Sustainable Practice in Underserved Settings Preventing Burnout and - PowerPoint PPT Presentation

What is wellbeing? Sustainable Practice in Underserved Settings Preventing Burnout and Promoting Wellness Diana Coffa, MD Director, Family and Community Medicine Residency UCSF, Zuckerberg San Francisco General Many roads lead to wellbeing and many lead away Where can we intervene? Healthcare system Self Work Workload/ Relationship Community of physicians community care work type with work Clinic system Community of colleagues Personal factors Wellbeing 1

Defining Burnout The State of the Science  Cynicism and depersonalization Number of PubMed Studies  Emotional exhaustion 3000  Loss of sense of efficacy 2500 2000 1500 1000 500 0 Physician Wellbeing Physician Burnout Burnout as a state of dissociation Burnout as a state of dissociation  Cynicism and depersonalization  Cynicism and depersonalization Dissociation from others Dissociation from others  Emotional exhaustion  Emotional exhaustion Dissociation from emotions and self  Loss of sense of efficacy  Loss of sense of efficacy 2

Burnout as a state of dissociation Burnout as a defensive strategy  Cynicism and depersonalization Dissociation from others  Emotional exhaustion Dissociation from emotions and self  Loss of sense of efficacy Dissociation from systems and work role Artist: Maggie Taylor http://maggietaylor.com/ Risk factors for burnout What brings us back from burnout? Structural Personal  Low sense of control  Stress at home  High workload  Less hobbies or enjoyable activities  High ratio of non- meaningful work  Less self-care  Conflict with co-workers  Temperamental factors  Conflict with patients  Alexithymia  Financial strain 3

How does Alexithymia lead to burnout? Alexithymia  Lower capacity for empathy  No Read Emotions Lower capacity for meaningful contact and relationship  Lower capacity to notice, attend to, and appropriately respond to our own emotions Image Credit: Washington University Political Review In Medical Language, Burnout = What if we actually named emotions instead? Frustration Depression  What is this feeling? Hopelessness Fear  What does it need from me?  What information does it carry? Guilt Despair Grief Anger  What action is called for? Betrayal Doubt Shame Worry Fatigue Sadness 4

Clinic systems that impact wellbeing Accomplishment Shared mission High workload Creative work/ High ratio of Teaching “meaningless” work Supportive Inability to meet community patient needs Discord with Sense of meaning colleagues Connection with Discord with patients patients Loss of mission Sense of control integrity 18 AAFP Principles of Administrative Simplification AAFP Principles of Administrative Simplification  Certification and Documentation Physician order should suffice. Multiple forms should not be -  Prior Authorizations needed for PT, hospice, home health, DM supplies Must be justified - Eliminate annual recertification of DME supplies for chronic - conditions Transparent - Standardize forms - Eliminated for imaging, DME, and generics -  Medical record documentation Eliminated for effective medications for chronic conditions - Eliminate E/M leves -  Quality Measures Information should be acceptable if entered by any member of the - Standardized - team Patient centered - Record should be for information sharing. Check boxes and - templates do not contribute to patient well-being Evidence based - EHR vendors must collaborate with care providers to redesign - systems 5