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Professional Well-being & Burno= ut
Presented by –
Dr. Alan Shelton
Puyallup Tribal Health Authority
April 1, 2005
Intro – I’m honored and privileged to be here.  I’m going to talk bout wel= lness and the lack thereof that can occur in the lives of physicians.

Some of this is personal and some of this about the Native American concept of spirituality & inner life.

I am not an expert.  I am on a journey.  Came with humility= & hope that sharing my thoughts & experiences can be helpful!
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Case Presentation
n49 year old while male physician presents to colleague:  “I can’t do this anymore!  I have no energy for work.”
n20 years in community clinic
nDifficulty going to work
nSense of nothing to give
nGuilty over growing resentment of patients
nMinimal sense of accomplishment
No satisfaction

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Burn Out: Prevalent Stress Syndrome=
n3 main symptoms
=
nExhaustion
=
nDetachment
=
nLoss of satisfaction
Burn Out can be serious – emotional pain, careers at risk

There are three main symptoms

1.Exhaustion – physical & emoti= onal
Emotional exhaustion can involve
Sadness
Depression
Negativism
Decrease in creativity
Increase in cynicism

2.Detachment – clients & staff<= /font>
Anger
Defensive
Edgy

3.Loss of satisfaction
Loss of sense of accomplishment
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Burn Out
nPrime factor in turnover, absenteei= sm, declining morale, and personal dysfunction
n
nHope®Trigger for revitalization
Large continuum – may cycle to various stages
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Malaise:  Health Care Provider   Dissatisfaction
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nEpidem= ic of low morale
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nStrugg= les, concerns, frustrations
nHard t= o find minimal job satisfaction let alone VITALITY & ENTHUSIASM
The problem is even bigger if you look at the malaise or growing dissatisfact= ion among physicians.

Group of doctors Discouragement
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Why?
nWhat do you think= are the primary reasons that health care providers burn out= ?
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Causes
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nStress= +
<= span class=3DB1B style=3D'position:absolute;left:-7.03%;top:.3em'>nLack = of control
<= span class=3DB1B style=3D'position:absolute;left:-7.03%;top:.3em'>nSuppr= ession of emotion
<= span class=3DB1B style=3D'position:absolute;left:-7.03%;top:.3em'>nStriv= ing for perfection
<= span class=3DB1B style=3D'position:absolute;left:-7.03%;top:.3em'>nWorka= holic tendency
“Don’t feel”

•High expectation (too high)
•Feeling of inadequacy
•Unmet demands for time/energy
•Can’t please everyone
•Say yes to too many
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In Other Words…Out of Balance<= /div>
nEnantiadromia
nThe solution lies in the Native Amer= ican idea of wellness
•Enantiadromia
•personal identity bound up with profession= al identity that other facets of their being are starved
•Subverts non-work roles



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Thesis
nA “wellR= 21; health care professional will maintain an enthusiastic commitment to service and have an abundance of positive energy to face challenges thus experiencing a fulfilling career.
More than that…

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Wellness Defined
nWhen all aspects of our lives are in balance & harmony
nMore than absence of disease or enjoying good health
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nReflec= ted in behaviors & attitudes
Reflected in behaviors & attitudes - How one acts/reacts to situations problems & people

Sense of peace & wholeness

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Wellness Circle
nGift from Native community
nFour aspects of life
nWhen in balance & functioning at optimum
nPhysically fit
nMentally stimulated
nEmotionally adjusted
nSpiritually connected
To be well:  Vitality & balanc= e in each aspect

Walk in balance

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= Emotionally    
Adjusted
  Physically
Fit      
Wellness Circle
Spiritually <= /b>
Connected
Menta= lly
Stimulated
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Spirituality
nThe key.  The foundation.  The essence.
nTo Native people – spirituality is foremost
nReverent attitude toward all things
nAwe, gratitude, worship
nAwake to a divine presence in all things
Not a realm apart or an extracurricular activity, but the essence
We are not physical beings…but
Reality is more than objects & motion.
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Spirituality vs. Religion
nIntertwined and related, but not equivalent
nSpirituality precedes religion =
nReligion can be thought of as a brid= ge to spirituality
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nReligi= on may enhance or hinder  spirituality
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Spirituality
nAbout belief syst= ems involving mystery & faith
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nFocuse= s on intangible elements
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nBrings= purpose & meaning
Beyond Proof

