Wellness Issues for Emergency Medicine Residents

Jim Holliman, M.D., F.A.C.E.P.Professor of Military and Emergency MedicineUniformed Services University of the Health SciencesClinical Professor of Emergency MedicineGeorge Washington UniversityBethesda, Maryland, U.S.A.

Wellness Issues for E.M. ResidentsLecture Outline

General importance of wellness considerationsWork schedulingFamily interactionsOutside activitiesPersonal healthSupport mechanisms

Wellness Issues for E.M. ResidentsLecture Goals

Familiarize E.M. residents with wellness issues

Help individuals develop personal wellness plans and programs

Promote discussion of wellness issues

What is "wellness" ?

Same as "well-being"Person's state of being should be :

ƒ Pleasingƒ Desirableƒ Appropriateƒ Healthy

Cannot be taken for granted but must be planned

Goal is to enable successful & comfortable coping with stresses

Stress Factors in E.M. Residency

Intense work environmentPatient demands & expectationsRisk of illness / injuryLong work hoursLimited time for family / recreationSleep deprivationCriticism by other specialtiesPerception of lack of knowledge or confidence

Stress Factors on Residents from the E.D. Work Environment

Time pressure to see patients quicklyLarge numbers of patientsMust manage multiple simultaneous patientsOther concurrent work duties & demands

ƒ Answering referral phone callsƒ Answering paramedic radio callsƒ Informing relatives & other physicians

Unpredictability of patient presentations

Types of Patients that Cause Stress for E.M. Residents

Severely injured, especially childrenƒ Disfigurement

MalodorousVictims of deliberate harmHostile CombativeInappropriately demandingPsychiatric

Coping with the Stress of Caring for the Severely Injured

Focus on providing care for the patientInvolve other E.D. personnel as a teamTreat the patient's pain earlyTry to see a mix of acute and minor cases (don't just see a continuous stream of severe cases only)

Coping with the Hostile Patient

Try to find out the real reason for their hostilityƒ Often is due to fear or anxiety which can be addressed

Explain situation carefully & completelyInvolve the attending earlyIf situation seems unsalvagable, then transfer care of patient to another resident

Coping with the Inappropriately Demanding Patient or Family

First : carefully explain the situationSecond : find out what is really concerning the patient & address that

Third : have the attending speak to the patientFourth : have a nurse or other non-physician re-explain things to the patient

Finally : don't allow yourself to do something inappropriate just to satisfy the patient or family

Coping with the Stress of Seeing Psychotic Psychiatric Patients

See them only in a secure area or accompanied by other E.D. staff

Utilize sedative medication early after medical clearance

Have a plan in place for early involvement of psychiatrist and admission or transfer

Don't spend fruitless time trying to reason with the acutely psychotic patient

Coping Measures for General E.D. Workload Stress

Take a couple of short breaks out of sight of the patients

Don't skip mealsEnlist appropriate help of co-workers

ƒ Obtain extra personnel if neededƒ Call personnel in earlier

Measures for Dealing with the Stress of Patients Dying in the E.D.

Residents should have training in "death-telling" from faculty

Should involve counselor, chaplain, or nurse to assist in talking to family

May help to have conference afterward of all involved personnel to review case

Residents should have access to counselors themselves if needed

Should quickly focus on caring for the next patient

Coping with the Stress of Shift Work

E.M. physicians spend more time at night at work than most other physiciansƒ But have less on-call time and fewer unexpected work time demands

Should only have limited responsibilities for work or conferences on day following night duty

Should have at least 24 hours off after night shift before switching to day shift

Should ensure equitable distribution of night shifts among residents & faculty

Should allow night residents to sleep if not busy

Home Aspects of Coping with Night Shift Work

Don't drink too much coffee in the morning if planning to sleep

Have "breakfast" before going to bedTry to ensure quiet sleeping area (turn phone off)

Make sleeping area as dark as possible (blackout curtains)

Sleep till afternoon if in a series of night shiftsSet alarm & wake by noon if finishing a single or series of night shifts to allow return to normal sleep schedule at night

Improving Relations with Co-workers in the E.D.

