up and trained and focused on helping people, not doing that administrative work.”
The article and the podcast are here.
Friday, August 4, 2017
Moral distress in physicians and nurses: Impact on professional quality of life and turnover
Austin, Cindy L.; Saylor, Robert; Finley, Phillip J.
Psychological Trauma: Theory, Research, Practice, and Policy, Vol 9(4), Jul 2017, 399-406.
Abstract
Objective: The purpose of this study was to investigate moral distress (MD) and turnover intent as related to professional quality of life in physicians and nurses at a tertiary care hospital.
Method: Health care providers from a variety of hospital departments anonymously completed 2 validated questionnaires (Moral Distress Scale–Revised and Professional Quality of Life Scale). Compassion fatigue (as measured by secondary traumatic stress [STS] and burnout [BRN]) and compassion satisfaction are subscales which make up one’s professional quality of life. Relationships between these constructs and clinicians’ years in health care, critical care patient load, and professional discipline were explored.
Results: The findings (n = 329) demonstrated significant correlations between STS, BRN, and MD. Scores associated with intentions to leave or stay in a position were indicative of high verses low MD. We report highest scoring situations of MD as well as when physicians and nurses demonstrate to be most at risk for STS, BRN and MD. Both physicians and nurses identified the events contributing to the highest level of MD as being compelled to provide care that seems ineffective and working with a critical care patient load >50%.
Conclusion: The results from this study of physicians and nurses suggest that the presence of MD significantly impacts turnover intent and professional quality of life. Therefore implementation of emotional wellness activities (e.g., empowerment, opportunity for open dialog regarding ethical dilemmas, policy making involvement) coupled with ongoing monitoring and routine assessment of these maladaptive characteristics is warranted.
The article is here.
Psychological Trauma: Theory, Research, Practice, and Policy, Vol 9(4), Jul 2017, 399-406.
Abstract
Objective: The purpose of this study was to investigate moral distress (MD) and turnover intent as related to professional quality of life in physicians and nurses at a tertiary care hospital.
Method: Health care providers from a variety of hospital departments anonymously completed 2 validated questionnaires (Moral Distress Scale–Revised and Professional Quality of Life Scale). Compassion fatigue (as measured by secondary traumatic stress [STS] and burnout [BRN]) and compassion satisfaction are subscales which make up one’s professional quality of life. Relationships between these constructs and clinicians’ years in health care, critical care patient load, and professional discipline were explored.
Results: The findings (n = 329) demonstrated significant correlations between STS, BRN, and MD. Scores associated with intentions to leave or stay in a position were indicative of high verses low MD. We report highest scoring situations of MD as well as when physicians and nurses demonstrate to be most at risk for STS, BRN and MD. Both physicians and nurses identified the events contributing to the highest level of MD as being compelled to provide care that seems ineffective and working with a critical care patient load >50%.
Conclusion: The results from this study of physicians and nurses suggest that the presence of MD significantly impacts turnover intent and professional quality of life. Therefore implementation of emotional wellness activities (e.g., empowerment, opportunity for open dialog regarding ethical dilemmas, policy making involvement) coupled with ongoing monitoring and routine assessment of these maladaptive characteristics is warranted.
The article is here.
Thursday, March 30, 2017
Risk considerations for suicidal physicians
Doug Brunk
Clinical Psychiatry News
Publish date: February 27, 2017
Here are two excerpts:
According to the American Foundation for Suicide Prevention, 300-400 physicians take their own lives every year, the equivalent of two to three medical school classes. “That’s a doctor a day we lose to suicide,” said Dr. Myers, a professor of clinical psychiatry at State University of New York, Brooklyn, who specializes in physician health. Compared with the general population, the suicide rate ratio is 2.27 among female physicians and 1.41 among male physicians (Am J Psychiatry. 2004;161[12]:2295-2302), and an estimated 85%-90% of those who carry out a suicide have a psychiatric illness such as major depressive disorder, bipolar disorder, alcohol use and substance use disorder, and borderline personality disorder. Other triggers common to physicians, Dr. Myers said, include other kinds of personality disorders, burnout, untreated anxiety disorders, substance/medication-induced depressive disorder (especially in clinicians who have been self-medicating), and posttraumatic stress disorder.
