Wellness Section Newsletter - August 2010, Vol 14, #2
Wellness Section Meeting at Scientific Assembly
Make plans to attend the Wellness Section Meeting!
Wednesday, September 29, 2010
4:00 pm – 5:00 pm
Mariners A, Mandalay Bay Resort & Casino
Tentative Agenda Items:
- Greetings/opening statements/introduction of attendees
- Wellness booth/wellness activities update
- Update from the task force on the aging physician
- Building the section
-Outreach to young physicians
- Other issues
Come join your colleagues to discuss the issues most pertinent to physician wellness. If you are interested in running for office or have additional items to add to the agenda, please contact us.
Be sure to check the schedule on-site as meeting times and location could change.
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Edd D. Thomas MD, Editor
What follows is a brief introduction to the articles contained herein. It is my wish by doing this to aide your management of time in digesting the information and advice.
You can look to these introductory summaries as a method of familiarizing yourself with the expected content and be economical in your use of the time available to you at the moment. With all due respect to you our readers and the authors, please keep in mind this admonition. The editor does not imply any warranty of his skill in producing these summaries and one should not think less of the articles or their authors just due to my shortcomings in these verses.
My findings on this my second newsletter to produce as editor would not be complete without expressing an honest respect and appreciation of our Section Chair. During the crush to produce each newsletter I am always astounded at the width and breadth of Dr. Weichenthal’s understanding of the essence of wellness in life and the ED. Her residents and students are truly blessed as has been demonstrated by some of their contributions to our section’s newsletters.
Lastly it too often goes without saying but this Newsletter and so much much more would not have been possible without the seemingly endless skill, counsel, consoling, guidance and aid of Marilyn Bromley and her assistant Julie Williams of the ACEP staff.
Message from the Section Chair
The mysterious dance of life and death continues both in my work and in my home life.
A soulful rendering of the day to day life we live in and out of the ED.
Editorial on Wellness and Life in the ED
(Need a little pick me up? Take this link and turn up the volume: http://www.youtube.com/watch?v=X9wD-vv1sRU)
No really, take the link first. It will give some idea about the stranger who has hijacked your newsletter. This is an intro piece giving some of my own philosophy about wellness along with some honest to goodness pearls on interpersonal conflict management in and out of the ED. Who am I? For that you will have to read the last article in this newsletter.
Via Las Vegas!
Dr. Weichenthal shares some important wellness advice for dealing with the Scientific Assembly. She advises not just not on how to get the most of your experience there but also how to live the experience with an attitude of wellness.
Read up on Wellness
This is a review of the current wellness library of publications. These are from discussions on the Council of Emergency Medicine Residency Directors (CORD) Web Site. All of us, currently in training or with long experience in the practice of emergency medicine, would be wise to spend some time studying here.
Wellness Booth Update
A rundown of the services offered at the ACEP Member Wellness Booth this year.
Your New Editor, An Introduction
This is my attempt at saying hello and allowing the reader to come to know me in a way that otherwise would take years. This is proper since one’s make up, experiences in life and bias truly can affect the literary output of a newsletter.
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Message from the Section Chair
Lori Weichenthal, MD, FACEP
Greetings to you all.
I know that if you have chosen to be a member of the wellness section of ACEP, that you deal with in your own life about how to be well as a physician and a human being. Sometimes we are tempted to view these as separate endeavors but if we examine the issue of wellness carefully we know that they are not. As emergency physicians, we are just human beings who have the awesome experience of being present with other human beings as they deal with some of the most important moments of their lives, all while we are dealing with our own lives.
I am sitting down to write this piece after preparing dinner for my family and cleaning up afterward. I indulged by using a cleaning spray that is infused with lavender to clean my counters. In the ED, my experiences are frequently very odiferous so I enjoy the chance to indulge in pleasant smelling cleansers to clean my home. Such small acts remind me of my humanity and my need to maintain it. In a much more profound way, my experiences at work and in my personal life have reminded me of the fragility of life and how everything is about change and the dance between life and death.
This week in our ED, we managed a major multicasualty incident between a bus and a car. In the end there were many wounded, 4 seriously injured and 6 dead. Three of those deaths were young women at the beginning of their lives; the other three were older individuals. The families of these people are all still dealing with the profound grief of their loss. As a physician, I also feel their loss although in no way as intensely as the family and friends of these individuals do. I know that the other care providers in my department feel the loss too.
