College • Collège |
President’s Message
Balancing life and work Kathy Lawrence
O
ver the past several months I have reflected on the practice of family medicine and what it has meant to me as a person and as a professional. As I thought about what I might write this month, I was repeatedly distracted by the sound of birds chirping and the light reflecting off the lake. It is summer in Saskatchewan, and it is one of the times I set aside each year to help maintain the balance between my personal and professional life. Not long ago, I was struck by a comment from a colleague who said he had lost the balance between vacation and work and that he was starting to feel familial repercussions. Sadly, this is not an unusual comment to hear from those I work with, but it stood out for me at the time because I was in the process of preparing a presentation on health and well-being for a group of new residents.
Physician as person The Educating Future Physicians for Ontario project was undertaken in the 1990s to understand what Ontarians wanted from their physicians and how medical schools should change their training in response to this. This material formed the foundation for CanMEDS and CanMEDS–Family Medicine. In that original work, one of the roles was physician as person. It focused on one’s ability to balance professional and personal roles, to cope with the stresses of medical practice, and to share something of oneself with patients.1 This concept remains within the CanMEDS roles and also is part of the definition of competence for the purposes of Certification within our College.2 However, I wonder if we need to be more deliberate in our discussion of this dimension. The ability to share something of oneself with patients is an important aspect of the patient-doctor relationship that must be used with the same competence that we use our other abilities like clinical reasoning or procedure skills. We know that there is a fine balance between healthy self-disclosure and boundary violations. Staying physically and emotionally healthy is important for ensuring that we share of ourselves when it is in the best interest of our patients and not when it is to address our own needs.
Where the balance lies I remember the face but I have forgotten your name— sometimes, after a particularly long and challenging day, when you look in the mirror, it can feel that way. Cet article se trouve aussi en français à la page 762.
MD CCFP FCFP
For some of our colleagues it becomes every day—they realize that the way they interact with those around them does not reflect the person they are or want to be. Burnout has been described as a work-related syndrome characterized by emotional exhaustion, depersonalization, and diminished feelings of professional success.3 We experience burnout when we are unable to reconcile what we do with what we expect of ourselves or what others expect of us.3 I have heard on many occasions from physicians that it was only when they changed the nature of their practices that they realized the effect their careers were having on themselves and their families. For many, the recovery from that kind of practice took years. These physicians say that no one should ever practise in the way that they did. I have also heard serious concerns from members of our profession about how practices that are limited in scope and commitment—and that are therefore thought to provide better balance—are not in the best interest of our discipline or patients. I believe there are important conversations to be had to understand where the balance lies between these 2 views. However, we need to consider our duty to ourselves as well as our duty to society in these conversations. Residents in my training program are provided with a collection of electronic resources about health and safety and have at least 4 different options for seeking help if they find themselves in physical or mental distress. How good are we about doing this for ourselves in practice? How good are we at helping our colleagues recognize when they need help, and then helping them access this assistance? There are a number of useful resources available to physicians through their provincial medical associations, as well as at www. ePhysicianHealth.com, which was specifically developed for Canadian physicians. Whether you believe you are in distress or not, I encourage you to seek out resources to help you be as healthy as possible for yourself, your family, and your patients. By the way … we speak of all Canadians having access to family physicians. Do you have one? References 1. Neufeld VR, Maudsley RF, Pickering RJ, Turnbull JM, Weston WW, Brown MG, et al. Educating future physicians for Ontario. Acad Med 1998;73(11):1133-48. 2. Working Group on the Certification Process. Defining competence for the purposes of certification by the College of Family Physicians of Canada: the evaluation objectives in family medicine. Mississauga, ON: College of Family Physicians of Canada; 2010. Available from: www.cfpc.ca/uploadedFiles/ Education/Certification_in_Family_Medicine_Examination/Definition%20 of%20Competence%20Complete%20Document%20with%20skills%20 and%20phases.pdf. Accessed 2014 Jul 9. 3. Puddester D. Off my game: recognizing and managing burnout and depression [Web module]. Ottawa, ON: ePhysicianHealth.com. Available from: www. ePhysicianHealth.com. Accessed 2014 Jul 8.
