Front-line physicians stressed and anxious at work and home
New study reports moderate to severe stress levels in ER doctors during the frenetic early phase of COVID-19 pandemic
July 21, 2020
Science Daily/University of California - San Francisco
Amid the COVID-19 chaos in many hospitals, emergency medicine physicians in seven cities around the country experienced rising levels of anxiety and emotional exhaustion, regardless of the intensity of the local surge, according to a new analysis led by UC San Francisco.
In the first known study to assess stress levels of U.S. physicians during the coronavirus pandemic, doctors reported moderate to severe levels of anxiety at both work and home, including worry about exposing relatives and friends to the virus. Among the 426 emergency physicians surveyed, most reported changes in behavior toward family and friends, especially decreased signs of affection.
"Occupational exposure has changed the vast majority of physicians' behavior at both work and home," said lead author Robert M. Rodriguez, MD, a professor of Emergency Medicine at UCSF. "At home, doctors are worried about exposing family members or roommates, possibly needing to self-quarantine, and the effects of excess social isolation because of their work on the front line."
The results, which appear July 21, 2020, in Academic Emergency Medicine, found slight differences between men and women, with women reporting higher stress. Among male physicians, the median reported effect of the pandemic on both work and home stress levels was 5 on a scale of 1 to 7 (1=not at all, 4=somewhat, and 7=extremely). For women, the median was 6 in both areas. Both men and women also reported that levels of emotional exhaustion or burnout increased from a pre-pandemic median of 3 to a median of 4 after the pandemic started.
Lack of PPE was associated with the highest level of concern and was also the measure most often cited that would provide greatest relief. The doctors also voiced anxiety about inadequate rapid diagnostic testing, the risk of community spread by discharged patients, and the well-being of coworkers diagnosed with COVID-19.
But the survey also showed clear-cut ways of mitigating anxiety:
Improve access to PPE;
Increase availability of rapid turnaround testing;
Clearly communicate COVID-19 protocol changes;
Assure access to self-testing and personal leave for front line providers.
The responses came from faculty (55 percent), fellows (4.5 percent), and residents (about 39 percent), with a median age of 35. Most physicians lived with a partner (72 percent), while some lived alone (nearly 15 percent) or with roommates (11 percent). Nearly 39 percent had a child under age 18.
The study involved healthcare providers at seven academic emergency departments and affiliated institutions in California, Louisiana and New Jersey. Researchers noted that the majority of study sites were in California, which at the time of the survey had not yet experienced the large surges of patients seen in other areas of the country. But the study found that median levels of anxiety in the California sites were similar to those in the New Orleans and Camden sites, which were experiencing surges at the time.
"This suggests that the impact of COVID-19 on anxiety levels is pervasive and that measures to mitigate stress should be enacted universally," Rodriguez said. "Some of our findings may be intuitive, but this research provides a critical early template for the design and implementation of interventions that will address the mental health needs of emergency physicians in the COVID-19 pandemic era."
The study is longitudinal, with this first phase focused on the early "acceleration" phase of the pandemic. Subsequent studies will address stressors that have arisen throughout the course of the pandemic, including childcare and homeschooling demands, the economic impact of fewer patients overall in the ER, and possible development of long-term post-traumatic stress.
https://www.sciencedaily.com/releases/2020/07/200721084205.htm
Consensus report shows burnout prevalent in health care community
October 23, 2019
Science Daily/Vanderbilt University Medical Center
Clinician burnout is affecting between one-third and one-half of all of U.S. nurses and physicians, and 45 to 60% of medical students and residents, according to a National Academy of Medicine (NAM) report released today.
Vanderbilt University Medical Center is among 32 institutions and foundations that sponsored the 296-page report, "Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being," which investigates the causes of widespread clinician burnout and offers solutions to address the problem at its source.
"There's an all too direct connection between clinician burnout and health care safety and quality. While clinician burnout isn't a new problem, its worsening prevalence and impact are due to system factors inherent in the modern health care system," said Matthew Weinger, MD, professor of Anesthesiology and Norman Ty Smith Chair in Patient Safety and Medical Simulation at VUMC, and a member of the NAM authoring committee for the new report.
"The Committee came to realize that addressing clinician burnout will require a deliberate and substantive health care system redesign with a focus on those activities that deliver the most value to patients while enabling and empowering clinicians to deliver high-quality care," he said.
