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Wellness Section Newsletter - March 2014

circle_arrowSimplifying Your Life to Improve Your Wellness - Wellness Section Newsletter, March 2014
circle_arrowFrom the Board Liaison - Wellness Section Newsletter, March 2014
circle_arrowProvider Wellness is our Life-Jacket for Quality Improvement and Patient Safety - Wellness Section Newsletter, March 2014
circle_arrowSubmitting an Article - Wellness Section Newsletter, March 2014
circle_arrowRelative Deprivation in the World of Medicine - Wellness Section Newsletter, March 2014
circle_arrowEditor’s Book Review - Wellness Section Newsletter, March 2014
circle_arrowPositive Psychology - Wellness Section Newsletter, March 2014
circle_arrowSection Member Count - Wellness Section Newsletter, March 2014
circle_arrowA Teeter Totter Model of Medical Ethics and Maintaining Wellness - Wellness Section Newsletter, March 2014
circle_arrowProvider Communication and its Effect on Critical Thinking, Patient Satisfaction, Care, and Outcomes - Wellness Section Newsletter, March 2014
circle_arrowGuide to Wellness for the Emergency Physician - Wellness Section Newsletter, March 2014
circle_arrowThe New Physician Workforce: Three Steps to Ensure Alignment, Performance and Career Satisfaction - Wellness Section Newsletter, March 2014
circle_arrowWellness Section 2013 Annual Meeting Minutes - Wellness Section Newsletter, March 2014

Simplifying Your Life to Improve Your Wellness - Wellness Section Newsletter, March 2014

Sarah McCullough, MD, FACEP, Chair, Wellness Section

Last Winter I was feeling particularly “well.” I was on vacation, which for most of us instills a sense of wellness. However, this was a different sort of vacation. It was very focused and my goal was to summit a mountain. Indeed there were times that I was probably not physically well, with oxygen saturations in the 60-70's, but I felt well. After returning home I lost that sense of well-being and decided to figure out what it was about the experience that made me feel so good.

On the trip, I had responsibilities and worked hard physically and mentally but my distractions were few. I hired a guide who took care of the planning and kept us safe. I also hired a porter to help carry part of my load. There was no time spent on showering, it was not even an option. There was little decision about what to wear-the more you took with, the heavier your load. We ate what was prepared and really did not have to do dishes. I had a cup, a spoon, fork, and a Leatherman knife. There were no phone calls, mail, emails, texts, etc to deal with. There was the option of going to the Internet Cafe at base camp, but I did not. Night time was for sleeping. During the day I hiked and rested. I had time to read a non-medical book, journaled, listened to music, ate, and prepared to hike.

I have concluded that a simpler life may be what gave me a sense of wellness. My daily activities were very basic and I had few distractions. Now the question is how to accomplish this, short of moving into the wilderness.

I have spent time during the past year evaluating how to simplify my life. A simple life has different value and meaning for every person. You can find any number of ideas on the internet or in books. The first step is to define priorities - perhaps a handful - in your life. Then, do things to simplify your life so you can focus on these priorities. Where does all the time go? It may be helpful to make a list of how you spend your day. Determine what is in line with your priorities and eliminate or minimize time spent with the other activities. It is important to be able to say no to avoid taking on commitments that are not in line with your priorities. Perhaps it is best to focus on one area at a time and determine what would make your life more simple or “easier.”

What can be done to simplify your work? Consider a “salaried” position as opposed to fee for service. This would enable you to work with a definite budget. Limit the number of hospitals that you are working at and choose a hospital that is a shorter distance from your home. A consistent shift may make your life easier, even if it is the night shift. You would have a better idea of your schedule and there would be less effects on your circadian rhythm. Consider a job that utilizes scribes, you may spend much less time at work after your shift.

How about finances? Start by having just one bank. Use auto pay and auto deposit when possible. Limit the number of credit cards that you have so there are less payments to be made, and of course, have them on auto pay. Consolidate your investments. There will be less to manage and less mail. Pay off your mortgage. There would be one less payment to make and you will have freedom knowing that you do not have the debt.

Simplify your home. Bigger is not always better, it may just be a lot more work. Consider moving to a smaller home, condo, or apartment. You will have less debt and a lot less housework. If you stay in your “bigger” home, hire a cleaning service and assistance that you need to maintain the home. A gardener, housekeeper, and personal shopper all are intended to make your life easier. No matter where you live, get rid of the clutter. What clutters your house clutters your life.

Electronics.... where to begin? Designate a specific time to answer emails, text messages, skype, twitter, phone calls etc. Turn off the alert buttons. Deal with each communication as you see it. Do not become a slave to your smart phone.

What about every day home life? Would it be helpful to hire a nanny? How about eating? Hire a cook? If you do your own cooking, consider limiting your trips to the grocery store, or better yet, order groceries on line for delivery. Cook on designated days to make food for a period 2 weeks or even more. Or, if there is a nearby deli, it may be easiest to just go there to pick up food.

There are any number of ways to simplify your life. Just start somewhere. I recommend “Simplify your Life” by Elaine St. James for some very specific ideas on how to simplify your life. I also was entertained by “Speed Cleaning” by Jeff Campbell and the Clean Team. This has revolutionized my cleaning process. The short answer to simplifying your life is to automate, eliminate, delegate, or hire help. Start with just one idea and see how it can make your life easier so there is more time for your priorities.


From the Board Liaison - Wellness Section Newsletter, March 2014

Jay Kaplan, MD, FACEP

Allow me to introduce myself. My name is Jay Kaplan and I am the ACEP Board of Directors liaison to the Wellness Section this year. I have been a member of the Wellness section for many years, including being Chair in the past. I am grateful to feel blessed in my work and at home. I continue to love the clinical practice of emergency medicine and at home I have 3 beautiful daughters (ages 21, 24 and 26) and a wonderful wife-partner-companion of 35 years. I know that many of you are already be aware of ACEP leadership; for those who do not know, I thought I might provide some background for what we do as a Board to promote and safeguard your practice.

The Board of Directors provides day-to-day management and direction to ACEP and serves as its policymaking body. Board members are elected by the ACEP Council and serve three-year terms, with a limit of two consecutive terms, representing a wide variety of backgrounds and work experiences in emergency medicine. All of the current twelve members of the Board continue to work clinically in the emergency department setting. Currently we have two members of the Board who are women and we are actively seeking those interested in being nominated to run for the ACEP Board of Directors this next year. Every section in ACEP is assigned a section liaison who serves as a resource for the section.

