Often when we talk about improving health care, we turn to the Triple Aim. Developed in 2007 by the Institute for Healthcare Improvement (IHI) in the United States, the Triple Aim captures three objectives for a better quality health system: Improving a patient’s experience of care, improving population health and doing this at a reasonable cost. It has become a way of thinking embraced by many health care systems around the world.
The Triple Aim takes a big-picture, system-wide approach that can be applied to any part of the health care system, as well as across all levels of an organization. The ultimate endgame is a sustainable health care system that patients trust and that contributes to healthier populations.
Magbule Doko is a family physician in Windsor, Ontario, and an adjunct professor at The University of Western Ontario
School. Career. Children. Partner. Parents. Siblings. Being a Doctor. Getting Older. Turning 30. Teaching the next generation of doctors. Next step in my career. In-laws. Body. Health. Meditation. Having another baby. Trying to make the world a better place. Trying to understand who I am. Vacation time. Couple time. Debt. Income. Work. People living. People dying. Crying. New life. ...continue reading →
Amy Gajaria is a third year resident in the Department of Psychiatry at the University of Toronto
Last week was the first snowfall of the season in Toronto. Usually, the first sight of fluffy white flakes collecting on city streets would have me dreaming of strapping on my cross-country skis. This, year, however, the first snow left me huddled inside, frightened of slipping on ice.
Towards the end of September I badly damaged my ankle when attending a charity event. In a few moments I went from an active 30-something to someone unable to stand independently. After the paramedics got me to the nearest hospital, the first thing that popped out of my mouth was not “pain medication STAT” (that was the second thing), but instead “I’m a doctor. I hate being a patient.”
I later told myself that this was because I wanted to speed up communication and avoid unnecessary explanations. ...continue reading →
Dr. Sabine Ziegler is a general practitioner with an interest in palliative care, practising in Ettlingen, Germany
For readers from Canada, a "mother land" of physician health, my reflections on physician health in Germany may surprise; the structures in Germany are not nearly as well developed as in the USA, Canada or Great Britain.
Doctors in Germany can prescribe and self medicate without any consultation or assessment by a colleague- which means drug misuse, including benzodiazepines, is possible. Long working hours, high professional responsibility and little recreational time lead to a large percentage of doctors feeling physically and psychologically affected. On top of that is the constant confrontation with suffering, fear and death. Doctors also often crumple under the high demands they create for themselves. It doesn't fit with a doctor’s self-perception to seek help for their own problems. Yet when a sick healer tries to cure himself most of the time it doesn't work. Every year around 150 German physicians end their lives. ...continue reading →
Professor Dame Carol Black is Principal of Newnham College Cambridge, Expert Adviser on Health and Work to the Department of Health, England, Chair of the Nuffield Trust, and Chair of the Governance Board of the Centre for Workforce Intelligence. She was a keynote speaker at the recent International Conference on Physician Health
Whatever the nature of their work, whatever skills they bring to bear, however strong their calling and dedication, employees come under the influences of their workplace and of those who employ them. It is as true for doctors as it is for the drivers of tube trains, the builders of Olympic stadia or civil servants in Whitehall. The evidence, gathered painstakingly over many years, in such different arenas of work, is consistent and strong. It leaves no doubt about the characteristics that we look for in identifying good work and a good workplace.
The effects of workplace influences are felt and measured to varying degrees in ways that are clear. First is the personal health and wellbeing of employees – their physical health and their mental health, the former often measurable declared, the latter often masked and hidden.
Second is the performance of the group, the team, and ultimately the institution for which they work. In health care such performance is measured in terms of the quality of patient experience, the safety of care and health outcome.
These measures correlate with features common to organisations which have achieved success in promoting staff physical and mental health and well-being. ...continue reading →
Jonathan Tomlinson is a general practitioner in London, UK, and a NIHR In Practice Research Fellow at the Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry
Kate Granger, a young doctor with cancer, recently wrote a book called 'The Other side'. It's a book for doctors ‘to be better able to understand exactly what being the patient is really like …” Other medical writers have also been motivated by the shocking realisation that medical education and clinical practice had taught them so little about what it’s like to be a patient, the particular problems that doctors themselves have in coping with illness and the health risks associated with their profession; loss of identity, shame and stigma, the need to be treated as a person and an acute awareness of mistakes were common themes of narratives.
Inspired by their stories, I have been leading teaching seminars with medical students, GP trainees, GP trainers, GP retainers, medical humanities students and the public and learned a few more lessons along the way.
Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
“It was the loneliest I’ve ever felt,” said my consultant surgeon colleague as he described lying in his hospital bed the night before cardiac surgery. Even with all his surgical experience, familiarity of the surroundings, knowledge of his own hospital, and utmost confidence in his cardiac surgical colleagues and anaesthetist, he was scared. Despite what our patients might think, being a doctor is no defence against illness and doesn’t make coping with illness any easier.
But, we are our own worst enemies. We put immense pressure on ourselves and don’t want to let our medical colleagues or patients down. I once listened to a single-handed rural GP who had recent chest pain and was awaiting an angiogram. His greatest worry was that he could not get a locum to cover his patients ...continue reading →
People sometimes ask me whether doctors are any different from other people when it comes to their mental health. Do they suffer more or less? Do they have different disorders and distress? The truthful answer (as with so many human questions) is a bit like, “Yes and No”.
Of course doctors can have physical and mental health issues, but this fact is often hidden from public view. Mental suffering in particular is a clandestine experience, and disclosure is especially hazardous for doctors, since it adds professional jeopardy to their burden of shame and guilt.
Awareness of doctors as human beings with real personal problems and stresses is not widespread ...continue reading →
Trisha Greenhalgh is Professor of Primary Health Care and Dean for Research Impact at Barts and the London School of Medicine and Dentistry, London, UK
The Professor of Trauma Surgery texted me: “Can I come and see you today please?”
I had started work at 8 am and it was already 4.30 pm. I had four more meetings in my diary. But he had never asked before, so I decided it must be important. I texted back: “6.30 in my office, if you’re still around.”
He was early. I buzzed him in, and asked wearily, “How can I help?”. We overlapped on a committee so I assumed he wanted to talk business.
Dr Andrew Dunlop is a General Practitioner in Edinburgh, Scotland, UK
As a doctor, to be quite honest, I never really thought about how hearing loss would affect a person’s life, and certainly never thought of the impact of suddenly becoming severely deafened. I tended to think of hearing loss as a condition which rarely, but tragically either occurs in early childhood or more commonly affects the elderly.
My experience revealed to me that hearing loss can sometimes be sudden and profound.
As a middle-aged GP, in a comfortable suburban practice in Edinburgh, I had been used to being the health care provider and advocate for my patients. I was confident, positive, self-assured and a very social being.