Transcript Stress from Work, Personal and Family Life

Stress from Work, Personal
and Family Life:
Perspectives of a Family Physician
Mark J. Yaffe, MDCM, MClSc, CCFP, FCFP
Associate Professor of Family Medicine,
McGill University and St. Mary’s Hospital Centre
Disclosure
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Someone in this room likely authorizes that
part of my income that comes from McGill
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Longstanding clinical and research interests
in today’s topic
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Some McGill employees in my practice
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Up to ½ of my professional time has been
spent as a manager for educational or
health care delivery issues
Many years of trying to juggle home life,
professional life, & family caregiver
responsibilities for 3 family members with
serious chronic illness.
Overview of Presentation
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Why is a FP interested in this topic and
from what perspective?
Look at examples of competing needs and
some life stressors
Stressors I have heard from some McGill
staff?
Discuss signs & symptoms of stress
What is “well aging”?
What is chronic disease , & the role it plays
in our lives?
Family Caregiving as a major stressor
Opportunities for change
What is a Family Doctor ? *
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Generalist
Cares for both sexes
All ages
Holistic care
Aware of and responds to biological,
psychological, social, ethical, &
spiritual needs of patients
Has a specific diagnostic process
*optimal
Developmental Tasks
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Life span (life cycle) literature talks
of predictable challenges in personal
development, relationships , & jobs
that each of us must face—some
handled successfully, some less so
A parent, PHYSICIAN, or other
“provider” may assist an individual
with his / her developmental tasks.
Family Doctors’ Diagnostic Process * (1)
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Influenced by awareness of what a
patient wants:
To be: Seen
Heard
Understood
Diagnosed
Given an explanation
Given a solution
*optimal
Family Doctors’ Diagnostic Process * (2)
Depends on a professional relationship
that:
 Is carried out over time
 Is influenced by cues gathered from
a patient’s bio-psycho-social-ethicalspiritual issues
 recognizes that the doctor has a
“privileged ” relationship that permits
him / her to “bear witness” to
changes in the mind, body, and soul
of ones patients.
*Optimal
Family Doctors’ Diagnostic Process * (3)
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Involves direct contact with a patient
Influenced by doctors’ awareness of
relevant aspects of a patient’s life through
the care for other “family” (significant
others) members
Realism:
Can’t always care for family members–
depend on understanding generic life span
issues , e.g. young adults are pre-occupied
with career advancement
*Optimal
Terminology: Disease vs. Illness *
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Disease: the pathophysiological
manifestation of disruption of
biological homeostasis
Illness: the impact that a disease
has on an individual ‘s ( family)
physical and /or psychological
being and , lifestyle, etc
*Kleinman et al
Illness Model*
Questions that could be asked directly or
indirectly:
(1) What do you think caused your problem?
(2) Why do you think it started when it did?
(3) What does the illness do to you?
(4) How severe do you perceive it to be?
(5) What treatment do you expect for your
problem?
(6) What results do you expect from the
treatment?
(7) What fear (if any) do you have of your
illness?
* Kleinman et al
Impact of Illness (1)
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Medication: cost, side-effects
Disability
Psychological Distress
Impairment of Social Functioning
Altered Relationship with
Family/Friends
Impact of Illness (2)
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Pain
Sleep Disturbance
Job, Earnings
Self-Perception : New diagnosis of
Hypertension assoc. with increased job
absenteeism (not caused by the
hypertension)
Dynamic and Competing Pressures
and Interactions
Expectations
Attitudes
Morals
Priorities
Rules
Values
Standards
Employer
Family
Self
An Anecdote
Thanks to a
great
Professor!
Personal, Job, & Family Stressors
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Strain of making decisions and judgement calls,
particularly those done under pressure
Maintaining knowledge, skills, and credibility in the
field / discipline in which one works
Change imposed from “outside” or “above”
Organizational audits of your performance
Volumes of mail
With aging, multi-tasking is not as easy
Finances (Moon-lighting on the side)
Children: Pregnancy, nurturing, attention,
consumerism
Spouses / intimate others: emotional, nurturance,
sexual intimacy, career, lifestyle
Aging parents
Community expectations ( ? more committees)
Magical Thinking
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Managers are problem-solvers: “ I will
handle this problem….I’ve always solved
things”….may lead to cumulative,
sometimes unnoticed stress symptoms
Some managers may become accustomed to
solving the organization’s or others
problems, but ignore their own…
There may be a continuous organizational
expectation of high performance……creating
inappropriate sense of power
(…like some MDs)
….It can be intoxicating…..
Example of Magical Thinking
What do I hear from some McGill staff?
Are more people at risk for stress?
Are we evolving a culture of
managers?
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Increasing number of vice-principals
Addition of associate vice –principals
Creation of provosts, vice-provosts
More associate chairs and associate
directors.
Do inconsistent decision-making styles stress
employees and create health concerns?
Motivation…..Demotivation
Impact of Stressors
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Not all people exposed to the same
stressors develop symptoms or illness
Intervening factors include physical
factors, emotional “make-up”, genetic
endowment, previous life experience.