In the past year we as ACEP have had the following accomplishments:

  1. Had the largest educational meeting ever – what was formerly called the Scientific Assembly and is now being called “ACEP 13” (and the next will be ACEP 14) – we had 6,264 four day registrations, for the first time surpassing the 6,000 attendee mark.
  2. Continued our very successful Wellness Booth, which is for many emergency physicians the one time they have their health checked annually.
  3. Surpassed the 32,000 member mark – this is a great testimony to the value emergency physicians see in belonging to ACEP.
  4. Joined the Choosing Wisely campaign – and announced our list of five tests and procedures that may not be cost effective in some situations and should prompt discussion with patients in order to both educate them and gain their agreement regarding avoidance of such tests and procedures, when appropriate.
  5. Planned a significant revamp of ACEP News with the designation of a new medical editor, Kevin Klauer, DO. As of January 1, it is called ACEP Now.
  6. Released the 3rd edition of the ACEP National Report Card on Emergency Care in the US
  7. Worked with the Emergency Medicine Foundation to create an endowment for EMF, which will grow our capacity to fund practical research to help you in your practice and with the health policy challenges we face, as well as provide funding for young researchers.

At the same time that we as a board and organization are representing your interests nationally, I want to make certain that you feel supported in your local clinical and educational pursuits. If there are issues which you feel that we as a Board need to explore and act upon, please let me know.

If there is anything that I can do to assist you, please contact me.


Provider Wellness is our Life-Jacket for Quality Improvement and Patient Safety - Wellness Section Newsletter, March 2014

David L. Meyers, MD, FACEP

Some recent postings on our Wellness Section elist identified many factors which can cause, contribute to or result from un-wellness and its extreme manifestation, burnout. Some of these elements include workplace dissatisfiers like frustrating EMRs, unresponsive consultants,* difficult patients, bullying colleagues,** time pressures, communication problems;* others are human factors like cognitive biases, knowledge limits and issues in our personal lives which impact our critical thinking, decision-making and day-to-day performance.

One personal story in particular on the elist resonated with me - an emergency physician’s symptoms of a worsening neurological condition for which he repeatedly visited his specialist. During those visits he questioned whether his condition could be caused by a treatable exacerbation of a co-morbid condition rather than coming from an unalterably progressive condition. The treating physician verbally reaffirmed the primary neurological diagnosis without satisfying his concerns over a worsening co-morbid condition. Where was the critical thinking; where was the active listening; where was the mindfulness, and where was being in the present with the patient? This subsequently led to the perception that his physician was no longer “there for him,” because of multitasking and frustration over having to answer the same questions on multiple visits.

Though he had a second opinion from another neurologist, he finally sought a “third” opinion outside of Neurology. The new examining doctor diagnosed an interim progression of a mechanical cause for the worsening neurological deficit and was referred for surgical decompression. The procedure subsequently arrested further progression of the problem and improved some of his other symptoms.

Sad to say, I was not at all surprised by this scenario, and I bet few physician readers would be from their own (or family members’) encounters as patients. Indeed, Donald Berwick founded the Institute for Healthcare Improvement (IHI) as a result of his and his wife’s experience with a difficult diagnosis and sub-optimal care.

So why did this breakdown in critical thinking and misdiagnosis happen? More importantly, why does this happen every day in patient-physician encounters, OUR encounters, throughout health care? And MOST importantly, what can be done; what can WE as individuals and leaders do to reduce diagnostic errors?

The treating physician maintained the primary diagnosis in spite of the patient’s concern and questions, notwithstanding that the patient was a physician. Was it a matter of not really listening? Was it due to the ubiquitous cognitive biases and failures at work in every doctor-patient, in fact every HUMAN, encounter - availability, anchoring, search satisfaction, etc. Probably, but in all likelihood there were other human factors at work, setting the stage, framing the encounter - a harried physician, behind schedule; a less than adequate interval history and physical exam; maybe a distracting personal problem with a sick child; not enough sleep the night before; a frustrating encounter with the department Chair; a newly installed EHR in the office that isn’t working very well - the activities and hassles of daily life and professional practice. All causes of un-wellness and low provider job satisfaction – ultimately leading to burnout.

A number of recent surveys have shown that physicians as a group are among the least satisfied workers in America, and a substantial number predict they will leave medicine, drastically change their practice setting or advise their children NOT to follow in their footsteps. In fact, physician burnout is now, decades after warnings about it were first published in the medical literature, recognized to be a serious problem, present in all specialties, all age groups of physician and even in medical students and residents. And as widespread as burnout is, and as much as we believe it affects patient care, there is precious little forward progress based on the science defining its specific impact on clinical judgment, mistakes, malpractice and adverse patient outcomes.

We are making progress in understanding the human factors and biases which influence our behavior and in recognizing the importance of wellness as critical to improving physician performance and our practice of medicine, but we are still in the primitive stages of identifying and using resources - information technology including clinical decision support, e- and mHealth, natural language processing and analytics; crowd sourcing; risk assessment apps and checklists; clinical care teams; undergraduate, graduate and continuing medical education; psychology, mindfulness and meditation; and PATIENTS - to solve this/these problems.

What is certain and key in my view, is having collaboration on many fronts. To that end, on a recent conference call with leaders of ACEPs Quality Improvement and Patient Safety Section, I talked about the Wellness Section discussion and raised the possibility of our sections working together, possibly via a joint section grant, to tackle this common and dangerous problem. There will also undoubtedly be roles for Informatics and other sections in finding ways to tackle this critical issue which has such an impact on all of our patients. Watch for more dialogue on this and contribute to the discussion and elucidation of solutions. We owe that to our patients and indeed, we owe it to ourselves.

* Discouraging Disruptive Behavior: It starts with a Cup of Coffee!

* A Cup of Coffee Conversation. Center for Patient and Professional Advocacy at Vanderbilt

Resource: http://www.mc.vanderbilt.edu/centers/cppa/

Note from the Editor:
This editorial piece by Dr. Meyers highlights the position that there are multiple reasons for misdiagnosing and poor patient outcomes. What is also important to note is that provider wellness is not just an island by itself but is the actual “life-jacket” for better patient outcomes. It is intimately inter-related with the task of decreasing medical errors, whether diagnosing or treating. At present there is a big push, from all levels in the medical field, for improving patient outcomes by having patient-focus health care teams. What is missing is the acknowledgement of the importance of wellness among the members of the healthcare team and giving it equal weight and effort for improvement – to bring out the strengths of all.

**Heroes Need Not Apply, Brain D. Wong, MD, MPH, Second River Healthcare, 2013
A fictional book (though based on 20 years of consulting by the author) on the relationship between “bullying” and inter-disciplinary/intra-disciplinary communication, un-wellness and poor patient outcome while demonstrating ways to improve the work place environment to encourage communication, professionalism and a team approach towards improved patient outcomes.


Submitting an Article - Wellness Section Newsletter, March 2014

 

Please consider submitting an article for an upcoming issue of this newsletter – you never know when your “story” or experience may help a colleagues’ wellness. You may submit an article at any time. Please submit your article to Julie Rispoli.