At the same time, I am dealing with personal losses in my own life. I come from a very small nuclear family consisting of my family, my sister’s family and my mother. My sister and her family are moving thousands of miles from me after a life time of being close together. It will be the first time in 43 years that I will be separated from my sister and her family. At the same time, my elderly mother will be moving close to me and I will assume responsibility for her care.
In this same week, our cousins son military vehicle was struck by a improvised bomb in Afghanistan , a close friend’s father died of complications of dementia, and we are currently waiting for a friend of ours to arrive at our home to stay so that he can visit his mother who fell this week and fractured our humerous and ribs. The mysterious dance of life and death continues both in my work and in my home life.
When I began my medical career, I bought into the idea of professional distance from the patient as a way to successfully deal with being a physician. However, the deeper I delve into life, the more I come to believe that this artificial separation is detrimental, both to me and my patients.
Yes, there is much I can offer to my patients and families regarding my medical expertise and experience. But, perhaps more powerful is my experience as a fellow human being on this road called life. Perhaps my willingness to meet with them on this road will help them to heal and also help me to heal as well.
I invite you all to share your own experiences on your journey via the web server or through the newsletter. For, in the end, we are all in this experience together.
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Edd D. Thomas, MD
Hello friends and fellow travelers along this, one of the paths “less travelled.” This life, in medicine, is an adventure which turns out to be somewhat complex and interactive with other parts of life. Most of us never expected this, those many years ago as we struggled over essays and interviews and long waits for that “acceptance” letter.
This editorial attempts to give some perspective to this edition of the newsletter. Also contained are some golden nuggets on interpersonal interactions that I have learned and still struggle with putting into practice. I guess that is just another of those reasons why medicine is a practice, not a simple trade.
My own experiences of life confirm that the mission of the Wellness Section is a vital one to our colleagues, both in and out of ACEP. What we share, learn and process together becomes not only a great gift to ourselves but to all those with whom we share this bounty.
Unfortunately, the devil is not only in the details but, with such spiritual matters, is also in the timing. The usual way in which we live our professional lives, such does not lend itself well to careful planning for “the moment.” The skillful manipulation of our daytimers, or whatever paper or electronic device you use for arranging your schedule, usually fails to make “the moment” appear. It is that moment that I hope we all are looking for in order to share this bounty we harvest as members of the Wellness Section.
What is “the moment?” My personal understanding of what I imply is to define that moment in time when we have the right thing to say to someone. Personally, I can remember far too many events where it was some time afterward, minutes to days, when I mentally kick myself what I said or didn’t say.
One method I will share in more detail in the future is what I call, named after the mentor who shared it with me, the Merseberger. This is for difficult interpersonal situations. It consists of a few simple steps not necessarily in this order. They are:
- A phrase that I have seen become more powerful than any other in negotiating a “situation.” “Help me understand.”
- “What are your concerns?”
- “What were you thinking when …?” (This must be said in a compassionate tone. WARNING- Be sure you have practiced this step with a confidant and really have yourself under control when using it.)
- “What were you feeling when …?”
- In times of anger, become QUIET. Do not unload. Criticism is NEVER to be given in anger. Do this in a completely confidential & private location.
- Practice using this phrase over and over again throughout this process, “Help me understand.”
- Leave your ego on the shelf. “Let others be stupid.” You are the adult and the leader, you are not permitted to be rash with patients or staff. Then go cash your paycheck and live life outside the ED.
An example to minimize these situations might be this: Perception as a major factor. Be proactive and be sure that the patient knows what they are being treated for. Be proactive and be sure that the staff knows the WHY. Many ED and life situations can be reduced or eliminated by these simple considerations to the Perception of the others involved.
Everyone you work with is dedicated to the task, as such they are always wanting to learn more. It goes without saying that one has to tailor this to the individual. My suggestion would be to learn a phrase or two for broaching the subject; eg, “Mrs. Johnson’s case reminds of one of my first cases of acute, decompenstated CHF. It was then that I learned the real meaning & value of understanding ………….”
Life inside and out of the ED might just be logical summation of our mission in the Wellness Section.
This edition of the Wellness Section newsletter is geared just toward that goal. What follows are some thought provoking articles on just that goal. Read with interest and know that the contributors are in this with you, this “road less traveled.” Please do not hesitate to write to our authors to discuss their insights or just to say thanks for the extra time they took out of their busy lives to create their article.
I have been asked to provide you with an introduction to who I am as your editor. This is right and proper since no one can pen a work without the influence of ones own experiences and bias. Such is included at the end of the newsletter.
