Wellness Section Newsletter - March 2008, Vol 12, #2
Can We Do it All?
Julia M. Huber, MD, FACEP
Can we do it all? Must we do it all? Many of us used to think so, and speaking personally, feel that this was a requirement to feel successful. The buzz word these days, however, is "balance." As I sit down to write this letter, a subcommittee of the wellness committee is preparing a brief statement on balance as it applies to the field of emergency medicine, specifically with regard to what Dr. Gloria Kuhn refers to as having "time for life events," whether it is pregnancy, family leave, personal sick leave, or taking time for caring for aging parents. How to make time for the natural events that take place over the course of one’s lifetime and career, regardless of one’s specialty?
ACEP president Linda L. Lawrence, MD, FACEP, is preparing a talk on this very topic, and has requested members’ input and anecdotes; likewise, the aforementioned subcommittee is seeking the same. If you have a story to tell or a specific take on how to balance, juggle or somehow manage your life as emergency physician, parent/family member, volunteer or other worker, please share it! You may email me at: firstname.lastname@example.org and I will forward your piece to both Dr. Lawrence and our section newsletter editor, Dr. Vicken Totten at Vicken.Totten@UHhospitals.org
Other section news includes the submission of two separate letters of intent for grants in the area of wellness. Dr. Vicken Totten (see below) has a proposal regarding an assessment of those who have worked long term in the field of emergency medicine. Those of you who attended the section meeting at SA in Seattle will also recall Dr. Shay Bintliff literally "blowing the whistle" on violence in emergency departments and passing around a bag of brightly colored whistles to do exactly that. Her letter of intent also outlines a similar program proposal. I will keep you all posted on the progress of these letters of intent. Section members need to be aware that there is indeed funding out there for small grants; keep this in mind for next year.
Finally, many thanks to those of you who responded to the questionnaire/needs assessment regarding a potential ‘parents-with-infants’ lounge.
American Association of Women Emergency Physicians (AAWEP) section chair Kathy Hall-Boyer, MD, FACEP and I will be passing on our suggestions to ACEP shortly, including a request for a small but well labeled area such as the first aid station to be used for infant care. We hope this is a proposal that seems workable for the convention organizers and we will keep you all updated regarding the feasibility of our suggestions.
As we clear out from under the debris of high winds and tornadoes here in Kentucky, I feel grateful that our family and neighbors are all safe and well. Nothing like a small natural disaster, a seeming imbalance of Mother Nature, to give one perspective. Best wishes for a happy and healthy spring!
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"He who has a why to live can endure almost any how." ~ Viktor Frankl
Vicken Totten, MD, FACEP
Few of us now living have endured a Nazi death camp like the Jewish German psychiatrist, Viktor Frankl, did. He wrote "Man’s Search for Meaning" after surviving the holocaust. His most quoted phrase is, "He who has a why to live can endure almost any how." John Grinder said, "Meaning is the contribution an organism makes to experience." "Meaning," or the ‘why’ of experience is the essence of a spiritual life. Infusing a sense of meaning, of purpose or of mission is one characteristic of an excellent leader. Physicians who thrive in our difficult environment often do so because they have a sense of mission. Having a "why" can make all the difference.
But what else can make that crucial difference?
The Wellness Section has embarked on an ambitious project. Some emergency physicians survive and thrive in their careers, and many of them do so in "less than optimal" work environments. Others burn out early and leave emergency medicine. Still others of us suffer cyclic burnout with recovery, a period of professional wellbeing, sometimes followed by another episode of burnout. The project we have embarked on is to identify the factors common to physicians who thrive during a long career in emergency medicine. Within the next year, you may be one of the lucky ones who will be surveyed. If not, you can still be part of this wellbeing project.
The working group has identified 3 domains of interest: Workplace characteristics; physician’s personal characteristics, and circadian issues. We invite members of the section to contribute factors to each of these domains. (Even new domains, if you wish!)
This issue of the Newsletter has an article on the Toxic Workplace by Dr. David F Baehren. In it, he explores some toxic workplace factors. As you read the article and think about it, you may notice other workplace factors that enhance or diminish workplace wellbeing. Please send them to the editor by email for potential inclusion in the survey. The address is email@example.com.