 


Relative Deprivation in the World of Medicine - Wellness Section Newsletter, March 2014

Saleen Manternach, MD, FACEP

“There are two kinds of people, those who do the work and those who take the credit. Try to be in the first group; there is less competition there.”--‐ Indira Gandhi

As Emergency Medicine physicians we are the first group – we understand that we just need to get it done. We rarely get accolades, but trudge on because we are warriors. But sometimes, a feeling of wanting interferes. Until a few months ago, I had never heard the term “relative deprivation,” or even known that I, at times, suffer from this condition.1

Simply, it means to compare yourself to others who are relative or similar to you rather than to the general population (and to feel inferior). For example, when you completed your undergraduate education, you were most likely at the top of your class. However, once you entered medical school and surrounded yourself with others at the top of their respective classes, you started doubting your intelligence and wondered whether the admissions committee read your MCAT scores incorrectly.

These feelings are a normal part of human nature. Some theories suggest that relative deprivation may at times motivate us to strive for better results and to make change. Then again, if this “condition” is left unchecked, it can lead to low self-esteem, resentment, and feelings of inadequacy. This can be harmful to our souls as humans and physicians. As Emergency Physicians, we are expected to think on our feet – there is no time to hesitate. Being held to unattainable standards of perfection while bearing witness to human misery and mortality can be crippling. Some days your best is just not good enough.

Because you are not aware of similar trials and tribulations of your colleagues, you may feel ashamed or incompetent. You try to embrace collegial suggestions in the spirit of betterment and learning, but start doubting yourself and your abilities. The next shift looms. Your clouded self – judgment is harsher than it should be. In the spirit of wellness this year, let us make a conscious effort to remember that we all bring a unique set of skills and qualities to our patients and to the practice of medicine. We have all worked hard to become physicians --‐ healers. At times it may be difficult to recognize our highly specialized talents (because we are surrounded by high achieving colleagues with similar talents and skills), it is helpful to step back once in a while and reflect. As we try to navigate the ever--‐changing medical landscape, let us remember that not everyone can do what we do. We are everyday heroes.

1. I learned about it after reading Malcolm Gladwell’s book “David and Goliath.”


Editor’s Book Review - Wellness Section Newsletter, March 2014

Randall M. Levin, MD, FACEP

Heroes Need Not Apply: How to Build a Patient-Accountable Culture without Putting More on Your Plate.
Brian D. Wong, MD, MPH, Second River Healthcare, Bozeman, MT, 2013

Dr Wong's book strongly brings out your empathy and compassion for those who are on the opposite sides (both patient and provider) of medical care, who can suffer. By focusing on the everyday struggles and the unhealthy work environments which exist, it gives the catalyst to continue to want to help heal the existing medical care system. It exposes those significant barriers which are dangerous and counterproductive to healing (for both the patient and care team). It gives us hope that there is a better way to connect to our healing spirit and the reason why we entered the medical profession. Regaining the trust, which comes from patient-focused care provided by healthy medical care teams, can again be the reality. Improving patient outcome and provider wellness are interrelated. Though a fictional account based on Dr Wong's many years of consulting, his characters run true and give an emotional rollercoaster ride between anger and sadness while being balanced with a sense of relief that “things” can change. This is an important read for Hospital Wellness Committees, administrators, physicians, nurses, health care team members, and for those who utilize the health care system. Before we can heal and change, we have to know what is broken - Dr Wong’s “Heroes” does just that, as it points to how that change can occur.

The next step in healing the system is to create mentoring for our colleagues to assist with change so that they don’t leave practice out of frustration and burnout.

Disclosure: I have no relevant financial relationships to disclose.


Positive Psychology - Wellness Section Newsletter, March 2014

Randall M. Levin, MD, FACEP

As a follow up to his two part article on Positive Psychology from previous Wellness Section newsletters, Neil Farber, MD, PhD, continues to promote wellness with the following information and resources.

Linked below are two books that Dr. Farber has written. Both are available on Amazon:

The Blame Game: The Complete Guide to Blaming: How to Play and How to Quit

Making Lemonade: 101 Recipes to Convert Negatives into Positives

The Action Board
The Action Board is both a powerful motivational tool and a process for bringing your thoughts, values, strengths, and actions into alignment with your goals.

The Action Board system is based on evidence-based goal-setting research and provides a specific, action-oriented framework of 10 simple steps for reaching your most fulfilling goals.

Take time to visit The Action Board facebook page and the Web site The Key To Achieve.


Section Member Count - Wellness Section Newsletter, March 2014

 

The Wellness Section currently has 147 members

 


A Teeter Totter Model of Medical Ethics and Maintaining Wellness - Wellness Section Newsletter, March 2014

H. Steven Moffic, MD
Lead blogger for Psychiatric Times, Behavioral Healthcare, and the Hastings Center “Over 65”

There is no question that the ultimate goal of medicine is to help patients. This is most obviously reflected in the AMA's Principles of Medical Ethics. Just to make doubly sure that all physicians keep this foremost in their minds, the emphasis on patients was even increased in the 2001 revision.

In the Preamble, it says: “ . . .a physician must recognize responsibility to patients first and foremost . . .” First and foremost was the added phrase in this revision. Then, just to be sure we got the point, a new principle was added that stated the essence of the Preamble in other words. Section VIII states: “A physician shall, while caring for a patient, regard responsibility to the patient as paramount.”

There were good reasons for this renewed emphasis. As business and business ethics transformed the practice of medicine, especially to try to control costs, there was a need to sustain our essential healthcare ethics. Medical ethicists, in a new field, emphasized patient autonomy as one of the essential medical ethics principles.

Now, there is even a further development in the patient focus with a model called “patient-centered care.” This model emphasizes a particular aspect of the patient comes first philosophy. This model places greater emphasis on the patient's involvement - as much as autonomy appropriately desires - in establishing the goals of treatment.

However, at the same time as we put renewed and increased emphasis on the patient, what may be relatively lost are the other important ethical responsibilities. The rest of the Preamble goes on to add: “…as well as to society, to other health professionals, and to self.” Responsibility to society is inherent in licensing requirements and the systems of care that payers support. This is the business of medicine, of which physicians generally have limited control. However, responsibility to other health professionals and to oneself is essentially up to us. After all, who provides the care to patients but ourselves, and if our own personal needs are not sufficiently met, will care of the patient not inevitably suffer somewhat? Given that healthcare will be provided more and more by teams in organizations as Accountable Care Organizations roll out, effectively joining the self to others on a team is essential.