Vol 60: august • août 2014
| Canadian Family Physician
•
Le Médecin de famille canadien
761
President’s Message
Balancing life and work Kathy Lawrence
O
ver the past several months I have reflected on the practice of family medicine and what it has meant to me as a person and as a professional. As I thought about what I might write this month, I was repeatedly distracted by the sound of birds chirping and the light reflecting off the lake. It is summer in Saskatchewan, and it is one of the times I set aside each year to help maintain the balance between my personal and professional life. Not long ago, I was struck by a comment from a colleague who said he had lost the balance between vacation and work and that he was starting to feel familial repercussions. Sadly, this is not an unusual comment to hear from those I work with, but it stood out for me at the time because I was in the process of preparing a presentation on health and well-being for a group of new residents.
Physician as person The Educating Future Physicians for Ontario project was undertaken in the 1990s to understand what Ontarians wanted from their physicians and how medical schools should change their training in response to this. This material formed the foundation for CanMEDS and CanMEDS–Family Medicine. In that original work, one of the roles was physician as person. It focused on one’s ability to balance professional and personal roles, to cope with the stresses of medical practice, and to share something of oneself with patients.1 This concept remains within the CanMEDS roles and also is part of the definition of competence for the purposes of Certification within our College.2 However, I wonder if we need to be more deliberate in our discussion of this dimension. The ability to share something of oneself with patients is an important aspect of the patient-doctor relationship that must be used with the same competence that we use our other abilities like clinical reasoning or procedure skills. We know that there is a fine balance between healthy self-disclosure and boundary violations. Staying physically and emotionally healthy is important for ensuring that we share of ourselves when it is in the best interest of our patients and not when it is to address our own needs.
Where the balance lies I remember the face but I have forgotten your name— sometimes, after a particularly long and challenging day, when you look in the mirror, it can feel that way. Cet article se trouve aussi en français à la page 762.
MD CCFP FCFP
For some of our colleagues it becomes every day—they realize that the way they interact with those around them does not reflect the person they are or want to be. Burnout has been described as a work-related syndrome characterized by emotional exhaustion, depersonalization, and diminished feelings of professional success.3 We experience burnout when we are unable to reconcile what we do with what we expect of ourselves or what others expect of us.3 I have heard on many occasions from physicians that it was only when they changed the nature of their practices that they realized the effect their careers were having on themselves and their families. For many, the recovery from that kind of practice took years. These physicians say that no one should ever practise in the way that they did. I have also heard serious concerns from members of our profession about how practices that are limited in scope and commitment—and that are therefore thought to provide better balance—are not in the best interest of our discipline or patients. I believe there are important conversations to be had to understand where the balance lies between these 2 views. However, we need to consider our duty to ourselves as well as our duty to society in these conversations. Residents in my training program are provided with a collection of electronic resources about health and safety and have at least 4 different options for seeking help if they find themselves in physical or mental distress. How good are we about doing this for ourselves in practice? How good are we at helping our colleagues recognize when they need help, and then helping them access this assistance? There are a number of useful resources available to physicians through their provincial medical associations, as well as at www. ePhysicianHealth.com, which was specifically developed for Canadian physicians. Whether you believe you are in distress or not, I encourage you to seek out resources to help you be as healthy as possible for yourself, your family, and your patients. By the way … we speak of all Canadians having access to family physicians. Do you have one? References 1. Neufeld VR, Maudsley RF, Pickering RJ, Turnbull JM, Weston WW, Brown MG, et al. Educating future physicians for Ontario. Acad Med 1998;73(11):1133-48. 2. Working Group on the Certification Process. Defining competence for the purposes of certification by the College of Family Physicians of Canada: the evaluation objectives in family medicine. Mississauga, ON: College of Family Physicians of Canada; 2010. Available from: www.cfpc.ca/uploadedFiles/ Education/Certification_in_Family_Medicine_Examination/Definition%20 of%20Competence%20Complete%20Document%20with%20skills%20 and%20phases.pdf. Accessed 2014 Jul 9. 3. Puddester D. Off my game: recognizing and managing burnout and depression [Web module]. Ottawa, ON: ePhysicianHealth.com. Available from: www. ePhysicianHealth.com. Accessed 2014 Jul 8.
Vol 60: august • août 2014
| Canadian Family Physician
•
Le Médecin de famille canadien
761