Clinical Psychiatry News
Publish date: February 27, 2017
Here are two excerpts:
According to the American Foundation for Suicide Prevention, 300-400 physicians take their own lives every year, the equivalent of two to three medical school classes. “That’s a doctor a day we lose to suicide,” said Dr. Myers, a professor of clinical psychiatry at State University of New York, Brooklyn, who specializes in physician health. Compared with the general population, the suicide rate ratio is 2.27 among female physicians and 1.41 among male physicians (Am J Psychiatry. 2004;161[12]:2295-2302), and an estimated 85%-90% of those who carry out a suicide have a psychiatric illness such as major depressive disorder, bipolar disorder, alcohol use and substance use disorder, and borderline personality disorder. Other triggers common to physicians, Dr. Myers said, include other kinds of personality disorders, burnout, untreated anxiety disorders, substance/medication-induced depressive disorder (especially in clinicians who have been self-medicating), and posttraumatic stress disorder.
(cut)
Inadequate treatment can occur for physician patients because of transference and countertransference dynamics “that muddle the treatment dyad,” Dr. Myers added. “We must be mindful of the many issues that are going on when we treat our own.”
Association Between Physician Burnout and Identification With Medicine as a Calling
Andrew J. Jager, MA, Michael A. Tutty, PhD, Audiey C. Kao, PhD Audiey C. Kao
Mayo Clinic Proceedings
DOI: http://dx.doi.org/10.1016/j.mayocp.2016.11.012
Objective
To evaluate the association between degree of professional burnout and physicians' sense of calling.
Participants and Methods
US physicians across all specialties were surveyed between October 24, 2014, and May 29, 2015. Professional burnout was assessed using a validated single-item measure. Sense of calling, defined as committing one's life to personally meaningful work that serves a prosocial purpose, was assessed using 6 validated true-false items. Associations between burnout and identification with calling items were assessed using multivariable logistic regressions.
Results
A total of 2263 physicians completed surveys (63.1% response rate). Among respondents, 28.5% (n=639) reported experiencing some degree of burnout. Compared with physicians who reported no burnout symptoms, those who were completely burned out had lower odds of finding their work rewarding (odds ratio [OR], 0.05; 95% CI, 0.02-0.10; P<.001), seeing their work as one of the most important things in their lives (OR, 0.38; 95% CI, 0.21-0.69; P<.001), or thinking their work makes the world a better place (OR, 0.38; 95% CI, 0.17-0.85; P=.02). Burnout was also associated with lower odds of enjoying talking about their work to others (OR, 0.23; 95% CI, 0.13-0.41; P<.001), choosing their work life again (OR, 0.11; 95% CI, 0.06-0.20; P<.001), or continuing with their current work even if they were no longer paid if they were financially stable (OR, 0.30; 95% CI, 0.15-0.59; P<.001).
Conclusion
Physicians who experience more burnout are less likely to identify with medicine as a calling. Erosion of the sense that medicine is a calling may have adverse consequences for physicians as well as those for whom they care.
Mayo Clinic Proceedings
DOI: http://dx.doi.org/10.1016/j.mayocp.2016.11.012
Objective
To evaluate the association between degree of professional burnout and physicians' sense of calling.
Participants and Methods
US physicians across all specialties were surveyed between October 24, 2014, and May 29, 2015. Professional burnout was assessed using a validated single-item measure. Sense of calling, defined as committing one's life to personally meaningful work that serves a prosocial purpose, was assessed using 6 validated true-false items. Associations between burnout and identification with calling items were assessed using multivariable logistic regressions.
Results
A total of 2263 physicians completed surveys (63.1% response rate). Among respondents, 28.5% (n=639) reported experiencing some degree of burnout. Compared with physicians who reported no burnout symptoms, those who were completely burned out had lower odds of finding their work rewarding (odds ratio [OR], 0.05; 95% CI, 0.02-0.10; P<.001), seeing their work as one of the most important things in their lives (OR, 0.38; 95% CI, 0.21-0.69; P<.001), or thinking their work makes the world a better place (OR, 0.38; 95% CI, 0.17-0.85; P=.02). Burnout was also associated with lower odds of enjoying talking about their work to others (OR, 0.23; 95% CI, 0.13-0.41; P<.001), choosing their work life again (OR, 0.11; 95% CI, 0.06-0.20; P<.001), or continuing with their current work even if they were no longer paid if they were financially stable (OR, 0.30; 95% CI, 0.15-0.59; P<.001).
Conclusion
Physicians who experience more burnout are less likely to identify with medicine as a calling. Erosion of the sense that medicine is a calling may have adverse consequences for physicians as well as those for whom they care.