So, now, not only do we have responsibility for our own skills, but those skills must blend into teams. Though these responsibilities can provide great meaning to the lives of physicians, it can also take a toll. Long hours, outside regulations, team conflicts, and the everyday traumas of unsuccessful outcomes can affect our well-being adversely and lead to burn-out. Certainly, some technical care can be given by rote and habit, but neither the patient nor the physician will likely be satisfied by this factory-style of care. The antidote to this stress may be a corresponding and renewed emphasis on physician wellness.

Mental, physical, and even spiritual wellness can help the physician to maintain excellence. Caring for the patient may depend in part on caring for ourselves.

If the AMAs Principles of Medical Ethics don't quite recognize or convey the complementary needs of patients and clinicians well-enough, what can? Perhaps all of us, when we were children, played on a seesaw. Balancing the two sides of the teeter totter was a game of cooperativeness and/or dominance. Now apply that model to medicine. Business builds the medical teeter totter. Caregivers can give some advice as to how it should be built. But once we and patients get on our two parts of the seesaw, how do we best balance one another so neither side falls off. At times, one may need more attention than the other, but both need to be kept aloft. Taking time out to periodically maintain this balance is essential to wellness.


Provider Communication and its Effect on Critical Thinking, Patient Satisfaction, Care, and Outcomes - Wellness Section Newsletter, March 2014

“and what do you want me to do”

Randall M. Levin, MD, FACEP

For this spring's edition of the Wellness Section Newsletter, I called for comments related to a recent office visit with my physician while following-up for my medical care. I referred to the following statement (which most EPs probably have said to patients, colleagues, family), “...and what do you want from me (or variations of same).

I can remember prior to Palliative Care being part of EM that the thought was always there. I need to be taking care of sick people, why did “they” send you to the department. This is one of the reasons why I have supported Palliative Care in the ED - we can always do something, we can always “heal” by showing our compassion and empathy.

The experience brought to light several points related to patient satisfaction and outcomes: 1) Communication between the doctor and the patient affects the patient perception of being cared for and patient outcomes and risk management; 2) The Art of Medicine is just as important as the Science of Medicine in creating a healing environment for the patient; and 3) creating a healing work environment allows the staff and healthcare team members’ strengths to improve patient outcomes. Unfortunately, these points are affected by physician wellness, satisfaction and burnout. Facility wellness also plays a large role in creating the right environment.

Can providers (the entire medical team) have the scope of practice skills, compassion and empathy, but yet still be blinded to the patient's needs in care? I feel that answer is yes and it is based upon poor communication and not being present for the patient. Since un-wellness/burnout affects our “soft skills,” this subject content is appropriate for our newsletter.

The following experience is not just another “when the Doc is the patient” editorial piece. The words, I didn't know what it was really like to be a patient until I was a patient, though often stated, do not apply. I have always been very sensitive to the patient's (and their family members') needs. My interaction with the patient was based on how I (as a patient) would like to be treated; how I would react to the words, the body language, etc. I have been a champion for this type of interpersonal interaction with patients who presented themselves to the ED. This included family/friends calling me for medical help or advice.  

This can also be applied to the “Good Samaritan” who cares for a victim of violence or trauma, when there is a limit on what we can physically do. We can always be a “healing, calming, stabilizing” presence for that person until the “real help” comes (EMS). Sometimes it is as easy as holding a hand and saying “I am an Emergency Doctor and I will be here with you.” That is how I would like to be treated.

But aren’t we taught to say “some words” instead of just being present?  I had this exact conversation with a 4th year medical student recently. Yes, we were taught to ask “and how can I help you today,” with emphasis on empathy and compassion. The problem occurs when that “phrase” is corrupted by our tone of voice, our own “un-wellness”/frustration/burnout. What I have tried to do by bringing this issue to the section is to make the point that through maintaining wellness we stay connected to the true reason why we are asking the question, why we entered the field of medicine. The phrase will always be perceived as one of empathy and compassion when it comes from being truly connected to our healing spirit. This was very nicely noted in one of the response comments.

“What do you want from me?” is indeed a common question, and the written word doesn’t show the sound of the voice. I would like to think that my personal voice tone when I ask that question makes it clear that if what they need or want is something that I can provide, I am here to do it. I often also answer that “I imagine that you would really like it if I could return you to the [state of wellness you had as a young man/woman] and you know I can’t, but I CAN do something. This is what I can do right now; this is what you can do for yourself, and this is where you could go for more answers. Dr T.

Remember, it is the perception of the patient which allows the relationship to be a healing one, even if it is not a “curing” one. Unwellness can block that which can be the most healing aspect of our care for our patients. That unwellness can come from “not knowing” what else can be done and leads to the phrase “and what did you want from me today” – “…we already went through all of this…”

We also know that unless we are really listening and not being dismissive of the patient, we will most likely know when we need to turn “180 degrees” or revisit an evaluation which was recently done. As Emergency Physicians, our Critical thinking is essential. We have to have the Science for the scope of practice for EM but we cannot lose sight of the Art of Medicine which allows us to access to the Science and optimal use of our EM competencies.

At first I was hesitant to use my experience for the basis of this discussion, but after hearing from other acquaintances (mostly from medical care employees and friends) that they also had similar experiences, I felt that it would be better to tell the following story in the first person. Being my personal journey, it is based on my “perception” as a patient.

The Journey:

I had begun to notice various symptoms, including numbness, beginning in the great toe first on the left side and later on the right side. At first, I thought that it was related to being on my feet in the arena and improper shoes. I did not notice imbalance or decrease of strength to my feet or lower extremities. I knew that in the past I had issues with a mild disc issue to the lower lumbar, treated conservatively, and various paresthesias to my upper extremities. Could some of my physical symptoms be coming from un-wellness and developing burnout (subconscious hyperventilation, etc)?

I eventually went to a neurologist due to an increasing problem with spreading paresthesias and at times pain to the digits of my feet, but no specific radicular symptoms. The only other symptom was pain to the deep buttocks and this was diagnosed as Piriformis syndrome on the right side with intermittent irritation to the underlying sciatic nerve. I also noted a changing sense of fine motor control to my left upper hand and paresthesias. I had work-ups including MRIs, lab and EMGs. Dx: peripheral neuropathy (PN), degenerative joint disease to various levels and some lower Spinal Stenosis. The peripheral neuropathy was diagnosed as idiopathic (or possibility familial on a second opinion visit). The spinal stenosis was “not significant.” I had unfortunately, left active ED practice due to complete burnout by this time. Some of my physical symptoms (except for the lower extremity) improved – burnout causing physical symptoms is well-documented in the literature.

I had repeat EMGs and other tests, saw neurologists (not doctor shopping, but second opinion visit), all diagnosing the same condition. Prognosis - slow progression of increasing symptoms, though they should not lead to inability to ambulate. I had good patient/physician interaction with the physicians I chose to see and felt that they were being thorough in their work-up (first MRI showed lumbar stenosis but not significant).

