Understanding and Cultivating Well-being for the Pediatrician: A compilation of the latest evidence in pediatrician well-being science

Preface
Acknowledgments
Contents
Part I: Introduction to Pediatrician Well-Being
	Chapter 1: Physician Well-Being Challenges: An Historical Perspective
		Introduction
		Part 1: The Foundation of Organized US Medicine
			Early Century Physician Factions Develop, Creating Divisions and Hierarchies
				Regular Physicians
				Homeopathic Physicians
				Eclectic Physicians
				Physician Factions Enabled Philosophical Divides and Hierarchies in Medicine
			Regulars Fuel Scientific Reductionism and Emotional Minimization
			Homeopaths and Eclectics Assimilate
		Part 2: The Influence of the Flexner Report (1910)
			Flexner and the Triple-Threat
			Flexner and Mind–Body Dualism in Medicine
		Part 3: Physician Leaders Cultivate Structural Inequities
			Impact of Gender Discrimination, Racism, and Ethnocentrism on Physician Well-Being
			Flexner and Inequities in Medicine
		Part 4: Foundational Shifts in Twentieth Century Healthcare
			Major Shifts in Public Trust of Medicine
				The Boom and the Bust in Twentieth Century Public Trust in Medicine
				Physicians Begin to Advocate for Patient-Centered Care but Mistrust Remained
				The Corporatization of Medicine
				Personalized Medicine
				The Electronic Health Record (EHR)
		Conclusions
		References
	Chapter 2: Defining and Conceptualizing Pediatrician Well-Being
		Part 1: What Is Well-Being?
			“Western” Medicine’s Conceptualization of Well-Being
			Key Issues in Current Well-Being Constructs
				The Diversity Problem
				The Individual and the Collective
				Critiques of Happiness
			Where Does Suffering Fit in?
			Toward a More Holistic and Inclusive Model of Well-Being
				The Ecologic System
				Equanimity
				Re-defining Self-Care
		Part 2: Pediatrician and Physician Well-Being
			The Evolution of Physician Well-being
		Part 3: A Model of Pediatrician Well-being
			Sources and Roots of Our Model
			Foundations of Well-Being
				Activities
				Identity
				Environment
					The System
					Physical Environment
					Psychosocial Environment: Culture and Climate
			Well-Being Domains
				Emotional and Psychological Well-Being
				Physical Well-Being
				Connection
				Meaning and Purpose
				Authenticity
		Conclusion
		References
Part II: Challenges to Pediatrician Well-Being
	Chapter 3: Acute and Chronic Illness in the Physician
		Some Herons
			My Story: The Diagnosis
				28 August 2017 10:00 AM
				20 September 2017 08:00 AM
				26 September 2017 12:00 PM
				27 September 2017 12:00 PM
		Illness in the Physician
			Barriers to Care
			Lack of Support for Physicians with Mental Illness
			Lack of Assistance for Identifying and Treatment of Substance Use Disorders in Physicians
			My Story: The Treatment
				October 2017
				8 October 2017–4 July 2018
		Paid Sick Leave and FMLA
			My Story: Working while in Treatment, Working while Ill
				1 March 2018
					My Morning Daily Meditation
		Burden of COVID
		Conclusion
			Still Here
			My Story: In Remission, Almost…
				12 Sep 2021
			My Story: My Mission Statement
		References
	Chapter 4: Importance of and Barriers to Preventive Health
		Introduction
			Physician Preventive Health
		General Health Status
			Summary of Published Data (Table 4.1)
			Association with Pediatrician Well-Being
		General Preventive Care in the Clinical Setting
			Summary of Published Data (Table 4.2)
			Association with Pediatrician Well-Being
			Barriers
		Nutrition
			Summary of Published Data (Table 4.3)
			Association with Pediatrician Well-Being
			Barriers
		Exercise
			Summary of Published Data (Table 4.4)
			Association with Pediatrician Well-Being
			Barriers
		Sleep
			Summary of Published Data (Table 4.5)
			Association with Pediatrician Well-Being
			Barriers
		AAP Pediatrician Life and Career Experience Study (PLACES)
			General Health Status and General Preventive Care in the Clinical Setting
			Exercise and Sleep
			Work–Life Balance
		Conclusion
		References
	Chapter 5: Substance Use Disorders and Recovery
		Introduction
		Epidemiology
			Substance Use in Medical Students
			Substance Use in Resident Physicians
			Substance Use in Pediatricians and Other Physicians
		Treatment and Recovery
			Physician Health Programs
		Substance Use Disorders and Pediatrician Well-Being
			Impact of Healthcare Culture
			Emotional and Psychological Well-Being
			Physical Health
			Connection
			Meaning and Purpose
			Authenticity
			Workplace Supports for Physicians with SUD
			Work–Life Integration
			Influence, Challenges, and Opportunities of Technology
		Conclusion
		References
	Chapter 6: Chronic Stress and Workload
		Understanding and Cultivating Pediatrician Well-Being
			What Is Stress? (An Evolving Understanding)
			Stress: Why Does It Matter?