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Via Las Vegas!
Lori Weichenthal, MD, FACEP
ACEP returns to the sunny city of Las Vegas! And although, this city is known more for inequity than for wellness, there are many options available for relaxation and reflection while you attend the ACEP conference in Sin City.
Wellness activities abound at the conference, perhaps most clearly represented by the Wellness Booth in the exhibit hall that is open from 9:30-3:30 daily. At the booth you can have your blood pressure checked, have basic blood chemistries drawn, participate in a wellness screen and receive information on how to lead a more balanced life.
There will also be a daily morning guided meditation available from 8-9 am in Shell Seekers B and a lunch time yoga session (12-1 pm) that will allow you to relax in the chaos of Scientific Assembly in Las Vegas. Alcoholics Anonymous and Narcotics Anonymous meetings will be available during the conference (Tuesday 6:30-7:30 am and Wednesday 6:30-7:30 am, respectively).
If you are not overwhelmed with meetings, we invite you to attend the Wellness Section meeting on Wednesday, September 29 from 4-5 pm.
Most of all we hope that you enjoy the city and the conference. The ACEP Scientific Assembly is a wonderful time to get together with colleagues and friends and to share experiences. Such interactions are vital to are wellness. If you need a little down time, the majority of hotels have spas and exercise faculties for your enjoyment.
Food options abound in Las Vegas and if you are looking for some healthy alternatives consider the café at the Canyon Ranch Spa in the Venetian or Spago in the Forum Shops at Caesar’s Palace. Of course, Las Vegas is all about indulging and there is much to say about that so don’t hesitate to enjoy all the variety of food that is available to you.
If you enjoy running or walking and are an early bird, I would recommend a jaunt on the strip. In the early morning, there is much to see and not much traffic. After 9 am, I would only recommend the journey for those who enjoy dodging pedestrian traffic.
Finally, if you have a car or access to one, I would recommend traveling out to Red Rock Canyon. It is only 20 miles from the Las Vegas Strip but you feel like you are a million miles away. There are places to walk, run and hike and awesome places to rock climb.
In all, Las Vegas should be a great place for us all to meet, greet, enjoy and reconnect with others and ourselves.
Hope to see you all there!
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Lori Weichenthal, MD, FACEP
There was a recent discussion on the Council of Emergency Medicine Residency Directors (CORD) Web Site www.cordem.org about wellness books for residents. As I read the emails, I totally agreed that these are great books for residents to read but I also think that they are great books for those of us further along in our careers to read or revisit. So, with great admiration to CORDEM, I list some of their recommended books for you to consider for the next time you have a few minutes and want to think about your career, calling and life.
Recommended books include:
- Oh, The Places You will Go
- The Tao of Pooh
- Seven Habits of Highly Effective People
- The Four Agreements
- All I Really Need to Know I Learned in Kindergarten
- The Alchemist
- The Last Lecture
- Tuesday’s With Morrie
- Working Knights
- The Medical Marriage
- How Doctor’s Think
- Care of the Soul of Medicine
Clearly, this is a partial list of many great books that can help you to reflect on your life and profession. Perhaps you can pick one up to read pool side in Las Vegas. And if you discover a new (or old one) that rocks your world, please share it with us.
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For ACEP Physician Members!
A $150.00 value – only $20.00 for ACEP physician members!
Admission tickets to the Wellness Booth may be obtained at the Scientific Assembly registration desk or at the ACEP Member Services Booth (within the ACEP Resource Center) in the Exhibit Hall at the Mandalay Bay Convention Center.
? Blood Chemistry Panel
? Hepatitis B Antibody or Hepatitis C Antibody or PSA or High Sensitivity CRP or TSH
? Flu and Tdap vaccines
? Body Composition Analysis
? Blood Pressure
? Burnout Survey
? Wellness Related Resource Materials
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Edd Thomas, MD
Where shall we begin? I was born ………. Naw. A little more recent perhaps.
As of this writing I may well be one of the older members of the Wellness Section. So, mind your elders!
No not that old. Greg Henry is far older than me… J at least he acts like it. By the way, if you have not read the article about Dr. Henry’s last ever ED shift in the March 9, 2010, issue of EP Monthly, http://www.epmonthly.com/columns/oh-henry/the-last-shift .....YOU SHOULD.