Over the subsequent years, there was slow progression, but overall I was still able to perform normal physically activity, though indeed fine motor changes started to be a concern. I had a variety of episodic “paresthesias,” some visual changes including one episode of double vision (though I have history of migraines), so as I presented to my follow-up appointments, started to ask the question, tell me why my situation was not coming from MS or my spinal issue which may respond to surgical treatment. I was assured that “everything” that I was experiencing was related to the PN and not to spinal stenosis or MS.

Symptoms continued to “speed” up in the interim related to episodic bouts of radicular paresthesias alternating between both legs which followed L3/L4/L5. The “Piriformis” pain was now a daily problem vs. being a positional and intermittent in the past. My ambulation was being affected, my balance was being affected and I sensed an increased problem with going up stairs. I was now experiencing loss of ability to abduct my toes and experienced severe cramping to mostly the flexor muscles from the thigh down - minimal flexion would cause spasms - again tell me why this is not a NM problem or Spinal problem. I was even told (though probably in jest) that if we send you to a surgeon, you know they will want to “cut” something.

Let me fast forward to late last year and an appointment I again made with my neurologist over my persistent and increasing concerns. In prior visits I had felt comfortable and trusted my physician, but I was experiencing new symptoms that appeared to be more episodic and radicular in distribution. I realized my diagnosis had been based on the previous radiological studies and other neurological work-up. I was told that PN could explain most if not all of my symptoms. Initially because of my trust and respect, I blindly accepted the change in symptoms as expected from progression of the PN, but then I started to question that assumption with the changing and new symptoms. The comment to me was “what do you want me to do”?

MY perception (as a patient) was that the doctor was saying: I have already told you your diagnosis and prognosis, so why are you here today? Why are you asking me questions that I have already addressed? Let it go and accept your condition. As with my initial visits and work-up, the physician was typing on the computer and was not having direct eye-to-eye contact with me. (Resource: Gamble M. Are we trading happy physicians for efficient ones?Becker’s Hospital Review. March 3, 2014.) In the prior visits, it did not bother me but during the last visit it did. How could the physician truly sense and pick up the cues pointing to my anxiety/concern/frustration over the possibility of a missed diagnosis or changing condition that needed to be revisited?

My perception was that the words being said by me and how I said them were not being truly heard or sensed. I had trust in the initial clinical approach, which included critical thinking related to my initial presenting complaints – yes including the first MRI. At this visit, the physician was not in the present with me. Where was the critical thinking process that would have allowed my provider to easily pick up my cues? Something was different and on that day the provider’s critical thinking was blocked.

This difficulty of a physician being in the ‘present’ with the patient while multitasking was highlighted in an article titled: Texting While Doctoring: A Patient Safety Hazard. Sinsky CA, Beasley JW. Ann Intern Med. 2013;159(11):782-783. A physician was quoted, “…I am always multitasking . . . I am entering orders, checking labs, downloading information while I talk to the patient. It requires chronic hypervigilance, which is exhausting and demands conscious effort to stay in the ‘present’ with the patient.”

As a patient, from that perspective, I felt embarrassed I was doing something wrong by being in the office for a follow-up appointment; telling myself I had to accept that my symptoms were from PN and not from a co-morbid condition. However, I was definitely not satisfied. It was as if I was supposed to apologize to the doctor for even making the appointment.

Why do patients feel it is their fault for coming into the ED at 3am or for a “minor” problem? Why should or do patients feel they have to apologize for seeking medical care or advice? They deserve respect as one human being seeking help from another. Yes we can instruct and educate the patient on what signs to look for, when and where to follow-up, and when appropriate, educate about overuse of the ED; but we should always be connecting with the patient.

In the department, my verbal response (and hopefully body language) was “it is okay, that is why we are here for you.” I am sure we have all experienced a return patient and having the need to revisit our approach to the previous work-up or clinical decision. (In the ED, return visits can occur within hours or days, though in outpatient practice returns can be over months or years.) We also know that if we are really listening (and not being dismissive) to the patient, we will most likely know when we need to turn “180 degrees” or revisit an evaluation which was recently done. As emergency physicians, this is essential. We have to excel in the Science of EM but we cannot lose sight of the Art of Medicine which allows us to stay connected to the patient and ourselves. This is not what I experienced during my last appointment. My trust in the physician’s judgment had been eroded. My concerns were not alleviated. I still was not referred to a surgeon for an opinion on whether any of my symptoms were related to a correctable surgical problem.

All it would have taken was an understanding that my repeat question and request was that I wanted to be assured that my progressing and changing condition was not related to a correctable back problem; I would have hoped to be referred to a back surgeon.

As a physician, enough was enough, I needed to take the next step so I saw one of my surgical colleagues who I had known for over 35 years. He was not multitasking with the computer and had direct eye contact with me. He was in the present. I again asked the question, tell me why this is not a correctable/surgical condition. He HEARD what I was asking and he knew (being mindful of my concern) that I was not comfortable to “just” go with PN because if my symptoms were progressing to a surgical condition, and I didn't act on it, I could have permanent loss of function to my lower extremities. I was not saying that I did not have PN, all that I was trying to find out was if I had something else that was not being addressed or followed properly. He ordered a repeat MRI of the lumbar spine (last one was ordered 2 -3 years prior during my initial neurological work-up).

The MRI results came back. My colleague called me when he received the results telling me that I had significant interim worsening of the spinal stenosis and needed to see a spinal surgeon as soon as possible. I had complete effacement at the L4/L5 level (and lesser to other levels).

I am now 8 weeks post-op from lumbar laminectomy. I still don't know the ultimate outcome of my surgery (will take months to determine), but I do know that that the progressing symptoms which I was experiencing have already started to resolve.

The above description of events is not meant to “call out” my specialist, but to highlight the problem with not being present with the patient, nor having direct eye-to-eye contact with the patient because of multitasking. The issue is improper communication leading to “closed” decision making by the physician and how the patient perception based on this communication leads to patient dissatisfaction. I felt that I just “needed to live with my condition” and that my physician was getting more distant from me for continuing to ask the same question. Something was different in our interaction. I sensed the physician was getting frustrated. Being an advocate of physician wellness, I perceived this frustration was coming from unwellness (as you already know, studies show that unwellness/burnout affects communication and patient satisfaction, compliance and outcomes).

On the other hand, I may have perceived something that was not correct (physician unwellness) for even the most well and satisfied among us can still have communication issues. But when I left that office, I was upset, frustrated and (luckily) sought out another physician opinion to address my question.