Next issue, Dr. Megan Fix will contribute an article on physician characteristics – those which help and hinder a long and satisfying career in emergency medicine. In the following issue, Dr. Vicken Totten (your humble editor) will discuss the contributions of circadian disruption and shift work on emergency physicians.
We want to incorporate as many of your ideas and suggestions as possible. Please write! Correspondence meant for newsletter inclusion may be edited for length and clarity.
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Beating the Toxic Workplace, "I know it when I see it"
David F. Baehren, MD, FACEP, Mitchell B. Cordover, MD
It’s no surprise to anyone that many workplaces (both in and out of the health care sector) are referred to as "toxic." Comic strips and television shows have won wide audiences poking fun at the toxic workplace. For those of us that have had to ride the waves in toxic ships, the laughter is bittersweet. These noxious workplaces are the source of quite a bit of angst for the entire health care team, doctors included. Toxic workplaces are places where the work environment is frustrating, isolating, and insensitive to our needs as professionals and as individuals with a life outside of medicine that it is almost impossible to maintain a sense of wellness working there. A toxic workplace can be threatening to our job security, capricious in the application of quality measures and so meddlesome that they can distract us from safe medical practice. These toxic workplaces rob Emergency Physicians of the underpinnings of job satisfaction that we need to withstand the inevitable natural stresses in our career.
The first step in detoxifying your department is to establish a vocabulary you can use to diagnose specific problems and address them. Supreme Court Justice Potter Stewart wrote that hard core pornography was hard to define but "I know it when I see it." The same could be said for the toxic workplace. But without being able to make concrete observations and suggestions, we are left with endless grumbling that result in no real improvement. As hard as it is to define, there are common factors that poison the hospital workplace. Those factors include a sense that promises made are not promises kept (Unreliability), Exclusion, Retaliation, Fear, Ingratitude, Privilege, Scheduling problems, Conflict, and Poor Leadership. The discussion to follow represents the extremes of these traits, and -- no one facility is guilty of all at once.
The underlying culture of many hospitals is the root cause. Devaluing the ED often starts at the top of the organization and flows downhill. However, many facilities are eager to use the ED to its full potential. They want a stable and committed staff and often understand the dangers and problems inherent to an unhappy crew. The practices described here would not be knowingly encouraged by a hospital administration that understands the full importance of the ED. Being able to discuss these factors in precise terms with your director and the hospital is often the way to start a willing change.
Characteristics of the toxic workplace and what to do about it:
Unreliability: Astute parents learn early on that if they don’t walk the walk, their children will do what they do, not what they say. The fastest way to have cynicism spread through an organization is for management to repeatedly say one thing and do another. The classic examples are when hospitals advertise a specific service and then fail to materially support the mission of that service or when they reassure us that they will solve a problem and fail to follow through.
The unfortunate consequences to wellness of this kind of administrative negligence are two-fold. First, the burden of delivering the new and much advertised service falls on the doctors and nurses on the front line, despite the failure of the hospital to staff up, get the needed equipment and space or change their budget priorities. The responsibility for us to provide care in 30 minutes or to provide special cardiac services somehow does not evaporate when the rest of the program does. More importantly, unreliable leadership leads to hopelessness and distrust. It is very hard to enjoy being invested in your work when you can’t trust what the leadership tells you. Cynicism about the administration leads to a cycle of withholding trust and effort, emotional disengagement from work and further cynicism.
Solution: It is self defeating to think of the hospital and ED leaders as deliberately or maliciously duplicitous. While some rare individuals are consciously trying to deceive you, in most cases, they are well-meaning and sincere. They may also be ill-informed, naïve, unrealistic, distracted, disorganized and a hundred other things that keep them from following through on their best intensions. Enforce follow-up by scheduling follow-up meetings or deadlines, and ensure that your advocate (eg, a colleague or your director) is part of the process. Agree to undertake new responsibilities stepwise as resources come on line. If the Chief knows there is a meeting coming up, he/she’ll feel obliged to so something, if only on the day of the meeting. The key here is that you WANT to have trust and they WANT you to. Make that a "clearly stated goal" of every new promise or change, especially if it has been a problem in the past.
