The importance of work for doctor's health - Profession Dame Carol Black at the 13th International Conference on Physician Health

The 13th International Conference on Physician Health (ICPH) opens today in London, UK.  The conference is sponsored by the American, British and Canadian Medical Association and has chosen to focus on milestones and transitions relevant to the lives of physicians around the world.

Professor Dame Carol Black, a Principal of Newnham College Cambridge and an Expert Adviser on Health and Work to the Department of Health, England and Chair of the Governance Board of the Centre for Workforce Intelligence.  In November 2011, she completed an independent review for the UK Government of sickness absence in Britain that has led to considerable change in the workforce in the UK.

The UK has done a great deal of work in the area of workplace health.  Professor Black referred to a wealth of research done in Trusts, Hospitals, Private Practice Settings and think tanks....and consistently linked studies to practical lessons for physicians.

Some of these lessons include:

- Doctors are workers employed in a safety-critical sector (on par with aviation, oil industry, rail)

- Product of labour is health

- Work is, in general, good for health (Marmot and The Work Foundation) providing it is "good work" in a "good workplace" (e.g., visible leadership, accountable managers, attention to health, empowering employees to care for their health, fair, flexible)

- Good workplaces engage doctors well

- Engaged workforces are safer - less accidents, complaints, errors

- In the UK, common mental health problems, MSK issues, workplace/employee disengagement, and other issues prevent doctors from working...or working well

- Family physicians play critical role in helping patients, including doctors, in both leaving work and returning to work; the medical certificate they write to employers is critical for an appropriate and successful rehabilitation

- Worklessness is a health hazard for many physicians

- The children of today are the doctors of tomorrow and should be empowered to choose a healthy workplace

- Tools like the NHS Roadmap to Workplace Wellness and Health@Work Charters helpful and positive http://tinyurl.com/ogt9u2c

- Emphasized the need to develop services and supports for physicians moving towards and through retirement

Perhaps the two most powerful comment for me were her emphasis on working with education and social systems to enhance the resilience of today's children and her identification of critical elements of a healthy practice environment.  Putting change into practice will require a great deal of political influence and leadership.

Great Read: What Doctors Feel (How emotions affect the practice of Medicine) by Dr. Danielle Ofri

Several years ago, a colleague was cleaning out his bookshelf and gave me copies of Dr. Danielle Ofri's books Singular Intimacies:  Becoming a Doctor at Bellevue and Medicine in Translation:  Journeys with My Patients.  The first took me back to my early years of training and practice and reminded me of the many beautiful (and stressful) experiences of the time.  The second was a more inspirational read, focused as it is on patient resiliency and courage.  Both reminded me of the power physicians have to tell powerful, educational, and emotional stories that can influence others to stretch, grow, and learn.

Dr. Ofri is an internist at Bellevue Hospital and an associate professor at New York University School of Medicine.  Her latest book, What Doctors Feel (How Emotions Affect the Practice of Medicine) was a great long weekend read...full of vivid storytelling that captures the not so obvious emotional journey of physicians as they care for their patients (and, to a degree, each other and themselves).

We never really know what a physician is thinking or feeling as they care for their patients....if they have just been yelled at by a hostile colleague, experienced a frustrating patient death or complication, are worried about their marriage or kids, are mind-numbingly tired (or depressed), or...yet, that world can have a profound impact on the quality of the care they deliver.

Dr. Ofri does a great job illustrating the complexities of this inner world of physicians and peppers her narrative with reference to what evidence exists in this unexplored corner of physician health.

Grateful to Dr. Ofri for making a weekend on call much more interesting (a real page turner in between cases); she reminds us of the powerful role the humanities play in enhancing our resilience, insight, and motivation.

How can surgeons promote learner/patient safety threefold?

A reader sent me an article that I really enjoyed over the weekend.  Not only was it focused on Surgeons, a group of colleagues I have tremendous respect for, it also focused on an eloquent and simple strategy to promote learner and patient safety.

The intervention was simple.  From the paper:

"A randomized clinical trial in which medical students (n=55) were randomized to an “encouraged” (E, n=28) or “discouraged” (D, n=27) group. Participants underwent personality tests to assess decision-making styles, and were then trained on basic tasks (“burn” then “cut”) on a laparoscopic surgery simulator. After randomization students assisted at a simulated laparoscopic salpingectomy. The senior surgeon used either an “encourage” (E) or a “discourage” (D) script (e.g.: E: “Your opinion is important.” D: “Do what I say. Save questions for next time.”). Otherwise, the surgery was conducted identically. Subsequently a surgical mistake was made by the senior surgeon who instructed students to cut without burning. Students were considered to have spoken up if they questioned the instruction and did not cut."

The outcome?  Equally simple but of a profound impact:

"The students in the encouraged group were significantly more likely to speak up (23/28, 82% vs. 8/27, 30%, P<0.001). "

This is exciting - a supervising surgeon can increase - almost threefold - the motivation and ability of a learner to speak up in a crucial moment by doing nothing more than a singular encouraging statement.