Sunday, March 5, 2017
What We Know About Moral Distress
Patricia Rodney
AJN, American Journal of Nursing:
February 2017 - Volume 117 - Issue 2 - p S7–S10
doi: 10.1097/01.NAJ.0000512204.85973.04
Moral distress arises when nurses are unable to act according to their moral judgment. The concept is relatively recent, dating to American ethicist Andrew Jameton's 1984 landmark text on nursing ethics. Until that point, distress among clinicians had been understood primarily through psychological concepts such as stress and burnout, which, although relevant, were not sufficient. With the introduction of the concept of moral distress, Jameton added an ethical dimension to the study of distress.
Background
In the 33 years since Jameton's inaugural work, many nurses, inspired by the concept of moral distress, have continued to explore what happens when nurses are constrained from translating moral choice into moral action, and are consequently unable to uphold their sense of integrity and the values emphasized in the American Nurses Association's Code of Ethics for Nurses with Interpretive Statements. Moral distress might occur when, say, a nurse on a busy acute medical unit can't provide comfort and supportive care to a dying patient because of insufficient staffing.
The article is here.
AJN, American Journal of Nursing:
February 2017 - Volume 117 - Issue 2 - p S7–S10
doi: 10.1097/01.NAJ.0000512204.85973.04
Moral distress arises when nurses are unable to act according to their moral judgment. The concept is relatively recent, dating to American ethicist Andrew Jameton's 1984 landmark text on nursing ethics. Until that point, distress among clinicians had been understood primarily through psychological concepts such as stress and burnout, which, although relevant, were not sufficient. With the introduction of the concept of moral distress, Jameton added an ethical dimension to the study of distress.
Background
In the 33 years since Jameton's inaugural work, many nurses, inspired by the concept of moral distress, have continued to explore what happens when nurses are constrained from translating moral choice into moral action, and are consequently unable to uphold their sense of integrity and the values emphasized in the American Nurses Association's Code of Ethics for Nurses with Interpretive Statements. Moral distress might occur when, say, a nurse on a busy acute medical unit can't provide comfort and supportive care to a dying patient because of insufficient staffing.
The article is here.
Monday, December 5, 2016
Why Some People Get Burned Out and Others Don't
Kandi Wiens and Annie McKee
Harvard Business Review
Originally posted November 23, 2016
Here is an excerpt:
What You Can Do to Manage Stress and Avoid Burnout
People do all kinds of destructive things to deal with stress—they overeat, abuse drugs and alcohol, and push harder rather than slowing down. What we learned from our study of chief medical officers is that people can leverage their emotional intelligence to deal with stress and ward off burnout. You, too, might want to try the following:
Don’t be the source of your stress. Too many of us create our own stress, with its full bodily response, merely by thinking about or anticipating future episodes or encounters that might be stressful. People who have a high need to achieve or perfectionist tendencies may be more prone to creating their own stress. We learned from our study that leaders who are attuned to the pressures they put on themselves are better able to control their stress level. As one CMO described, “I’ve realized that much of my stress is self-inflicted from years of being hard on myself. Now that I know the problems it causes for me, I can talk myself out of the non-stop pressure.”
Recognize your limitations. Becoming more aware of your strengths and weaknesses will clue you in to where you need help. In our study, CMOs described the transition from a clinician to leadership role as being a major source of their stress. Those who recognized when the demands were outweighing their abilities, didn’t go it alone—they surrounded themselves with trusted advisors and asked for help.
The article is here.
Harvard Business Review
Originally posted November 23, 2016
Here is an excerpt:
What You Can Do to Manage Stress and Avoid Burnout
People do all kinds of destructive things to deal with stress—they overeat, abuse drugs and alcohol, and push harder rather than slowing down. What we learned from our study of chief medical officers is that people can leverage their emotional intelligence to deal with stress and ward off burnout. You, too, might want to try the following:
Don’t be the source of your stress. Too many of us create our own stress, with its full bodily response, merely by thinking about or anticipating future episodes or encounters that might be stressful. People who have a high need to achieve or perfectionist tendencies may be more prone to creating their own stress. We learned from our study that leaders who are attuned to the pressures they put on themselves are better able to control their stress level. As one CMO described, “I’ve realized that much of my stress is self-inflicted from years of being hard on myself. Now that I know the problems it causes for me, I can talk myself out of the non-stop pressure.”