Often articulated as growing in wisdom or increasing love

Growing in wisdom or increasing in love – unable to measure
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Difficult for Professionals
nWe have traveled the path of science
nModern medical education chooses logical, analytical, and rational approaches
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nWe val= ue the mind
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nOur cu= ltural tendency to deny        = ;  mystery has left us spiritually undernourished & out of balance
We value the mind and depend on science for solutions

I believe science & spiritually can be complementary and must be used together if one is to be in balance
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My Story with a Traditional Healer
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Spiritual Assessment
nDo I have a sense of connection with= the divine?  With others?
nDo I have awe & reverence, yet a feeling of oneness with the Great Spirit?
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nDo I l= ive a life of trust?
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nAm I c= alled to service?
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Analogy with Physical Fitness
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nExerci= se
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nGood d= iet
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nAvoidi= ng bad habits
Helpful in evaluating & determining how to improve spirituality
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Exercise
nPrayer/meditation – comparable activity in spiritual realm nNo spi= ritual power without        = ;           daily discipline
Exercise -    Daily regular work = out to maintain condition
     Can’t miss…discipline

No surprise-   If not daily routine, spiritual life in quiet reflection & gratitude to the creator that we remain spiritual midgets
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Daily Practice of Meditation
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nAllowi= ng silence to fill your mind
nBrings = an increased sense of well being & energy nCan bui= ld awe & awareness of divine presence working within us
Story of man with power.
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Healthy Diet
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nHow do= we feed our spiritual lives?
<= span class=3DB1B style=3D'position:absolute;left:-7.03%;top:.3em'>nTime = in nature
<= span class=3DB1B style=3D'position:absolute;left:-7.03%;top:.3em'>nCerem= onies
<= span class=3DB1B style=3D'position:absolute;left:-7.03%;top:.3em'>nChurc= h
<= span class=3DB1B style=3D'position:absolute;left:-6.52%;top:.3em'>nReadi= ng inspirational/devotional material
<= span class=3DB1B style=3D'position:absolute;left:-7.03%;top:.3em'>nListe= ning to music
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nThe ke= y to to practice it regularly
How do we feed our spiritual lives?
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Avoiding Bad Habits
nThree habits block spiritual health & prevent connectedness
=
<= span style=3D'font-size:117%;layout-flow:horizontal'>n   Complaining
<= span style=3D'font-size:117%;layout-flow:horizontal'>n   Lack of forgiveness
<= span style=3D'font-size:117%;layout-flow:horizontal'>n   Worrying
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Complaining
nEasy & common – an initial reflex when things don’t go the way we want
nOpposite of gratitude
nDifficult to trust or be open to        = ;     divine will
Opposite of gratitude – Which is the heart of prayer
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Lack of Forgiveness
nWe have all been hurt & memories= are long
nBitterness poisons the spirit & closes the heart
<= span class=3DBB style=3D'position:absolute;left:-6.08%;top:.3em'>nForgiv= ing is letting go, a release        = ;          that opens us to connectedness
<= span class=3DBB style=3D'position:absolute;left:-5.63%;top:.3em'>nForgiv= ing is an act of the heart that brings peace of mind
Also known as…holding a grudge

It helps to know or understand people act out of the condition of their lives


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Worrying
nBeing troubled about something =
nCarrying a core of anxiety – a heaviness
nCommon in physicians
<= span class=3DBB style=3D'position:absolute;left:-6.08%;top:.3em'>nOpposi= te is peace of mind
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Anxiety to Peace of Mind
nMindfulness – being in the moment
nPrayer – Brings perspective&#= 13;
nTrust – ultimately it will be= ok
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Impact of Spirituality
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nSense = of “calling”
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nAttitu= de
<= span class=3DBB style=3D'position:absolute;left:-6.47%;top:.3em'>nExpect= ation
<= span class=3DBB s