Tagged: The University of Michigan

Occupational stress: Doctors may suffer when unable to save lives

Physicians who treat the terminally ill may suffer from emotional stress when unable to save patients’ lives. Burnout and compassion fatigue are two serious forms of occupational stress physicians may suffer, according to research by Michael Kearney, M.D.

Kearney, a palliative care physician at Santa Barbara Cottage Hospital in California, describes burnout as “the end stage of stresses between the individual and the work environment.” Compassion fatigue is “secondary post-traumatic stress disorder, or vicarious traumatization — trauma suffered when someone close to you is suffering.”

Health care journalist Jane Brody addresses the stress and anxiety oncologists struggle with in a new article for The New York Times. Brody writes, “A doctor with compassion fatigue may avoid thoughts and feelings associated with a patient’s misery, become irritable and easily angered, and face physical and emotional distress when reminded of work with the dying.” Compassion fatigue may lead to burnout.

Up to 60 percent of practicing physicians report symptoms of burnout.

According to Brody: “Patients and families may not realize it, but doctors who care for people with incurable illness, and especially the terminally ill, often suffer with their patients. Unable to cope with their own feelings of frustration, failure and helplessness, doctors may react with anger, abruptness and avoidance.”

Physician suicide linked to occupational stress

According to Crystal Phend, senior staff writer for MedPage Today, ”Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems.”

Phend cites a study by Katherine J. Gold, M.D., of the University of Michigan in Ann Arbor, who found that problems with work were three times more likely to have contributed to a physician’s suicide than a nonphysician’s. Mental illness was also 34 percent more common before a suicide among physicians.

Up to 60 percent of practicing physicians report symptoms of burnout

“The results of this study paint a picture of the typical physician suicide victim that is substantially different from that of the nonphysician suicide victim in several important ways,” Gold wrote for General Hospital Psychiatry. ”Inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians.”

Although physicians have more access to health care, they may be reluctant to seek help. ”I think stigma about mental health is a huge part of the story. There is a belief that physicians should be able to avoid depression or just ‘get over it’ by themselves,” Gold wrote.

More than 200 of the 31,636 suicide victims reported in the National Violent Death Reporting System from 2003 to 2008 were physicians.

Meditation may help physicians

A 2008 study published by the Journal of Palliative Medicine, in which researchers studied 18 oncologists, found that physicians who viewed their work with patients as both biomedical and psychosocial found end of life more satisfying than those with a more biomedical perspective.

“Physicians, who viewed their physician role as encompassing both biomedical and psychosocial aspects of care, reported a clear method of communication about end of life care, and an ability to positively influence patient and family coping with and acceptance of the dying process,” the researchers concluded.

“In contrast, participants who described primarily a biomedical role reported a more distant relationship with the patient, a sense of failure at not being able to alter the course of the disease, and an absence of collegial support.”

Kearney recommends “mindfulness meditation,” a Buddhist-influenced practice for physicians suffering from stress. “The doctor is able to recognize he’s being stressed, and it prevents him from invoking the survival defense mechanisms of fight (‘Let’s do another course of chemotherapy’), flight (‘There’s nothing more I can do for you — I’ll go get the chaplain’) and freeze (the doctor goes blank and does nothing).” He claims that even 8-10 minutes a day of “mindfulness meditation” can help.

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End of life care varies across top hospitals

The nation’s top 23 academic medical centers differ significantly in intensity of care provided to patients near the end of life, according to findings from the Dartmouth Atlas Project. The report, ”What Kind of Physician Will You Be,” is intended to help fourth-year medical students find the best residency to complete their training.

The authors suggest that when terminally ill patients receive unnecessarily aggressive and expensive care, quality of life diminishes. “Hospitals providing a higher intensity of care did not generally score higher on measures of patient experience, patient safety, or processes of care.”

The report’s premise is that physicians who complete their residencies at hospitals with more effective end of life care will be in a better position to not only serve patients, but to reform health care as well.

“Your choice in a residency program will shape your care for patients for years to come and can also present opportunities to lead improvements in health care,” the authors, including Anita Arora, M.D., Geisel School of Medicine at Dartmouth, write in their report.

The culture and environment of medical centers, described as the “hidden training curriculum,” impacts how doctors interact with the terminally ill, but such culture isn’t widely reported to prospective students. This report aims to remedy that.

“To compare the overall treatment of chronically ill patients, the report calculated a hospital care intensity index that combined the average number of days these patients spent in the hospital in the last two years of their life and the average number of physician visits in the same period,” Duke’s Chronicle reports.

Hospice care enrollment rates during the last six months of life was one area in which hospitals differed widely. The University of Michigan Medical Center had 59.1 percent of patients enrolled in hospice, while Mount Sinai Medical Center only had 23.1 percent.

The report also found that NYU’s Langone Medical Center had 66.6 percent of patients in their last six months of life seeing 10 or more doctors, while St. Mary’s Hospital / Mayo Clinic had only 52.4 percent seeing the same amount.

“Learning how to use health care resources wisely, provide high-quality care, and incorporate patient preferences into a care plan is just as important as learning to work up a patient,” said Alicia True, a co-author of the report and medical student at the Geisel School of Medicine at Dartmouth.

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