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Posters at 2023 Winter Brain Conference 7 Jan 2023, 3:39 pm

Check out our posters at the 2023 Winter Brain Conference

Metcalf M, Tanner B, Interactive Digital Media to Reduce Medical Student Depression and Alcohol Use. Poster presented at the 2023 Winter Conference on Brain Research Meeting, January 21, 2023, Snowbird, UT. [Sat 1/21/2022 @3:30 PM – 4:30 PM]

Tanner B, Metcalf M Barriers to Entrepreneurship for Women Neuroscientists. Poster presented at the 2023 Winter Conference on Brain Research Meeting, January 23, 2023, Snowbird, UT. [Mon 1/23/2022 @3:30 PM – 4:30 PM]

Tanner B, Metcalf M. Combined Anti-Psychotic Treatment in Acute Manic Psychosis. Poster presented at the 2023 Winter Conference on Brain Research Meeting, January 22, 2023, Snowbird, UT. [Sun 1/22/2022 @3:30 PM – 4:30 PM]

The post Posters at 2023 Winter Brain Conference appeared first on Clinical Encounters: Lift.

Simulation Summative Study Results Are In! 5 Aug 2022, 6:52 pm

Clinical Tools just completed the summative study for a Phase II grant exploring how medical students respond to a computer-based simulation, Lift: Peer Support. It was designed to help students learn about peer support and other important skills to increase resilience and avoid burnout. We are very excited about the preliminary results that we have analyzed so far.

What was the goal?

We wanted to assess the final prototype’s impact on medical students’ quality of life, alcohol and substance use, depression, and resilience. The study also evaluated the participant’s confidence, satisfaction, and opinions about the experience, which included use of the Lift simulation prototype and the website.

What we found out

The results for this computer-based intervention are very promising. Overall, the intervention has promise for improving confidence, attitude, and intended behavior. The simulation was well-received, enjoyable, and worth doing.

We had medical students take a series of surveys before and after the study. We have found that the intervention had positive impacts in the 2-week period after using it. Those positive trends included:

increased energy levels,
decreased drug and alcohol use,
decreased depressive symptoms,
several decreased burnout symptoms,
increased adaptation to change.
a decrease in feelings of failure due to alcohol use. (statistically significant)

Stay tuned as we continue to report this data!

For Further Information

Company: Clinical Tools and Health Impact Studio

Email: feedback@clinicaltools.com

Website: Lift.ClinicalEncounters

Founder, President, and Vision Leader: Bradley Tanner, MD, ME

The post Simulation Summative Study Results Are In! appeared first on Clinical Encounters: Lift.

In the News | GrepBeat: All Work And No Play Makes For Dull-Minded Healthcare Workers 29 Jul 2022, 9:01 pm

All Work And No Play Makes For Dull-Minded Healthcare Workers

The post In the News | GrepBeat: All Work And No Play Makes For Dull-Minded Healthcare Workers appeared first on Clinical Encounters: Lift.

Clinical Tools – Receives Award in the 2022 International Serious Play Awards Program 21 Jun 2022, 5:58 pm

FOR IMMEDIATE RELEASE: 6/21/2022

[Chapel Hill, NC, June 21, 2022] – Clinical Tools, Inc. is Honored as Silver Medal Winner in the 2022 International Serious Play Awards

Clinical Tools and our subdivision, Health Impact Studio, were selected as a winners in the 2022 International Serious Play Awards. This competition — held annually — recognizes the world’s best serious games resources.

Clinical Tools received a Silver Award for the Lift: Medical Student Peer Support and Resiliency Skills simulation in the Healthcare / Medical Training category. The employees at Clinical Tools / Health Impact Studio were honored to be selected as a winners.

Clinical Tools, Inc. (CTI) is a diverse group with expertise in medicine, psychology, public health, basic sciences, programming, project and program management, gaming, information technology, and communications. Based in Chapel Hill, the company has a 20+ year history of success with providing online continuing medical education.

Health Impact Studio, a division of Clinical Tools, utilizes gaming technology to create healthy lifestyle change. The company combines expertise from medicine, psychology, public health with gaming, to create innovative games to positively impact health. Health Impact Studio creates games for healthcare professionals, medical students, and the general public on topics like well-being, obesity, addiction, and nutrition.

The Serious Play Conference explores game-based learning with leaders in the serious game industry across the globe. The conference brings together professionals in game development, universities, healthcare institutions, government, corporations, and more. The Serious Play Conference is a leader in the future of training and education!