Why ACEP for a non-emergency medicine residency trained (EMRT) emergency physician? I am both a student of emergency medicine and one of the, as it was phrased so …. gracefully(?) at a council resolution committee meeting, one of the grandfathers of emergency medicine. So, I feel a deep need to continue to contribute to the profession, the art of emergency medicine. Since I am no longer permitted to teach emergency residents, as a non-ABEM, this gives me a bit of that missing gratification. “Grandfather” did not know about the grandfather clause until it had already closed. That was one of my failures for not already being in ACEP. Otherwise I would have known.
So, I joined ACEP in 1992. It also explains why I have been so active in the Certification and Workforce Section. I was one of those, huddled together at the Council meeting 2 years ago. We were a group charged with the pursuit of FACEP for all non-ABEM members. Our decision that day led to the final chapter in a very difficult and painful phase in the life of ACEP. So I voted with the majority to agree to the Georgia resolution which closed the FACEP pathway. The injustices still continue in discrimination in the workplace and academia. That is why we still exist as that section. We continue to lobby for those cast aside by new ED groups from places they have practiced for over 20 years.
In addition, we are now working for a sense of rationality in the workforce numbers problem. At present rates, there will never be enough EMRT’s to fill all ED positions. In the back of our minds is the very real fear for our fellow citizens who might have need of emergency services in areas where the EMRT’s refuse to work. That takes up a very hefty chunk of the United States. Stay tuned for efforts to revitalize a workforce of non-EMRT’s to staff those facilities, BUT to do it in such a way as to maximize the qualifications of those standing in the gap.
You should note, in relationship to Dr Bern’s letter on involvement at ACEP, it has given me an opening to all of the leadership; even the ones who opposed us at the Chicago council meeting. You should get involved. Attend Scientific Assembly but get there 3 days earlier and see how ACEP functions. If you have any desire to get involved, let me assure you the leadership of ACEP will help you right along. I found them all to be both understanding and willing to listen to any well formed idea for evolving ACEP and the practice of emergency medicine.
I have over 25 years in medicine, most of it as an emergency physician. I trained in family practice at one of the few Level 1 hospitals where we actually ran our own unit patients, did all of our own procedures and treated our own patients in the ED. Of course, were a far away comparison to the family practice programs in general that do not necessarily produce potential family practice physicians to practice emergency medicine. If I recall correctly I put in over 30 swan ganz catheters and delivered approximately 300 babies. So, not your usual family physician.
During my time I worked as attending in Level II facilities in Atlanta handling some of the most extreme trauma and medical cases. At one point I began and ran a critical care course for attending physicians in a Level III that functioned as a Level II, 55,000+ visits per year; trauma numbers were about 70% that of Grady Memorial Hospital with an inverse mix of penetrating vs blunt to that received at Grady. Still I would have at least one and usually 2 or 3 gunshot wounds’s to myself per shift.
After 9/11, I went back with the Army to help manage the ED at Fort Benning for 3 years. I really wanted to deploy and shoot some Al Qaeda’s, but the Army kept changing the age limit to deploy. Always raising it but 2 years too far for me to deploy. Now I could deploy but I am too much of a smartass for the hierarchy to put up with in present state of affairs. Instead, I joined the Georgia State Defense Force, drilling one weekend each month and running mock terrorist drills with SWAT and others, and a member of the GA DMAT G3, just have a lot of paperwork to finish in order to deploy. I am also the private practice medical representative to the GA Governors Advisory Committee on Pandemic events.
My previous life was as an engineer. No, wait, there were 5 years spent in construction quality control before I finished my BS at Georgia Tech, then I became an environmental & earth sciences engineer before there was such a title. All sorts of projects in clean up of hazardous sites to being the chemical & biohazards safety office at Emory Medical School and Georgia Tech in the early 1980’s.
Lots of disaster experience first hand, many medical mission trips to Africa, Romania, Siberia and Point Barrow, Alaska. I write two newsletters for disaster response groups and include my work in the Disaster Medicine Section at ACEP. I serve as medical director for several organizations who deploy short-term missions teams to, well, too many places to name.
In summary, I am a firebrand for justice, a smartass, a compassionate care giver in and out of emergency medicine and ………… a certified rugby coach with a high school team and assist at a major college.
Lastly, I am proud to serve in the Wellness Section in whatever capacity which I may assist.
Guess that is enough for now. Oh, I started and managed a 25 page quarterly magazine in medical school along with running the weekly newsletter. NOW, that is enough for now. See, told you it was far more than you wanted to know.
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This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.