Healing thyself (and others, too): Tips for doctors for 2016
Ah, 2015; we hardly knew ye. But the truth is that the year that was left many lessons for doctors to apply during MMXVI – aka 2016. It was a long December but there is reason to believe this year will be better than the last, especially if you incorporate the following tips into your practice.
Burnout. Studies have shown that burnout is more common in doctors than in any other professionals. Keep an eye out for these signs of doctor burnout:
· You have a high threshold for stress. Director of the Division of General Internal Medicine at Hennepin County Medical Center in Minneapolis Mark Linzer pleads to “please don’t ignore the stress, even if you can take it.” His research on the subject, which goes all the way back to 1996, has found that physicians who consistently operate under high stress are at least 15 times more likely to burn out.
· You have an overly chaotic practice. “People tend to think it’s the patients that always stress doctors out, but actually, it’s the opposite,” Dr. Linzer says. “Caring for patients keeps doctors motivated. What burns them out is caring for patients in a high-stress environment. Change the environment and you’ll change the overall quality of care.”
· You and your boss disagree over values or leadership. Doctors who work at a large hospital or private practice need to feel their superiors share the same values for medicine and patient care; otherwise they may start to lack motivation.
· You are an emotional buffer. “Often, the doctor acts as an emotional buffer,” Dr. Linzer says. “We will buffer the patient from our own stressful environment until we can’t take it anymore.”
· Your work gets in the way of family events. “When (physicians) can’t (spend quality time with loved ones), it’s all they think about during the day and the patient suffers,” says Dr. Linzer.
· Lack of control over work schedule and free time. Dr. Linzer advises practices that “if you standardize, customize;” meaning that practices should customize the schedules of physicians who must work a long standardized set of hours each week, in order to allow for the flexibility to fit changes or needs in their daily lives.
· You neglect yourself. If you consistently fail to take care of yourself, you may start caring less for your patients as well. “As physicians, we want to be altruistic but one of the keys to altruism is self-care,” Dr. Linzer says.
If the above sounds familiar, then it’s time to take the necessary steps to address burnout. Dr. Lotte Dyrbye said at the 2015 AMA Annual Meeting that physicians with burnout and depression remain independently associated with liability lawsuits, higher rates of suicidal thoughts, depersonalization, medical errors and deficient patient care. She suggested these measures:
· Take responsibility for your own self-care and happiness.
· Set aside time to do a work-related activity that you actually enjoy each week.
· Take vacations.
· Follow a healthy diet.
· Do not delay gratification.
Additionally, hospitals and practices should:
· Promote honest discussions.
· Encourage doctors to talk about medical errors.
· Create an index of wellness or a tool to help doctors gauge their risk of burnout.
Blood pressure. Measuring blood pressure is a rather simple and routine procedure – deceivingly so, in fact. Like tango, blood pressure measurement takes two; doctor and patient have to be simpatico in order to avoid inaccurate results. With that in mind, remember to always ask patients these three questions when measuring their blood pressure:
1. Were you rushing to get here or physically active right before this appointment?
The patient may need some time to rest before having their blood pressure measured.
2. Have you been taking your medication?
It’s not enough to know that a patient has been prescribed medications for high blood pressure; you need to receive verbal confirmation that they are actually taking it.
3. What’s your diet and physical activity regimen like?
This could lead to a follow-up question of ‘why’ if the patient does not eat healthily or is physically inactive. Explain how a healthy diet and physical activity can help reduce blood pressure.
Tips for getting an accurate blood pressure reading:
· Don’t have a conversation. Talking adds 10 to 15 mm Hg (the 3 aforementioned questions should be asked and answered prior to measuring).
· Put the cuff on a bare arm. Putting it over clothing adds 10 to 40 mm HG.
· Support the arm at heart level. An unsupported arm adds 10 mm Hg.
· Have the patient empty their bladder first. A full bladder adds 10 to 15 mm Hg.
· Support the back. An unsupported back adds 5 to 10 mm Hg.
· Ensure the patient’s legs are uncrossed. Crossed legs add 2 to 8 mm Hg.
· Support the feet. Unsupported feet add 5 to 10 mm Hg.
Financial health. No band-aid is large enough to stop a medical practice from bleeding money. But the following interventions can be useful in the prevention of monetary hemorrhage:
· Hire a trustworthy financial advisor. The duty of an advisor is to help you “cross your Ts and dot your Is,” according to orthopedic surgeon and professor at the University of South Carolina School of Medicine Dr. Angus McBryde. “The physicians I know who have gotten into trouble [with money] didn’t get good advice. You’ve got to have a resource.”
· Plan for the worst case scenario. “You’ve got to plan for at least one disaster,” Dr. McBryde says. “Everybody’s going to have some big bumps in the road, so you can’t just look at the projection of what you’ll have when you’re 60. You’ve got to shoot for more than you’ll think you’re going to need.”
· Invest in disability insurance. “There’s a higher chance of you becoming disabled than dying,” McBryde says. “I carried a huge amount of disability insurance. Fortunately I’ve never had to use it, but I have friends who were underinsured.”
· Revisit and update your estate plan. If you have one; if you don’t, work with a financial advisor (see? They do come in handy) to have at least the bare minimum in place (will, end-of-life and medical directives).
· Learn about your investment options. Many doctors do not make any investments out of sheer ignorance of their alternatives. Again, a financial advisor would be useful in such an endeavor.
· Learn about your own finances. “I started reading about finances and investing very small amounts of money,” professor and former chair of obstetrics and gynecology at Thomas Jefferson University Hospital Dr. Louis Weinstein says. “Doctors can be really dumb about finances, but it’s only because they never taught themselves.”