The best director I ever worked with carried a little spiral note pad in his breast pocket. When asked about some issue. He would jot it down. Even if he had no good news, you could depend on him getting back to you. We never felt ignored or disenfranchised, even if we could not afford to fix the slit lamp or change to staffing ratio.
Exclusion: The desire to be valued and have our opinions or ideas considered is a universal trait. EDs that exclude the doctors "on the front lines" from the decision process and hospitals that treat the ED like an unwanted stepchild destroy enthusiasm for their programs and waste a valuable source of insight and innovation. At its worst, this is the repeated snubbing that wears doctors down to the point that there is less pain in saying you don’t give a d**n anymore. The tragedy is that the people who know the most about the physician’s part in the operation of the ED are the ones excluded. It is hardly surprising that in facilities like this there is an endless cycle of disappointment in the performance and enthusiasm for hospital programs on the part of the hospital, and resentment and passive-aggressive resistance on the part of the Emergency Department. Staff turnaround, use of serial contract groups or alternating between staffing models can lead to a kind of emotional divorce that makes working agony.
Solution: It is ironic that the ones who are most likely to complain about being excluded are the least likely to show up at the committee meeting. This may be because the hospital or department has been unreliable as discussed above, or due to despairing that there is any hope that we can affect things. But like any reconciliation, someone has to take the first step. Hospitals have working committees that have real authority. If the ED is treated like a step-child by the medical staff it is often because we are not participating on them. Moreover, most hospital administrators and VP’s know the value of buy-in by the people who will implement their plans. This is your opening. However, two words of caution are due: First there is a language barrier between clinicians and the business folks that make our venue a viable enterprise. "Improved care" is seen as "better marketing, fewer litigation costs, improved physician- base reputation and regulatory compliance" not as "work flow is smoother for the clinician." Learn to see their perspective and speak their tongue.
Retaliation: Mistakes are made every day. Every clinician makes them. The root of mistakes is more often the system, not the individual. Toxic hospitals and groups punish and shame the individual instead of seeking a systemic solution. Not only does the individual lose self-esteem and positive feelings for the institution, the problem is not addressed and the opportunity to make mistakes is perpetuated. If this goes on long enough, even the best physicians will be inappropriately labeled incompetent.
From the wellness perspective, this punitive approach is the worst way to handle quality matters. We already work in a high stress environment, and we are generally a group that puts high expectations on ourselves. It is a formula for emotional exhaustion and burnout to add shame and fear of embarrassment or being fired to that already volatile mix. The feeling that someone is watching over our shoulders for what in the end may or may not even be an error is degrading. If we are in error, we learn just as well from a supportive director/colleague informing us so, respectfully. All too often we are weighed down with the need to defend reasonable care or differences in style. It’s like living with a plaintiff’s attorney sitting on your shoulder. Are WE the enemy? Treat us that way and we will become just that!
Solution: This is something that must be addressed from the wellness point of view and by the group. Objecting to the method of quality improvement as an individual just looks defensive. Random-chart quality review that depends on a committee of doctors or nurses and that can assign "levels" of error based on the committee’s opinions is archaic, not required, and does not improve systems. That system should be replaced with processes that look at the group’s performance, or individuals compliance with a PRE ESTABLISHED measure. (eg, "did pneumonia patients get the agreed upon drugs in the agreed upon time?"). No threats, no worrying if someone is second-guessing your every decision; only compliance with evidence-based medicine or group achievement of goals. If we do individually mess up, it is a private discussion, hopefully with someone who can provide suggestions or remediation. All professional feedback should be filtered through an emergency doctor who can block out anything petty or naïve.
Pulling this off will sometimes mean changing committee procedures and occasionally whole cultures. It is time-consuming but definitely worth it! Start by meeting with, talking with and finally prevailing on your partners and then your director. Somebody has to be on or have influence over the CQI committee to make this happen. The non -physician QA staffers are often surprised to find how much they can hurt the morale of the department, so don’t be surprised if it takes several voices to convince that that the we really do take it personally. They certainly don’t mean it personally and that disconnect is one part of the problem!