For Further Information

Company: Clinical Tools and Health Impact Studio

Email: feedback@clinicaltools.com

Website: Lift.ClinicalEncounters

Founder, President, and Vision Leader: Bradley Tanner, MD, ME

The post Clinical Tools – Receives Award in the 2022 International Serious Play Awards Program appeared first on Clinical Encounters: Lift.

Medscape’s Physician Burnout & Depression Report 2022: Summary and Commentary 8 Feb 2022, 5:33 pm

The Physician Burnout & Depression Report 2022: Stress, Anxiety, and Anger presents results from a survey of over 13,000 physicians in 29 specialties (Kane, 2022). It found that physicians taking the survey, which was given in 2021, had a burnout rate of 42%, and 21% said they were depressed. Of those with burnout, 54% said it has a strong to severe impact on their lives.

There are a number of limitations to the survey as a measure of the distress physicians face in their work and the impact in their lives. These include that the extent to which physicians who feel symptoms of burnout might be more drawn to take a survey on burnout than other physicians is not known. Nor is it known whether readers of Medscape, which conducted the survey, are representative of physicians in general. Furthermore, in this survey, physicians self assess their “burnout” rather than the component symptoms. However, because the survey is repeated annually using the same methods and questions, and because the number of participants is high with a broad representation of the different specialties, comparisons between years are likely to show fairly accurate trends. For example, the overall physician burnout rate has not changed much in these reports: The self-reported burnout rate in 2022 was 42%, in 2021 was 37%, and in 2020 was 42%. Unsurprisingly, considering the effect of the pandemic, the specialty having the highest rate of burnout in the 2022 report was Emergency Medicine (60%, an increase of 10% over the pre-pandemic 2020 report), followed by Critical Care (53%, an increase of 9% over the 2020 report). Family Medicine rates were also high in the 2022 report (51%), which may help explain why physicians in outpatient clinics unexpectedly had higher rates of burnout (58%) than specialties based in hospitals (48%).

Participating physicians chose from a list of possible contributors, the factor most affecting their burnout. “Too many bureaucratic tasks, such as charting and paperwork,” was by far the most commonly perceived contributor to burnout; it was selected by 60% of the participants. Only 34% of the physicians said “too many hours at work” contributes the most to their burnout. The factors that the physicians felt would most likely reduce burnout were a manageable work schedule, more money, greater respect, more autonomy, lighter patient loads, and more support staff. Approximately a third of participants perceived that each of these factors would most likely reduce burnout.

The report covers many other aspects of this topic, including how physician age and personality affect burnout rates, possible reasons for higher rates of burnout in women physicians than men, the effect of burnout on physician relationships, how COVID-19 has affected work-life happiness, physician response to burnout, and ways physicians keep up their happiness and mental health. The report also discusses the relationship between depression and burnout found in this survey and the impact of physician depression on patients.

Only 42% of physicians reported that their workplaces offer programs to reduce stress or burnout. Many physicians (49%) reported that they can deal with burnout or depression without help from a professional. Almost as many (43%) do not want to risk disclosure to a medical board and 32% do not want it on their insurance record. Interestingly, fewer physicians were concerned about colleagues knowing of their struggles. This supports developing peer support skills as a prevention for burnout, which is a focus of Lift.ClinicalEncounters.com.

Reference

Kane L. Physician Burnout & Depression Report 2022: Stress, Anxiety, and Anger. Medscape. January 21, 2022.

The post Medscape’s Physician Burnout & Depression Report 2022: Summary and Commentary appeared first on Clinical Encounters: Lift.

Clinical Tools – Spring 2021 Digital Health Awards® Winner 8 Jun 2021, 5:58 am

FOR IMMEDIATE RELEASE: 6/8/2021

[Chapel Hill, NC, June 8, 2021] – Clinical Tools, Inc. is Honored in 23rd Annual Digital Health Awards® Spring 2021 Session

Clinical Tools and our subdivision, Health Impact Studio, were selected as a winners in 23rd annual Digital Health Awards® program. This competition — held each spring and fall — recognizes the world’s best digital health resources.

Health Impact Studio received a Silver Award for the Lift application in the Mobile Digital Health Resources category. Clinical Tools received a Merit Award for the Lift for Health Professionals website in the Web-based Digital Health. Vaping Cessation Training also received a Silver Award in the same category.