The report discusses key issues that need to be addressed:
· Clinician burnout needs to be tackled early in professional development and special stressors in the learning environment need to be recognized. Leaders in health care and health professions education have a responsibility to foster, monitor and continuously improve work and learning environments.
· While some health care technologies appear to contribute to clinician burnout (poorly designed electronic health record systems, for example), there is real potential for well-designed and implemented technologies to help reduce burnout.
· Federal and state governments, other payors and regulators and the health care industry itself have important roles to play in preventing clinician burnout. Increasing administrative burdens and distracting clinicians from the care of their patients can directly affect burnout.
· Medical societies, state licensing boards, specialty certification boards, medical education and health care organizations all need to take concrete steps to reduce the stigma for clinicians seeking help for psychological distress and make assistance more easily available.
The report concludes with goals and recommendations centered on creating more positive work and learning environments, reducing administrative burden, enabling technology solutions, providing more support to clinicians and learners, and investing in research to address clinician burnout.
The new report is the latest in a series that includes the landmark volumes, "To Err Is Human: Building a Safer Health System" (2000) and "Crossing the Quality Chasm: A New Health System for the 21st Century" (2001).
https://www.sciencedaily.com/releases/2019/10/191023172121.htm
The power of gratitude in the workplace
March 13, 2019
Science Daily/Portland State University
The study shows that being thanked more often at work predicted better sleep, fewer headaches and healthier eating, because it improved nurses' work satisfaction
If you knew that expressing gratitude to a colleague would improve their life and yours, would you do it more often?
A new study by Portland State University researchers -- business professor David Cadiz, psychology professor Cynthia Mohr, and Alicia Starkey, a recent Ph.D. graduate in psychology -- together with Clemson State University professor Robert Sinclair, exhibits a positive relationship between expressed workplace gratitude, physical health and mental health.
The study, "Gratitude reception and physical health: Examining the mediating role of satisfaction with patient care in a sample of acute care nurses," shows that being thanked more often at work predicted better sleep, fewer headaches and healthier eating, because it improved nurses' work satisfaction.
Improving Self-Care in a Stressful Work Environment
The study involved a group of Oregon nurses, a profession that has a particularly high rate of burnout. Cadiz discusses the findings and how applying the research can have a significant impact on quality of life and job retention by preventing stress-related illnesses and disease.
"Nurses tend to have a thankless job. It's very physical, and they're often being screamed at by patients who are at their lowest. When nurses receive gratitude, it boosts them," Cadiz explains.
"This type of study helps us understand how to keep nurses in the workforce in a healthy way. Nurses strongly align their profession with their identity and often look out for patients more than themselves. The gratitude matches up with their identity, gives them satisfaction in a job well done and ultimately increases self-care."
Many people inherently connect their identity to their job and feelings of appreciation within their roles. Employers who understand and react to this can create positive social and economic change.
Gratitude is Good Business
From an organizational, policy and leadership perspective, Cadiz says that employers should create formal or informal opportunities for people to express gratitude. Including gratitude in a business plan is an essential step that many business leaders miss, and that omission can have financial consequences.
"Employees that receive positive feedback are healthier, and that can impact the bottom line," adds Cadiz. "Preventing headaches and other stress-related symptoms means fewer sick days, and, in this case, cuts down the cost of replacement nurses and overtime pay."
These small changes can have a dramatic fiscal impact over time, which can result in more staff, better pay rates and increased benefits.
The big takeaway -- express gratitude when you see someone doing a good job. A positive feedback loop impacts you and those around you, and can ultimately shape a healthier and happier community.
https://www.sciencedaily.com/releases/2019/03/190313091929.htm
Workplace stress can take a toll on your brain surgeon, too
February 9, 2018
Science Daily/University of Southern California - Health Sciences
When it comes to workplace stress, even doctors aren't immune to its effects. For doctors training to become neurosurgeons, burnout is common, and certain workplace stressors -- like unrewarding mentor relationships, difficult coworkers and not getting enough exposure to the operating room -- can lead to it, according to a new study from the Keck School of Medicine of USC.
Building the skills needed to treat complex neurological conditions like stroke, brain tumors or spinal cord injuries requires a highly demanding, seven-year training program. The pressure of that training can sometimes lead to emotional exhaustion, an inability to connect with others or feeling unaccomplished, which are components of burnout. Understanding what factors influence burnout can be a powerful catalyst for change.