				Eustress
				Negative Stress
			Stress and Our Health: The Mind–Body Connection
				The Effects of Cumulative Stress
			The Stress Response: Physiology
				Chronic Stress
			The Relaxation Response: An Antidote to Stress
			Understanding Workload
				Physician Work Demands Elaborated
			Physician Workload and Its Impact
				Work Out of Balance
				Job Control and Workload
			Work Resources, and Solutions
				The Electronic Health Record: A Complex Case of Demands and Resources
				On Efficiency
			Critical Steps in Systems Design to Optimize Physician Work for Well-Being
			Stress and Workload
		References
	Chapter 7: Physician Burnout
		Definition of Physician Burnout
		Epidemiology of Burnout
		Consequences of Burnout
		Drivers of Burnout
		Individual Drivers
		Systemic and Institutional Drivers
			Job Demands and Workplace Flexibility
			Leadership Behaviors
			Electronic Medical Record
			Other Factors
		Conclusions: Solutions and Strategies for Mitigating Burnout
		References
	Chapter 8: Moral Distress and Injury
		Moral Injury: Basic Concepts
			The Moral Injury of Healthcare
			The Origins of Moral Injury Theory
			Medical Community Embrace of the Moral Injury in Healthcare Concept
			Should Moral Injury and Burnout Be Considered Overlapping Concepts?
				Similarities in Healthcare Worker and War Veteran Personal Characteristics That May Pre-dispose to Moral Injury Symptomatology
				The Continuum Between Moral Distress and Moral Injury
			Evidence for the Impact of Moral Distress on Well-Being
				Moral Distress and Burnout
				Moral Injury and Burnout
				Impact of System, Organizational Factors, and Healthcare Culture on Moral Challenges and Physician Well-Being
				Moral Injury and the Coronavirus Pandemic
			Approaches to Mitigating Moral Distress and Injury
		Conclusion
		Moral Distress, Moral Challenges: Cases
		References
	Chapter 9: Challenges in Diversity, Equity, and Inclusion
		What Is Diversity, Equity, and Inclusion?
		Epidemiology and Construct of Diversity, Equity, and Inclusion
			Intersectionality
		Benefits of DEI Extend Beyond Minority Physicians Alone
		The Intersections of Health and Well-Being with Diversity, Equity, and Inclusion
		Epidemiology: Who Are Pediatricians in the USA?
			Race and Ethnicity in Medicine
			Gender and Gender Identity in Medicine
			Sexual Orientation in Medicine
		Physical, Emotional, and Psychological Well-Being
			Effects of Racism on Physical and Psychological Well-Being
			Bias, Discrimination, and Racism in Medicine
			Sexism and Gender-Based Discrimination in Medicine
			Sexual Orientation and Homophobia/Transphobia in Medicine
			Effects on Evaluation, Recognition, and Career Progression
			The Minority Tax
		Authenticity
			Professionalism
			Who Is Allowed To Feel?