Recognize your limitations. Becoming more aware of your strengths and weaknesses will clue you in to where you need help. In our study, CMOs described the transition from a clinician to leadership role as being a major source of their stress. Those who recognized when the demands were outweighing their abilities, didn’t go it alone—they surrounded themselves with trusted advisors and asked for help.
The article is here.
Wednesday, August 10, 2016
Why are doctors plagued by depression and suicide?
By Judith Graham @judith_graham
STAT News
Originally published July 21, 2016
Here is an excerpt:
The starkest sign of the crisis gripping medicine is the number of physicians who commit suicide every year — 300 to 400, about the size of three average medical school classes. Male doctors are 1.4 times more likely to kill themselves than men in the general population; female physicians, 2.3 times more likely.
The grim tally is probably an under-count, since many suicides aren’t listed as such on death certificates. And it doesn’t include suicides among medical students, which aren’t tracked systematically in the United States.
In one study of six medical schools, nearly 1 in 4 students reported clinically significant symptoms of depression. Almost 7 percent said they had thought of ending their lives in the last two weeks.
The article is here.
STAT News
Originally published July 21, 2016
Here is an excerpt:
The starkest sign of the crisis gripping medicine is the number of physicians who commit suicide every year — 300 to 400, about the size of three average medical school classes. Male doctors are 1.4 times more likely to kill themselves than men in the general population; female physicians, 2.3 times more likely.
The grim tally is probably an under-count, since many suicides aren’t listed as such on death certificates. And it doesn’t include suicides among medical students, which aren’t tracked systematically in the United States.
In one study of six medical schools, nearly 1 in 4 students reported clinically significant symptoms of depression. Almost 7 percent said they had thought of ending their lives in the last two weeks.
The article is here.
Wednesday, July 27, 2016
Doctors have become less empathetic, but is it their fault?
By David Scales
Aeon Magazine
Originally posted July 4, 2016
Here is an excerpt:
The key resides in the nature of clinical empathy, which requires that the practitioner be truly present. That medical professional must be curious enough to cognitively and emotionally relate to a patient’s situation, perspective and feelings, and then communicate this understanding back to the patient.
At times, empathy’s impact seems more magical than biological. When empathy scores are higher, patients recover faster from the common cold, diabetics have better blood-sugar control, people adhere more closely to treatment regimens, and patients feel more enabled to tackle their illnesses. Empathetic physicians report higher personal wellbeing and are sued less often.
If the case for empathy is clear, the way to boost it remains murky indeed. New research shows that meditation and ‘mindful communication’ can increase a physician’s empathy, spawning a niche industry of training courses. Yet this preoccupation has missed the glaring deficits in the work environment, which squelch the human empathy that doctors possess.
The article is here.
Aeon Magazine
Originally posted July 4, 2016
Here is an excerpt:
The key resides in the nature of clinical empathy, which requires that the practitioner be truly present. That medical professional must be curious enough to cognitively and emotionally relate to a patient’s situation, perspective and feelings, and then communicate this understanding back to the patient.
At times, empathy’s impact seems more magical than biological. When empathy scores are higher, patients recover faster from the common cold, diabetics have better blood-sugar control, people adhere more closely to treatment regimens, and patients feel more enabled to tackle their illnesses. Empathetic physicians report higher personal wellbeing and are sued less often.
If the case for empathy is clear, the way to boost it remains murky indeed. New research shows that meditation and ‘mindful communication’ can increase a physician’s empathy, spawning a niche industry of training courses. Yet this preoccupation has missed the glaring deficits in the work environment, which squelch the human empathy that doctors possess.
The article is here.
