Category: Stanford Plavin

Grief from patient loss. High stress due to overwork. Disregarded personal mental and physical health.

It’s all too common for physicians to suffer from poor well-being thanks to the unprocessed emotions and excessive work associated with the job. Moral distress, burnout, and compassion fatigue are great risks to healthcare workers all over the world, causing sub-par clinical decision-making and poor patient care.

Thus, Stanford Plavin, MD says clinicians should utilize self-care to optimize their physical and mental health, ensuring zero medical malpractice and flawless diagnoses.

Why Physicians Need to Take Care of Their Physical and Mental Health

All clinicians risk burnout through personal- and work-related factors. The former includes:

• work overload (either from insufficient resources or huge patient volumes)
• lack of control in the work environment
• spending much of their work on tasks unaligned with their career goals; and
• lots of work-home interference

While the latter personal characteristics give physicians predispositions to burnout, include:

• being female
• working in a one-person practice
• new to the career; and
• lacking control over private events

Clinicians caring for seriously sick patients face a higher likelihood of burnout, compassion fatigue, and moral distress, causing inefficacy, exhaustion, and cynicism.

The statistics are overwhelming; 69% of oncologists and palliative care staff experience emotional exhaustion, up to 25% suffer depersonalization, and 33% to 50% report inefficacy.

The consequences of physicians experiencing these difficulties, especially long-term, can be disastrous. For example, studies have shown that burnout increases the likelihood of medical errors, low patient satisfaction, and longer recovery times following discharge.

How Physicians Should Look After Their Physical and Mental Health

Given the negative impacts of compassion fatigue, burnout, and moral distress, physicians need the training to stay physically and mentally healthy throughout their working life. After all, they can’t truly help others if they aren’t firing on all cylinders themselves.

Luckily, there are a few ways clinicians can do this, such as:

Practice Self-Awareness

Emotionally challenging moments and the healthcare industry go hand-in-hand. And self-awareness is the first step physicians should take to deal with distressing times.

Doctors find it hard to meet their own needs since their entire day (and night) is focused on their patients. Yet, from neglecting eating to struggling with sleep, self-attention is vital so they can continue to provide five-star care.

Reflective activities like journaling can help clinicians figure out how they’re feeling, and, thus, how to alleviate the problem. Naming emotions shifts brain activity from the emotional side to the insightful and problem-solving area.

Take Breaks

When experiencing an emotional trigger, clinicians can suffer from an amygdala overhaul. In other words, their emotions come to the forefront, causing lash outs, crying, or yellowing.

Stepping outside could do the world of good for them at this point. Regardless of their workload, taking time out gives them time to clear their head, refocus, and provide outstanding patient care when they return.

Build and Maintain Healthy Habits

Practicing healthy habits as a doctor is critical. After all, they’re considered health role models. So, they should prioritize sleep, bring healthy snacks to work, and do some physical exercise when they can. It’ll benefit both their physical and mental health! At the end of the day, healthy physicians boost patient care.

Arguably one of the most important aspects of all kinds of surgery, anesthesia is used not only to prevent pain during surgery, but to ensure a safe procedure for all concerned.

Stanford Plavin explains that there are three main types of anesthesia used, depending on the surgery: local, regional, and general. Each requires a careful balance of the right drugs, administered by an anesthesiologist, for the most appropriate, pain-free care.

Types of Drugs Used During Surgery

There is a myriad of drugs on today’s market, and the anesthesiologist’s job is to select the right ones for the specific surgery.

Local Anesthetic

For routine procedures, such as stitching a wound or taking a small biopsy, a local numbing agent is applied to the area and once the procedure is finished, it wears off relatively quickly.

Drugs such as Lidocaine, Mepivacaine, and Bupivacaine are examples of amino amides local anesthetics, that work by blocking nerve impulses and thus numbing the area for the required time.

There are similar drugs, belonging to the group amino esters, and they include Procaine and Tetracaine. The main difference between the two groups are the complex effects they have on the body’s system, so the anesthesiologist must decide on the correct drug for the procedure.

Regional Anesthetic

When numbing a larger area, such as from the waist down, a regional anesthetic is used, and the patient remains conscious.

