1. Managing Stress In the Medical Practice Workplace Some Unconventional Perspectives 1,2,3 A CME Presentation for Holzer Medical Center Kendall L. Stewart, MD, MBA, DLFAPA August 1, 2012 1 Thank you for honoring me with your invitation to speak. 2 I hope to provide a different perspective about stress in your medical practices. 3 And I hope to point out some practical strategies you can begin to implement to make your professional lives better.

2. Why is this important? People say that our lives are too stressful.our lives are too stressful People say that working in healthcare is stressful.working in healthcare is stressful People say that this stress is killing us.stress is killing us People say we must find ways to decrease the stress in our professional lives.decrease the stress in our professional lives People are wrong. 1,2 Stress in not the problem. Stress is the solution. It’s the kind of stress that matters. After listening to this presentation, you will be able to: –Identify three perceived categories of stressors in doctors’ and nurses’ professional lives. –Detail three things that most of us want out of life, –Specify three kinds of interventions you can deploy to manage the stress in your life more effectively, and –Explain why much of what people say about stress is wrong. 1 I’m a psychiatrist. I can tell you what is wrong and what you need to do. I can’t do it for you. 2 I once tried to help a husband be more romantic.

3. Is the stress in our lives killing us? No. The lack of stress in our lives is killing us. Eating too much of the wrong stuff is killing us. Obesity is killing us. Our sedentary lifestyles are killing us. Smoking and drinking and drugging are killing us. Changing this is stressful and most of us are disinclined to expose ourselves to this kind of stress. So, it is the pursuit of stress-free living that is killing us instead.

4. What do most people want out of life? People want to do what they feel like doing. People don’t want to do what they don’t feel like doing. People want to be paid more for it. People want to be told how wonderful they are, particularly when they are not. People want others to think the way they think. People want others to do what they want them to do. 1 People want to be loved. People don’t want to be criticized. People want to feel comfortable. People don’t want to feel uncomfortable. People want stress-free lives. 1 Unlike Freud, I know what women want.

5. What are the most common stressors in physicians’ professional lives? 1 SOMC Physician and Nurse Focus Group, July 2012.

6. What are the most common stressors in nurses’ professional lives? 1 SOMC Physician and Nurse Focus Group, July 2012.

7. What are some of the signs of a “stressed” medical practice workplace? 1 Negative people set the tone. People don’t feel accepted by their colleagues. People don’t feel good about the quality of their work. People don’t feel good about their leaders. People don’t feel good about the communication in the workplace. People don’t speak forthrightly “on the record.” People keep secrets. Powerful people throw temper tantrums regularly. 2 People overreact to minor aggravations such as computer glitches. People who are rank conscious discourage dissent. People want more money. People dread to come to work. People don’t feel they have the resources they need to do their jobs. The positive people are looking for another job. 1 Adapted from American Medical Group Association Provider Satisfaction, November 2011. 2 A surgeon came to my office in a rage complaining that the Director of Surgery would not talk to him.

8. What is the most significant stressor in your life? It’s you. It’s the situations you put yourself in. It’s the way you perceive things. It’s your sensitivities. It’s the way you react to stuff. It’s your bad habits. It’s your unwillingness to change—even when you know you should. It’s you. Really. 1,2 1 Think of all the miserable people you know. Have any of them said, “I’m a miserable cuss and it’s my fault?” 2 I was waiting to check out of the parking lot with a physician colleague.

9. What are your options for decreasing the unhealthy stress in your life? You can decrease your exposure to unhealthy stress. You can increase your exposure to healthy stress. You can change your reactions to your environment and the people in it. You can take drugs. You can go ahead and die. That’s about it. 1,2 1 Knowing what to do is not usually the problem; doing it is. 2 A woman presented with anxiety, but was unwilling to do anything I recommended.