The employees at Clinical Tools / Health Impact Studio were honored to be selected as a winners. The Lift app and website were chosen from more than 700 entries judged by a panel of distinguished experts in digital health media.

The Digital Health Awards® program is organized by the Health Information Resource Center(SM) (HIRC), a national clearinghouse for professionals who work in consumer health fields. Other well-known HIRC programs include the annual National Health Information Awards(SM), (healthawards.com) which annually recognizes the nation’s best consumer health programs and materials (for non-digital resources), and the annual National Women’s Health & Fitness Day® (fitnessday.com/women).

For Further Information

Company: Clinical Tools and Health Impact Studio

Email: feedback@clinicaltools.com

Website: Lift.ClinicalEncounters.com

Founder, President, and Vision Leader: Bradley Tanner, MD, ME

The post Clinical Tools – Spring 2021 Digital Health Awards® Winner appeared first on Clinical Encounters: Lift.

Barriers to Mental Health Treatment for Health Care Professionals and Students 1 May 2021, 1:38 am

Getting support when you need it is a critical part of mitigating the effects of stress and developing well-being.

Example reasons an individual might seek help:

Learning to develop new coping skills
Improving the ability to tolerate difficult emotions, such as intense guilt, sadness, or anxiety
Getting help with the mourning of a loss

What might prevent healthcare professionals from obtaining needed support?

Health care professionals may have concerns about communicating with a provider knowing they may get a diagnosis and that diagnosis might later affect their employment or licensing. Even communicating with someone within an organization informally may seem risky due to uncertainty about the protection of that conversation. Consider these impediments to getting help described by the AMA (Berg, 2020):

Professional licensure at the state level often involves answering questions about physical and mental health status, which can result in physicians not seeking treatment for treatable illness.
Professional liability insurance also requires disclosure of mental health concerns, which is another barrier to seeking appropriate treatment.

Countering common misconceptions about mental health care (Mt. Sinai, 2020):

Getting help is being responsible and healthy. You may develop a positive coping skill and benefit not only yourself but also those you work with and the organization.
You do not have to be mentally ill or even wait until you are suffering a lot to get help.
Most insurance covers mental health with copays ranging from 0 to $30. You may also find a professional who uses a sliding scale.
If you are concerned about time, consider that if you are feeling better, you may become more efficient in dealing with difficult matters. Getting focused, limited care of just a few sessions is sometimes sufficient.
Mental health professionals are not allowed to reveal anything about your care to your employer, and your employer should not have access to mental health notes in your record.
Even highly independent, capable people sometimes benefit from getting help from others. Think of it as adding skills rather than giving up control.

For medical students: Rising 4th-year medical students in our focus group recommended taking advantage of existing systems of support in the schools. Nearly all medical schools have a support system for students, including some form of counseling and some sort of peer support, such as pairing senior students with new students or groups of students meeting with an attending physician to discuss issues for which they need support. Medical schools typically have counseling available to help students who are struggling and are prepared to help those who need more formal mental health support

Resources: See Lift’s Resources section for resources on mental health and finding help.

Additional Reading: (External Resources)

My First Therapy Session. Commentary by one medical student who sought help through mental health counseling.
Effect of getting mental health treatment AMA resource
New policies target mental health stigma in physicians, students AMA resource

Related Lift blog: Why Peer Support?

References:

Berg S. The 12 factors that drive up physician burnout. American Medical Assoc. 2020.

Mt. Sinai Medical Center. Common Misconceptions about Mental Health Care – Resource from Mt. Sinai Medical Center, NY., written to encourage healthcare professionals to seek mental health care when appropriate. 2020

The post Barriers to Mental Health Treatment for Health Care Professionals and Students appeared first on Clinical Encounters: Lift.

Why Peer Support? 28 Apr 2021, 8:46 pm

For Health Care Professionals and Students

The basics. What is peer support?

In peer support, individuals affected by major stress talk freely and share worries and describe experiences of pressure with someone who has had a similar experience or background (NCI, 2006). Peer support promotes self-efficacy and hope by sharing helpful knowledge gained through experience and modeling coping strategies (Bagnall et al., 2015). Peer support also provides some social support which is among the most important things you can do to remain resilient during your medical training and in medical practice.

A key element in peer support is that the person offering support often has been through similar problems themselves or is at least familiar with the context of the stressful event, such as the work environment in which it happened. The peer’s similarity to the individual being supported provides a relatable model that facilitates change that may be needed (Bandura, 1977).

