Update on Physician Wellness and Vitality - by Dr. Jane Lemaire

Background

The portfolio of Vice Chair, Physician Wellness and Vitality was created within the DOM in 2004 in order to identify and improve work-life balance issues for members of the Department and to promote physician wellness, in a scholarly fashion. The following is an update of activities over the past year, in collaboration with Professor Jean Wallace from the Department of Sociology, University of Calgary.

Research and Knowledge Translation

The Well Doc? Initiative was created as a vehicle to research and promote physician wellness issues. Well Doc? Module 1 explored the association between physician nutrition and cognition. Twenty FMC staff physicians told us how poor workplace nutrition made them feel unwell and impacted their ability to perform well at work. Objective testing confirmed that their brains worked better when well nourished! The results of this study have now been disseminated to stakeholders and policymakers, presented at an international conference (Society of General Internal Medicine, Minneapolis, USA) and published in two separate manuscripts (Lemaire et al. Nutr J. 2011;10:18 and Lemaire et al. BMC Health Serv Res. 2010;10:241). This simple story of how physicians need to fuel their bodies in order to function well has captured much attention. We have delivered multiple talks, workshops, and advice on how to meet the workplace nutrition needs. Well Doc? Module 2 is a randomized controlled trial of 40 physicians designed to assess the impact of a portable biofeedback on physician stress. Physicians who used the biofeedback device had a significant reduction in their stress scores. This research was presented at the 2010 International Conference on Physician Health in Chicago and the manuscript is in press (Open Medicine: Lemaire et al.) We are planning Well Doc? Module 3, a study exploring the dimensions of the complex and demanding task of being a Medical Teaching Unit preceptor. We hope that the results of this study will inform us as to how better prepare clinicians for this role and how to evaluate their performance.

In 2005, we interviewed 54 physicians from the DOM and subsequently published a four article series in the Canadian Journal of General Internal Medicine entitled "Reflections from internal medicine physicians". A study of 1200 colleagues from the CHR produced a manuscript describing how physicians cope and how those coping strategies are associated with burnout (Lemaire et al. BMC Health Serv Res. 2010;10:208). These findings were again shared through workshops and lectures and a substudy of this research, Sources and types of physicians' support were presented at the International Conference on Physician Health in Chicago.

We assessed the introduction of SCM and Vocera on the health care providers from W21C (Wallace et al. International Journal of Health Information Systems and Informatics. 2010;5:35-48 and Dunphy et al. Journal of Nursing Administration. In press Sept 2011).

A major part of the last year was spent evaluating the impact of a new Senior Resident Rotation Bundle (SRRB). It is clear that 24 hour on call duty hours will be abolished in the near future and we need to understand the impact of alternative scheduling designed to cover the 24 hour needs of an acute care teaching hospital. With the help of the Internal Medicine Chief Residents and the W21C Wellness research team, we studied the residents' perceptions of the impact of the SRRB on the senior residents' wellness, ability to deliver quality health care and medical education. We gratefully acknowledge the $10,000 grant awarded from the training program for support of this project. Other research initiatives include a study, in collaboration with Dr Mamta Gautam from the University of Ottawa, to explore what constitutes physician resilience. For this study, we have received a grant from the Calgary University Grants Review Committee. We are also collaborating with Dr Judy Duchscher from the Faculty of Nursing to explore the physician's transition from trainee to staff physician. We were also pleased to present keynote addresses on Physician Wellness at the SGIM international symposium on the physician workforce in Phoenix this May (after a side trip to the Grand Canyon!), and the Osler Symposium on Physician Wellbeing in Albuquerque.

Administration

We continue to advocate for and to represent physician wellness and vitality through many different avenues. As Vice Chair within the Department of Medicine, I advocate for physician wellness at the Medical Services Executive Meetings, and as a member of the ARP Management Committee. Wellness is now officially a portfolio within the W21C Research and Innovation Centre and Dr. Wallace and I are Co-Leads. I was the U of C representative for the Association of Faculties of Medicine of Canada Resource Group on Physician Health and Well-Being, and an ongoing member of the AMA Physician and Family Support Group Advisory Committee. I am also a member of the International Alliance for Physician Health. In a new position, I am a member of the planning committee charged with developing a series of workshops in order to help orientate new members to the Faculty of Medicine.

Final Comments

We are grateful to all of the physicians, other health care providers and leaders in the health care systems who take the time to participate in and support our research endeavours. It is not so unusual now to overhear dialogue around physician wellness as it surfaces in the hallways, doctors' lounge, on the wards and in the clinics. This paradigm shift related to physician wellness is proof that the profession and the public are beginning to realize that well physicians are essential to achieve excellence in providing patient centered care and highly skilled intellectual and technical expertise.

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