Rx forsanitytriagelovelaughterRAYMOND

Rx For Sanity:
Triage, Love and Laughter

Patricia L Raymond MD FACG
Rx for Sanity, Norfolk VA

www.RxForSanity.com

“Does It Make Your Ears
Wiggle?”
-N.E. Raymond

www.RxForSanity.com

Traits which make a good HCP
lead to ‘compassion fatigue’
• Strive for perfection
• Seek and accept responsibility
• Willingness to defer gratification and to
sacrifice

• HCP isn’t what we do, it’s who we are

www.RxForSanity.com

Compassion Fatigue
• Not related to:
– Hours worked
– Practice specialty
– Managed care prevalence
– Government interventions
• Related to loss of perceived control, loss of
personal-work balance

www.RxForSanity.com

Sometimes you have to take your
brain and stomp on it a little.
It just gets caked up.

Mark Twain

www.RxForSanity.com

Your Prescription for Sanity
• Triage: your professional life
• Love: Family, finances, & mental
health
• Laughter: Personal health

And we’ve only 75 minutes
to change your life!
Debbie Waiz www.RxForSanity.com

Triage: Your Professional Life


“Please back in
for prompter service.”
Sign on our endoscopy suite door


No time for Information Overload
• New techniques and
equipment
• Reading? Who has
time to read?


It’s not my job.


Nursing Stress is Universal
• Workload perceived as too great to give quality
patient care
• Unfairness in promotion opportunities, imbalance
between jobs and responsibilities, conflict with
colleagues, lack of appreciation of efforts by
superiors, responsibilities of role, long and tiring
work hours, inadequacy of equipment, and
problems experienced with patients relatives

www.RxForSanity.com

DWA (doctors with attitude)

www.RxForSanity.com

Exercise: The Perfect Day
• Get out your pen, and go to page two!

www.RxForSanity.com

Professional Rxs
• Seek clinical satisfaction
– Opportunity vs. Obligation
• WHY not WHAT
– Think creatively: challenges are
opportunities
– Raise the bar: Evidence based medicine
– Be a partner: proactive and critical
thinking…ask questions, ask questions,
ask more questions

Critical Incident Stress

• Create a healthy work environment
– Humor
– Take your breaks
– Debrief/ dump toxins
– In house stress management: Exercise,
Tai Chi, yoga, meditation

www.RxForSanity.com

People treat you the way you
teach them to treat you.
~Jack Canfield

www.RxForSanity.com

Rx for Information Overload
• “Car College”
» 15 min each way daily commute
– 15 min each way x 10 trips weekly =
2.5 hours per week
46 weeks per year = 119 hours per year

Needs card- Zazlove
Regional and national society
meetings
www.RxForSanity.com

“The great use of a life is to
spend it on something that will
outlast it.”
William James

www.RxForSanity.com

Find your Windmill
• Develop new tools: research, technology
• Complimentary Alternative Medicine (CAM)
• Mentoring of new nurses
• Disease specific volunteerism
• International, national, state or local
Consider petitions, politics, publicity

www.RxForSanity.com

Your mission in life is where
your deep joy
and the world’s deep hunger meet.
~Richard Nelson Bolles

www.RxForSanity.com

Love:
Family, Finances &
Mental Health


The Art of Healing
W.H. Auden

Most patients believe
Dying is something they do,
Not their physician,
That white-coated sage,
Never to be imagined
Naked or married.

Family and Medicine
• Divorce rates 10-20% higher than general
population
• Do we leave our communication skills at
the office?

Ann Int Med 2001
Sou Med Jou 2000


Financial stresses
• 35 to 45 y/o average personal debt equals
95% of annual income
• Most spend less than 1 hour per month on
retirement planning

• 2 of 3 HCPs does not have a will


Substance Abuse
• One in seven nurses during their career
– Similar frequency to general population
– Through legitimate Rx or diversion
– Demerol is drug of choice
– More common among nurses with access to
substance (ED, ICU, Endo)

West J Med 2001

Substance Abuse:
Your Choices

• No action
• Enable
• Report
• 50% report blackouts during patient care
while using

West J Med 2001

Nurse suicide
• One of the top five causes of death in nurses
• Six times higher rate than general public
• Felt to be related to CI stress
– Unrelated to incidence of substance abuse
– MD suicide (2 x male MD, 4 x female MDs) IS
related to substance abuse as predictor


Exercise: Focus Points
Go to page 3!