		Connectedness
		Meaning and Purpose
		The Path Forward: Diversity, Equity, and Inclusion Are Foundational to Well-Being
		References
Part III: Fostering Pediatrician Well-Being
	Chapter 10: Emotional Resilience and Mindset
		Introduction
		Why Emotional Resilience and Mindset Matter
		Mindfulness
		Positive Psychology and Self-Compassion
		Dynamic (vs. Fixed) Mindsets
		Cultivating Caring Connection
		Leading for Resilience
		Conclusion
		References
	Chapter 11: Compassion, Meaning, and Purpose in Medicine
		Meaning and Purpose
		The Purpose of Medicine
		Compassion as a Source of Purpose
		Physician Well-Being and Compassion
		The Needs of Patients and Parents
		Where Does Compassion Come from?
		A Deeper Understanding of Compassion
		A Relaxed Mind Is a More Compassionate Mind
		Thoughts
		Meditation
		Six Qualities of Compassion
			Generosity
			Ethics
			Tolerance
			Perseverance
			Concentration
			Wisdom
		Managing Our Sense of Self
		Putting It All Together
		References
	Chapter 12: Social Connection and Belonging
		Introduction
			The Umbuntu of Medicine
		Social Connection and Belonging (SC&B) Definitions and Theory
		Social Connection and Belonging: Professional Attrition and Burnout
		Social Connection and Belonging: Professional Fulfillment and Satisfaction
		Peer Support Programs
		Role of Mentorship and Sponsorship
		Institutional Utilization of Mentorship and Sponsorship
		Effective Mentorship
		Mentorship Training
		Professional Medical Organizations
		Professional Medical Organizations: Women and Underrepresented Physicians in Medicine
		SC&B and Personal Well-Being
		SC&B and Personal Health Outcomes
		Challenges and Opportunities in Cultivating SC&B at Work
		SC&B Among UIM and Historically Excluded Groups
		Establishing and Nurturing a Pipeline of Underrepresented Students and Faculty
		Promoting Authenticity Among UIM and Historically Excluded Physicians
		SC&B and Impostor Syndrome
		Healthcare Culture/Systems/Organizations
		SC&B and the Electronic Health Record
		SC&B as an Institutional Financial Investment
		SC&B and Patient Interactions
		SC&B and Physical Spaces at Work
		Conclusions
		References
	Chapter 13: Spirituality and Well-Being
		History
			Chiron the Healer, an Origin Story for Physicians
			The Evolution of Spirituality and Medicine
			Cultural Beliefs Reinforce the Separation of Medicine and Spirituality
		Spirituality and Its Relationship to Spiritual Beliefs, Values, and Practices
			Spiritual Beliefs
			Spiritual Values
			Spiritual Practices
				Are Physicians Spiritual?
				Physician Spirituality Compared to That of the General Population
				How Does Physician Spirituality Compare Internationally?
		How Does Spirituality Influence Well-Being?
			Emotional and Psychological Well-Being
			Physical Well-Being
			Connection, Meaning and Purpose, and Authenticity
		Challenges to and Opportunities for Physicians’ Spiritual Well-Being
			Spiritual Well-Being Support for U.S. Physicians
			Final Thoughts: An Allegory of the Hospital Chapel
		Conclusion
		References
	Chapter 14: Arts and Humanities
		Introduction
		Setting the Stage and Developing a Framework
			Debunking Myths: Medicine Vs. the Arts and Humanities
			Breaking It Down: Definition of Medical Humanities [10]
			Establishing a Framework
		Delving Into the Arts and Humanities
			History of Medicine and Philosophy
				History of Medicine
				Philosophy of Medicine
			Visual Arts
			Narrative Medicine and Storytelling
			Poetry and Prose
			Music
			Theater Arts
		Incorporating Humanities into to Medicine: From Training to an Academic Niche
			Medical Humanities in Medical Education
			Medical Humanities Within an Academic Career
				Making It Count: How to “Academicise” Work in the Medical Humanities
				Research in the Medical Humanities
		Conclusion
		References
	Chapter 15: Values Alignment
		Why Is Values Alignment Important?