How can peer support be useful?

Social support is a very important and powerful stress management tool. It can mitigate some of the acute distress physicians encounter daily and even reduce the severity of later symptoms (Brooks et al., 2018; Maunder et al., 2004). When social support comes from a peer who understands at least part of what the individual has experienced, it is easier to feel understood, which helps make the support more effective (Shapiro & Galowitz, 2016).

Peer support is often used to help individuals dealing with mental health or substance use problems (SAMHSA, 2020), but has also been utilized in medical settings to support physicians experiencing distress related to their work (Shapiro & Galowitz, 2016). Medical students in our focus groups rated peer support as one of the most important factors in maintaining their well-being in medical school. They valued having someone who appreciates and understands the stresses that they face and offers useful advice. Much of this support happens informally but formal peer support programs can be beneficial, especially when students get a little training in how to optimize the support they give. Getting support from a more senior student can help prepare you and warn you about what is to come in your training.

Five Steps of Peer Support

The steps involved come naturally for most people trying to help someone. However, following a loosely structured protocol and knowing a few extra skills can help it go more smoothly and assure that the peer you are trying to help gets the help they need. The main steps are:

Make a connection with your peer.
Elicit your peer’s story about what is concerning them and offer empathy.
Assess the impact on your peer including whether they are in crisis.
Provide an intervention that helps address what you learned in the first steps. Listening compassionately is the most important part. You may also elect to share what you learned through your experience or offer information on a resource that may help them.
Follow up with your peer later to see how they are doing.

Learn More in these training activities available on LIft:

Peer Support for Medical Students (includes an interactive 3rd-year medical student case that illustrates peer support by a 4th-year medical student in a school-sponsored peer support program. Also includes an instruction module on peer support skills.)
Pre-Clinical Academic Challenges An interactive 2nd-year medical student case that illustrates informal peer support by a third-year medical student.
Physician Peer Support (includes an interactive case example of a young hospitalist receiving peer support from a peer in another department through the hospital’s formal peer support program. Also includes an instruction module on peer support skills.)

References

Bagnall A-M, South J, Hulme C, et al. A Systematic Review of the Effectiveness and Cost-Effectiveness of Peer Education and Peer Support in Prisons. BMC Public Health. March 25, 2015;15(1):290. doi:10.1186/s12889-015-1584-x.

Bandura A. Social Learning Theory. Englewood Cliffs, NJ: Prentice Hall; 1977.

Brooks SK, Dunn R, Amlôt R, Rubin GJ, Greenberg N. A Systematic, Thematic Review of Social and Occupational Factors Associated With Psychological Outcomes in Healthcare Employees During an Infectious Disease Outbreak. J Occup Environ Med. 2018;60(3):248-257. doi:10.1097/JOM.0000000000001235. PMID: 29252922.

SAMHSA. Core Competencies for Peer Workers. SAMHSA. April 16, 2020.

Shapiro J, Galowitz P. Peer Support for Clinicians: A Programmatic Approach. Academic Medicine. September 2016;91(9):1200. doi:10.1097/ACM.0000000000001297.

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Alcohol Use Problems in Health Professionals 6 Apr 2021, 2:29 pm

Healthcare professionals are not immune from alcohol use disorders. Any use of alcohol by health care providers is a danger to the patients they are treating. Because patients’ lives are dependent on the ability of medical professionals to think quickly and rationally, it is imperative that medical professionals not use alcohol excessively. However, this is not always the case. Students and residents are under the immense pressures of medical education and training. Practicing providers are under constant stress to perform at high levels, and alcohol can be a mechanism to cope with stress (Yancey & McKinnon, 2010).

Alcohol Use Problems in Health Professionals

Substance use among healthcare providers has long been identified as a significant issue (Bakhshi & While, 2014). Alcohol use rates among health professionals are high, with 10%-15% of all health professionals exceeding limits at some point during their careers. Certain medical professions report a higher rate of alcohol use. ER physicians, physicians in practice alone, and psychiatrists are three times more likely to have excessive alcohol use (Baldisseri, 2007).

Compare the rate of alcohol use disorder in the general population of age 18 and over of 7.6 percent of men and 4.1 percent of women (NIAAA, 2019).

Excessive use by a healthcare provider can impact their attitude in treating patients with alcohol use disorder. In 1973 the AMA requested state medical societies monitor and treat physician substance abuse (Galanter et al., 2007). It is important that providers be monitored for their potential abuse issues as they can have detrimental effects on patient treatment.