• People • Shelter
• Work • Money
• Food • Fun
• Clothing

Repeat q 3 months


Personal & Family Rxs
• Take control
– Make time for family
• Become a ‘Multi-Shirker’ (Scott Adams)
• Hire a wife!
• Fee only financial advisor, or self-educate
about financial health
• Seek NHP (nursing health programs) for
yourself or others


Laughter:
Personal Health
& Wellness


The Science of Wellness


• Stop smoking
TobaccoFreeNurses.org


• Stop smoking
• Eating habits


AmIHungry.com


• Stop smoking
• Eating habits
• Exercise 30 minutes
daily


Exercise as Medicine
Cardiovascular disease, CHF,
CVA, PVD, Type II
Diabetes, Obesity,
Dyslipidemia, Cancer
(breast, colon, prostate,
pancreas, melanoma),
Asthma, COPD,
Osteoarthritis, Rheumatoid
Arthritis, Cognitive
Dysfunction
Booth, J Applied Physiology 2002;93:3-30

Hi,
This is a hassle to remind you to Have you exercised
today? Remember that your health is more
important than what you do. Meditate and journal
today too. Be in balance. Breathe. So get to it!

You'll be sent one of these hassles roughly every 2
days.

Thanks, -- The HassleMe Team
http://hassleme.co.uk/


HassleMe
http://hassleme.co.uk
Because sometimes in life,
you just need to be nagged...


• Stop smoking
• Eating habits
• Exercise 30 minutes
daily
• Sleep 8 hours a night


Aging and sleep
• Lancet 1999
• 8 hours verses 4 hours in normal college
students
• glucose intolerance identical to early adult
type diabetes
• TSH & cortisol levels like elderly
Mall study:
13 % less max happy with each hour < 8
7 = 87% 6 = 74% 5 = 61%



• Stop smoking
• Eating habits
• Exercise 30 minutes daily
• See a physician


1998- 2 polyps
1999- 2 polyps
2002- no polyps
2007- 5 polyps
(and a poor prep,
it is rumored)

Scott Adams/Dilbert: W.A.D. found


• Meditate/
breathe/ journal/
spiritual


Spirituality & medicine
• Meditation
– Psoriasis, heart disease, chronic pain
– UCLA meditation tapes to BP patients 73%
reduction in medication, 50% stop meds
altogether
• Journaling
– Smith Annals Internal Medicine COPD RA


Spirituality & medicine
• Optimism
– Mayo clinic: pessimists risk factor for
premature death, overall lower level of health,
more use of medical resources and higher
medical costs
– Internal Medicine News: pessimism worsens
lung function; pessimism equivalent to 20
pack- year smoking


• Meditate/ breathe/
journal/ spiritual
• Happiness list


may my mind stroll about hungry,
and fearless, and thirsty, and supple.
ee cummings
may my heart always be open


ColonoscopyJoke.com RxForSanity.com



• Meditate/ breathe/ journal/ spiritual
• Happiness list

• Have Sex
• Reassess quarterly


The Caerphilly Study:
Smith, Frankel, Yarnell, BMJ 1997
• N=918 males(45-59 y/o), 10 year f/u
• Stratified to self-reported frequency of
intercourse
– Low: Less than q month
– Intermediate
– High: BIW or more frequent
• Data adjusted for variables of age, social
class, systolic blood pressure, smoking,
baseline CAD, cholesterol

The Caerphilly Study: Results
Low Intermediate High
Frequency Frequency Frequency
All Cause Mortality
1.9 1.6 (CI 1.0-2.8) 1.0
CI 1.0-3.4
P<0.04

Coronary Heart Disease
2.1 CI 0.9 -5.1 1.8 (CI 0.8-4.0) 1.0
P<0.10


Women vs. Men
Quality vs. Quantity
• Sexual dissatisfaction for women is an
independent risk factor for MI
– Abramov, Psychosom Med 1976
• Lack of sex associated with death in men
• Lack of enjoyment associated with death in
women
• Duke Study on Ageing
– Palrnore, Gerontologist 1982


Rx Yourself Now:

If you really want to do
something you’ll find a way.

If you don’t,
you’ll find an excuse.


• Stop smoking
• Moderate your eating habits
• Exercise 30 minutes daily
• See a physician
• Seek the spiritual
• Make a “Happiness List”
• Have more/better sex
• Reassess quarterly

SSDT: Not sex!


This is your prescription for sanity:

• Medicine is an opportunity, not
an obligation
• The Perfect Day
• Focus Points
• Happiness List

• Have more (or better) sex

“Does It Make Your Ears
Wiggle?”
-N.E. Raymond


Don’t wait for a
second opinion!


Rx forsanitytriagelovelaughterRAYMOND

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