For those of you who are questioning why I didn’t take it upon myself earlier to see a spinal surgeon, knowing that I had spinal stenosis, my only answer would be I was suppressing acknowledgement of the symptoms. Who was I to question the docs from two academic institutions who I had seen – relative deprivation. I was only a community hospital emergency physician. Again, that is why it is so important for us to understand that what and how we communicate to the patient is so important. Because I trusted my doctor and the second opinion doctor, I was ignoring (suppressing) my own medical judgment consciously. My subconscious however was telling me to continue to ask the questions.

In summary, I would want us to really analyze why and how we would say these words, “…and what do you want me to do”? Is it a sign of our own frustration of not knowing what to do for the patient, our colleague or family member? Is it a sign of unwellness? We must take the time to reflect and be mindful of how we feel when the words are said. In reality sometimes all we “have to do” is to “listen,” be present, acknowledge the other persons existence. If indeed we are blocked from this, then we can acknowledge our own lack of communication skills or our own unwellness. In either case, we can start our healing journey – either through CME related to professionalism and interpersonal communication or seeking help for the unwellness/burnout.

This was just one personal story. Other stories have similar outcomes - patients coming in with unresolved symptoms or worsening symptoms - and the doctor asking, well, what do you want me to do?

The next question to ask would be “Is the work environment allowing us to stay connected and to actively listen?”  We should be advocates for the work environment which supports the physician attributes of Professionalism and Interpersonal Communication. Maybe, just maybe, if we created more efficient and fulfilling work environments, we could more easily take the time to actively listen, be present and offer our patients our advocacy for their healing. As a result, our patient experience scores would improve, our patient outcomes would improve and our own sense of well-being would improve. In the ED, stay connected with the patient; don’t be a “hero,” be a facilitator for the team. Empower the staff at all levels to assist in providing care. Oh yes, and if you are lucky enough to have a medical scribe, don’t forget him/her. This will allow you to have the time and energy to be in the present, to be a good communicator, to be truly connected with the patient, and to be a true “healer” even when you do not “cure.”

Part II of this piece (coming in the Fall newsletter) will focus on the “team” and the environment in which my surgical care was given. Was it a toxic work environment or a healing work environment? Was it allowing the staff’s inner strengths to come to the surface allowing the compassion, empathy and appropriate medical decision making and patient care to occur? I have championed for such a place where the Art of Medicine and the Science of Medicine are truly practiced to improve patient compliance, satisfaction, clinical outcomes and ultimately physician wellness, satisfaction and decrease burnout. Is there such an institution which encourages the connection to the healing spirit of the medical care team to that of the patient's or have I just been dreaming? I don’t think I have been dreaming. Part II will describe such a place.


Guide to Wellness for the Emergency Physician - Wellness Section Newsletter, March 2014

 

The Well-being Committee is updating the on-line Guide to Wellness for the Emergency Physician and would appreciate learning what you consider important information to include in this update. Please respond with your thoughts or ideas to: Marilyn Bromley

Wellness is key to your professional, social, and personal life and we thank you for taking time to respond.

Rita A. Manfredi, MD, FACEP
Associate Clinical Professor
Department of Emergency Medicine
Milliken Fellowship Graduate,
George Washington Institute for Spirituality and Health

The George Washington University School of Medicine
Washington, DC 20037

 


The New Physician Workforce: Three Steps to Ensure Alignment, Performance and Career Satisfaction - Wellness Section Newsletter, March 2014

The New Physician Workforce:
Three Steps to Ensure Alignment, Performance and Career Satisfaction
Define - Align - Develop

Authors: Bryan J Warren and Ted Kinney, Ph. D.

RAPID CHANGES AND NEW EXPECTATIONS

The business of medicine, the relationship between physicians and hospitals and the demands on physicians, are changing at an unprecedented rate. Unfortunately, how we educate, select, integrate and develop physicians hasn’t changed much in decades. As a result, hospitals are often disappointed with the degree of alignment with their medical staff, and with the performance of employed physicians. Physicians struggle to succeed and find career satisfaction. Consider what physicians are facing:

  • Having been trained in a model of professional autonomy and a culture of expertise and competition, they are now asked to function as part of multidisciplinary teams
  • Rapid advancements in diagnostic and treatment technology
  • Increasing complexity of managing a private practice
  • Adoption of electronic health records
  • Uncertainty about the role and function of the independent medical staff
  • The traditional solo and small group practice is disappearing
  • The growth of large groups and hospital employment is challenging the sense of professional autonomy
  • New payment methodologies that de- emphasize volume and reward outcomes and population medicine
  • A new emphasis on patient expectations and satisfaction
  • An increasing demand for services but a projected physician shortage

At the same time, hospitals and health systems need and expect more from physicians. The compassionate, paternal, solo practitioner, schooled in the art of medicine, champion of the individual patient, but oblivious to the business of healthcare or hospital administration, is no longer sufficient. Successful reformation of the American healthcare system, with an emphasis on value-driven care, assumes a new level of collaboration between physicians and hospitals, and a new set of physician behavioral skills, including:

  • Adaptability – Physicians are often naturally skeptical and resistant to change. They question data and want evidence that a change is in their patients’ best interests. Today, though, they need to rapidly adapt to new technology, care delivery models and expectations. Some of these conflict with their traditional training and practice. Given their leadership role, when changes are in patients’ and the organization’s best interests, we need physicians to be champions of change.
  • Innovation – We need physicians who will actively identify and develop ways to improve the quality of care, the patient experience, and to reduce costs.
  • Collaboration – Physicians are not selected for medical school, or rewarded in their training, for collaborative behaviors. Their world values competition and fierce individualism. They value professional autonomy and the culture of expertise. These characteristics can make it difficult for them to function in a multi- disciplinary team setting—now critical to organizational success and patient outcomes.
  • Patient-Focus – Physicians would likely argue that the entirety of their training and traditional approach to practice is “patient focused.” The singular goal of the model is to successfully diagnose and treat the patient’s condition. What we are asking of them now, though, is to more fully engage the patient and the family in their care, to work with colleagues, administrators and other disciplines to design care delivery models that more fully meet the patient’s needs. This requires physicians to think outside of the traditional “provider-focused” organizational model.

Business Acumen – Given the complexities of how care is provided and paid for, patient outcomes are inexorably linked to the business of healthcare. The inability or unwillingness to grasp practice economics means the practice can’t meet the patient’s needs and may not survive. Failure to understand hospital economics and the cost of care means that the organization can’t meet the needs of the community. Physicians must be active business partners in ensuring that payment models are aligned with the best care delivery models.

Leadership – Even if they’re not in an official leadership position, every physician, either in the OR, the clinic or on the unit, is in a leadership role. Traditionally, this has meant a hierarchical, authoritarian, expert form of leadership. What hospitals and treatment teams need now is a more collaborative, engaging approach to leadership.