Medical Student Alcohol Use

Overall use of alcohol in medical students (91%) (Ayala, 2017) is substantially higher than that seen in the general population (56%) as measured by the 2017 National Survey on Drug Use and Health (NSDUH) data on young adults aged 18 to 25 with past month alcohol use (NSDUH, 2018). A study found that ⅓ of medical students fit criteria for binge drinking and over ¼ used cannabis in the past year (Ayalal, 2017).

Physician Alcohol Use

In a study of over 7000 physicians, alcohol use disorder was more common than the general public: 12.9% of male and 21.4% of female physicians met diagnostic criteria for the older versions of this diagnosis (Oreskovich, 2015). The problem of alcohol use as a coping strategy continues in practicing physicians. For practicing physicians, obtaining privileges of a license almost always requires disclosure of treatment; such requirements further hinder seeking treatment prior to or in practice.

Nurse Alcohol Use

Alcohol use disorder appears to be a little less common than in the general population (Kaliszewski, 2019). However, around 10% of nurses will misuse drugs or alcohol during their careers at some point (Kunyk, 2015). Nursing involves several stressors and other risks that contribute to substance use problems: access to controlled substances, psychological/emotional stress from the work, lack of education regarding substance use, and physical stress, fatigue and pain (Kaliszewski, 2019). The frequency of substance use problems varies with the nursing specialty (NCSBN, 2011). Emergency room nurses have high rates of substance use problems. Nurse anesthetists have high rates of controlled substance use. Oncology nurses have a higher rate of alcohol consumption than other specialties. Smoking is higher among psychiatric nurses and cocaine use is more common in critical care nurses. Pediatric nurses are fairly low for substance use on average.

Burnout and Alcohol Use Problems

Burnout correlates with alcohol and substance use problems (Jackson, 2016; Oreskovich, 2015).

Medical students: In one study, ⅓ of medical students had symptoms of alcohol abuse/dependence and that use correlated with the burnout domains of emotional exhaustion and depersonalization (Jackson, 2016).
Physicians: Of approximately 6600 physicians self-identified as having burnout in a survey of over 15,000 physicians, 23% said that they cope using alcohol (Kane, 2019).
Nurses: A study of registered nurses found that typical 12-hour shifts are likely to lead to burnout and poor overall health.⁹ Some nurses may resort to substances to provide relaxation after a long and grueling day of work.

Stigma

The medical community at large has not always been forthcoming about individual provider substance use, despite the fact that physician addiction has been reported as early as 1869 (see review by Merlo & Gold, 2008). Fear of being professionally stigmatized because of alcohol use may prevent some health professionals from seeking needed treatment. This creates a dangerous situation for patients and leads to a higher likelihood of mistreatment.

Getting Help for Colleagues

Impairment among health professionals has the potential to impact the practice of other health professionals who are interacting with them in a multidisciplinary team. If you suspect your colleague has an alcohol use problem, you can seek to get them the help they need. Interestingly, addicted physicians that participate in a Physician’s Health Program experience higher success rates (measured by testing negative for alcohol or drugs) than physicians who attended other types of rehabilitation programs (DuPont et al., 2009). Health care providers may be sent to this type of treatment as a result of peer reports, as well as complaints from patients or family members, but they may only be in the pre-contemplative stage of change, which opens the possibility of relapse. Please see the Related Resources section for a review of the Stages of Change Model. Successfully monitoring your colleague and taking an interest in their recovery will lend support they may need to continue improving. However, some providers are reluctant to report their colleagues for fear that their own financial and occupation status may be in jeopardy (Yancey & McKinnon, 2010).

The legalities and ethics involved in reporting a colleague are beyond the scope of this content. They are well discussed in many other sources. See, for example, the article by BA Johnston, “Dealing with the Impaired Physician”, linked at the end of this content in Resources.

Treatment Options and Outcome

Treatment for excessive alcohol use is usually comprised of detoxification, along with psychiatric and medical evaluations, leading to ongoing rehabilitation (Yancey & McKinnon, 2010). Other components that can be included are immediate intervention, placement in an appropriate facility, uninterrupted therapy, rapid re-entry into practice, close monitoring, and a contingency plan. This type of situation may provide a stable support system with peers, which aids in recovery. Those who do not voluntarily enter into this type of rehabilitation program are often referred to an inpatient program as a preventative measure against putting their own patients in unnecessary harm. Within 5 years of admittance into a program, 78% of physicians were licensed and working in their specialty. In case reports, physicians say that returning to work can be awkward, but their partners are eager to see them return and people are generally supportive.

