Sanford H. Koltonow
Professional.Enyiron.ment.. Stressors Death.. and. .Dying
Personal.. Environmental.. .Stressors
Strategies. .forWell-Being Self-Assessment
Con„flict..Res,olu,tion MalpracticeLitigation ..Support
Identification. ofImpairment Resources
Physician well-being is an important personal and professional issue. Career satisfaction correlates with the following issues: (1) control over working conditions, (2) hospital administrative support, (3) having time for family and personal life, and (4) departmental security. The practice of emergency medicine requires a large knowledge base and advanced cognitive and interpersonal skills. Not quite as obvious is the need for excellent intrapersonal skills. Situations arise that conflict with one's personal values and produce intense feelings of uneasiness. To remain effective, coping methods need to be used that are adaptive and resolve conflict. The thought that one can meet all of a patient's needs ignores one's own needs for supports and limits.
Stress is necessary as a force that motivates. When excess stress becomes detrimental, it is more appropriately called distress. Much like Starling's law, each individual has his or her own curve with a point beyond which further stress causes less, rather than more, output.
Burnout is a state of physical, emotional, and mental exhaustion that occurs as a result of intense involvement with people over long periods in emotionally demanding situations. Burnout symptoms are characterized, in their extreme form, by physical depletion and chronic fatigue, feelings of helplessness and hopelessness, and the development of negative attitudes toward self, work, life. and others. Among physicians, symptoms of burnout are thought to be potential precursors of more severe manifestations of impairment, including alcoholism, drug abuse, and suicidal ideation.
Emergency physicians practice in an environment that can foster burnout. Critical decisions must be made with incomplete information. Noises, smells, crowding, children, families, terminal illnesses, substance abusers, psychiatric patients, police, and criminals are part of every day. It is easy to become overwhelmed.
The American Medical Association defines an impaired physician as "one who is unable to practice medicine with reasonable skill and safety because of physical or mental illness, including deterioration though the aging process, loss of motor skill, or excessive use ... of drugs, including alcohol." Various estimates of impairment range from 7 to 13 percent. Well before attrition occurs, there are warning signs that, with awareness, can be identified and remedied before a patient's care and a physician's status are threatened.
Suicide, the ultimate manifestation of impairment, accounts for one-third of the premature deaths among physicians. The percentage is higher for women, particularly young women. Annually, over 100 physicians complete suicide.
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