PPX

by Christina on June 24, 2013

At the end of all of our presentations for new patients admitted to the hospital, we discuss “prophylaxis” (PPX). Under this category we talk about things like anticoagulation to prevent DVTs, stool regimens to prevent constipation, and proton pump inhibitors to prevent stress ulcers.

As I come to the end of my second year of residency, I’ve been thinking a lot about how we can do a better job at resident prophylaxis, too.

Studies have shown that on any given day, 1 in 3 doctors suffer from symptomatic burnout! While I am not surprised but this number, it is unacceptable to me. How can we take care of patients if we cannot take care of ourselves?

Burnout is harmful for both patients and physicians. It leads to higher rates of medical errors, malpractice risk, physician divorce, drug and alcohol addiction, and suicide rates.

As part of my own self-treatment, I’ve been reading this document: The Physician Burnout Prevention Matrix.  

Dr. Dike Drummond masterfully addresses burnout prevention through this matrix:

He discusses how physicians have a missing skill set in preventing burnout, and goes through both personal and organizational ways to minimize stress and maximize recharge.

As a resident, I’m much more focused on the personal Quadrants I & II right now. The organizational tools feel out of my control, though they will be relevant in the future when I have more say over them.

Here are a few of his suggestions that stood out to me:

Quadrant I: Personal Tools to Decrease Stress

  • Write down a journal entry or story recounting a stressful/traumatic experience of yours from training or practice
  • “Treat yourself like a dog”
    • Create the habit of celebrating all “wins” no matter how small
    • Acknowledge yourself and everyone around you early and often
    • Catch people doing something right
  • Write down a description of your ideal patient encounter and favorite procedures: the patient encounter that has you saying “yes, that’s why I became a doctor.”
  • Master your documentation system: stop demonizing your electronic medical record, and decide to be a “Power User” instead
  • Commit to completing your charts daily
  • Get organized: never let your filing system get disorganized again
  • Understand and master your personal finances: Not understanding your personal finances in detail is a major stressor for most physicians.
  • Take care of your primary relationship: Your relationship with your significant other is one of the main sources of recharge energy when it is healthy. If your primary relationship is experiencing difficulties, it switches from a recharging to a draining activity and dramatically accelerates burnout.  Schedule and complete regular date nights.  

Quadrant II: Personal Recharge Activities

  • Create a “boundary ritual” between work and home: The best example of this is Mr. Rogers on his TV show. He would come in the door, change his shoes and put on his zip up sweater and sing a song before anything else.
  • Create and execute a weekly life scheduling process. Anything outside of work that is not on your schedule is highly unlikely to happen by chance. Adopt the habit of always having your life schedule with you just as you always carry a schedule of your work activities.
  • Learn and practice saying “NO” to requests for additional work activities. Practice saying “No” in the mirror until it feels natural.
  • Create, schedule, and execute your personal exercise program.
  • Make a Bucket List – the things you are determined to accomplish or experience before you die. Set a goal to cross one of them off each year.
  • Commit to and carry through on quality nutrition and meal planning

Quadrant III: Organizational Support to Decrease Stress

  • Have Mission Statement Commitment to Physician and Staff Wellness and Satisfaction
  • Have Physician Wellness Committee with a significant budget

Quadrant IV: Organizational Recharge Activities

  • Offer sabbatical privileges built into standard employment contract after a set amount of time
  • Provide onsite exercise facilities and exercise classes

Check it out for more.

 

{ 5 comments… read them below or add one }

Chris Palmer June 25, 2013 at 9:15 pm

This is an excellent post on an important topic. I agree totally with your comment, “How can we take care of patients if we cannot take care of ourselves?” A stressed, exhausted, dispirited, and enervated doctor may be a danger to patients. More attention needs to be paid to this issue! Thanks for a great post.

Reply

Gail Shearer June 25, 2013 at 9:24 pm

Great post! Many of the tips from Dr. Drummond are relevant to anyone in a stressful employment situation!

Reply

sj June 29, 2013 at 4:44 am

This was very informative, thank you 🙂 I especially like the idea of creating a “boundary ritual” between work and home. I would think that exercising or some form of stress reliving physical activity might be a good way to do this? Easier said than done, but I will definitely have to try it.

Reply

Viv September 28, 2013 at 3:40 am

Thank you for sharing Dr. Drummond’s Burnout Matrix. This is a great tool. I like the focus on reducing stress and also on recharging. Certainly helpful to not only to physicians.

Reply

dan October 8, 2013 at 1:28 pm

this was my two cents on the topic, written in first year of med school: http://danscreativeoutlet.wordpress.com/2012/03/26/how-to-not-burnout-a-comic-i-made-in-medical-school/

Reply

Leave a Comment

Previous post:

Next post: