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Wellness Section Newsletter - May 2013

circle_arrowFrom the Editor - Wellness Section Newsletter, May 2013
circle_arrowA Webinar Series is Starting this Month - Wellness Section Newsletter, May 2013
circle_arrow“Heroes Need Not Apply” - Wellness Section Newsletter, May 2013
circle_arrowPositive Psychology - Wellness Section Newsletter, May 2013
circle_arrowPositive Psychology: Part 1 - A Primer - Wellness Section Newsletter, May 2013
circle_arrowOvernight Shift Work and the Effects on EPs - Wellness Section Newsletter, May 2013
circle_arrowWisconsin’s Apology Bill - Wellness Section Newsletter, May 2013
circle_arrowPhysician Support - Wellness Section Newsletter, May 2013
circle_arrowWellness Section Meeting Minutes from ACEP SA 2012 - Wellness Section Newsletter, May 2013

From the Editor - Wellness Section Newsletter, May 2013

LevinMay2013Randall M. Levin, MD, FACEP - Life Member

I want to take a moment to thank the section leadership for bestowing the honor of me being recently elected as the Wellness section newsletter editor. I have been a champion for healthcare team wellness through having physician leaders and hospital administration work together to help our colleagues “be there for themselves” so they can be there for their patients. After retiring from practice after 28 years, I continue to champion the cause of Wellness through my involvement with ACEP at the national level and at my own hospital system at local level.

I attended a Wellness Conference back in 1995 – Physician Heal Thyself (some of you may indeed remember the conference). It was a career altering moment for me, not because of the specific content and competency tools learned, but (besides seeing the hundreds in attendance) having the focus on our own wellness – it was okay to be questioning our sense of well-being (or un-well-being). It was a “safe” environment to talk about issues which we tended to avoid – out of sake of our own embarrassment or potential affects on our careers. We were so used to “caring” for others that we forgot to care for ourselves. We didn’t realize what affect it was having on not only ourselves, our families, our colleagues, but most importantly on our patients and at times their outcomes. We were never trained to be anything other than individual stoic care providers and at times relying on others was frowned upon by our mentors. Acknowledging our emotions or the effects of the medical professional environment on our emotion psyche and physical well-being was not considered a strong trait. At another Wellness conference (flavor of the day) back in 2005, I recall the keynote speaker, Arsenio Hall’s, comment as he told his “story.” “I am concerned about you all. I am concerned about you because if you do not take care of yourself, how are you going to be there (as an empathetic, compassionate, communicating care provider) to care for me (the patient).”

Yes, we know of the multiple studies which point to the benefits for a healthy body and mind (eat well, sleep well, meditate well), but what if we can’t. I would like to see this newsletter focus not only on “tips on staying healthy,” but more to the point, to be a source for reflection, open dialogue, mentoring, facilitating open communication on the reality of those “antigens” blocking our inner healing strengths and the reason we went into the medical field. I want to have this newsletter look at the root causes of un-wellness and burnout which resulted in up to 46% of our colleagues noting that they have symptoms of burnout in the recent Medscape survey summary article on lifestyles of the medical specialties and burnout. We can be partners and leaders for the changing world of medicine, the first step is to heal and promote wellness among ourselves.

Thank you and I look forward to your content, your guidance, your stories, your “healthy tips.”

A Webinar Series is Starting this Month - Wellness Section Newsletter, May 2013

Randall M. Levin, MD, FACEP

The CME Webinar is an 8 part series: Wellness for the Healthcare Team through Positive Psychology. Please take this link to find out more about it and to register. The series starts on May 13th. The speaker is Neil Farber, MD, PhD and he presented the article on Positive Psychology for our newsletter this month.

We will also be following the series with a live CME activity on Wellness and Preventing Burnout on Oct. 19th, 2013 in Madison, WI. One of my speakers and planning committee members for the Conference, Lucille Marchand, MD, BSN, forwarded this article to me. Not only does it speak to the subject of wellness as it relates to relationships, it lists some approaches and steps to take along with potential seminars which deal with this subject.

Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: A meta-analytic review. PLoS Med. 2010; 7(7):e1000316

“Heroes Need Not Apply” - Wellness Section Newsletter, May 2013

Randall M. Levin, MD, FACEP

I recently received this link to a radio blog show and I feel it is very interesting related to the topic of wellness for providers. Specifically, this one is called, “Heroes need not apply: A unique view on accountable culture.” It deals with our “roles” on the healthcare team in caring for the patient rather than being “heroes.”

I posted this comment in which I expanded on how the content was really closely interconnected to the sense of well-being of the provider:

Outstanding subject and presentation. There is a significant in between-the-line message which I "heard." Wellness of the healthcare team is directly related to moving from the Hero mindset to the how can we work together to meet not only the needs of our patients for positive patient outcome, but almost as important what we need to do to stay feeling connected to the reasons why we entered medicine. As a care provider I fully understand Dr Wong's seeing of the light when he mentioned that to become doctors today, we have to give something of ourselves up - the start of the downward spiral of an unhealthy approach to field of medicine. Ultimately, this leads to dissatisfaction with our "jobs," because the work environment does not support creating conditions for developing and nurturing our "roles" on the healthcare team. Patient outcomes and safety can be adversely affected (along with an ever increasing risk of malpractice litigation). Burnout is just around the corner and we lose those compassionate and empathetic care providers who we disparately need.
I agree with Dr. Wong, finding our individual "role" and supporting the environment to help support that role will create well-being for both the patient and the provider.

Positive Psychology - Wellness Section Newsletter, May 2013

Randall M. Levin, MD, FACEP

My colleague and friend, Neil Farber, MD PharmD, pediatric anesthesiologist, author, martial arts expert, and contributor to Psychology Today, has written an article for our newsletter. It will be split into two parts.

The first part sets the stage for understanding the positive psychology approach to our daily professional and personal lives. Part 2 will help empower the reader to be a champion for creating a healing work environment where one can stay connected to the reasons why they went into the practice of medicine, stay connected to the healthcare team and colleagues, and stay connected to the needs of their patients and outcomes.

The first part is called Positive Psychology: A Primer and it is presented below. Please watch for Part 2 - Creating a Positive Healthcare Environment, in a future issue.

Positive Psychology: Part 1 - A Primer - Wellness Section Newsletter, May 2013

Neil Elliott Farber, MD, PhD
Assoc. Prof, Anesthesiology, Pediatrics, and Pharmacology & Toxicology
Medical College of Wisconsin
Staff Anesthesiologist
Children’s Hospital of Wisconsin
9000 W. Wisconsin Ave, P.O. Box 1997
Milwaukee, Wisconsin 53201-1997
Email Dr. Farber

Our Declaration of Independence guarantees only our right to “the pursuit of happiness”. Achieving happiness for most of us has been more elusive. Emergency physicians, like most people, yearn for happiness. However, while the average physician has more money, a higher education, a better job, and more material goods than the average American, happiness research has shown that these things do not often result in greater happiness or life satisfaction. A lifestyle survey distributed from 1/12/12 to 1/27/12 to 292,251 physicians received responses from 29,025 physicians from 25 specialties. Emergency physicians rated their happiness outside of work as a 4.01 out of 5 (pretty happy).1 According to a Pew Report2 34% of Americans rated their happiness as “very happy” and 50% as “pretty happy.” Similarly, approximately one-third of physicians rated themselves as 5 out of 5 (very happy) and 40% rated 4 out of 5 (pretty happy). Good news - Emergency physicians were in the top 5 for how happy they are with their lives outside of medicine. Bad news – “pretty happy” isn’t where we want to be.

We must be concerned about more than just happiness; the other side of the coin, well known in emergency medicine is the concept of burnout. A recent study3 on burnout surveyed 7,288 physicians nationwide and compared them to 3,442 workers of the same age group in other fields. At least one symptom of serious burnout, such as emotional exhaustion, depersonalization and a low sense of personal accomplishment was reported by 45.8% of physicians. Compared with their non-physician cohorts, doctors had a higher risk of emotional exhaustion (32.1% versus 23.5%) and overall burnout (37.9% versus 27.8%). What will come as no surprise is the fact that emergency medicine physicians suffered among the highest rates of burnout. The reasons for this has been attributed to working long hours, time away from family, increased demand of seeing more patients with limited resources, the pressure to cut costs, and loss of autonomy.

How do we improve happiness scoring? How do we decrease the burnout rate? I believe that the answer to both of these questions lie in the concepts of positive psychology.

This article will provide background on positivity and Positive Psychology, what it is and why it is important to experience and incorporate into your life.

What is Positive Psychology?
Where psychology has traditionally focused on treating illness, problems, and pathology; Positive Psychology4 concentrates its efforts learning about optimum functioning and the benefits and impacts of happiness, optimism and positivity. It is the scientific study of what makes life worth living – the study of the strengths and virtues that enable individuals, organizations, and communities to flourish.

The psychology of happiness addresses the pleasant life - positive subjective experiences, the good life - positive values and virtues, and the meaningful life - positive goals and purposes. Happiness is a difficult to define, generic term, which in one sense can be referred to as subjective well-being.

Downside of Negativity
Whether it’s your own negativity or you are the recipient of a coworkers’, friends’, or family members’ negativity, over times, it saps your energy and motivation.5 Negativity results in psychological, emotional and physical ills such as stress, depression, anxiety, substance abuse, sleep disturbances, loss of appetite, headaches, stomach aches, ulcers, back and neck pains, inflammatory bowel disease, hypertension, and cardiac illnesses.6, 7

Negativity also leads to poor communication and conflicts disrupting social, work, and family life. Negative people are more likely to experience job turnover, sick leave, exhaustion, and decreased commitment to relationships, families, and jobs.8,9 Negativity also inhibits productive teamwork and hinders performance.

Persistent workplace negativity has profound deleterious effects on employee morale. It drains the energy of your hospital and diverts critical attention from high quality patient care.10 Negativity may be displayed in the thoughts, attitude, outlook, actions, and words of one department member, or may appear as a group of voices responding to a workplace decision or event.

The Role of Positive Emotions
The role of negative emotions, such as fear, continue the survival of our species by removing us from danger. The belief that positive emotions broaden people’s awareness while expanding their thoughts and actions is known as the Broaden and Build theory.11 Positive emotions help us survive by building our resources, making us more creative, curious, wiser, receptive, and social. Positivity and happiness aren’t just “nice;” they are functional and helpful. It is not just that having friends, a great job, and a successful marriage make you happy; being happy actually helps you make friends, get a great job, and have a successful marriage.

Benefits of Positivity
Positivity is associated with improved mental and psychological health, improved self-esteem and self-confidence, more optimism, and better resilience against challenges and obstacles.5,12

Positivity also reduces stress, anxiety, depression, blaming, complaining and learned helplessness (the feeling of lack of control). Further, positivity improves communication, reduces conflicts and improves all of our personal and professional relationships.5 Thus not surprisingly, greater positivity is associated with more successful marriages.5,12

Positivity predicts performance. Positive affect has beneficial effects on clinical problem solving,13 cognitive processes,14 altruism,15 and decreasing own-race biases.16

In terms of physical health, positivity improves sleep, enhances immune function; including gamma globulins, and natural killer cells, and reduces levels of stress-related hormones while raising levels of dopamine, endorphins, and growth-related hormones. Positivity lowers the risk of infections, reduces pain, diminishes inflammatory responses to stress, lowers blood pressure, and decreases the incidence of cardiac illness, diabetes, and stroke.5,17-19 Positivity also improves longevity. Studies demonstrate that people with positive emotions and self-perceptions live longer – up to ten years longer!20 These are greater health benefits than can be achieved by quitting smoking, drinking, controlling your cholesterol or losing weight.

As related to working, positive people are more productive and satisfied in their jobs; more creative, innovative and engaged at work, more motivated and optimistic.21 From a management and coworker point of view, combining better mental, emotional, and physical health with improved job engagement and satisfaction, and better relationships with fewer conflicts at work, produces less job turnover, sick leave, and absenteeism. Coworkers will then also have more energy and more work engagement. Encouraging individual positivity, autonomy, and engagement is an important component of positive organizational behavior and corporate success. Thus, many Fortune 500 companies screen potential employees for positivity characteristics and optimism.

Positivity Concepts

  • The Positivity Ratio: Positive to negative interaction ratios of 3:1 or greater are associated with flourishing companies, and successful relationships; while a ratio of 1:1 – neutral, is associated with floundering companies, unsuccessful businesses, and poor relationships.22,23 That means that for every negative emotional experience that you undergo, you are involved in at least three positive emotional experiences. Ratios of greater than 10:1 are also not favorable as it appears that important issues and concerns may not be addressed. Positive experiences are more than just faking a happy face. There is evidence that insincere positivity may also be hazardous to your health.24
  • Happiness: Where does happiness fit in? Happiness is a process. Happiness comes more often from doing than from having. Happiness is a vague term varying from physical pleasure to heartfelt positivity. Whereas positivity more specifically involves emotions such as gratitude, hope, interest, inspiration, joy, and forgiveness as well as virtues such as wisdom, courage, justice, humanity, temperance and spirituality. The term happiness is often replaced with subjective well-being in positive psychology research.
  • Hedonic Treadmill: We adapt. There are certainly things that occur or that we can attain that will make us happier or more depressed. In general, even substantial emotional changes such as winning the lottery or becoming paraplegic, soon dissipate and we go back to our personal baseline level of happiness. The continuous pursuit of being happy and keeping up with the Joneses is known as the hedonic treadmill.
  • Set Point: We each have our own baseline level of happiness. While we may experience emotional highs and lows, over time our level of happiness comes back to rest at our “set point.” This set point appears to be determined by both nature and nurture.
  • Genetic Predisposition: There is some genetic predisposition to our level of happiness. Identical twin studies suggest that the genetic component of personality traits such as happiness or optimism accounts for approximately a third to a half of the variation in happiness between people.25,26 More recently researchers have uncovered a specific genetic link to happiness. Two variants of the 5-HTT gene have been identified that influence how satisfied people are with their lot in life.26 This gene is involved with serotonin transport and longer gene variants are associated with more efficient release and reuptake of serotonin. Those born with two long versions of the gene were more likely to label themselves as “very satisfied” with life than those who inherited two short versions. Of the 40% of subjects who said that they were “very satisfied” with life, 35.4% had two long variants of the gene and 19.1% had two short variants. Of those who were “dissatisfied” with life, 20% had two long variants and 26.2% had two short versions. This indicates a slight over-representation of the long gene variant in happier people. The author’s estimate that having one long version of the gene increased the number of people claiming to be “very satisfied” with life by approximately 8.5%, and two long versions raised the number by 17.3%. Headeya et al.25 has demonstrated that there is a significant “nurture” component to life satisfaction and that people can slowly improve their level of happiness – arguing against the set-point theory.
  • Not just a result: Positivity doesn’t just reflect health and success; it actually helps produce health and success.12 Thus, positivity has far reaching beneficial consequences. It’s not just that successful people are more positive; more positive individuals are also more successful.
  • Want what you have: Our goal should not be simply to have everything that we want. It is even more important that we want everything that we have.
  • Contagious: Positivity spreads from person-to-person. Thus, the adage, hang out with happy people.
  • Mindfulness and Savoring: Mindfulness is the action of being aware and present at all times in an open-minded, and non-judgmental fashion. Savoring is similar, although it involves an appreciative attentiveness with a focus on finding the positive.
  • Flow: Similar to “being in the zone”. Actively engaging in an activity for which you have passion and skills.
  • Signature strengths: In contrast to the DSM4 for psychopathology, positive psychology focuses on strength and virtues. Using your top five strengths (signature strengths) in new, unique ways,27 has been shown to result in long term increases in happiness and decreases in depression scores.
  • Gratitude: Focusing on three good things that happen each day has been demonstrated to result in improved happiness scores and lower depression scores.27
  • Learned Optimism: While there exists some genetic component to optimism, it is still a predominantly learned trait that is associated with better job performance and career and life satisfaction. Integral in learned optimism is “positive self-talk.” This is not the same as repeating positive mantras, but rather positively altering your beliefs.
  • Resilience: Possessing a resilient personality trait is associated with greater positivity. Resilience is also associated with “bouncing back” more quickly after a psychological or physical stress.
  • Social Beings: We are social beings and relationships are critical factors in our positivity. In a recent meta-analysis, positive, stronger relationships are associated with a 50% increased likelihood of survival.28
  • Positive Organizations: Organizational behavior is also critical to supporting positive individuals.

Positivity Part II will focus on how emergency physicians can bring positivity into the healthcare setting to achieve these positive benefits for themselves and their patients. Look for it in an upcoming issue of the ACEP Wellness Section Newsletter.

1. Peckham C: Medscape Physician Lifestyle Report: 2012 Results. Published online:
2. Pew Research Center. Are we happy yet? February 13, 2006.
3. Shanafelt TD, Boone S, Tan L,et al. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern
Med. 2012;172(18):1377-1385.
4. Seligman MEP, Csikszentmihalyi M. Positive Psychology: An Introduction. American Psychologist. 2000; 55 (1): 5-14.
5. Fredrickson B. Positivity. New York, NY: Crown Publishers; 2009.
6. László KD, Janszky I, Ahnve S. Anger expression and prognosis after a coronary event in women. Int J Cardiol. 2010;140(1): 60-5.
7. Thomsen DK, Mehlsen MY, Hokland M,et al. Negative Thoughts and Health: Associations Among Rumination, Immunity, and Health Care Utilization in a Young
    and Elderly Sample. Psychosoma Med, 2004; 66(3): 749-756.
8. Kijkara M, vanDierendock D, Evers A, et al. Conflict and well-being at work: the moderating role of personality. J Manage Psychol, 2005: 20: 87-104.
9. Giebels E, Janssen O. Conflict stress and reduced well-being at work: The buffering effect on third-party help. Eur J Work Organ Psy 2005; 14: 137-155.
10. Gawande A, Zinner MJ, Studdert DM, et al. Analysis of errors reported by surgeons at three teaching hospitals. Surgery, 2003; 133: 614-621.
11. Fredrickson B. The role of positive emotions in positive psychology: The broaden-and-build theory. American Psychologist. 2001; 56:218-226.
12. Lyubomirsky S, King L, Diener E. The benefits of frequent positive affect: Does happiness lead to success? Psychological Bulletin. 2005; 131:803-855.
13. Isen AM, Rosenzweig AS, Young MJ. The influence of positive affect on clinical problem solving. Medical Decision Making. 1991; 11: 221-27.
14. Isen AM. Positive affect, cognitive processes, and social behavior. Adv Experimental Social Psychology. 1987; 20: 203-53.
15. Isen AM, Levin PF. Effect of feeling good on helping: Cookies and kindness. J Personality and Social Psychology. 1972; 21: 384-88.
16. Johnson KJ, Fredrickson BL: Positive emotions eliminate the own-race bias in face perception. Psychological Science. 2005; 16: 875-81.
17. Tugade MM, Fredrickson BL, Feldman Barrett L. Psychological resilience and positive emotional granularity: Examining the benefits of positive emotions on
      coping and health. J Personality. 2004; 72: 1161-90.
18. Cohen S, Doyle WJ, Turner RB, et al. Emotional style and susceptibility to the common cold. Psychosomatic Med. 2003; 65: 652-57.
19. Richman LS, Kubzansky L, Maselko J, et al. Positive emotion and health: Going beyond the negative. Health Psychol. 2005; 24: 422-29.
20. Danner DD, Snowdon DA, Friesen WV. Positive emotions in early life and longevity: Findings from the nun study. J Personal and Soc Psychol. 2001; 83:261-
21. Diener E, Nickerson C, Lucas RE, et al. Dispositional affect and job outcomes. Social Indicators Research. 2002; 59: 229-59.
22. Losada M, Heaphy E. The role of positivity and connectivity in the performance of business teams: A nonlinear dynamics model. Am Behavioral Scientist. 2004;
      47: 740-65.
23. Fredrickson BL, Losada MF. Positive affect and the complex dynamics of human flourishing. American Psychologist. 2005; 60: 678-86.
24. Rosenberg EL, Ekman P, Jiang W, et al. Linkages between facial expressions of anger and transient myocardial ischemia in men with coronary artery disease. 
      Emotion. 2001; 1: 107-15.
25. Headeya B, Muffelsb R, Wagnerc GG. Long-running German panel survey shows that personal and economic choices, not just genes, matter for happiness.
      PNAS. 2010; 107: 17922-26.
26. De Neve J-E, Fowler JH, Christakis NA, et al. Genes, economics, and happiness. J Neuroscience, Psychology, and Economics. 2012; 5(4): 193–211.
27. Seligman ME, Steen PT. Positive psychology progress: Empirical validation of interventions. American Psychologist. 2005; 60:410-421.
28. Holt-Lunstad J, Smith TB, Layton JB. Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 2010; 7(7): e1000316.

Overnight Shift Work and the Effects on EPs - Wellness Section Newsletter, May 2013

Ernest Wang, MD, FACEP

Have you ever heard a patient who returned to the ED with worsening symptoms labeled as "non-compliant" because they did not take their medications?

I recently bumped into a colleague at the hospital as she was on her way out the door. She had come in the morning to do some administrative work and was now heading home - she was coming back for her night shift that night.

"Are you going to take a nap?" I asked her, as I ask many of my colleagues, nursing/staff co-workers, residents, and students.
"No, I can never sleep before a night shift, and the kids keep me up too," she replied.

This is an all too common answer to a real serious problem. How do we, as emergency care providers who have to be awake, alert, and empathetic, during a busy night shift, do so if we do not take the drug that will most affect our performance - SLEEP?

How do we manage the other parts of our lives (family, friends, administrative work, etc.) when we have to get ready for a night shift? Someone has to take care of the kids. I know, I have four. And my spouse is an emergency physician too!

We all have heard the statistics about the deleterious effects of sleep deprivation on the body - drowsiness, impaired critical thinking, increased risk of: stroke, hypertension, MI, diabetes, decreased sex drive, weight gain, and early risk death ( These are intuitively obvious to most of us in the health profession. But I would argue that the majority of us are partially or mostly "non-compliant" with our "med" on a regular basis.

Sure I've done it too - packing in a meeting or two during the day before the night shift, attending family obligations (out of want as much as out of guilt). But the funny thing is that, while on the shift, I've never said to myself, "Boy, I'm really glad I went to that meeting this morning!"

So what are some real "sleep game-changers" that will improve your health, your attitude, and your performance in the ED?:

1) Don't schedule meetings before the night shift. I made a conscious decision years ago to never go in to the office or do any type of administrative/teaching/writing work during the day. On the rare occasion that I violate this rule, I regret it every time. If your boss cares about you as a person, she/he will understand. If you are the boss and you don't do this, you are setting a bad example for your colleagues.

2) Keep family obligations to a minimum. Get a babysitter, moms and dads! I know this is hard - very hard - at times. But if you spend the whole day driving the kids to activities, etc., you'll be overtired. My wife and I take turns handling childcare responsibilities and we have a full-time help so that we do not take care of the kids on days we have to work nights. The kids will be there tomorrow, and they'll appreciate it more if you're awake and not cranky when you are with them.

3) Exercise and then take a nap. In March 2013, The National Sleep Foundation reported that exercisers slept better and deeper ( As such, "The National Sleep Foundation has amended its sleep recommendations for “normal” sleepers to encourage exercise without any caveat to time of day as long as it’s not at the expense of sleep." You don't have to go out and run a marathon. But I promise you, if you do some type of moderate to vigorous exercise, break a sweat, take a hot shower, and go to bed in a dark room, you will awaken refreshed and ready for the night.

These three suggestions are simple and effective, but not always easy. It does take personal commitment and discipline to do them routinely, but once you start doing them, they become, well, routine.

If you follow this prescription, I guarantee that you'll feel better about yourself, be healthier, have less anxiety about going to work, drink less coffee to stay awake, and consume less alcohol or sleep aids to fall asleep. It will make work more enjoyable because you'll be better able to empathize with patients and you'll make better clinical decisions.

And you'll recover better so that when you spend time with your family and friends, you'll be mentally "there" and awake to enjoy it. And isn't that what it's all about anyway?


Editor’s Note:

This is an important topic especially as we "become more mature" - older.

The way I dealt with this issue was I actually built a two story shed in my back yard. It initially was built for a playhouse on top of a storage shed, but I realized that for me to deal with the night shifts, I had to separate myself from "reality" for a few hours before I went to the overnight shift. I turned the playhouse into a larger room 10 x 15 feet, put in electricity, oil base-board heater, and a phone line. Since I built the structure by myself, just being involved in the building allowed me to "relax" and get involved with something that I really like to do - build (an outside activity which helps to deal with the issues of work-place stresses and career). So, I would go to “my up Northwood’s cabin” on the south side of my lot, gazing out at the trees lining my lot, to escape (mentally and physically) before a night shift. This allowed me the ability to fall asleep and was only awoken by my radio alarm or my family member coming to awaken me if I had to be called in early.

I agree with your approach and recommendations. We also had variable schedule made out a month at a time. We didn't have 4 overnight shifts in a row (I know that there are a number of docs (and groups) which do that, but for me I knew that the next day I would be off and free to “recover” - again mentally preparing myself to an off day (like a vacation day), even before I went into work. This helped me deal with the shift. All of this was related to allowing me to break away from the “anticipation anxiety of not sleeping that night” and “well, if I am off the next day” I can get through the night. All of this was most important to my well-being during my mid to later practice years when our resilience begins to falter.

I know each physician is different and deals with the night shift differently, but I know for some colleagues it would put a stress on their personal and professional lives. Some would work a whole month of night shifts, which allowed them to be off night shifts for the rest of the year, but during that month, you couldn't talk to them or deal with them. I am sure someone will quote an article about the “best way” to work the night shift, but in reality it boils down to the individual physician and group doing what is best for them. The problem occurs when the group’s dynamics or work environment does not allow for variability for the doctor to find what is best for them individually.

Thank you
Randall M. Levin, MD, FACEP

Wisconsin’s Apology Bill - Wellness Section Newsletter, May 2013

Randall M. Levin, MD, FACEP

I’ve included a link to an article related to supporting a bill which would protect physicians’ conversations with patients and/or families when there are bad outcomes. It would allow communication (not take away the plaintiffs rights). Studies show that communication efforts can help lessen subsequent lawsuits – an obvious factor in increasing stress and burnout among physicians. The article is here.

Several other state legislatures have considered similar bills: Arkansas, Indiana, Kansas, Massachusetts, Michigan, Montana, Pennsylvania, and Rhode Island.

