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Dialogue: David DeMaso, MD, on the Office of Clinician Support

David DeMaso, MD

What is the Office of Clinician Support (OCS)?
It’Äôs a safe forum where clinicians can come to talk about any concern they might have, whether it’Äôs related to work, personal life or patient safety. When I say clinicians, I mean anyone who does clinical work with patients ’Äîphysicians, nurses, social workers, physical therapists’Äîthey are all welcome to come in.

How long has the OCS been around?
Let me give you a little background. About 15 years ago, the hospital asked me to run a formal program for residents and fellows, which began as the Office of Resident and Fellow Support. Then about five years ago, the Medical Staff Association asked me to expand the program to all physicians, which then became the Office of Physician Support (OPS).

A year ago, as part of the hospital’Äôs ongoing efforts to improve quality of care, I was asked to be the ombudsman for the hospital. Rather than developing a formal ombudsman office, I suggested that we expand what I was already doing with the OPS to include all clinicians. Therefore, we became the Office of Clinician Support.

What makes the OCS different than an ombudsman office?
There are aspects of the program that are very much like an ombudsman office, and there are parts that function more like an employee assistance program.

When I started the first formal program 15 years ago, I found that no physicians were using our regular employee assistance program. Yet during the first year, more than 20 physicians came forward and made contact with our office. Over time, much like an ombudsman office, physicians increasingly have come to use the program as a safe forum in which to voice their concerns, organize their thoughts and consider their options. Similar to an employee assistance program, physicians have also come for advice and assistance across the whole work-life balance spectrum.

Also, an ombudsman is supposed to be completely impartial, and since I work here at the hospital, I didn’Äôt feel like I could truly accomplish that. There’Äôs also the matter of confidentiality, and of course, we do emphasize confidentiality. Information is not shared unless it’Äôs an incredibly unusual circumstance, like a clinician who might harm himself, and even then, we would always let the person know if we needed to break their confidence.

What concerns lead people to the OCS?
We focus on a few different things: patient/family concerns, like helping families cope with the death of a patient; non-patient work concerns, like personality conflicts with other staff; and personal concerns, like compassion fatigue or burnout.

For example, a clinician may be up all night with a patient who passes away before the morning rounds. And at the morning work rounds, the death might not even be mentioned. I’Äôve had a number of clinicians talk about feeling numb or upset after a day like that. They may go home and want to talk about it with family or friends, but they find that people change the subject.

These are very common things that clinicians will acknowledge when they discuss the work experience. The key is to empower individuals to manage their own concerns.

How do you encourage clinicians to communicate their concerns?
We try to normalize open communication, making it a part of every day practice. Many clinicians have developed a ’Äúcode of silence’Äù in that there’Äôs a tendency to be altruistic when it comes to their patients and ignore their own suffering. So they generally don’Äôt seek outside support.

In the past year, I’Äôve tried to do a lot of staff education about the risk factors that are associated with caregiver distress. These talks center on helping clinicians understand the sources for the various stresses that they experience every day. From coping research, we know that self-understanding is a critical component in promoting resiliency to stress. Once understanding is in place, clinicians are better equipped to reduce their own specific areas of distress. We’Äôve found that if we reach out, we can actually make a difference in people’Äôs lives and help them cope a little bit better. It’Äôs also important to note, that the physicians who staff the OCS are at all levels’Äîsenior, mid-level and junior. So clinicians who want to voice concerns can choose whom to talk to.

How do you see the program evolving in the future?
It’Äôll really depend on the volume. Since the beginning, it’Äôs been steady, with people always coming in and out. And we’Äôve had a three-fold increase in participation since July 2003, when we opened the program to all clinicians. But it’Äôs hard to say if we’Äôll maintain that pace.

Ideally, I hope the program becomes a valuable resource, where people feel they can come to talk about things. And if there are trends where something needs to change here in the hospital, I hope this office will become a voice for that.

How can clinicians make an appointment?
They can call our coordinator, my office or any of the physicians who work with me in the OCS. They can also email us or even stop us in the hallway’Äîwhatever works best for them. We try to get back to people within 24 to 48 hours. We’Äôll even see people that same day, if necessary. Clinicians are seen for one to three sessions at no charge, with outside referrals as needed.

To make an appointment, contact any of the following OCS staff directly:

Kathryn Skitt, OCS coordinator, ext. 5-6705
David DeMaso, MD, OCS dir., ext. 5-6724
Jason Andrus, MD, ext. 5-6751
Lourival Baptista, MD, ext. 5-7989
Pamela Beasley, MD, ext. 5-2200