Impairment on the Job

Impairment among health professionals is defined as not only being unable to practice within “acceptable standards of practice”, but also the inability to provide medical services without flaws in professional judgment (Baldisseri, 2007). It is important to recognize alcohol impairment among health care providers as it can negatively impact patient health as well. The health professionals may downplay their own use, because they are well-aware what is/is not healthy use and feel they can control their levels (Baldisseri, 2007). However, being under the influence of alcohol while on duty can create dangerous circumstances for both the patient and the provider’s colleagues as well.

Personal Use Impacts Screening Techniques

Interviews of health professionals who admitted drinking shows that their own use may cloud their ability to effectively screen patients. Some of the General Practitioners interviewed would only screen for or identify a patient’s level of use as high if the patient was consuming more than the physician (Kaner et al., 2006, Frank et al., 2008). Using their own use as a measuring tool is not an appropriate approach to patient screening and can result in inaccurate patient assessments and inadequate treatment. Additionally, physicians who consume more alcohol are less likely to counsel patients on alcohol use. Also, health care providers may be hesitant to teach about alcohol reduction among patients when they themselves engage in the same sorts of behavior (Kaner et al., 2006). This puts patients in danger, because they cannot be properly identified as having an alcohol use problem if the provider has one as well.

Resources

Success Story: A Physician Coming to Terms with Alcoholism. Massechusetts Medical Society article, 2018.

Physician Impairment. Chapter 7 in Emergency Medical Residents Association Wellness Guide. Defines impairment, offers several brief cases, how to recognize it, what to do/when to report it.

Candilis PJ, Kim DT, Sulmasy LS. Physician Impairment and Rehabilitation: Reintegration Into Medical Practice While Ensuring Patient Safety: A Position Paper From the American College of Physicians. ACP Ethics, Professionalism and Human Rights Committee.Ann Intern Med. 2019 Jun 18;170(12):871-879. doi: 10.7326/M18-3605. Epub 2019 Jun 4.
PMID: 31158847. Free Journal Article: A position paper by from the American College of Physicians.

Johnson BA. Dealing with the Impaired Physician. [Curbside Consultation] Am Fam Physician. 2009 Nov 1;80(9):1007-1008.

International Doctors in Alcoholics Anonymous

Association for Medical Education and Research in Substance Abuse

References

Ayala Erin E, Roseman Destiny, Winseman Jeffrey S, Mason Hyacinth RC. Prevalence, perceptions, and
consequences of substance use in medical students. Med Educ Online. October 26, 2017;22(1).
doi:10.1080/10872981.2017.1392824.

Bakhshi S, While AE. Health professionals’ alcohol-related professional practices and the relationship between their personal alcohol attitudes and behavior and professional practices: A systematic review. International Journal of Environmental Research and Public Health. 2014; 11: 218-248. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924442/ Accessed on: 2015-06-26.

Baldisseri MR. Impaired healthcare professional. Crit Care Med. 2007; 35(2): S106-16. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17242598 Accessed on: 2015-06-24.

DuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: physicians’ health programs. Journal of Substance Abuse Treatment. 2009; 36: 159-171.

Galanter M, Dermatis H, Mansky P, McIntyre J, Perez-Fuentes G. Substance-abusing physicians: monitoring and twelve-step-based treatment. American Journal on Addictions. 2007; 16:2: 117-123.

Jackson Eric R, Shanafelt Tait D, Hasan Omar, Satele Daniel V, Dyrbye Liselotte N. Burnout and Alcohol
Abuse/Dependence Among U.S. Medical Students. Acad Med J Assoc Am Med Coll. March 1, 2016.
doi:10.1097/ACM.0000000000001138.

Kaliszewski M, October 30, 2019. Why Nurses are at a Higher Risk for Substance Abuse. American Addiction Centers. October 30, 2019.

Kane, Leslie. Medscape National Physician Burnout, Depression & Suicide Report 2019. Medscape; January 16, 2019.

Kaner E, Rapley T, May C. Seeing through the glass darkly? A qualitative exploration of GPs’ drinking and their alcohol intervention practices. Family Practice. 2006; 23: 481-487. Available at: http://fampra.oxfordjournals.org/content/23/4/481.full.pdf Accessed on: 2014-09-26.