Fear: Hospitals and Groups sometimes use fear to manipulate behavior. Managers may have the mistaken belief that fear improves compliance and efficiency. Fear has no place in the workplace. Fear creates maladaptive behaviors, limits cooperation and causes overall productivity to plummet. Most costly of all is that fear causes employees to withhold all discretionary effort. This means doing the minimum work will needed to avoid unpleasant consequences. Companies that use fear as an "incentive" then wonder why there is a problem with employee retention and loyalty?!
Such a company may threaten to bring in an outside (or a different outside) group, cut hours or pay, fire individuals, change directors or merge your department into another. How can you commit to your work under such uncertain and adversarial circumstances? The upshot is that the doctors won’t invest the time and emotional capital to improve things. Working with one eye out for another job will amplify your discontent (you will rationalize your internal decision to leave) and minimize your tolerance of what otherwise would be minor annoyances. In psychology experiments that induce depression in dogs by giving them small electric shocks associated at the sound of a buzzer, just giving them the buzzer works to depress them once the association is made.
Solution: This tactic is often not a widespread culture so much as somebody’s personal style. So step one is to access that person! Setting up a department meeting is far better than generating a letter, with is easily ignored or taken as threatening or as "a shot across the bow"—a declaration of WAR. Remember, you have something they want. A happy, co-operative ED crew leads to a happy medical staff and patient population. It is one less thing for harried administrators to worry about. Openly discussing what statements or activities are threatening can sometimes surprise a director or administrator, who had no real intention to destabilize his ED group. What is the administration trying to achieve? How much of that is within the power of the individual doctors? Places that rely on fear will fall back on fear as a strategy.
Do not face this person as an individual. They may just fire you! If you face them as a group, you are safer. Nobody wants to lose the entire ED staff! We have all seen it happen that the entire ED crew will plan to leave after the hospital announces some threat or change, only to have the administration come in all surprised and conciliatory. They claim they "had no idea..!" By then it is often too late and the well is poisoned (no pun intended to well-ness).
Ingratitude: Everyone loves praise. A doctor may say she is not looking for praise but you can bet it is appreciated when it’s received! Praise is a great motivator. Conversely, failure to recognize top performance is a subtle but quite powerful de-motivator. Hospitals that don’t spend time looking for praise-worthy behavior will soon find that there is waning interest from employees to do those things. People naturally want to believe in the mission of an organization and be part of the success. When an organization fails to openly value employees, motivation wanes. As a group that claims elevated social status on the basis of exclusive knowledge, we base much of our professional self-esteem on the opinion of our peers. Doctors generally are known to base a disproportionate amount of their overall self esteem on their professional identity.
Of course, hospitals don’t have a monopoly on bad culture. National, regional and local emergency groups can sap the energy out of a doctor as quickly as any hospital. If part time workers can "cherry pick" shifts, overtime is uncompensated, illness or family concerns are dismissed, ("Sure, but you’ll have to arrange your own coverage!") and no attention is paid to circadian disturbance, doctors will see little reciprocation for the many little sacrifices we make "for the team" and the ingratitude will cause us disengage, burnout, or leave.
Solution: Unlike some of the workplace toxins we’ve addressed here, a culture of mutual appreciation does not necessarily need a top down kind of solution. Like any of these challenges, openly and honestly discussing it helps. But each of us can praise our colleagues, our director and the non-physician staff. It doesn’t take many "nice work" and "thank you" comments to get this trend started. Complementing your medical director is a good object lesson. Responding well to appreciation encourages more of it. Maybe it shows how shallow we all are, but we will accept praise from anybody who we think understands what we do.
The other issues mentioned should be addressed. It is not that we have no forum to bring them up and they are fair game. All too often we allow gripes like "the part-timer schedules are better" slide. These gripes are part of a pattern that is making it seem like our job is taking heartless advantage of us. Alternatively, getting time off for important family events, (whether they are crises, joyous occasions, religious, or merely important to us) is should be a GROUP discussion about department POLICY. It should not be an individual begging for a favor. If wellness is to be an expectation in the workplace, accommodation of family like should be policy.