"As a patient, you don't want your doctor to be depressed or demoralized when they're working on you, because they're not their best self," says the study's lead author Frank Attenello, MD, MS, assistant professor of clinical neurological surgery at the Keck School. "And as a society, we don't want to discourage people from becoming neurosurgeons, because we have a rapidly aging population in need of neurosurgeons' skills."
While research on burnout is gaining steam in many fields, not much attention has been paid to it in neurosurgery until now, Attenello explains.
To better understand it, Attenello and his colleagues surveyed 346 neurosurgery residents across the United States. Using an 86-item questionnaire, the team explored everything from whether residents felt satisfied with different aspects of their training to whether they were considering quitting training or leaving medicine entirely. Burnout was assessed using the Maslach Burnout Inventory, a validated tool that has been used to measure burnout both in health care and other professions.
The study, published today in the Journal of Neurosurgery, found that 81 percent of residents were satisfied with their career, but 41 percent had given serious thought to quitting neurosurgery at some point. The overall burnout rate was 67 percent -- more than double the estimated rate of burnout among American workers overall. Predictors of burnout included inadequate exposure to the operating room, hostile faculty, unsatisfactory relationships with mentors and social stressors outside of work.
"Some of the most impressive and energetic medical students enter neurosurgery," Attenello says. "When they encounter burnout, it limits their considerable potential, both with their patient care and possibly in their academic and research achievements for the field as a whole."
To help reduce the risk of burnout, Attenello and others at the Keck School have already implemented a new model for mentorship. This year, new residents in the Department of Neurological Surgery will choose their mentors, and the school will assign a backup mentor for additional support.
"Our study provided some valuable insights to the prevalence of burnout and some of the pain points in training neurosurgeons," says study co-author Steven L. Giannotta, MD, chair and professor of neurological surgery at the Keck School. "Recognizing that burnout exists and finding ways to address it are important steps educational institutions can take to mitigate it."
https://www.sciencedaily.com/releases/2018/02/180209100655.htm
Doctors' burnout should be treated as organization-wide problem
December 5, 2016
Manchester University
Current approaches to dealing with burnouts in doctors on an individual case-by-case basis is not effective and the issue should instead be tackled with organization-wide initiatives, according to researchers.
A meta-analysis study, which brought together the results of previously conducted research, was carried out to explore the effectiveness of interventions in reducing burnout in doctors. It explored the comparison between doctor-directed interventions that target the individual and organisation-directed interventions that target the working environment. The strength of the doctor's experience and the particular healthcare setting they worked in was also assessed.
The research concluded that while doctor-focused tactics such as mindfulness and cognitive behavioural are important, the greatest success at preventing and reducing burnout in doctors can be achieved through the adoption of organisation-directed approaches such as improved working environment and organisational culture.
Burnout is a major problem in the healthcare industry and is often driven by excessive workload, imbalance between job demands and skills, a lack of job control and prolonged stress. It is a syndrome consisting of emotional exhaustion, depersonalisation, and a diminished sense of personal accomplishment. Importantly, burnout can result in an increase in medical errors, reduced quality of patient care, and lower patient satisfaction.
It was found that organisations that combined several elements such as structural changes, fostering communications between members of the health care team, and cultivating a sense of teamwork and job control tended to be the most effective in reducing burnout. However, such intense organisation-directed interventions were rare and had not been evaluated sufficiently.
What's more, the evidence indicated that young doctors starting out in their career, are at higher risk of burnout compared to those with more experience, and interventions focused on enhancing teamwork, mentoring, and leadership skills might be particularly suitable for this group.
Dr Maria Panagioti, Research fellow in Primary Care at the University of Manchester who led this study said: 'Our findings clearly show that we need more effective intervention models to prevent burnout in doctors. Such models could be organization-directed interventions which promote healthy individual-organization relationships and view burnout a problem of the whole healthcare systems.'
