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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.
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Wellness Issues for E.M. ResidentsLecture Outline
General importance of wellness considerationsWork schedulingFamily interactionsOutside activitiesPersonal healthSupport mechanisms
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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
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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
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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
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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
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Types of Patients that Cause Stress for E.M. Residents
Severely injured, especially childrenƒ Disfigurement
MalodorousVictims of deliberate harmHostile CombativeInappropriately demandingPsychiatric
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Outdoor Hobbies to Consider
SportsGardening / landscapingPhotographyHikingCampingSwimmingOutdoor toy buildingBicyclingBoating / canoeingTarget shooting / huntingArcheryPaint ball
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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
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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
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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
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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
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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
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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