Wellness Issues for Emergency Medicine Residents Jim Holliman

Wellness Issues for Emergency Medicine Residents Jim Holliman, M. D. , F. A. C. E. P. Professor of Military and Emergency Medicine Uniformed Services University of the Health Sciences Clinical Professor of Emergency Medicine George Washington University Bethesda, Maryland, U. S. A.

Wellness Issues for E. M. Residents Lecture Outline ŸGeneral importance of wellness considerations ŸWork scheduling ŸFamily interactions ŸOutside activities ŸPersonal health ŸSupport mechanisms

Wellness Issues for E. M. Residents Lecture Goals ŸFamiliarize E. M. residents with wellness issues ŸHelp individuals develop personal wellness plans and programs ŸPromote discussion of wellness issues

What is "wellness" ? ŸSame as "well-being" ŸPerson's state of being should be : Pleasing ƒ Desirable ƒ Appropriate ƒ Healthy ƒ ŸCannot be taken for granted but must be planned ŸGoal is to enable successful & comfortable coping with stresses

Stress Factors in E. M. Residency ŸIntense work environment ŸPatient demands & expectations ŸRisk of illness / injury ŸLong work hours ŸLimited time for family / recreation ŸSleep deprivation ŸCriticism by other specialties ŸPerception of lack of knowledge or confidence

Stress Factors on Residents from the E. D. Work Environment ŸTime pressure to see patients quickly ŸLarge numbers of patients ŸMust manage multiple simultaneous patients ŸOther concurrent work duties & demands Answering referral phone calls ƒ Answering paramedic radio calls ƒ Informing relatives & other physicians ƒ ŸUnpredictability of patient presentations

Types of Patients that Cause Stress for E. M. Residents ŸSeverely injured, especially children ƒ Disfigurement ŸMalodorous ŸVictims of deliberate harm ŸHostile ŸCombative ŸInappropriately demanding ŸPsychiatric

Coping with the Stress of Caring for the Severely Injured ŸFocus on providing care for the patient ŸInvolve other E. D. personnel as a team ŸTreat the patient's pain early ŸTry 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 ŸTry to find out the real reason for their hostility ƒ Often is due to fear or anxiety which can be addressed ŸExplain situation carefully & completely ŸInvolve the attending early ŸIf situation seems unsalvagable, then transfer care of patient to another resident

Coping with the Inappropriately Demanding Patient or Family ŸFirst : carefully explain the situation ŸSecond : find out what is really concerning the patient & address that ŸThird : have the attending speak to the patient ŸFourth : have a nurse or other non-physician re -explain things to the patient ŸFinally : don't allow yourself to do something inappropriate just to satisfy the patient or family

Coping with the Stress of Seeing Psychotic Psychiatric Patients ŸSee them only in a secure area or accompanied by other E. D. staff ŸUtilize sedative medication early after medical clearance ŸHave a plan in place for early involvement of psychiatrist and admission or transfer ŸDon't spend fruitless time trying to reason with the acutely psychotic patient

Coping Measures for General E. D. Workload Stress ŸTake a couple of short breaks out of sight of the patients ŸDon't skip meals ŸEnlist appropriate help of co-workers Obtain extra personnel if needed ƒ Call personnel in earlier ƒ

Measures for Dealing with the Stress of Patients Dying in the E. D. ŸResidents should have training in "deathtelling" from faculty ŸShould involve counselor, chaplain, or nurse to assist in talking to family ŸMay help to have conference afterward of all involved personnel to review case ŸResidents should have access to counselors themselves if needed ŸShould quickly focus on caring for the next patient

Coping with the Stress of Shift Work ŸE. M. physicians spend more time at night at work than most other physicians ƒ But have less on-call time and fewer unexpected work time demands ŸShould only have limited responsibilities for work or conferences on day following night duty ŸShould have at least 24 hours off after night shift before switching to day shift ŸShould ensure equitable distribution of night shifts among residents & faculty ŸShould allow night residents to sleep if not busy

Home Aspects of Coping with Night Shift Work ŸDon't drink too much coffee in the morning if planning to sleep ŸHave "breakfast" before going to bed ŸTry to ensure quiet sleeping area (turn phone off) ŸMake sleeping area as dark as possible (blackout curtains) ŸSleep till afternoon if in a series of night shifts ŸSet 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 Coworkers in the E. D. ŸShould have regular meetings where all personnel are invited to discuss problems ŸCritical Incident Stress Debriefing may be useful for groups involved in major incident ŸHelpful to have social events outside the hospital for staff several times per year ŸInteractive problems should initially be addressed in private