Physician Support - Wellness Section Newsletter, May 2013

Randall M. Levin, MD, FACEP

We are all too familiar with the common approach to “good medicine, bad outcomes” and “bad medicine, bad outcomes” as it relates to clinicians. We are also familiar with the effects on our emotional well-being. Unfortunately, the lack of proactive support available to clinicians is a common finding. We would like to be able to offer links to programs which may help you champion proactive support for yourself and your colleagues at your facility. One such approach is found with Medical Induced Trauma Support Services (MITSS).

MITSS is a non-profit organization founded in June of 2002 whose mission is “To Support Healing and Restore Hope” to patients, families, and clinicians who have been affected by an adverse medical event. They define medically induced trauma as an unexpected outcome that occurs during medical and/or surgical care.

MITSS Toolkit
MITSS created this site in order to share tools that have been developed in pursuit of their mission. These documents are accessible and available for anyone interested and it’s their hope that healthcare organizations, patients, families, and clinicians may find the information useful.

Clinician Support Toolkit for Healthcare

MITSS Organizational Assessment Tool for Clinician Support

Wellness Section Meeting Minutes from ACEP SA 2012 - Wellness Section Newsletter, May 2013

Wellness Section Meeting
October 9, 2012
4:00 pm – 5:30 pm
Hyatt Regency Denver (HQ Hotel)
Capitol 1, 4th Level


Fourteen members were present for all or part of the meeting and included: Lori Weichenthal, MD, FACEP, Chair; Alex Rosenau, DO, CPE, FACEP, president –elect; Jay Kaplan, MD, FACEP; and ACEP Staff, Rhonda Whitson and Marilyn Bromley, Staff Liaison.

Compassion Fatigue Presentation

Major Points Discussed
Dr. Weichenthal welcomed everyone to the meeting. Dr. Weichenthal did a presentation titled, “Compassion Fatigue.” This presentation included group participation. The audience was asked to think about: what gives my life joy and meaning; based on my answers what are my values and priorities in my life and work. Dr. Weichenthal led the audience through a self-reflection exercise, compassion meditation and the audience filled out a self-assessment for compassion fatigue.

Dr. Sarah McCullough presented a certificate of appreciation to Dr. Weichenthal for her years as chair. Dr. McCullough will service as chair for the next 2 years.

Wellness Section Elections were held and the officers elected were:
    Chair-elect – Dr. Shelly Greenman
    Councillor – Dr. Susan Haney
    Alternate Councillor- Dr. Christina Bourne
    Secretary/Newsletter Editor – Dr. Randall Levin

Ms. Whitson gave an update on the Wellness Booth. Ms. Whitson reported the through-put process was going well and although the pre-SA sign-up for the booth was robust, the traffic appeared to be less than expected.

Dr. Weichenthal was thanked for conducting guided yoga during the lunch hour.

The group asked that signage for meditation room and family with infants lounge be increased. There was a brief discussion on the merits of having a ‘wellness suite’ that would include the aforementioned rooms and the wellness booth. It was suggested that having the booth outside the conventional hall would make it more feasible to extend the hours.

Dr. Greenman gave an update on the work of the Well being Committee on behalf of Dr. Louise Andrew who was not able to attend due to a previously scheduled trip to Hong Kong.

Dr. Greenman reported on Council activities.  It was noted there were no specific resolutions on wellness. Those present discussed the debate on the Choosing Wisely resolution.

Drs. Rosenau and Kaplan offered some remarks, noted their support for physician wellness, and thanked the section for their on-going efforts.

On behalf of the ACEP Educational Meetings Department, section members were asked:

    1. What do you think emergency physicians need more CME or training in? 
        Strong support for courses on physician wellness, dealing with stress, and recommend consideration be given to developing an ACEP Physician Wellness
    2. What can ACEP offer that will make an impact on patient care or operations, and why?
         Providing information and resources on staying well, so emergency physicians can continue to practice in the specialty

The meeting was adjourned at 5:45.

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