Emotional intelligence – Since the 1980’s the business world has recognized a set of emotional and behavioral skills, distinct from intellect, that often predict success. Self and social awareness, social skills and self regulation allow an individual to navigate group dynamics, influence people and communicate effectively. These are what physicians need today and their absence is often the cause of physician failure.

Expectations have changed in two other important areas:

Productivity – Physicians in private practice have a natural incentive to be productive. Historically, productivity decreases when a physician moves to employment but hospitals now expect a reasonable return on their investment. Physicians are now faced with a new emphasis on productivity metrics –visit volume, RVUs or revenue generation. Bonuses are tied to productivity and patient outcomes. After negotiating what seems to be a fair bonus structure, though, physicians often discover that operational efficiencies make those goals unattainable.

Disruptive Behavior – Hospitals are less tolerant of physician disruptive behavior. It is costly. It derails physician careers. It impacts organizational success and even the quality of patient care. There is plenty of discussion about managing disruptive behavior but little about how to prevent it.

Some physicians are prone to disruptive behaviors. They have common personality traits like high levels of excitability, low levels of emotional control and personal trust, and difficulty getting along with groups. They exhibit what psychologists often refer to as “derailer” behaviors. These personality traits can often be managed. If a physician is aware of them, mentored and developed from day one, he has a much better chance of success. Similarly, these traits tend to manifest themselves under pressure - pressure to meet expectations that may be seen as unrealistic, particularly in the face of insufficient operational support. In other words, if we manage behavioral tendencies as we would with any other highly paid professional, and provide an environment where success is achievable, we can prevent some disruptive behavior.

A FAILING APPROACH

While all of these changes have been taking place, little has been done to prepare and develop physicians to succeed. Three factors contribute to this failure:

Physicians are Poorly Equipped to Handle the Changes

A few progressive medical schools and residency programs are incorporating training on emotional intelligence and the business of healthcare. Most physicians, however, enter the workforce woefully unprepared for all they’ll face outside of the exam room or operating suite. They have little training on how to function within an organization, to work in teams, to lead, communicate with patients, how a hospital or practice operates and our healthcare system operates around them, or how to take charge of their own career.

In other industries, we commit resources to structured training and development to give highly paid, valuable employees the tools and skills to succeed. Similar efforts for physician are still in their infancy. Older physicians struggle to adapt to a changing world. Younger physicians have unrealistic expectations and a poor understanding of what will really determine their success.

An Out Dated Approach to Recruiting and Turnover

Physician recruiting remains a numbers game. The hospital is looking for a certain number of physicians to build its network and often willing to over-spend. Recruiters are trying to improve their “time to fill” metric and fill quotas. The physician candidate is unaware of what he needs to succeed and defaults to focusing on only the salary number. He can negotiate productivity and quality bonuses, but knows nothing about the infrastructure and support necessary to meet the goals.

Physician turnover is increasing and the bulk of it takes place in the first few years of practice. Surveys show that the number one reason for leaving is not money. Early turnover is almost always about a poor fit or a failure to meet the physician’s expectations.

Turnover can derail a career and negatively impact a hospital’s quality, patient satisfaction and care delivery initiatives. Losing a single physician costs a hospital as much as $1 million. Yet, with every loss, they return to the same approach and start the cycle all over again.

Hospitals Assume that Employment Ensures Alignment

Some hospitals actually consider “employment” as an alignment strategy. Ask them about alignment and they talk about joint ventures, new program development and employment models. Alignment, as an initiative, is as important with employed physicians as it is with independent physicians. Signing an employment agreement does nothing to ensure that a physician’s goals are aligned with yours or that he is collaborative, adaptable and patient-focused.

The result? Physician turnover and disruptive behavior are on the rise. We have a shortage of skilled physician leaders. Physician career satisfaction is declining. Hospital CEOs still rate physician alignment as one of their biggest challenges. Patient safety, outcomes and cost metrics still lag.

A NEW APPROACH – THREE SIMPLE STEPS

The vision is of productive, collaborative, innovative physicians who take leadership roles in transforming healthcare. Certainly some are well-suited to the task. Medicine has always had its share of dynamic leaders. The new challenges we face, though, require that every physician is capable of assuming this role to some degree. We can take our cue from other industries where talent at the highest levels is systematically chosen and developed. We can do this without sacrificing the special nature of medicine – the sacred pact between doctor and patient and the physician’s role as his patients’ champion. Rather than de- valuing physicians, this approach acknowledges that physicians aren’t merely clinical commodities, but the driving force behind success.


Step 1 - Define What Success Looks Like

 
In one respect, this approach is not really new. Talent wins. Attract and retain the best physicians and you increase your chances of success. The difference is in how we define talent. Graduates from the best schools, from the most prestigious fellowship programs, are still valuable, but we need to consider other critical skills.

Before you can begin finding and developing these new physicians, you need to define, with some specificity, what they look like. Do the foundational work to figure out what physician behaviors align with your vision, mission and values. What are the specific behavioral competencies that will predict success - perhaps some combination of collaboration, business acumen, compassion, patient-focus, adaptability and leadership. But go further. What specific behaviors will be expected? Which are unacceptable?

Now define specific performance expectations related to volumes, gross revenue, patient satisfaction scores and other outcomes metrics. Finally, define non-clinical responsibilities and expectations. Do you expect the physician to participate in program development, quality and cost initiatives, administrative, management or leadership efforts?


Step 2 – Align Goals and Expectations

 
Now that you have a better picture of what you are looking for, how do you ensure that the physician’s goals and expectations are aligned with yours? This is a three step process: (1) An analysis of “operational fit”; (2) A new approach to the physician interview; and (3) An analysis of relevant behavioral skills.

Operational Fit

We sometimes hear that recruiters do the work to ensure a good fit. The results would indicate otherwise. Recruiters, either internal or contracted, only scratch the surface. They aren’t physician performance experts. They are physician placement experts. It’s not much of an exaggeration to say that the current “fit” analysis is rarely more than the hospital deciding it needs a surgeon, the surgeon confirming that the hospital has an OR, and the courtship begins.

Take steps to understand a candidate’s expectations regarding work hours, patient volumes and other productivity goals. How much operational support (staff, space, equipment) will they need? Interest and experience with non-clinical responsibilities? Is the surgeon willing to collaborate with a hospitalist program? Has the physician ever used a mid-level provider?

Even if you find areas where expectations and goals aren’t aligned, the relationship may still work. This process gives you the chance to resolve differences from day one, rather than finding out two years later that you have an unhappy physician. A simple, twenty minute “operational fit” survey can often prevent the $1 million turnover loss.

The Interview

The physician interview is traditionally useless as predictor of success. The science and art of the interview have rarely been applied to physicians. Physicians often conduct the interviews although they’ve had no training. They make the common mistake of focusing on first impressions, on the candidate’s training, communications skills and on general “likeability.” None of these predict performance. Of course, you cannot interview a physician as you would a nurse or patient-care technician, but you can incorporate behavioral interviewing techniques.