Should have regular meetings where all personnel are invited to discuss problems

Critical Incident Stress Debriefing may be useful for groups involved in major incident

Helpful to have social events outside the hospital for staff several times per year

Interactive problems should initially be addressed in private

Improving Relations with Your Family or Significant Others

Most Important Principle : DON'T NEGLECT YOUR FAMILY !

Must allocate sufficient dedicated time to family

Have family tour the E.D. so they know some of the work stresses you face

Resident families should get to know each other, communicate regularly, and agree to help each other out regularly

Methods for Residents' Families or Significant Others to Interact Supportively

Set up rotating baby-sitting serviceRotating evening "pot-luck" dinnersRegular group meetings for supportAttend hospital or department social functions

Importance of Personal Health and Well-Being

Maintaining one's personal health ensures greater enjoyment & efficiency at work

Maintain balanced dietƒ Consider bringing food pre-prepared at home when on work duty

ƒ Try to stick to regular meal scheduleRegular exerciseAvoid drugs, tobacco, & excessive alcoholSufficient sleepExtra rest or limit activity if infectious illness occurs

Key Method to Help Ensure Wellness : Make a Personal Schedule

VERY IMPORTANT to write out a general long term schedule & a more detailed short term (one month) schedule

THEN STICK TO THE SCHEDULE !Important to plan time for :

ƒ Familyƒ Exerciseƒ Recreation / hobbiesƒ Social eventsƒ Vacationƒ Academic pursuits

Recommended Considerations for Your Personal Schedule

Consult your family or significant other for events significant for them

Be flexible with your fellow residents to cover work duty to allow them to attend their important events so they will do the same for you

Schedule specific times for exercise

Importance of Developing Hobbies

Don't center your life around medicine onlyShould develop interests outside medicineI recommend pursuing at least one "indoor" and one "outdoor" hobbyƒ So if the weather happens to be bad on one's day off, the indoor hobby can be enjoyed

Best hobby choices are ones that can be shared by spouse, significant other, or family members

Hobbies that create something can be the most rewarding

Indoor Hobbies to ConsiderPainting / drawing / draftingMusicSewingIndoor gardeningWoodworkingModel buildingToy makingOther craftsBoard games / computer gamesFilm developingCooking Wine or beer making

Note that watching TVor reading do not countas hobbies

Outdoor Hobbies to Consider

SportsGardening / landscapingPhotographyHikingCampingSwimmingOutdoor toy buildingBicyclingBoating / canoeingTarget shooting / huntingArcheryPaint ball

Other Activities to Consider Outside the Hospital

Must be careful with these to not interfere with time for familyƒ Youth counselingƒ Sports team supervisionƒ Lecturing to students or the publicƒ Career advising for studentsƒ Volunteer work with eldersƒ Political activism

Importance of Career Planning

Should establish & prioritize career goalsMake sure family or significant other has input into & understands your career goals

Must integrate financial planningDiscuss with E.M. facultySet realistic goalsUpdate or change as needed

Establish a Personal Support System

Prearrange a "confidante" person to whom you can talk about any problemƒ A person who understands stresses of medical career is best, but does not necessarily have to be a person in the medical field

E.M. faculty should arrange availability of other counselors as needed

Make sure confidentiality is assured

Helping Your Fellow E.M. Residents

Should have regular meetings of all the residents to discuss problems

Should maintain cooperative, rather than competitive, atmosphere in the residency

If a resident shows signs of stress or work decompensation, other residents should encourage counseling and be extra supportive

All residents should maintain willingness to make schedule changes and cover for times of illness for other residents

Options to Deal With Major Unresolved Stresses

Discuss carefully with counselor firstTake a vacationSwitch rotations with another residentE.M. Program Director may grant a temporary reduced work schedule

Take on a new "distracting" project such as an academic project

Wellness Issues for E.M. ResidentsSummary

Stick to a prearranged personal scheduleMaintain healthy lifestyleDevote sufficient time to familySet career goalsMaintain flexibility & helpfulness for other residents

Utilize personal support structure early for any major problems