Owl Newsletter January 2019 e-Newsletter Photo by Fred Seligman, MD Inside... Burnout.................................................................................................... 3 - 6 AACAP’s Life Members Fund ...........................14 Chair Column.......................................................................................... 7 In Memoriam ........................................................ 16 Philippe Pinel: A Veritable Clinical Ancestor for Us................... 8 - 10 Throughout the Years ........................................ 17 Looking Back on 40 Years of Adolescent Substance Abuse Treatment................................................................................................. 11- 13 COMMITTEE Owl Jokes Richard L. Gross, MD Jokes submitted from Martin Drell, MD Cynthia R. Pfeffer, MD Q: What do you call an Owl get together? Perry B. Bach, MD A: A HOO-tenanny Marilyn B. Benoit, MD Q: What is a bird’s favorite Beatles song? Martin Drell, MD Editor A: Owl you need is love John E. Dunne, MD Q: What do you call an Owl with armor? Joseph J. Jankowski, MD A: A Knight Owl Allen Mark Josephson, MD Q: What do you call an Owl mystery? Paramjit Toor Joshi, MD A: A hoot-dunit Douglas A. Kramer, MD, MS Q: What does an Owl say when he leaves? John Schowalter, MD A: Owl be seeing you Ellen H. Sholevar, MD John B. Sikorski, MD Q: What do you call an Owl magician? A: Hoooo-dini Samantha Phillips Managing Editor Q: What do you call a baby Owl swimming? Jaime Owens A: A moist-owlette Production Editor Q: What’s more amazing than a talking Owl? A: A spelling bee Get involved - submit articles for the Q: What do you call Owl gang violence? Owl Newsletter! A: Drive by hootings Get involved - submit articles for the Owl Newsletter! We want to hear from you! Let us know what you are up to, how you’re doing, and more! Please send materials to [email protected]. The deadline for the next issue is March 15. Martin Drell, MD Burnout It is clear that things in A Mayo Clinic handout on burnout lists the following medicine have been chang- stressful contributing factors: ing for some time, that the pace of change appears to be Lack of control - An inability to influence decisions intensifying, and that change that affect your job — such as your schedule, assign- will continue. Despite change ments, or workload — could lead to job burnout, as being ever-present, it is clear could a lack of the resources you need to do your that many doctors do not like work. what’s happening, nor how it Unclear job expectations - If you’re unclear about makes them feel and act. the degree of authority you have or what your super- Martin Drell, MD Studies tend to confirm this visor or others expect from you, you’re not likely to overall. Stress levels are up, along with burnout and feel comfortable at work. suicide. If the studies are to believed (and I believe Dysfunctional workplace dynamics - Perhaps you them), up to 50% of physicians and two out of five work with an office bully, or you feel undermined by psychiatrists suffer from burnout, which is defined by colleagues, or your boss micromanages your work. Izau, Kirch, and Nasca as a syndrome characterized These dynamics can contribute to job stress. by emotional exhaustion (which includes negativity, Mismatch in values - If your values differ from the cynicism, and the inability to express empathy or way your employer does business or handles griev- grief), a feeling of reduced personal accomplishment, ances, the mismatch can eventually take a toll. loss of work fulfillment, and reduced effectiveness. Poor job fit - If your job doesn’t fit your interests and skills, it might become increasingly stressful over Burnout, which can be measured by the Maslach time. Burnout Inventory which consists of three major Extremes of activity - When a job is monotonous or components: physical exhaustion, depersonaliza- chaotic, you need constant energy to remain focused tion (which manifests in being cynical and sarcastic — which can lead to fatigue and job burnout. towards patients), and lack of efficacy with a loss of Lack of social support - If you feel isolated at meaning and purpose. work and in your personal life, you might feel more stressed. High Maslach scores have been correlated with Work-life imbalance - If your work takes up so decreased job satisfaction, system inefficiency, in- much of your time and effort that you don’t have the creased medical errors, decreased patient safety, and energy to spend time with your family and friends, increased malpractice lawsuits. It seems logical to you might burn out quickly. wonder if it is also correlated with statistics indicat- ing an increase in suicide in doctors. To this list, I would add being incessantly exposed to the pain and suffering of our patients. How many The statistics for such suicides are estimated at 400 people upon hearing you are a child psychiatrist, per year, which is equivalent to eliminating the grad- come up to you and say, “I don’t know how you do uating classes of seven medical schools each year. what you do?” Burnout is when you have a hard time This does not help the well-known doctor shortage. answering this question. 