Privilege: In single owner groups everyone knows the arrangement. As long as the dictator is benevolent and compensation is reasonable, there is not too much complaining. In self-identified "democratic groups" there is an expectation of fair treatment. Problems arise when expectations and reality collide, such as when the democracy affords "more fairness" to a few at the top. If the financial arrangements are not transparent or reflect too steep a pyramid arrangement, then the de-motivating effects can be substantial.
Solution: Sometimes this problem evaporates with an open-minded inspection of the facts. We recently had some grumbling about an associate medical director getting an "unfair" number of day shifts. Some of us brought it up at a department meeting. It seems this person has a daily 7 am meeting, multiple day-time committees, calls disgruntled patients during business hours and has other commitments. When she went over the swing and night shifts she did work, only to come back or stay over to do her other work, it actually looked like she was working pretty hard. Nobody especially wanted her job. She makes extra money, but we did not want her to make less, even if we did want us to make more.
It certainly does happen that individuals take unfair advantage of their position. Two approaches have proved useful and can be used step wise. The evil twin of praise is not blame. It is shame. Letting your "privileged person" know that your see them doing something that is clearly unfair may shame them into at least mitigating their behavior. Grumbling among ourselves does nothing. People who treat themselves preferentially often have a strong internal rational for doing so. "I’m the director, aren’t I? I do a lot of additional things," or "I have seniority and that should be worth something." It would be unusual for someone to tell themselves "I’m in a position to be a complete prat and the lot of you can bugger off." So you can’t expect those with the ability to do so, to abandon all advantage. Still, shame commonly works.
If shame fails, the second approach is one we all learned in grade school. "Tell on them!" Everybody works for someone. If the medical director insists on abusing his position (eg, abandoning his part of the double coverage to do office work, thus double dipping, never working late shifts, or refusing to pitch in and work an empty shift), then complain to his department chief, regional medical director or the chief of staff. This can be done informally in the doctor’s lounge, but if it is to rise to the level where the person in authority is to put him/herself out, they will have to hear it from several people and understand that it is real threat to morale. Remember that the administration/group/division really wants the ED to run smoothly. If the next person up the pecking order will not engage, and the privileged person will not be embarrassed into more equalitarian behavior, you may have to decide how important this issue is to you. You do not want to poison your own attitude over someone else’s good luck, when your luck is acceptable enough. Again, it is best not to do this as an individual. Do it as a group with your colleagues. Then it isn’t just the "bad apple complaining again" but a generalized problem.
Schedule: This subject has two faces: circadian disruption and understaffing. Separately and together they make physicians want to "kill the messenger" and blame the schedule maker. Understaffing can erode enthusiasm because the workhorses feel the extra nights and weekends away from family are not rewarded. To add real injury to insult, an understaffed ED is subject to long waits, angry patients, an incessantly frantic pace and pressure for productivity from an unhappy administration. Stress upon stress!
Circadian disruption by itself causes depression. Entire books have been deservedly written about it. There is no issue that is a greater threat to our long term health and career longevity. Woe to the department that ignores what are now well-know rules about moving your rhythm forward, getting adequate time off to reset, working many or very few disruptive shifts and so on.
Solution: It is clear that adequate staffing is a balance between budget needs and revenue for a hospital department that can be a loss leader. The arguments against deepening the hospitals loss, or alternatively, reducing its profits with more staff are often heard and don’t carry much weight with the people whose backs are breaking under the load. Therefore, point out to administration that this list that includes patient satisfaction, reduced turnaround time, improved catchment-area, and admitting attending staff satisfaction they should add physician wellness. The stability and morale of the group is certainly worth as much as the rest of those items on the list.
This little article is not the place to offer advice about scheduling schemes. Dr. Cordover has been collecting them for years and would be glad to share his collection. From the point of view of the toxic workplace, however, there is an important point. A significant part of the dissatisfaction over the schedule can grow from a lack of control. I have recently joined a group where the monthly template is distributed and the doctors submit their scheduled days that they don’t want to work. There is a monthly meeting and the "revised" schedule is passed out with the holes showing. We chat about it. There and then people take responsibility for making a schedule. There are few switch backs and it is rare that we leave without the month covered. I don’t suggest that this will work everywhere, but the fact that we feel that we have control and we buy into the need to cover the shifts takes the sting out working too many weekends or the occasional overly long run of days. It is a tough schedule, but not a toxin in the workplace.