Wednesday, June 1, 2016
Don't make Important Decisions When You are Hungry
The Stomach-Derived Hormone Ghrelin Increases Impulsive Behavior
Rozita H Anderberg, Caroline Hansson, Maya Fenande and others
Neuropsychopharmacology (2016) 41, 1199–1209
doi:10.1038/npp.2015.297; published online 21 October 2015
Abstract
Impulsivity, defined as impaired decision making, is associated with many psychiatric and behavioral disorders, such as attention-deficit/hyperactivity disorder as well as eating disorders. Recent data indicate that there is a strong positive correlation between food reward behavior and impulsivity, but the mechanisms behind this relationship remain unknown. Here we hypothesize that ghrelin, an orexigenic hormone produced by the stomach and known to increase food reward behavior, also increases impulsivity. In order to assess the impact of ghrelin on impulsivity, rats were trained in three complementary tests of impulsive behavior and choice: differential reinforcement of low rate (DRL), go/no-go, and delay discounting. Ghrelin injection into the lateral ventricle increased impulsive behavior, as indicated by reduced efficiency of performance in the DRL test, and increased lever pressing during the no-go periods of the go/no-go test. Central ghrelin stimulation also increased impulsive choice, as evidenced by the reduced choice for large rewards when delivered with a delay in the delay discounting test. In order to determine whether signaling at the central ghrelin receptors is necessary for maintenance of normal levels of impulsive behavior, DRL performance was assessed following ghrelin receptor blockade with central infusion of a ghrelin receptor antagonist. Central ghrelin receptor blockade reduced impulsive behavior, as reflected by increased efficiency of performance in the DRL task. To further investigate the neurobiological substrate underlying the impulsivity effect of ghrelin, we microinjected ghrelin into the ventral tegmental area, an area harboring dopaminergic cell bodies. Ghrelin receptor stimulation within the VTA was sufficient to increase impulsive behavior. We further evaluated the impact of ghrelin on dopamine-related gene expression and dopamine turnover in brain areas key in impulsive behavior control. This study provides the first demonstration that the stomach-produced hormone ghrelin increases impulsivity and also indicates that ghrelin can change two major components of impulsivity—motor and choice impulsivity.
The article is here.
Rozita H Anderberg, Caroline Hansson, Maya Fenande and others
Neuropsychopharmacology (2016) 41, 1199–1209
doi:10.1038/npp.2015.297; published online 21 October 2015
Abstract
Impulsivity, defined as impaired decision making, is associated with many psychiatric and behavioral disorders, such as attention-deficit/hyperactivity disorder as well as eating disorders. Recent data indicate that there is a strong positive correlation between food reward behavior and impulsivity, but the mechanisms behind this relationship remain unknown. Here we hypothesize that ghrelin, an orexigenic hormone produced by the stomach and known to increase food reward behavior, also increases impulsivity. In order to assess the impact of ghrelin on impulsivity, rats were trained in three complementary tests of impulsive behavior and choice: differential reinforcement of low rate (DRL), go/no-go, and delay discounting. Ghrelin injection into the lateral ventricle increased impulsive behavior, as indicated by reduced efficiency of performance in the DRL test, and increased lever pressing during the no-go periods of the go/no-go test. Central ghrelin stimulation also increased impulsive choice, as evidenced by the reduced choice for large rewards when delivered with a delay in the delay discounting test. In order to determine whether signaling at the central ghrelin receptors is necessary for maintenance of normal levels of impulsive behavior, DRL performance was assessed following ghrelin receptor blockade with central infusion of a ghrelin receptor antagonist. Central ghrelin receptor blockade reduced impulsive behavior, as reflected by increased efficiency of performance in the DRL task. To further investigate the neurobiological substrate underlying the impulsivity effect of ghrelin, we microinjected ghrelin into the ventral tegmental area, an area harboring dopaminergic cell bodies. Ghrelin receptor stimulation within the VTA was sufficient to increase impulsive behavior. We further evaluated the impact of ghrelin on dopamine-related gene expression and dopamine turnover in brain areas key in impulsive behavior control. This study provides the first demonstration that the stomach-produced hormone ghrelin increases impulsivity and also indicates that ghrelin can change two major components of impulsivity—motor and choice impulsivity.
The article is here.
Wednesday, May 4, 2016
Surgeon General Concerned About Physician Burnout
by Joyce Frieden
MedPage Today
Originally posted April 10, 2016
Here is an excerpt:
But in the months since he has taken office, a growing concern about emotional well-being emerged "from conversations I had with community members, and it is based on the science developed over the years that tells us emotional well-being is an important driver of health."
"People think that emotional well-being is something that happens to you -- things line up in your life, you have the right job, and your health is good, and [you are in] a happy family and in a good relationship and you're happy in your emotional life," he said. "But there's a growing body of science that tells us there are things we can do to develop our emotional well-being proactively, and that in turn can have a positive impact on our health."
Murthy noting that promoting well-being doesn't require reinventing the wheel as there are already programs focused on emotional well-being that have significant outcomes for health and education, but people just don't know about them.
The article is here.
MedPage Today
Originally posted April 10, 2016
Here is an excerpt:
But in the months since he has taken office, a growing concern about emotional well-being emerged "from conversations I had with community members, and it is based on the science developed over the years that tells us emotional well-being is an important driver of health."