3 Burnout In summary, people who are “burnt out” are not burnout, relaxation, and mindfulness that will come “happy campers” and are cynical and critical with warnings that failure to complete them in a about what they do. They are often involved in timely manner will potentially lead to dire conse- downward escalating cycles of grief and woe. quences for myself, my school, and the human race When at work, they are irritable, impatient, and/or in general. withdrawn. I have been struck in my readings on the subject Their productivity is usually decreased. They can that the burn out articles are often population-based have somatic complaints and may compensate and stay away from the uniqueness of the individu- with poor lifestyle choices (drugs, alcohol, eating als involved. Many do not mention developmental, disorders) that have subsequent physical conse- biological, and psychological issues in those they quences (diabetes mellitus, obesity, heart disease, are doing research on. high blood pressure), and emotional consequences (adjustment disorders, depression, anxiety, suicide, To me, the devil is in the details. I suspect, for etc.). Their feelings can impact their interpersonal instance, that mental illness does not improve one’s relations both at work and outside of work. stress tolerance nor resilience in the face of a prob- lematic workplace. It is noted that that the Accreditation Council for Graduate Medical Education (ACGME) has In my own case, I have a long running personalized evolved over the years to an increased focus on battle with electronic medical records that seem to protecting trainees. It has focused on work hours have been invented to show how stupid I am. The with more prescriptive requirements and more fact that research shows that I am not alone in my monitoring, etc. “EMR phobia,” as judged by the surveys that show that 20% of psychiatrists feel that EMRs contribute In my estimation, these actions have subequen- to their burnout, does not make one whit of differ- ty increased the stresses on faculty. I believe the ence to my individual anguish. ACGME now agrees with this and now thinks that something needs to be done. They probably will The same survey shows that 60% of psychiatrists not admit that their well-meaning past non-sys- indicate that the main contributor to their burnout temic actions may have played a part in effectively was having too many bureaucratic tasks, which creating a problem of burnout in the faculty. includes EMRs, which have added 20% more work for doctors. A recent talk I heard mentioned that The ACGME has now announced systemic ini- this extra work translates into added hours of work tiatives that put the medical schools in charge of time at home which has been lovingly referred to as the wellness of their faculty and staff in addition “pajama time.” to the wellness of trainees and patients. This will force the medical schools to figure out how to The fact that I currently have a different EMR for enhance the wellness of their faculty. I cynically each of the two clinics I work at, and may have a (n.b., one of the signs of burnout) await my orders third EMR in my future, does not reduce my stress on how to become “well,” starting with mandated levels. computer-based training modules on wellness, 4 Burnout At one of the clinics, I found myself not wanting work as “not fun.” He quotes an article by Dr. Ronald on to go to work. After some soul searching, I realized mindful practice that indicates that those physicians who it was not the clinic, nor its patient load, nor the find meaning in their work, if only for 20% of their work, short appointment times, but my slow mastery of are much less prone to burnout. We certainly all know the prescription writing portion of the EMR that I friends who prefer work to their less than happy lives was suddenly forced to use. One gets used to one’s outside of work. prescription pad after 40 years. While writing this column, which focuses on the Owls, Things are better now that I have all but mastered my mind wondered to thinking of my own future retire- this completely non-intuitive prescription writing ment with a modicum of anxiety. I certainly heard of program, except for how to write two months worth similar anxieties in persons at all points along the con- of stimulant scripts for stabilized patients. When tinuum of activities, from being fully employed to being asked what all this anxiety is about, I liken it to fully retired.