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The James A Vohs Award ••Summer 1999 / Vol 3, No 2 |
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A Stress Awareness Program for Physicians: "Care for the Caregiver"-- A Review. | to pdf >> By Lee Jacobs, MD, Associate Editor If the Permanente Medical Groups are to distance themselves from competitors, we must build on our distinct competitive advantage: the group model. We can do this by continuing to find new ways to support each other as we cope with the stresses of a busy medical practice. Supportive interventions for Permanente practitioners have been the topic of several recent articles in The Permanente Journal, ranging from the article on Clinician-Patient Communication1 to the article in the most recent edition on wellness intervention to support impaired physicians.2 The challenge for all Permanente Medical Groups is to discover opportunities for us all to learn and grow, to increase our enjoyment of our practices, and to further widen our competitive edge. This is what motivated me to audit a recent CME program on stress management, Care for the Caregiver, presented by the Southern California Permanente Medical Group (SCPMG). As is true for all Permanente Medical Groups, we in the Georgia Region realize how stressful the work life of our clinicians can be. I had been told that this innovative program teaches about stress in a way that Permanente physicians can identify with completely. I attended the program with the intent of adopting it for use by The Southeast Permanente Medical Group if the program lived up to its advance billing.
The three-hour program effectively combines brief, didactic discussions of basic stress management with entertaining, meaningful vignettes on the stresses encountered by the typical--and even stereotypical--Permanente physician. A major goal of the program is for physicians and other providers to recognize their level of stress, to identify their personal stressors, and to better manage that stress. The program emphasizes throughout that it is the personal responsibility of each individual clinician to deal with the stressors in his or her practice. The course is not intended to convey a long list of coping skills but instead to present basic concepts while making it clear that more detailed programs on such coping skills are both necessary and available to Permanente practitioners. I especially liked the idea of presenting a "menu" of these more extensive stress management programs on the course evaluation sheet. The program was developed by five SCPMG physicians--Drs. Steven Crain, Edward Wang, Judy Salz, Alexander Lee, and Kip Tulin--along with William Skilbeck and others from the Kaiser Permanente Educational Theatre Programs Department in Southern California. Drs. Crain and Wang were instructors for the session that I attended; Dr. Salz also attended. Having fellow Permanente physicians as instructors gave participants a reassuring sense that the instructors had "been there, done that." Especially noteworthy was their opening disclosure that the program was not the result of an administrative dictum but instead was conceived and developed in 1996 by "grassroots" physicians to meet a need. That comment got attention. The three hours passed rapidly. Clearly, the presenters have learned how to use varied teaching techniques to present their points effectively and to keep the session moving. Especially effective was the practice of having a third Permanente instructor (Dr. Salz) in the audience to make observations and to embellish the discussions. Those of us who import this program should consider using this added dimension if we are to give our Medical Groups the full effect of the program. A key component of the program is the series of dramatic vignettes written by Rodney Gerber and Sharon Burke and performed by actors from an acting troupe (CareActors) from the Educational Theatre Programs Department. These vignettes effectively stimulate emotions that reinforce learnings on stress management. The audience might have chuckled at some of the Permanente stereotypes, but probably everyone in the room did some "soul searching" as to just how realistic this stereotype might be. They may well have thought, "This could be me!" The talented, experienced actors were crucial to the teaching experience and probably will be the most challenging aspect to duplicate in transporting the program to other KP Regions. Clearly, these individuals have presented this program many times; they knew well how to respond to the audience. In addition to having the benefit of several dress rehearsals, the performers are trained in both physician-patient communication skills and stress reduction. Rodney Gerber was so convincing as a stressed-out "Permanente physician" that I believed I could put him to work in my module! The other "Permanente physician," Kelly Coleman, was not only convincing and entertaining but also instructive. Sandra Kinder as a nurse and Ben D'Aubery as a patient were equally effective. The program coordinator (my contact for arranging my visit) was Lisa Beezley-Lippman. Undoubtedly, the challenge of transporting this program to other Permanente Medical Groups is to advance local performers far enough along on the learning curve that they can be effective. This achievement may require several dress rehearsals before performers "go live" as well as that they attend basic courses on stress reduction, as the Southern California actors did in preparation. They must become familiar with the stresses of a medical practice, because these situations are not easily scripted: they are best learned from experience. One future embellishment to consider, or more likely a second program, would be an adaptation for health care teams. In this era of team-based care, I envision a valuable team dialogue about job stressors and possible corrective steps. The program was so well done that we are definitely transporting it to Georgia. I also encourage other Permanente Medical Groups to consider adopting Care for the Caregiver for their physicians and other practitioners. Lisa Beezley-Lippman tells me that she is more than willing to assist other KP Regions who would like to assess the program for their Medical Group. She can be contacted at 323-259-4531. Do you have a favorite program that you found especially helpful in coping with your busy practice? If so, please let us hear from you!
References 1. Stein T, Nagy VT, Jacobs L. Caring for patients one conversation at a time. Permanente J 1998 Fall;2(4):62-8. 2. Senft RA, Evers K, Savery RJ. Outreach to physicians with problems: a four-year experience. Permanente J 1999 Winter;3(1):39-43.
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