George Lewith, Professor of Health Research at the University of Southampton who supervised the research, said: "This work suggests that if we want to retain safe and professionally competent NHS clinicians working in very demanding front line jobs we need to support their mental and physical health and creating appropriate and enabling working environments for them. Efforts need to be focused on finding appropriate ways of reaching doctors who work in stressful environments to ensure their wellbeing is taken care of. If we don't patient safety could be at risk."
https://www.sciencedaily.com/releases/2016/12/161205120500.htm
Employees of medical centers report high stress, negative health behaviors
September 8, 2016
Science Daily/Mayo Clinic
Approximately 15 to 20 percent of adults in the U.S. will report high levels of stress, several American surveys have found. A new study has identified stress and burnout as a major problem employees face within the medical industry, leading to negative health behaviors. With rising stress levels in the workplace for employees, many companies are looking to integrate, engage and enroll employees into wellness programs.
"It's important to teach individuals to monitor their stress levels over time and practice effective, ongoing stress-reduction strategies, such as getting involved in wellness programs, this will in-turn help health care employees live a happy and health life," says Matthew Clark, Ph.D., lead author of the study and resiliency expert at the Mayo Clinic Healthy Living Program.
The study, which is published in the Journal of Occupational and Environmental Medicine, measured stress and health behaviors (exercise, nutrition, sleep, etc.) by a series of five annual surveys administered to 676 participants who are employees at Mayo Clinic and have access to a wellness center. A significant relationship was found between the stress levels of an employee and four domains of quality of life: poor physical health, low mental health, poor nutritional habits and lower perceived overall health. Unfortunately, according to the study, employees who reported high stress levels and perceived poor quality of life also reported the lowest usage of wellness programs.
According to Dr. Clark, "Increasing the awareness of wellness centers and programs in academic medical environments will increase the quality of life of employees and lead to less physician and staff burnout."
Many companies are taking note of burnout and job strain in their staff and have created wellness centers, offer stress reduction programs, provide wellness coaching and healthy sleep programs for their employees in an effort to reduce stress, job strain and burnout. Muscular strength, cardiovascular fitness and flexibility exercises are also beneficial to overall quality of life, Dr. Clark writes.
He adds, "We are beginning to encourage employees to monitor their stress levels and to engage in daily resiliency practices, such as exercise, time with family and friends, meditation or gratitude journaling, to help reduce their stress levels and improve their quality of life."
Given the significance of stress in the workplace, the researchers note that exploring ways to effectively engage employees who have high levels of stress into wellness programs warrants further investigation.
https://www.sciencedaily.com/releases/2016/09/160908165052.htm
Mindful Meditation, Shared Dialogues Reduce Physician Burnout
September 23, 2009
Science Daily/University of Rochester Medical Center
Training in mindfulness meditation and communication can alleviate the psychological distress and burnout experienced by many physicians and can improve their well-being, researchers report.
The training also can expand a physician's capacity to relate to patients and enhance patient-centered care, according to the researchers, who were led by Michael S. Krasner, M.D., associate professor of Clinical Medicine.
"From the patient's perspective, we hear all too often of dissatisfaction in the quality of presence from their physician. From the practitioner's perspective, the opportunity for deeper connection is all too often missed in the stressful, complex, and chaotic reality of medical practice," Krasner said. "Enhancing the already inherent capacity of the physician to experience fully the clinical encounter—not only its pleasant but also its most unpleasant aspects—without judgment but with a sense of curiosity and adventure seems to have had a profound effect on the experience of stress and burnout. It also seems to enhance the physician's ability to connect with the patient as a unique human being and to center care around that uniqueness.
"Cultivating these qualities of mindful communication with colleagues, anectodotally, had an unexpected benefit of combating the practitioners' sense of isolation and brought forth the very experiences that are such a rich source of meaning in the life of the clinician," he said.
"The most salient element was the collegial effect of weathered physicians reflecting on mutual experience using a theme-based approach in a safe environment," Chamberlain said. "It is a unique opportunity to return to our roots as physicians, exploring in a workshop format abstract yet key emotionally charged or difficult issues that many of us had not visited so academically since medical school. Perception of the impact and approach to those issues is quite different once tempered by experience, particularly in a program that emphasizes awareness of the moment. It is a singular opportunity to do-over some of our medical school experience, and get much more out of it than the first time, as one reflects on how others in the group have grappled with and addressed the complex experiences of being a physician whose life touches and is touched by others constantly. The program is all about the experience of being a physician. Not what to do, or how to do it, but what it feels like. That is unique, and quite refreshing."
http://www.sciencedaily.com/releases/2009/09/090922162259.htm