Well-MED: The Newest International Physician Health Gathering of Minds

Efharis Panagopoulou, PhD (Aristotle University Medical School, Greece) and Anthony Montgomery, PhD (University of Macedonia, Greece) recently launched the "First International Meeting on Wellbeing and Performance in Clinical Practice" in Alexandroupolis, Greece.

There have been similar conferences elsewhere in Europe (in fact, very soon will be the International Conference on Physician Health in London, England), Australia, New Zealand, the United States and Canada and there is much need and interest in more opportunities for scholarly work and connectivity in the field of health professional health.

This event attracted an all-star list of keynote speakers and invited experts on physician health including Canada's own experts Dr. Jean Wallace, Dr. Pierre Gagne, Dr. Todd Hill and Dr. Joan Horton.

The theme of the event was "Doctors think.  Doctors feel.  Doctors do." and attracted participants from 31 countries involved in medicine, nursing, psychology, ethics, sociology and economics.

The conference has published abstracts from its amazing agenda for broad dissemination - a very useful and practical outcome.  For those interested in the field, the abstracts are worth the read.  You can follow them on Facebook as well.

Hopefully, there will be a 2nd conference - congratulations to all!

So...you want to be an opinion leader? Try this succinct and practical approach.

Every summer, Vitalsmarts hosts a fantastic three day event in Utah for trainers across the world.  It is a great to time to catch up with like-minded people, most of which are busily working hard to change the world for the better.

Today's pre-conference workshop, part of the REACH Labs, focused on how individuals can consider how they can best influence change.  Social scientist David Maxwell, one of the authors of the bestselling books Crucial Conversations, Crucial Conversations, Influencer, and Change Anything, took our group through an experiential process.

We looked at our professional challenges from the perspective of becoming an opinion leader and change agent...in the world of physician health that raises all sorts of factors revolving around motivation (our own motivation to care for ourselves and each other, the motivation of those people around us to compel us towards healthy behaviours, and the non-human aspects of physician health such as safe working conditions/policies and procedures/rewards and consequences) and ability (our skills to care for ourselves and others, the skills of the people around us to help or hinder us, and the skills of the system to join us in a journey of sustainability).  

If you are struggling with a change issue and are curious how you can influence the opinions of those around you then I suggest you read Influencer:  The New Science of Leading Change.  Maxwell et al take a massive amount of research data and translate evidence into a succinct and practical tool of change.

Doesn't succinct and practical sound tempting?

Connection: Whatworks4me.org

Shout out to Drs. Steve Adelman, Eddie Phillips, Diane Shannon, & Frank Fortin who are editors of the What works for me blog.  Jointly sponsored by the Massachusetts Medical Society and the Institute of Lifestyle Medicine, physicians are encouraged to share their stories and experiences and use the blog to demonstrate their best practices.

The editors write:

"What works for you? What do you do at home, at work, and in the community, to keep your personal batteries fully charged? What personal and professional practices keep you engaged and excited, when you are “on duty” and when you are “off duty?”

Please submit a 300-600 word account of what works for you. Try to dig beneath the surface a bit and reveal the “why” behind your passion. Consider including a patient anecdote (disguised and de-identified) to make your story come alive. Do patients know what works for you? How have they reacted?"

What works for me shares stories of creativity, music, exercise and nutrition, mutual support and reflection...all fresh from the lived experience of colleagues.

Well worth both reading...and contributing.

Celebration Saturdays: Dr. Helen Ward - Innovator in Forensic Psychiatry

Colleague Dr. Helen Ward has won the College of Physician's and Surgeon's prestigious Council Award - a well deserved honour.

Dr. Ward is a highly regarded educator, clinician, and colleague. Her innovative application of best practices in serving the needs of society's most mentally ill has been recognized by her peers across Ontario.

The CPSO press release reads:

The Council Award recognizes physicians who have demonstrated excellence in eight physician roles. These roles include the physician as a scientist, a scholar and a health advocate, among others.

Dr. Ward is clinical director of the Royal Ottawa Mental Health Centre’s 46-bed forensic psychiatry unit where she supervises 10 psychiatrists, in addition to carrying a caseload of 12 to 16 inpatients, as well as 250 outpatients.

She was instrumental in spearheading the creation of the Mental Health Court in Ottawa. The collaborative program - between the Crown, judges and defence lawyers – is designed to help offenders with serious mental illness such as manic depression, severe anxiety, schizophrenia, bipolar disorder and dementia get easier and faster access to treatment, and at the same time, determine their capacity for criminal behaviour or to face trial.

Dr. Ward is a tireless advocate for the mentally ill. She has spoken at international conferences on the subject of mental health courts to promote this approach in other jurisdictions. She has also testified before the Canadian Senate on this topic, as well as the potential negative consequences of a DNA bank for offenders found not criminally responsible on criminal charges.

In presenting the award, Council member Dr. Andrew Falconer said, “Dr. Ward’s patients are fortunate to have her as their physician. With her compassion and commitment, she serves as a role model for us all.”

The CPSO Council congratulates Dr. Ward for her dedication to the profession and to her patients.

A real role model - congratulations!