Conflict: Some say that some conflict is good for an organization. This is only true if disagreements are resolved dispassionately and don’t become personal attacks. Back biting and grudge holding poisons group harmony. Necessary dissent disappears over fears of personal retaliation.
Solution: We are here for the patients. It is a workplace. We are professionals.
Leadership: Weak leaders have problems retaining employees. Leaders with unrealistic expectations, poor communication skills, and limited emotional maturity don’t engender loyalty. The biggest threat to loyalty is failure to support a physician when behavior or patient care is called into question. Strong leadership can make even the most difficult workplace tolerable by keeping doctors engaged and making them feel respected. Infusing a sense of mission is a mark of leadership.
Solution: The ED is an inherently stressful place to work and good leadership is key. The feature that identifies the best leader is that he knows that you don’t work for him; he works for you! Protecting us from retaliation, making us know our efforts are appreciated, mediating conflict and the rest are all part of his/her job. The person of the leader can sometimes be the source of workplace toxicity, but luckily, leadership is not solely invested in that person.
There is a pattern in the solutions we offer here. First, significant leadership rests with YOU, the doc in the pit. It is there to be exercised. You don’t need to be invested with power to participate in the leadership of your workplace. The power rests in our ideas and in our willingness to get engaged in the cause of preserving our personal and workplace wellness. You and your colleagues as a group, can detoxify your workplace, even if the initiative does not arise from the current administration. While no director is without his/her strengths and weaknesses, the vast majority are deeply invested in making the department work well and are willing to work hard, especially if they can count on the support of their group.
The second important point is that physician wellness is an essential asset of your department. It at the heart of what you want for yourself and it is the prerequisite for what the facility wants from your department. It is a common interest for all parties. Maintaining wellness is an end in itself that can and should bring up in negotiating improvements in your situation.
When reliability, exclusion, retaliation, fear, and ingratitude infect the culture of any organization the cure is challenging but not impossible. Patience and willingness to become engaged on your part, and buy-in from those at the top are required for meaningful change. A ship begins to turn long after the decision to change course is made. Unless the leadership is willing to give the command to change course, however, the sailors will start counting the number of lifeboats on deck.
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Tips to De-stress
Reprinted with permission of Belleruth Naparstek, MA, LISW. You may access her website at www.healthjourneys.com
- Take Care of Your Body
Try to do all those things you know are good for your physical well being: get regular exercise; take it easy on the caffeine, sugar and alcohol; get enough sleep; eat healthy food-you know this stuff. This is the baseline of stress reduction.
- Track Your Physical Comfort
Take time to check in and see how your body is feeling. Once you notice, you can make small corrections to relieve discomfort before it takes over. Breathe into tight places; Stretch and move when your back or neck feels stiff; Look out the window when your eyes are straining at the computer screen; Massage your neck and press the accupoints when a headache is lurking-But you have to notice what’s amiss first.
- Learn to Relax at Will
Develop a regular practice to ground and relax you. If possible, start and end the day with guided imagery, yoga, meditation, relaxation, deep breathing, petting the cat in a rocking chair or listening to soothing music. Even five minutes, twice a day, will give you some protective ballast against the day’s stresses. And if you can’t manage this daily, do it whenever you can.
- Take a Mini-Break When You’re Getting Crazed
When you find yourself starting to lose it, or butting up against your own rigidity or circular thinking, take a quick break. Step away. Go to the bathroom. Go outside for a walk, do some guided imagery, play some music, call a loving friend or do a couple of yoga stretches. Five minutes of conscious AWOL can clear your mind and give you back your perspective, flexibility, and common sense.
- Dose Your Day with Humor
Humor, by its nature, provides instant distance, balance, and perspective, if even for a moment. As long as it’s not aimed at mocking others, it allows us to step back and take everything, including ourselves, less seriously. So, practice the art of finding the ludicrous, paradoxical, and nonsensical in daily events. And laughing itself is priceless. A belly laugh changes biochemistry and clears out emotional gunk like little else.