A simple example: If your organization has identified “adaptability” as an important competency, the traditional interview may include the following question:

“We are going through a good bit of change. Are you comfortable adapting to change?” Not surprisingly, the candidate’s response is generally “Yes.”

A structured, behavioral approach to the same question:
“We are going through a good bit of change which can be a challenge. Have you had to deal with changes to your practice, perhaps changes you didn’t necessarily agree with, and how did you deal with it? What was the outcome?” If the candidate can’t think of a single example, he’s never had his adaptability tested. If he has, physicians more so than other professionals, are likely to be forthright and tell you about the experience, even if their response was to resist the change. The best case scenario is he cites an example and can tell you that although he questioned it, he did so in a constructive manner and eventually adapted and even suggested further improvements for the good of the organization. This is the adaptable candidate.

Physician Behavioral Assessments

Finally, more organizations are using physician-specific assessments to understand behavioral strengths and weaknesses. Well designed tools are able to predict an individual’s level of emotional intelligence, ability to collaborate, adapt, respond to stress and lead. These can be used to screen out candidates who are clearly not a good cultural fit, or to help understand and prevent possible problems. They can be used near the end of the recruiting process or early in on-boarding. They can take anywhere from twenty minutes to several hours for a more robust, in-depth assessment. These are the tools that companies use to help in executive hiring decisions. In the past, organizations were leery of testing physicians, but there is a growing realization that the value of the information more than out-weighs concerns about candidate reaction. It is important, though, to choose the right tool(s) for the situation. Start with a tool designed for a healthcare setting – ideally for physicians. It must also be appropriately positioned with physicians as a way to ensure a good fit for both parties and to ensure that the physician has the best chance to grow and succeed.


Step 3 - Develop Each Physician Resource

 
You bring a physician into the organization. You’ve done all you can to address realistic expectations and goals. While you don’t have complete alignment, you both understand where there are challenges. You understand the physician’s behavioral tendencies and they fit your culture although you have a few concerns. Now what? At this point, most physician groups or hospitals drop the ball. They plug the physician in and hope for the best. Perhaps there is a report card tracking performance metrics. Perhaps there are meetings where performance metrics are discussed. Perhaps a more senior physician teaches them how to navigate organizational challenges. Perhaps the physician develops into the high performing leader you need – or perhaps not.

In any other industry, we’d never leave this much to chance. Think of each physician as an important executive hire who’s growth will contribute to your success. Consider the following framework of a development program:

  • A useful practice report card that tracks meaningful metrics. They should be both individual and organizational metrics to encourage accountability for organizational success.
  • On-going evaluation of operational barriers to success – satisfaction with practice growth efforts, ancillary services support, facilities and staff. Consistent reporting on initiatives that remove barriers to success. Nothing frustrates a physician more than being challenged on performance expectations when no one recognizes or addresses the operational barriers.
  • Engage the physician in creating a development and growth plan. What are the short and long term career goals and the action plan?
  • Use the behavioral assessment to develop important behavioral weaknesses. What’s the plan for improving collaboration, leadership, communication or emotional intelligence?
  • On-going education on leadership skills, practice and hospital economics and related topics.
     

CONCLUSION

Perhaps no need has been so ignored in the push for healthcare reform, than the need to prepare and position physicians to succeed – to succeed in their careers in the face of great changes – and to succeed as leaders and partners in changing the way care is delivered. The template for success already exists. Other professions have adapted to similar challenges. Define how the work environment and demands have changed and start developing the requisite skills during education and training.

Hospitals, health systems, physician groups and physicians, themselves, will benefit from this relatively simple three step process of defining what the new vision looks like, putting in place a process to understand and improve alignment, and then implementing a developmental plan for every one of these valuable resources.

____________

Ted Kinney, Ph.D., is an industrial-organizational psychologist. He leads the Healthcare Solutions consulting team and is Director of Research and Development for Select International. He works with leading healthcare systems on improving behavioral performance.

Bryan J. Warren, is the Manager of the Healthcare Solutions Team. He has twenty years of experience in healthcare, working as an attorney for hospitals and physicians and then as a consultant on hospital performance and physician-hospital alignment.

About Select International’s Healthcare Solutions:
• Candidate screening and in-depth assessments, such as NurseFit®, ServiceFit® for Healthcare, Physician Insight Program, Select Assessment® for Physicians, and Health-care Executive Assessment
• Hiring process re-design to maximize efficiency and legal defensibility
• Award winning Select Interviewing® for Healthcare


Wellness Section 2013 Annual Meeting Minutes - Wellness Section Newsletter, March 2014

American College of Emergency Physicians
Wellness Section Meeting

October 15, 2013
Seattle, WA

Minutes


Participants

Thirty two members were present for all or part of the meeting and included: Lori Weichenthal, MD, FACEP, Past Chair; Randall M. Levin, MD, FACEP, Secretary/Newsletter Editor; Jay Kaplan, MD, FACEP, Board Liaison; Rhonda Whitson, RHIA; and Marilyn Bromley, Staff Liaison.

Agenda

Welcome
Board Liaison Update
Election – Chair Elect
Reports
Wellness Booth
Well-being Committee
Council
Discussion

Major Points Discussed

Dr. Lori Weichenthal, immediate past chair welcomed everyone. She reported that Chair Dr. Sarah McCullough had a conflict and was unable to attend ACEP13.

There were several section members that volunteered for the chair-elect position. Dr. Julie Sanicola-Johnson was elected.

It was noted that attendance at the Wellness Booth was down but people were pleased with the configuration and how smoothly members were able to get their services. A comment was made that weighing at the booth doesn't account for age. One very thin individual was advised to lose 7 lbs.

The Well-being Committee met on Monday. A summary of the 2013-14 objectives was provided.

Brief report was given on the Council meeting. It was noted that a Council Resolution endorsed by the Section in support of nursing mothers would be going to the Board.

A general discussion took place regarding what the section could do to help improve emergency physician wellness. The majority of those in attendance agreed that materials on burnout (management and coping) were of significant importance to the membership, along with information, resources and reports on resiliency, self-care, care of caregivers, mindfulness, meditation, impairment, addictions, and mental illness. Concern was expressed that these resources/materials cross the entire spectrum of the emergency physicians’ career - residency to retirement.

Dr. Rosanna Sikora reported that she was starting a national study of wellness in residents.

A call was given for members of the section to submit articles and information for the section newsletter. Dr. Randy Levin asked that article or suggestions for things that members would like to be seen in the newsletter be sent to him.

Members were asked to let Dr. McCullough and Dr. Levin know if they were willing to help update and improve the Wellness Section Microsite.


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