"People think that emotional well-being is something that happens to you -- things line up in your life, you have the right job, and your health is good, and [you are in] a happy family and in a good relationship and you're happy in your emotional life," he said. "But there's a growing body of science that tells us there are things we can do to develop our emotional well-being proactively, and that in turn can have a positive impact on our health."
Murthy noting that promoting well-being doesn't require reinventing the wheel as there are already programs focused on emotional well-being that have significant outcomes for health and education, but people just don't know about them.
The article is here.
Nurses Say Stress Interferes With Caring For Their Patients
By Alan Yu
NPR.org
Originally posted April 15, 2016
Here is an excerpt:
Almost 20 percent of newly registered nurses leave a hospital within the first year for the same job elsewhere, or a different job in a different organization, according to a 2014 study. Rushton says to her, that means health care organizations aren't investing enough in their nursing staff.
Nurse burnout also is linked to moral distress, Rushton says, from situations where nurses know what they should do for their patients but can't act on it. For example, nurses might have to give a patient at the end of life a treatment that causes suffering without any medical benefit. She just started a program called the Mindful Ethical Practice and Resilience Academy to try to help new nurses deal with moral distress.
It's a series of in-person workshops, some of which involve nurses using simulations to practice how to make their ethical concerns heard at work. One scenario includes a patient with a complex medical condition and a nurse has been caring for him and talking to him for days following the recommended treatment.
The article is here.
Note: There are several significant areas that apply to mental health professionals in terms of stress, moral distress, professional respect, and overwork.
NPR.org
Originally posted April 15, 2016
Here is an excerpt:
Almost 20 percent of newly registered nurses leave a hospital within the first year for the same job elsewhere, or a different job in a different organization, according to a 2014 study. Rushton says to her, that means health care organizations aren't investing enough in their nursing staff.
Nurse burnout also is linked to moral distress, Rushton says, from situations where nurses know what they should do for their patients but can't act on it. For example, nurses might have to give a patient at the end of life a treatment that causes suffering without any medical benefit. She just started a program called the Mindful Ethical Practice and Resilience Academy to try to help new nurses deal with moral distress.
It's a series of in-person workshops, some of which involve nurses using simulations to practice how to make their ethical concerns heard at work. One scenario includes a patient with a complex medical condition and a nurse has been caring for him and talking to him for days following the recommended treatment.
The article is here.
Note: There are several significant areas that apply to mental health professionals in terms of stress, moral distress, professional respect, and overwork.
Wednesday, March 23, 2016
Physician Burnout Is a Public Health Crisis
Arthur L. Caplan
MedScape
Originally published on March 4, 2016
Here is an excerpt:
We've got a problem in this country with doctors. It's kind of an epidemic, but no one is talking about it. It is burnout. A recent study from the Mayo Clinic showed that in 2011, 45.5% of doctors reported that they felt burned out, and that number has now risen to 54.4% in 2014. More than half of all doctors in this country are saying, "I really feel that some aspect of my work as a doctor is making me feel burned out."
This is really trouble. It's trouble because a doctor who feels this way can commit more errors. They suffer from compassion fatigue, or just not being able to empathize with others because they have their own emotional issues. They may retire early, thereby reducing the workforce. They may have problems managing their own lives; 400 doctors committed suicide last year, which is double the rate of the population average. There's trouble for patients in having a workforce that's burned out. There's trouble for doctors in terms of their own health and well-being. We don't talk about it much. We like to think that doctors can handle everything, but it's clearly not true. It's a problem and there ought to be some solutions.
The article is here.
MedScape
Originally published on March 4, 2016
Here is an excerpt:
We've got a problem in this country with doctors. It's kind of an epidemic, but no one is talking about it. It is burnout. A recent study from the Mayo Clinic showed that in 2011, 45.5% of doctors reported that they felt burned out, and that number has now risen to 54.4% in 2014. More than half of all doctors in this country are saying, "I really feel that some aspect of my work as a doctor is making me feel burned out."
This is really trouble. It's trouble because a doctor who feels this way can commit more errors. They suffer from compassion fatigue, or just not being able to empathize with others because they have their own emotional issues. They may retire early, thereby reducing the workforce. They may have problems managing their own lives; 400 doctors committed suicide last year, which is double the rate of the population average. There's trouble for patients in having a workforce that's burned out. There's trouble for doctors in terms of their own health and well-being. We don't talk about it much. We like to think that doctors can handle everything, but it's clearly not true. It's a problem and there ought to be some solutions.
The article is here.
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