Transcript

Lee Tetreault:

Welcome to frequently asked questions from the session Caring for me, Caring for you, strategies to pursue personal health and create a culture of wellness. We are joined by Dr. Pipas. Before we begin with these questions doctor, would you be able to reiterate a few key pointers from today's session to our audience?

Dr. Pipas:  

Thank you, I'd be happy to. I'm committed to the concept and reframing of our ability to care for ourselves as a way of enhancing our ability to care for others and I think this might be counter-intuitive to the way many of us have been trained that others come first, but as we began to think about filling our own tank, if you will, with that analogy that put your own mask on, first and then help others that by taking care of ourselves, we are actually better equipped to care for others. And my premise for all of this work is that my health is critical to my effectiveness as a... And you can fill in the blank, as a physician, as a teacher, as a parent, as a wife, and really by focusing on the shift in thinking that I matter and that I'm not invincible to the health needs, doing the same for me as I do for my patients, no more, no less can contribute to my being more effective.

Lee Tetreault:

Great, let's start with some of the frequently asked questions. First, who is responsible for the health of health professionals?

Dr. Pipas:  

That's a great question, I think we all have... As a society, as an institution, as physicians and members of health care teams, allowed physicians to somehow be immune to some of the needs of healthcare that we sometimes think physicians can't get sick, they're not hungry, they don't need sleep or food or any of the basics that we need as humans and in some ways that's trying to put them on some superhuman pedestal, which is absolutely unrealistic and has caused a lot of the challenges that we're now seeing with the rates of burnout being so much higher than in the general population. And so I think we have to look at it from both sides of the angle, both the individuals making changes in their own behaviors, but also it's somewhat insulting, I think, from a provider's perspective to think that these are people who are experts in the knowledge and the skills, but that they're not able to take care of themselves, it's really that they're not able to take care of themselves in an environment that might actually be unsupportive or in some cases, toxic. And so I think the system needs to make changes and ultimately, we are the system.

And so I think that the ability to change a system comes from individuals within it and so the ultimate responsibility is ours, but we need to both have skills to focus on our own personal health, as well as to redesign systems and make changes at the organizational level that supports wellness among health professionals.

Lee Tetreault:

How can health professionals be responsible to care for patients, team members and themselves?

Dr. Pipas:  

It seems like they have to do it all, right? I think, again, this is a mindframe shifting in the focus and some of the strategies include being able to prioritize time differently or being able to say no and some health professionals will say, "Does that mean I have to go part-time in order to balance all these things?" And I think being able to reframe some of the demands that we have and these can be done on the level of leadership training, they can be done on the level of practice where we maximize the roles of other team members that physicians who are focusing on trying to do everything themselves, are gonna find ourselves unable to do anything well. And so, being able to say, "No," being able to balance, being able to take time for ourselves has an exponential benefit in caring for others.

Lee Tetreault:

Should wellness be a mandated component of curriculum for health professionals in training?

Dr. Pipas:  

Yes. There's no question that for us to break this cycle, we need to mandate this type of curriculum in medical schools. I think the mandate word is an interesting concept because not any one strategy should be mandated, but we need to mandate that we are all competent to not only role model, but to sustain our own health and wellness. How we do that needs individual determination, and so we need autonomy as to what I may need versus what you may need, but that we all have to somehow be able to demonstrate that we are competent as physicians to take care of our own health just again as we do with our patients.

Lee Tetreault:

How do we go about changing the system to support wellness among health professionals?

Dr. Pipas:  

So there's more and more literature looking at some of the strategies that are being implemented at systems levels whether it's the team level, the clinical team, looking at having scribes and MAs, many resources there. There's also implementation strategies that are surfacing as best practice around schools and educational programs such as pass/fail, and supporting leadership training. I think that the major perspective is really to think about this as a call to all organizations and certainly in an academic medicine article recently, Tate Schoenefeld calls us all to say, "We have to have the health of health professionals at the top priority. Just like Bodenheimer did when he charged us with the quadruple aim. This is not about just taking good care of patients, but it's about not doing it at the expense of our health professionals." So we really need to think about, "What are the top levels of strategies? How do we begin to do this in a business case, to invest the money back into the system that we're losing with every burned out health professional?" And there's actually dollars and numbers that are associated with this to do it in a way that we get a return on investment by investing in ourselves.

So if we know that we're losing, and again, Tate Schoenefeld has identified, over $6000 per physician that's burned out, and half a million dollars potentially to replace a physician that's not working or that's present and not functioning, then we can take even 10% of that dollars and put it back into the system. And so now we need organizations to identify champions of this whether they're chief wellness officers or other titles as wellness champions, wellness leaders, we need organizations to commit to high-level goals and strategies and we need frontline interventions to be coming from those people that are at the front line, who have a knowledge and understanding of what needs to change. And then we need to have metrics that we can measure, we need to have vision articulated, we need to have monitoring capabilities and then we really need to celebrate the changes. And so it's really the same as we use with any improvement process, but we need to do it thinking about the wellness of health professionals as the ultimate goal.

Lee Tetreault:

And lastly, what evidence-based strategies exist for promoting personal health?

Dr. Pipas:  

So this is my own research and I have been excited working in this area because, for the majority of the work, it challenges me to walk the walk. And so, as I've written a book recently, A Doctor's Dozen: Twelve Strategies for Personal Health and a Culture of Wellness, it was really about taking from all the different aspects of my roles, learning from my patients. So each chapter is illustrated by a patient story of somebody who had challenges but used evidence-based strategies to make change. It also came from my research around what are these science-based, evidence-based strategies. And then from my teacher hat, really looking at how do we implement these with either curriculum or actual exercises for application. And so there's lots of different findings out there, including mindfulness, and self-reflection, resilience training, journaling, narrative writing, obviously, physical exercise, going out in nature, social health supports, looking at time management, looking at media usage, being able to adapt concepts of change, looking at cognitive reframing, emotional intelligence, appreciative inquiry.

There's so many different resources out there and how we can both learn these as practitioners, and then incorporate them in training for both medical students and residences is going to be the key for us moving forward in turning around the epidemic right now of burnout among health professionals. I'm excited to be a part of this movement, and I'm very eager to see the benefit to ourselves. So cheers to all of our health.

Lee Tetreault:

Thank you so much for this information, Doctor. This is very helpful and thank you for your time.

Dr. Pipas:  

My pleasure.




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