Manifestations of stress may not
appear as “job impairment”, but in
fluctuating ability to do a job
Signs & Symptoms of Stress*(1)
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Reluctance or dread in going to work
Chronic complaining to colleagues or
superiors
Taking more time off to “re-charge”
Low patience with members of work
team or family
Increasing pre-occupation with
income /financial security
Frequent turning to colleagues for
help with emotional needs
*Modified from
physician impairment literature
Signs & Symptoms of Stress(2)
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Fantasies about early retirement,
time spent doing other things, change
in job
Inappropriate anger towards spouse,
significant others, family, friends,
colleagues, superiors
Deceased ability to focus
Difficulty in making decisions / wrong
decisions in professional /personal
life
Decreased ability to hear the needs of
family
Clinical Anxiety or Depression
Signs & Symptoms of Stress(3)
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Inability to physically relax : tense
muscles
Frequent degrading of peers
Inappropriate use of alcohol, drugs,
gambling
Interrupted sleep
Sense of meaninglessness, isolation,
loss of confidence
Loss of ability to pace oneself
Loss of sense of humour
Libido change / sexual dysfunction
Headache, backache, abdominal pain
Life Stressors & Aging Well
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What does “aging well” mean?
What are the assumptions
underlying aging well?
How do we prepare to age well?
Is the term well-aging
judgemental?
Do you “fail” if you don’t age
well?
AGE “WELL”
Healthily
In a good
way
Admirably
Pleasantly
Favourably Properly
Acceptably
Correctly
Suitably
Agreeably
Perfectly
Satisfactorily
AGE
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“ WELL”
Genetic Predisposition
Environmental Factors (good/bad)
Disease Course /Gradients/ Impacts
Coping Styles……Attitudes
Support Systems
Finances
Risk Factors
Illness May be Normative,
(not isolated incidents).
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Living longer because of new technologies
and medications
Canada -Population: 31,752, 842
16,000, 000 live personally or through
family with chronic disease.
*Canadian Chronic Disease Prevention Centre
What is chronic disease?*
Usually:
 non-infectious origins
 uncertain cause
 multiple risk factors
 slow to develop
 prolonged affliction
 impairment/functional
disability.
*CCDPC
Chronic Disease
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Some forms of heart disease
Stroke
Neurodegenerative disorders
Chronic respiratory disease
Diabetes
Some mental disorders
Cancer
Degenerative musculoskeletal
disorders
Burden of Chronic Disease
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By 2020 non-communicable
disease will globally account for
73% of deaths and 60% of
disease burden
Some chronic diseases have
commonality in the impact they
have on families:
Family Caregiving
Family Caregiving :
A workforce stressor
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Not a new reality, but an
increasing occurrence for adults
of all ages since , from newborns
to elderly, people are living
longer with more complex
illnesses
Often reduces the physical and
emotional resources of those in
the work force
Family Caregiving Tasks*
Assisting a dependent person with
daily living:
 Eating, meal preparation,
shopping, banking, dressing,
bathing, toileting, transportation
 Giving medication
 Emotional support
 Help with decision-making
 Attendance at doctors’
appointments
*partial list
Impact of Family Caregiving? (1)
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Positives: often hard to see (increased
contact, gratification, giving back)
Negatives:
--Competing needs for ones time for:
Self
Spouse (intimate other)
Children and other family members
Recreation and fitness
Work (work day and take-home)
--Increased expenses ( ?? unexpected)
-- Emotional: Denial, Anger, Bargaining,
Guilt, Depression, Anxiety, insomnia
Impact of Family Caregiving (2)
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Doctors commonly see symptoms & illness
directly linked to CG burden .
CG die earlier than non-caregivers
Daily preoccupation with CG likely lowers
efficiency and creativity at work.
CG is often an undeclared cause of job
absenteeism because stress is not a
recognized diagnosis for medical disability doctors forced to be creative with medical
form completion.
Impact of Family Caregiving (3)
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Some CGs are unhappy with absence of “fair”
treatment: If the “clock” and criteria for promotion
/ advancement takes into account pregnancy
/maternity leaves, shouldn’t the “clock” reflect the
social and normative reality of CG?
“my CG role exhausts me……it not severe enough for
my boss to recognize since my performance is
passable”
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“ I can’t compete….I have no time for “out of hours”
work.”
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“my CG financial obligations may force me to leave
this job”
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Caregiver Literature: CGs are gradually forced to
decrease their career ambitions!
Impact of Family Caregiving (4)
Financial:
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When an employer adjusts salary on the basis of
comparative performance, there may be potential for CGs
to lose out
McGill: A larger fraction of academic annual salary
increment is via merit (3.23%) vs. across the board
(1.25%)
Across the board is +/- COLA based on Montreal economic
indicators---yet inflation rates for health care (ie for CGs)
far exceeds Bank of Canada annual inflation rates
Non-public nursing home: $60,000/yr
Supplementation of RNA care (10hrs/day): $80,000
For CGs decreased sense of financial control for self/family
produces less sense of ……“personal commitment to the
university”
What can be done to help?
Despite the fact that Prevention
against disease is strongly
advocated, North American
health and social services tend to
be more Curative (Reactive)
than Preventative
Recognition of Family Caregiving
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Social reality that will only grow
Israel: 30 doctor-certified paid days of leave
/yr. to assist with CG issues.
Some North American companies are
looking at CG leave / job sharing options.
Some organizations are considering CGs be
included in equity guidelines.
Employees should consider the potential
benefits of higher health premiums for
better health care coverage.
Should universities, promoters of
knowledge translation, explore further the
needs of its caregiver employees?
What do patients want?
To be:
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Seen
Heard
Understood
Diagnosed
Given an explanation
Given a solution
What do PEOPLE want
7) Not to become patients
8) To have the means to avoid
preventable problems
9) To have perspective to deal
with situations over which one
may not have control