A common use for a regional anesthetic would be an epidural for a woman in labor, and this is usually administered using such drugs as Bupivacaine or Lidocaine, along with opioids, including Fentanyl and Sufentanil.

General Anesthetic

The most complex is general anesthetic, where the patient is put to sleep for the duration of the procedure. An anesthesiologist must balance sedative drugs with analgesics, the drugs that prevent pain.

Propofol is most used to send a patient to sleep, via an IV in their arm. It allows the patient to continue to breathe by themselves. Other drugs include Midazolam, which helps a patient relax, and can be given even before they have entered the operating room.

Pain relief administered during and after surgery can range from Acetaminophen (known in many places as Tylenol) to stronger narcotics like Morphine and Fentanyl.

For lengthy, complicated surgeries, inhalant drugs are used to not only send a patient to sleep but ensure they have no memory of the surgery. These drugs include Sevoflurane and Desflurane.

Deciding Which Drugs to Use

Anesthesiologists are fully trained doctors who have specialized in anesthesiology medicine. The decisions they make on the drugs they use are based on a complex mix of factors.

The anesthesiologist examines the details of the intended surgery, such as the length of time anesthesia will be needed. They determine what kind of anesthesia is required (local, regional, general) and in what dose.

They must also consider existing medical conditions, allergies, or possible interreference from other drugs when performing anesthesia.

All these factors ensure a procedure that is as efficient and pain-free as possible, leaving the patient with better chance for a swift recovery and no long-lasting effects.

Since anesthesiology became a common practice, it has progressed and changed through new technology, especially in recent years.

Anesthesiology over the last decade has improved in perioperative technology, methods of electroencephalographic anesthesia monitoring, advanced neuromuscular transmission monitoring, automation in the delivery of anesthetics, and advancements in telemedicine.

Stanford Plavin explains the developments and advancements of these different aspects of anesthesiology over the last 10 years below.

Perioperative Technology

Changes in perioperative technology over the past decade have improved patient care. One of these improvements is the utilization of checklists. In one study, the surgical death rate fell from 1.5% to 0.08% after introducing a surgical checklist, and the inpatient complication rate dropped from 11% down to 7%.

Other advancements include perioperative cardiac monitoring through the use of 3D echocardiography. This means that real-time monitoring of valvular functioning, including ventricular filling, and cardiac contractility, can be possible.

The invention of handheld ultrasound devices has made access to ultrasound technology easier and more accessible, therefore allowing the detection of any symptoms of the early onset of clinical deterioration. Overall, this has improved patient care as well as made bedside ultrasonography a possibility.

Electroencephalographic Anesthesia Monitoring

Depth of anesthesia monitors, such as the bispectral index monitor, or BIS, have come into play in recent years as well. This type of monitoring utilizes technology to process EEG information that gives a measurement of the patient’s consciousness level during implementation of anesthesia.

Neuromuscular Transmission Monitoring

Neuromuscular blockade monitors, conventional mechanomyography, or MMG, and other various versions of neuromuscular monitoring devices measure muscle function through the measuring of physical phenomena other than the typical force measurement.

One particularly attractive category of these devices is acceleromyographic monitors or AMG monitors. One of the simpler versions of this device would be the TOF-WatchTM.

This device measures acceleration using a piezoelectric sensor that is attached to a freely moving thumb. One commonly discussed con of this device, however, is that the piezoelectric sensor may not always be aligned properly, causing inconclusive results.

Automation of the Anesthesia Delivery

At the end of the 20th century, anesthesiologists were primarily using tools and machines to distribute anesthetics. Now, automated anesthetics are becoming more and more prevalent. Anesthesia workstations, infusion pumps, and monitors have advanced over the last decade, and new technology is always on the horizon.

With artificial intelligence becoming increasingly prevalent, it’s only a matter of time that it will make its way into pre-operative, operative, and post-operative practices.

Telemedicine Technology

Telemedicine is the result of videoconference products frequently seen in the eye of the consumer. The use of petite high-resolution cameras, microphones, and broadband data connections is being seen more frequently in perioperative examinations, ICU care, intraoperative monitoring, and post-operative assessments.

Conclusion

Although the development of anesthesiology depends greatly on each individual health care practice and hospital, the trends seem to be going towards automation, non-invasive forms of monitoring, as well as remote monitoring and management systems.