LIN Session – Resident Wellness


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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN

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brendan c. -

I have heard so many lectures about this and feel like you are left with nothing at the end except awareness.
It's like telling me about Brugada, how important it is, but leaving out a picture of the EKG and a not providing a s treatment pathway.

I would love emrap to start an email or twitter or something... to try and help. Bryan Sexton / Duke University used to send me an email every day " 3 good things" in an email every day. Can't stand Dukies (from UNC-CH) but this was gold. Summary

Each night before you go to sleep:
1. Think of three good things that happened today.
2. Write them down.
3. Reflect on why they happened.

This was the written program but email works better. Come on EMRAP tell us how to treat this hugely morbid and fatal disease: burnout and depression. You can do it!

Christopher D. -

Thanks!! There are some papers on this now.

West et al. wrote an article in the Lancet in September of this year (PMID: 27692469 ) where are they talk about some interventions that may help with physician burnout.

It is my hope that this session on EMRAP lights a fire under the listeners and they demand more on this topic. I am happy to help lead this discussion if that is helpful.

Tremendous kudos to Mel and his team for making this chapter free for everyone. It really shows the commitment to the listeners and other emergency physicians and how important people think this issue is.

Lastly, several months ago there was an EMRAP chapter by Dike Drummond and Rob (May 16) where Dike talked about some strategies and practical ideas that you can implement at your shop tomorrow.

Kevin M. -

3. You don't agree with your bosses values or leadership.

Noting that in in the larger sense my bosses and leadership are pushed by outside agencies such as CMS, JHACO, Pt "Satisfaction Scores." I find this to be amongst the top two things about work that makes me want to quit.

To paraphrase a rap verse...."I never gave a .... about a metric because a metric never gave a .....about me.

After 20 year of practice and because I keep myself up on the literature- rarely do I find myself stressed at work because of clinical load or clinical decision making or procedural challenges- except for the ridiculous and conflicting metrics that seemingly attempt to keep me running, like some rat in a lab-designed wheel, Bed to physician, LOS, LWBS, Sepsis metrics, STEMI metrics, CVA metrics, Trauma Level 2 activation....ooops, stop whatever you're doing and go right there.....three traumas in a row at 3 am but the family in room 12 is "Getting antsy" and that'll mean low satisfaction scores which will cost me 20% of my bonus.....and the beat goes on. At the end of the day, I realized that it was actually killing me, actually shortening my life, which means less time that my children will have me around. And those rules and those stressors are set up by people who never, ever, ever, ever, have to deal with the same stress that can cost them year off of their lives. So, I decided to let it go. I study every day, keep up, provide excellent care, treat my patients well, and delete the negative emails that try to tell me that since only 5/11 people of the more than 1100 I saw the last quarter, gave me a 9 or 10, I'm not a good doctor. I have had to say to that sort of nonsense in order to save my own life.

Ian L. -

Wellbeing is important -how you are at the time .
Also attitudes as regards how you deal with errors and how the legal system can be a real stress .
There ought be a decade of anonymity re all errors unless due to malice -and open disclosure of errors leading to bad outcomes to teach others and as a catharsis and the patients ought be highly compensated .
Great saves ought be remembered and remembered you have to tick yourself for good work .

Robert L., M.D. -

My hat is off to Dr. Doty for shining a light on an epidemic of massive proportions in our specialty. The 2015 Mayo Clinic survey reported prevalence of over 65% of all emergency physicians as burnt out. If more than half of us are burnt out, it cannot be just an individual issue, this is a systems based issue that needs systems based solutions! We need our specialty societies to advocate for us at the key drivers of burnout.
I appreciate Dr. Doty's call for normalizing our conversations around the enormous stressors that we face in emergency medicine. I would also add that one the most powerful things we can offer to our colleagues when these conversations do happen is our own vulnerability. The statement "me too" is so powerful when we are struggling with things that for better or worse cause us shame and drive us to isolation. My hope is we can with kindness, gentleness and empathy walk with our colleagues through the tough times that inevitably happen in our profession.

Christopher D. -

Thanks Robert.

Christopher D. -


Thank you for your comments! I agree that a HUGE part of normalizing this conversation is to expose our own fears and vulnerabilities to those that approach us (and maybe those that don't) and let people know that these stressors, these feelings, these challenges are part of Emergency Medicine. Essentially, they are an occupational hazard for our specialty.

Tribalism is strong in our specialty. Letting our colleagues know that these feelings often are mutual, and are an expected part of our specialty, is immensely powerful. It lets our colleagues know. that they are still part of our tribe.

You will be happy to know that all the major organizations in Emergency Medicine are participating in a summit next month in Dallas to discuss collaborative strategies for improving physician wellness and resiliency in our specialty. Once again, Emergency Medicine leads the way. This is the first time that I can remember when all of the major organizations in EM EM stood on the same side of an issue. Hopefully, the summit bears fruit and collaborative groups and strategies are identified and created. Thank you again for your comments and for taking care of our colleagues. Chris

Mark J. -


Just listened to this issue of EMRAP. I have been working with Dike Drummond for the past year. Would love to connect and see what you have going at your place.

Mark Jaben, MD

Christopher D. -


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