- Be Realistic & Know Your Limits
It’s a wonderful thing to know what you can and cannot do. Wrestle your perfectionism to the ground and don’t let the idealized expectations press you into doing more than you can realistically manage. Say no. Set limits. Work smart. This is especially important around holiday time, when trying too hard to do too much creates the exact opposite of the holiday feeling you’re striving for, and you morph into the cranky, resentful, martyred, overworked nightmare you swore you’d never be.
- Manage Your Time
A corollary is to try not to over-commit. If you do, make a list and prioritize. (Just getting these things out of your head and onto a piece of paper will reduce some stress.) If the list is out of control, look it over and assess what has to go-and then cancel, with apologies. Then tackle things you can finish, one at a time if at all possible. Work mindfully at it, and enjoy the satisfaction that comes with getting it done. Procrastination can be a terrible stressor.- We’re always aware of what we should be doing while we’re not doing it, and it’s a real joy-killer and energy-sapper. Do a piece of it and check that sucker off!
- When Scheduling, Give Yourself Room To Breathe
If you find yourself scheduling yourself with back to back meetings, consider the possibility that you’re an adrenaline junkie, running from appointment to appointment to feed your addiction. Leave time between things, to catch your breath, reflect on what’s next, acquaint yourself with a calmer class of neurohormones that return you to equilibrium. Once you get out of the habit of racing, you won’t be so eager to go back to it, I promise.
- Throw Something Out Every Day
Useless clutter is another low level, subliminal stress-producer. And we all know how quickly a clean surface can attract overwhelming piles of stuff. If you commit to throwing out one or two things a day, it really helps. And it you’re one of those people who need to see your papers spread around you as you work (I am), just contain the surface area you allot to this!
- Keep Asking Yourself If You’d Rather be Happy or Right
A lot of stress is generated-for ourselves and others-by our need to be right, show we’re right, prove we’re right. And really, so what if we establish we’re right? We cleanse our psychic pallet and de-gunk our day by letting go of any issue and moving on. Mind you, this is not the same as being a chump. It’s about taking care of ourselves, and therein lies right relationship, clear focus, and yes, happiness.
- Don’t Be Proud-Get Support When the Chips are Down
Sometimes talking things out with someone you trust will allow you to safely acknowledge your feelings, let off some steam, get away from circular thinking and rearrange your mislaid perspective. Sometimes friends even have helpful advice to give. Sometimes they actually stop us from doing something really dumb.
- Practice Staying in the Moment
By mindfully going about your day, putting your awareness into what you are doing at the moment, you will be using even mundane, everyday activities as the focus of meditation, and simple as it sounds, you will regain peace and balance. Yes, peeling potatoes can be a route to spiritual attainment and inner peace!
- Notice Little Moments of Beauty and Sweetness
This sounds hokey but it works. Notice beauty around you and take a moment to breathe it in…same with a smile, a gracious act, a loving gesture. Practicing gratitude for these lovely bits and pieces of daily life is a potent way to de-stress, and it’s contagious, too.
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ACEP Section Grant Process
Two letters of intent regarding Wellness were submitted. The topics are:
Characteristics of emergency physicians: the personal, chronobiologic and organizational characteristics of emergency physicians who are resistant to decompensated stress syndrome (burnout).
Preventing Violence in and Around the Emergency Department
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Future Wellness Booth Questions
The Wellness Booth continues to be one of the most visited booths at Scientific Assembly. Please see the current list of services below. There have been other services suggested or offered at the Wellness Booth in years past. The editor would like to hear from you about what you think should be offered.
Current Wellness Booth Services
- Flu shot
- Chemistry Panel – 26 items including lipid profile.
- Choice of one of the following lab tests:
- Hepatitis B antibody
- Hepatitis C antibody
- Blood pressure check
- Body fat measurement
- Maslach burnout inventory
- Wellness related materials
||Are there different services you feel should be offered at the Wellness Booth?
||Each year at the Wellness Booth, the Maslach Burnout Survey is available for members to complete. Would you like to see the aggregate data from the surveys published?
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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.