10. Create a culture of excellence at work. Performance –Focus on results.Focus on results –Identify meaningful performance indicators.meaningful performance indicators –Insist on comparative data.comparative data –Pursue perfection. –Publish your results. Processes –Deploy a practical process- improvement process. –Involve people in meaningful process improvement.process improvement –Empower leadership teams to decide and execute.leadership teams –Use task lists to hold people accountable.hold people accountable –Document key processes as a part of succession planning.Document key processes People –Manage yourself first.Manage yourself first –Field the best possible leadership teams.Field the best possible leadership teams –Recognize the stars. –Recognize the average people more. –Extrude the net-negative people. 1Extrude the net-negative people Planning –Embrace discomfort.Embrace discomfort –View problems as opportunities. –Align the organization around a few strategic values. strategic values –Adopt a decision-making process that is inclusive, transparent and evidence-based. –Clarify who opines and who decides. 1 Let me tell you about what a nurse told me while I was making rounds one Sunday about our Net-Negative process.

11. Embrace energizing discomfort as a lifestyle. Write a blueprint for a values- based life and follow it. Become a health and wellness role model. Focus on results. Talk to people instead of about them. Manage conflict promptly and effectively. Reframe distress as an opportunity to change. Resist the seduction of materialism. Stifle the urge to flaunt your power. Abandon arrogance as a defense. Suppress feelings of entitlement. Stop expecting people to read your mind. Quit being so cynical. 1,2 Stop being so sensitive. Choke off pointless rumination. Control your temper. Grow a thick skin. Stop expecting difficult people to change; predict them and manage them instead. Develop a passion for serving others. Become a respectful team player. Become a process improvement expert. 1 Some cynicism is healthy, but exclusive reliance on this view of life will make you miserable. 2 A man went to apply for social security and forgot his wallet.

12. Reprogram your brain. 1 Stop viewing others as “good” or “bad.” Stop drawing conclusions from a few experiences. Stop focusing on the negatives and ignoring the positives. 2 Stop minimizing others’ positives. Stop jumping to negative conclusions about others. Stop blowing things out of proportion. Stop allowing your feelings to dictate your opinions and behavior. Stop thinking what others “should” or “ought to” do. Stop labeling others based on their shortcomings. Stop blaming others for your problems. 1 Adapted from a common list of cognitive distortions identified through Cognitive Behavior Therapy (CBT). 2 Let me tell you how I reframed those annoying weekend rounds.

13. What have we learned? Stress in not killing us. The lack of stress is killing us. You are the biggest stressor—for good or ill—in your life. You can put this powerful insight to work in your life today. Knowing what to do about the unhealthy stress in your life is not the problem. Doing it is. Will you do it? Or will you settle for a poorer quality life and die sooner? 1,2 1 My colleagues at SOMC are nominating me as a wellness warrior. 2 Let me tell you about my experience so far.

14. Where can you learn more? Join the discussion about practical approaches to more effective leadership on the SOMC Leadership Blog.SOMC Leadership Blog Learn more about Southern Ohio Medical Center here.here Review and download this presentation and related presentations and white papers here.here Learn more about how to confront others effectively by reading A Portable Mentor for Organizational Leaders.A Portable Mentor for Organizational Leaders Order Spark: The Revolutionary New Science of Exercise and the Brain here.Spark: The Revolutionary New Science of Exercise and the Brain Order Feeling Good: The New Mood Therapy here.Feeling Good: The New Mood Therapy Order Younger Next Year: Live Strong, Fit and Sexy—Until You’re 80 and Beyond here.Order Younger Next Year: Live Strong, Fit and Sexy—Until You’re 80 and Beyond

15. How can you contact me? 1 Kendall L. Stewart, M.D. VPMA and Chief Medical Officer Southern Ohio Medical Center Chairman & CEO The SOMC Medical Care Foundation, Inc. 1805 27th Street Waller Building Suite B01 Portsmouth, Ohio 45662 740.356.8153 StewartK@somc.org KendallLStewartMD@yahoo.com www.somc.org www.KendallLStewartMD.com 1 Speaking and consultation fees benefit the SOMC Foundation.

16.  Safety  Quality  Service  Relationships  Performance   Safety  Quality  Service  Relationships  Performance  Are there other questions? 1 1 Here are two physician stars who reduce the stress in their workplaces every day. 2 Dr. George Pettit is an OBGYN. Dr. Bob Knox is an ophthalmologist.