Kunyk D. Substance Use Disorders among Registered Nurses: Prevalence, Risks and Perceptions in a Disciplinary Jurisdiction. J Nurs Manag. January 2015;23(1):54-64. doi:10.1111/jonm.12081. PMID: 23952722.

Merlo LJ, Gold MS. Prescription opioid abuse and dependence among physicians: hypotheses and treatment. Harv Rev Psychiatry. 2008; 16: 181-194.

NIAAA. Alcohol Facts and Statistics. NIAAA. 2019.

NCSBN. Substance Use Disorder in Nursing. Unites States of America: National Council of State Boards of Nursing; 201

NSDUH. Center for Behavioral Health Statistics and Quality. Reports and Detailed Tables From the 2017 National
Survey on Drug Use and Health (NSDUH) | CBHSQ. United States Department of Health and Human
Services. Substance Abuse and Mental Health Services Administration. 2018.

Oreskovich Michael R, Shanafelt Tait, Dyrbye Lotte N, et al. The prevalence of substance use disorders
in American physicians. Am J Addict. January 2015;24(1):30-38. doi:10.1111/ajad.12173.

Yancey J, McKinnon H. Reaching Out to an Impaired Physician. Fam Pract Manag. 2010; 17(1): 27-31. Available at: http://www.aafp.org/fpm/2010/0100/p27.html Accessed on: 2015-04-28.

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Elements Leading to Physician Burnout (Part 3) 26 Mar 2021, 6:15 pm

Physician work-related stress is a significant problem.^1–3 U.S. physicians report higher than normal burnout rates⁷and increased health problems, including alcohol use problems,^5,6 excess weight,^7,8 poor sleep,⁹ less exercise,^8, and low career satisfaction.¹⁰ Physicians experience the burnout triad of:

Emotional exhaustion (and depression) – discussed in Part 1 of this series.
Interpersonal disengagement (Depersonalization) – discussed in Part 2 of this series
Low sense of personal accomplishment¹¹ – Part 3

Changing Sense of Personal Accomplishment & Regret

A low sense of personal accomplishment is a signal of burnout for most professionals³⁹; however, the standard measure of personal accomplishment may not be appropriate for physicians⁴⁰. Physicians perceive medicine as a calling, a lifelong career, and a core component of their identity. From medical school onward, physicians define their worth by a dedication to patients. The meaning of being a “doctor” starts with “white coat ceremonies⁴¹” at the end of medical school. Physician performance rarely drops significantly at the first detection points of burnout, although it reduces efficiency⁴² and impacts time spent with patients and their overall satisfaction.⁴³ In disasters or pandemics, we readily see a willingness to jump in and dedicate themselves entirely to the task, independent of the risk or challenge. Therefore, even if feeling burned out, physicians are not likely to deny patient care impact or describe their work as meaningless until very late. It would go counter to their sense of identity as physicians.

Sense of personal accomplishment both improved and worsened during the COVID-19 pandemic in terms of external validation. While many people do celebrate healthcare workers as heroes in the pandemic, physicians surveyed also described a feeling of anger and betrayal when protective gear and medical equipment are not available, or others downplay the severity of the disease or spread misinformation.⁴⁴

Career Regret: The experience of career regret is a better measure of lost professional identity. They may express regret for a past decision to enter medicine; older physicians, the desire to retire early.⁴⁵^–47 The simple statement, “I regret going into or staying in medical practice,” is profound in a career where that choice had lifelong implications. Further, it is a safe question to ask. Most physicians would likely answer very negatively. An increase in career regret, as with depersonalization or exhaustion, is a clear sign of burnout.

A supporting system cannot wait until career regret is prominent, and the physician has chosen to seek one-to-one counseling. At that point, the impact is typically profound, since seeking counseling is unfamiliar to many physicians. By the time physicians consider counseling, it is often late in burnout; 10% of such physicians think of leaving medicine.¹⁷

How can Lift help?

While a changing sense of personal accomplishment and regret are part of the burnout triad, we reject the view that these terms are crushing weights that you cannot handle or that you must build up a barrier in defense. This element of burnout is not out of your control. At Clinical Tools, we propose solutions that lift health care providers up, empower them, and build upon their existing strengths, talents, and experience. Start with who you are, lift yourself, your colleagues, and the healthcare profession up.

References