			Challenges to Pediatrician Values Alignment
		Values Alignment at the Individual (Micro) Level
			Interactions in Clinical Practice
			Conflict Between Personal and Work-Related Values
			Values Alignment in a Diversifying Pediatric Workforce
		Values Alignment at the Institutional (Meso) Level
			Administrative Burden in the Workplace
			Fixed Versus Flexible Work
			Constraints of Pediatric Practice
			Values Alignment and Wellness
			Inclusivity in the Workplace
		Values Alignment at the Structural (Macro) Level
			Cultural Differences in a Diversifying Workforce
			Values Alignment in Socio-Political Contexts
		Practical Opportunities and Solutions
		Conclusion
		References
Part IV: Bringing It All Together Through a Career
	Chapter 16: Developmental Milestones of a Career
		Introduction
		Professional Identity Formation
		Exploring Well-being Throughout the Career
		Early Career Pediatricians
			Professional Identity Formation for the Early Career Pediatrician
			Risk of “Survival Mentality”
			Work Schedule
			Academic Pressures
			Mentorship
			Imposter Syndrome
			Burnout
		Early Career Pediatrician Resources
			Internal Resources
				Emotional, Psychological, and Physical Well-Being
				Authenticity
			External Resources
				Connection at Work
				Workplace Flexibility
			Parenthood or Caregiving Outside of Work
				Unique Challenges of Parenting as a Pediatrician
				Fertility Challenges
				Parenting Newborns
				Additional Parenting Challenges
				Impact of Parent-identity on Professional Identity
				Resources for Pediatrician Parents
			Internal Resources
				Emotional and Psychological Well-Being
				Authenticity
			External Resources
				Psychological, Emotional, and Physical Well-Being
				Connection
			Mid-career Pediatricians
				Expanding One’s Niche
				Mid-career and Mentorship
				Unique Mid-career Challenges for Pediatrician Sub-populations
				Health Status
		Resources for Mid-Career Pediatricians
			Internal Resources
				Authenticity
			External Resources
				Connection
				Late Career and Retirement
				Physical Ailments and Outside Responsibilities
				Ageism
				Identity Shift Nearing Retirement
				Retirement Resources
			Internal Resources
				Creating a Professional Bucket List
				Emotional and Psychological Well-being
			External Resources
				Succession Planning
				Financial Security
				Social and Spiritual Support
		Conclusion
		References
	Chapter 17: Leveraging the Power of One’s Brand: How Applying a Marketing Framework Can Help You Thrive in Academics
		Identifying Your Personal Brand
		Leveraging Your Brand Sweet Spot in Academics
		Rebranding
		Going from Hobby to Academic Recognition
		Rejection Resilience and Academics
			Expecting Rejection
			Increasing Transparency
			Leveraging Mentorship
		References
	Chapter 18: Integrating Well-being into Pediatrician Culture and Practice
		Introduction
		Creating a Culture of Wellness
		The Importance of Culture for Pediatrician Well-Being
			Understanding the Culture of Medicine
			The Hidden Curriculum
		Recentering on the Core Values
			The Ethics of Self-Care
			Integrated Well-Being
		Challenging the System
			Culture and Values
			The Individual Approach to Fostering Wellness Within a Healthcare System
				Mentorship
				Professional Development
				Improving the Efficiency of Practice
			The Operational Approach to Fostering Wellness in a Healthcare System
				Leadership Training Programs
				Creating Norms and Expectations That Foster a Culture of Wellness
				Professional Development Programs
				Team Engagement, Celebration, and Reward Programs
				Service Recovery Programs
				Peer Support Programs
				Work Environments, Staffing, and Supporting Efficiency of Practice
		Personal Resilience
			Individual
			Work Unit
			Organization
			National
		Work-Life Harmony
		References
Index