5/9/2016

Clinician Burnout and  Dealing with  Difficult Patients

Classic Difficult Patient Case 

The Challenging Patient: Problem Solving for the Professional Care Giver Conference Michael R Privitera MD MS Professor of Psychiatry Medical Director, Medical Faculty and Clinician Wellness Program University of Rochester Medical Center. [email protected]

Groves JE. Taking Care of the Hateful Patient. NEJM. 298(16)883‐887. April 20, 1978

Aggression as Iceberg Continuum

What is Workplace Violence? • Any physical assault, threatening behavior, or  verbal abuse occurring in the workplace,  includes but is not limited to such events as: – Beatings, shootings, rape, suicide or attempts  psychological traumas, such as threats to harm,  obscene phone calls, intimidation, bullying,  incivility, harassment, including being followed or  sworn at*. –

*Italics also referenced if definitions of disruptive behavior.

Department of Health and Human Services, Centers for Disease Control and Prevention (2008) National Institute for Occupational Safety and Health. Exposure to Stress. Occupational Hazards in Hospitals. http://www.cdc.gov/niosh/docs/2008‐136/pdfs/2008‐136.pdf

As Perceived by the Recipient

Mega-violence examples: Law or society's common perception of violence: Severe transgressions against individuals.

Below the line of society’s colloquial definition of violence. Many are part of formal definition of Workplace Violence (NIOSH) Cause micro-traumas which are additive and cumulative. Privitera, M.R., Bowie, V. and Bowen, B. (2015) Translational Models of Workplace Violence in Health Care. Violence and Victims, 30, 293-307.

Mega-violence

Homicide, assault, threats of harm, terrorism, etc. Micro-violence examples:

Micro-violence

Incivility Disrespect Deprivation of human needs Disruptive Behaviors (TJC) Belittlement Bullying, Micro-aggression Micro-insult Micro-invalidation. Badgering, hassling others Persistent cumulative aggravations. Poorly designed work procedures, policies, mandates, laws, regulations. Toxic management behaviors.

1

5/9/2016

Opposite of Burnout is Engagement

Dose‐Response Relationship

Adjusted Odds Ratio

More Workplace Violence‐> More Burnout, ITL and ITC

2

*** ***

1.5

**

Burnout

*** **

Intention to Leave Nursing

1 0.5

Intention to Change Employer

0 Seldom

Monthly

Weekly

Increasing Amount of WPV

** P