Improving Relations with Your Family or Significant Others ŸMost Important Principle : DON'T NEGLECT YOUR FAMILY ! ŸMust allocate sufficient dedicated time to family ŸHave family tour the E. D. so they know some of the work stresses you face ŸResident 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 ŸSet up rotating baby-sitting service ŸRotating evening "pot-luck" dinners ŸRegular group meetings for support ŸAttend hospital or department social functions

Importance of Personal Health and Well-Being ŸMaintaining one's personal health ensures greater enjoyment & efficiency at work ŸMaintain balanced diet Consider bringing food pre-prepared at home when on work duty ƒ Try to stick to regular meal schedule ƒ ŸRegular exercise ŸAvoid drugs, tobacco, & excessive alcohol ŸSufficient sleep ŸExtra rest or limit activity if infectious illness occurs

Key Method to Help Ensure Wellness : Make a Personal Schedule ŸVERY IMPORTANT to write out a general long term schedule & a more detailed short term (one month) schedule ŸTHEN STICK TO THE SCHEDULE ! ŸImportant to plan time for : Family ƒ Exercise ƒ Recreation / hobbies ƒ Social events ƒ Vacation ƒ Academic pursuits ƒ

Recommended Considerations for Your Personal Schedule ŸConsult your family or significant other for events significant for them ŸBe 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 ŸSchedule specific times for exercise

Importance of Developing Hobbies ŸDon't center your life around medicine only ŸShould develop interests outside medicine ŸI recommend pursuing at least one "indoor" and one "outdoor" hobby ƒ So if the weather happens to be bad on one's day off, the indoor hobby can be enjoyed ŸBest hobby choices are ones that can be shared by spouse, significant other, or family members ŸHobbies that create something can be the most rewarding

Indoor Hobbies to Consider ŸPainting / drawing / drafting ŸMusic ŸSewing ŸIndoor gardening ŸWoodworking ŸModel building ŸToy making ŸOther crafts ŸBoard games / computer games ŸFilm developing ŸCooking Ÿ Wine or beer making Note that watching TV or reading do not count as hobbies

Outdoor Hobbies to Consider ŸSports ŸGardening / landscaping ŸPhotography ŸHiking ŸCamping ŸSwimming ŸOutdoor toy building ŸBicycling ŸBoating / canoeing ŸTarget shooting / hunting ŸArchery ŸPaint ball

Other Activities to Consider Outside the Hospital ŸMust be careful with these to not interfere with time for family Youth counseling ƒ Sports team supervision ƒ Lecturing to students or the public ƒ Career advising for students ƒ Volunteer work with elders ƒ Political activism ƒ

Importance of Career Planning ŸShould establish & prioritize career goals ŸMake sure family or significant other has input into & understands your career goals ŸMust integrate financial planning ŸDiscuss with E. M. faculty ŸSet realistic goals ŸUpdate or change as needed

Establish a Personal Support System ŸPrearrange a "confidante" person to whom you can talk about any problem ƒ A person who understands stresses of medical career is best, but does not necessarily have to be a person in the medical field ŸE. M. faculty should arrange availability of other counselors as needed ŸMake sure confidentiality is assured

Helping Your Fellow E. M. Residents ŸShould have regular meetings of all the residents to discuss problems ŸShould maintain cooperative, rather than competitive, atmosphere in the residency ŸIf a resident shows signs of stress or work decompensation, other residents should encourage counseling and be extra supportive ŸAll residents should maintain willingness to make schedule changes and cover for times of illness for other residents

Options to Deal With Major Unresolved Stresses ŸDiscuss carefully with counselor first ŸTake a vacation ŸSwitch rotations with another resident ŸE. M. Program Director may grant a temporary reduced work schedule ŸTake on a new "distracting" project such as an academic project

Wellness Issues for E. M. Residents Summary ŸStick to a prearranged personal schedule ŸMaintain healthy lifestyle ŸDevote sufficient time to family ŸSet career goals ŸMaintain flexibility & helpfulness for other residents ŸUtilize personal support structure early for any major problems