Thursday, November 3, 2011

Care for the Caregivers

Patricia Lindholm, MD,
Immediate Past MMA President
I have just returned from two inspiring events in the past week.  First the MMA held a summit meeting on Sharing Solutions to Combat Burnout.  The conference was conceived as a session to share and learn from people working on physician wellness in their organizations.  There were a variety of presentations highlighting diverse and unique approaches to addressing wellness in physicians as well as studying the effectiveness of interventions or programs.  The audience was also asked to share their ideas on how the MMA can help facilitate the development of wellness strategies for physicians.  It was gratifying to see the interest in the topic and I believe we could easily have spent twice the time in order to answer audience questions and even to lengthen the presentations.  In the near future the presentations will be made available on the MMA web site with our other wellness resources.

I also attended the second biennial Canadian Conference on Physician Health.  The theme for the meeting was “Healthy Physicians = Healthy Communities”.  I have long admired the Canadian Medical Association’s international leadership in physician wellbeing.  After having an informal discussion with two Canadian family physicians at breakfast the first morning, it occurred to me why the Canadians have worked on the issue for so long.  These physicians were from different provinces and each in solo practice.  Each was in practice for about 25 years (like myself) and female (like myself).  For the most part, Canadian physicians tend to own their businesses and are facing increasing overhead expenses and decreasing payment as are the U.S. physicians.  More of their physicians are in extremely remote areas where there is little collegial or technological support.  These two physicians each shared that some years ago they had taken a two-year leave of absence from the practice of medicine due to burnout.  They do not have colleagues to cover their practices, and often cannot obtain locums coverage.  If ill or on vacation they have to close their offices.  Furthermore there is no paid vacation since they are self-employed and they continue to pay the overhead. 

I attended a breakout session regarding the stress of litigation on physicians.  There was a video scenario of a young rural physician who had been staffing an ER where she saw a patient with a painful swollen leg.  She felt it was cellulitis, but of course it turned out to be a deep vein thrombosis and the patient died of pulmonary embolus.  Of course the clinical diagnosis of DVT is not straightforward, which is why we have tests like d-dimer and ultrasounds.  This doctor would have had to send the patient fifty miles to get an ultrasound!  That is quite a decision for a remote solo doctor to make.  I reality-checked the scenario with an OB-GYN physician who had practiced in a remote area and she confirmed that lack of resources is a fact of rural practice. 

There was an interesting “debate” about the issue of limiting physicians’ work hours (or resident work hours).  Two physician leaders spoke in favor of mandatory work hour limits and two spoke against.  To my surprise both sides had compelling arguments.  I believe they were randomly assigned a position to present and of course each had data to support their arguments.  The ending plenary speaker was Dr. Roberta Bondar who was the first neurologist to take part in a space shuttle mission.  One of her themes was to maintain our curiosity and continue learning throughout our lives. 

Workshops on “music and medicine”, mindfulness meditation, nutrition, caring for physicians as patients, combating the stigma against mental illness and psychiatry, supporting medical students and residents were presented, among other topics.  Time was set aside for exercise (run/walk) or mindfulness meditation. 

Having witnessed the strong interest in addressing physician wellbeing among Minnesota physicians, I believe that we should be able to develop a more comprehensive conference in the future.  We had some visitors from the Dakotas and also several physicians who came for their own personal edification rather than from an organizational perspective.  I am very proud of the good work that is happening in Minnesota and we have much to offer to our colleagues around the country. 

I am also encouraged that the AMA President-elect, Dr. Jeremy Lazarus, plans to make physician wellbeing the emphasis of his upcoming term.  It is time to care for the caregivers.