Burn out

Joan Von Feldt joan.vonfeldt at GMAIL.COM
Wed Feb 3 17:03:35 UTC 2016


Meredith
We designed a longitudinal curriculum for 2nd year residents.
here our some references

Ogdie AR, Reilly JB, Pang WG, Keddem S, Barg FK, Von Feldt JM, Myers JS.:
Seen Through Their Eyes: Residents' Reflections on the Cognitive and
Contextual Components of Diagnostic Errors in Medicine. *Acad Med. * 87(10):
1361-1367, Oct 2012.

Ogdie A, Myers J, Von Feldt J.: In reply to Kunimatsu and Yoshizawa. *Acad
Med* 88(4): 436, April 2013.

Reilly JB, Ogdie AR, Von Feldt JM, Myers JS: Teaching about how doctors
think: a longitudinal curriculum in cognitive bias and diagnostic error for
residents.  *BMJ Qual Saf*  Aug 16 2013. PMCID: doi:
10.1136/bmjqs-2013-001987

Joan M. Von Feldt, MD, MSEd
Professor of Medicine
Division of Rheumatology
University of Pennsylvania
Clinical office: 215-662-2454
Cell: 215-900-5659
Or 267-283-5828
*"Learning is like rowing upstream; not to advance is to drop back."*







On Tue, Feb 2, 2016 at 8:53 AM, Masel, Meredith C. <mcmasel at utmb.edu> wrote:

> Hi all,
> Every year I partner with the GME Dean to teach >400 residents
> Interpersonal Skills and Communication techniques. Yesterday we had our
> first "Empathy: Level II" group of the year. Within the workshop we discuss
> burnout-empathy balance. Looking back, there were about 20 minutes where we
> could have injected a bit about the relationship to medical error.
> Considering we are teaching 2nd year residents (all specialties), what
> approaches do you recommend for getting the message through clearly that
> this doesn't just happen *around* them, but can happen *to* them? We have
> time for a video, a few slides for data, and/or prompting questions to open
> discussion.
>
> Meredith Masel, MSW, PhD
> Oliver Center for Patiet Safety & Quality Healthcare
> UTMB Galveston
> www.utmb.edu/olivercenter
>
> *From:* Baang, Ji Hoon
> *Sent:* 2/2/16, 2:11 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Burn out
> My little contribution in changing the culture when I round with my
> residents and students is that I tell them to ignore the administrators. I
> tell them to focus on taking care of your patients, learning medicine and
> being a good doctor. Write notes to communicate and tell people what you
> are thinking. If a patient wants to stay because she/he just wants to stay
> for 1 more night because it is cold and rainy outside, I tell them to let
> the patient stay. And at the end of rounds, I ask our team, “So how do you
> think we did with our length of stay? Our readmission rate? Our patient
> satisfaction score?” And more often than not, we end up doing a decent job
> and make our administrators happy. And most importantly, we all have fun
> taking care of our patients.
>
> After my training, I worked in industry for a few years. I learned a
> little bit about the business literature. I think what we are seeing in
> medicine closely resemble what pharma did in the 1980s. Emphasizing metrics
> and profit to the extent that it is changing our culture. Pharma used to be
> a well respected business until sales and marketing became the main driver
> of its business. And we all know what happened. The most successful and
> sustainable businesses really focus on what is really important. The
> customer, and in our case the patient. Metrics are their for our patients
> and not for profit. And so if you focus on the patient, the metrics often
> fall into place. For example, if you have a patient in front of you and you
> know the diagnosis on day 1, your length of stay will not be long. It is
> often the patient with no diagnosis and no plan that tends to stay for many
> days and weeks.
>
> I think a lot of the burnout issue comes from the simple fact that people
> are just not having fun, because they are focusing on issues that they
> don’t really care about. I know I am oversimplifying a complex problem but
> even complex problems have a root cause. In this case, I think the root
> cause is that many are not able to find meaning in the work that they do
> anymore.
>
> I’ll end with a quote from a business man that I think is relevant to what
> is happening in medicine today:
>
> *We try to remember that medicine is for the patient. We try never to
> forget that medicine is for the people. It is not for the profits. The
> profits follow, and if we have remembered that, they have never failed to
> appear. The better we have remembered it, the larger they have been*.
>  - George Merck
>
> Ji
>
> Ji Hoon Baang, M.D.
> Assistant Professor of Clinical Medicine
> Internal Medicine Subinternship Director
> The Lewis Katz  School of Medicine at Temple University
> Philadelphia, PA
> (T) 215-707-1622
> (F) 215-707-0943
>
>
> On nichollsvi2 at GMAIL.COM> wrote:
>
> Mr. Maude,
>
> When hospitals motto appears to be #profitoverpatients, I don't think they
> will care about the workerbee doctors. Its pretty obvious they don't,
> unless it is to keep the money rolling in to pay for admin salaries.
>
> Vic
>
>
> On 2/1/2016 6:17 AM, Jason Maude wrote:
>
> Alan
> This is very depressing. Are you seeing any impact from the IOM report yet
> in helping to change culture? I am expecting/hoping that the report will
> start being discussed by hospital boards and this will eventually translate
> in some sort of action which could include providing and encouraging the
> use of decision support as you describe.
> Regards
> Jason
>
>   Jason Maude
> Founder and CEO Isabel Healthcare
> Tel: +44 1428 644886
> Tel: +1 703 879 1890
> www.isabelhealthcare.com  <http://www.isabelhealthcare.com/>
>
>
>
>
>
>
>
> Alan.Morris at IMAIL.ORG>  wrote:
>
> Thanks - this is likely to continue until we, as a profession, focus on
> the core problem:  the overtasked physician, asked to do humanly
> impossible decisions without effective decision support.  I believe we
> will be mired in this problem set unless we target automatic control of
> medical tasks (closed loop protocols) with adequately detailed computer
> protocols.  This requires a cultural change and recognition that the
> Hippocratic model (the expert model) is necessary but by itself
> insufficient.  Most of the time I feel as if I am talking to a wall.
> Have a nice day and Happy New Year.
> Alan H. Morris, M.D.
> Professor of Medicine
> Adjunct Prof. of Medical Informatics
> University of Utah
>
> Medical Director, Urban Central Region Pulmonary Function Laboratories
> Pulmonary/Critical Care Division
> Sorenson Heart & Lung Center - 6th Floor
> Intermountain Medical Center
> 5121 South Cottonwood Street
> Murray, Utah  84157-7000, USA
>
> Office Phone: 801-507-4603<tel:801-507-4603 <801-507-4603>>
> Mobile Phone: 801-718-1283<tel:801-718-1283 <801-718-1283>>
>
>
>
>
>
>
> On 1/30/16, 08:57, "Robert Bell"
> <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG
> <0000000296e45ec4-dmarc-request at list.improvediagnosis.org>>  wrote:
>
> The AMA Morning Rounds today has an excellent article on Physician
> burnout. It mentions Errore in Medicine.
>
> Rob Bell, M.D.
>
>
>
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-- 

Joan M. Von Feldt, MD, MSEd
Professor of Medicine
Division of Rheumatology
University of Pennsylvania
Clinical office: 215-662-2454
Cell: 215-900-5659
Or 267-283-5828
*"Learning is like rowing upstream; not to advance is to drop back."*






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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