Wellness Week - January 22-26, 2024

Day 1 - Connect to What Matters: Welcome to Emergency Medicine Wellness Week! (Monday, January 22)

Connect to What Matters: Welcome to Emergency Medicine Wellness Week!

Emergency Medicine Wellness Week is an essential reminder of the critical role played by emergency medicine physicians in our healthcare system. It’s also an opportunity to reflect on the current state of emergency medicine, including its pros and cons. In this post, we will explore the challenges and rewards that emergency medicine professionals face daily, emphasizing the importance of connecting to what truly matters in this demanding field. And we’ll give you a sneak peek for what’s coming later in the week!

The Upsides of Emergency Medicine:

Lifesaving Interventions: Emergency medicine provides the unique opportunity to save lives and make a significant impact on patients in their most critical moments. The ability to act swiftly and decisively is a source of immense pride and satisfaction for emergency medicine physicians.
Novelty: Emergency physicians encounter a wide variety of cases, from trauma and acute illnesses to minor injuries and psychiatric crises. This diversity keeps the profession intellectually stimulating and ensures that no two days are the same.
Rapid Problem Solving: The fast-paced nature of emergency medicine requires physicians to think on their feet and make crucial decisions quickly. This constant problem-solving cultivates adaptability and sharpens clinical skills.
Teamwork: Collaboration is integral to emergency medicine. Physicians work closely with nurses, paramedics, allied health, and specialists to provide the best care possible. The camaraderie and support within the team can be immensely rewarding.
Community Impact: Emergency departments often serve as the first point of contact for individuals in crisis. This makes emergency medicine physicians vital community healthcare providers, offering immediate care and guidance when needed most, particularly for marginalized populations.

The Challenges of Emergency Medicine:

High Stress and Burnout: The relentless pace and pressure of emergency medicine can lead to high levels of stress and burnout. Long hours, frequent overnight shifts, and exposure to trauma take a toll on both mental and physical well-being.
Emotional Toll: Dealing with patients in critical conditions, witnessing suffering, experiencing violence and sometimes losing patients is emotionally taxing. This emotional burden can impact the mental health of emergency medicine professionals.
Paperwork: Increasing administrative tasks, such as documentation and regulatory compliance, can detract from the time emergency physicians spend with patients, leading to dissatisfaction.
Resource Constraints: Many emergency departments face resource shortages, overcrowding, and insufficient staffing, which can hinder the delivery of quality care and increase stress levels for healthcare providers.

Connecting to What Matters:

In the midst of the challenges and rewards that emergency medicine offers, it’s crucial for emergency physicians to connect to what matters most in their professional lives. Over the next week, we will bring you posts on connecting to what matters most outside the ED, people you know (and don’t!), peer support networks, and an end-of-week wrap up!

Emergency medicine is a profession that demands a lot from its practitioners, but it also offers profound rewards in terms of patient impact and clinical excitement. As we celebrate Emergency Medicine Wellness Week, let us remember to connect to what truly matters—our well-being, our patients, and our passion for saving lives. By addressing the challenges and nurturing our strengths, we can continue to provide excellent care in the emergency department while prioritizing our own health and happiness.

Dr. Sara Gray

Dr. Sara Gray is a mom, doctor, and scientist who works at St Michael’s Hospital in Toronto. She likes running, travelling and public speaking, and hates traffic, trolling and bad red wine. She thinks we need more wellness in medicine and is working on restoring her own work-life balance, along with that of her colleagues.

Day 2 - Connect to What Matters, Outside the ED (Tuesday, January 23)

Connect to What Matters, Outside the ED

Lots has been written about how you are the average of the 5 people you spend the most time with. This idea has spun off discussions about the 5 people you need in your life, even likening it to having a personal board of directors for major life decisions.

For the second day of wellness week, we have adapted this concept specifically for emergency physicians because, let’s face it: having the right people in your corner is just as critical as knowing the latest febrile infant protocol.

To kick things off, I turned to ChatGPT and asked it to frame these essential people in the context of medical equipment. This is what it came up with:

Stethoscope ally

Your grounding force; they are the steady heartbeat that keeps you centred.

Confidential monitor

Like your trusted cardiac monitor, these are the people in whom you trust to share the highs and lows for the day, while safeguarding confidential information.

Culinary defibrillator (wins the cheesy award)

Just as the defibrillator revives a heartbeat, the CD revives your flagging energy with a good meal or well-timed snack.

Sage ultrasound

Similar to an ultrasound providing insights into the unseen, the sage ultrasound is a mentor who imparts wisdom by revealing hidden nuances. (I particularly liked that analogy, as a former PoCUS lead)

Needless to say, I thought perhaps that humans could do better, so this is what my colleagues at Queen’s emerg & I came up with.

Dogs

Considered honorary people since they listen, laugh at jokes, and love it when you drop some food. Generally, they make everything better.

The Anchor

Whether a spouse, partner, family member or friend, they ground you daily, providing a sanctuary of normalcy. After a long shift, they instinctively know not to ask about dinner choices: they just bring you your favourite meal.

Failure friends, (popularised by Dr. Sara Gray)

These are the folks who can listen to your failings (& your feelings about your failings), providing support & reframing. Ideally you need someone from the failings & feelings squad for all aspects of your life: clinical work, academic work, home life etc.

Friends of all types

From the comedian to the reality checker, the shrewd confidante, the challenger, the listener, the collapse-into-giggles-at-the-wrong-moment-er, or the Netflix consultant. We are all different, but you know who you need.

Sandwich Years Simplifiers

People to help with childcare, sibling care, and elder care, and several layers of backups. They understand that the home front crises always happen at the most inconvenient times. (And along those lines, excellent colleagues who understand without questioning, offer to cover, and maybe even drop off a meal at your house.)

Life Smoothers

People that have expertise in areas that we may not: an accountant, lawyer, financial advisor, therapist, coach, housecleaning service, handyperson, gardener…

The Sages

Mentors, sponsors and allies who set you up for success by sharing their wisdom on how to navigate challenges in work and life.

A good barista

Because, after all, a good cup of coffee can solve many problems.

The connections with the people around us are what make our lives rich and interesting. Each member of your personal cast fulfills a vital role in maintaining your sanity, providing comic relief, and sustaining you for the next challenge. So today, consider reaching out to one of your connections and tell them why they are so special to you. After all, in the ED and in life, it is the people we surround ourselves with who make all the difference.

Dr. Louise Rang

Dr. Louise Rang is an emergency physician and associate professor at Queen’s University Department of Emergency Medicine. She is currently in her dream role as the Professional Sustainability & Wellness Lead for the department, which allows her to work creatively and collaboratively to improve physician and departmental wellbeing. She is an active member of the CAEP Wellness Committee.

Day 3 - Wise Advice: Talk to Strangers! (Wednesday, January 24)

Wise Advice: Talk to Strangers!

Connection can occur in the most unexpected circumstances, like a short interaction with a stranger. Further to this, you can make an effort to foster brief periods of connection to enhance not only your wellbeing, but that of the other person! In our practice of emergency medicine, we have the opportunity to tap into this every day at work!

Our brains don’t always know what can improve our wellbeing. Did you know that research has shown that meaningfully connecting with a stranger improves not only your own positivity, but also that of the person you spoke to? We might think that speaking to a stranger would be awkward and that the other person would be bothered – but this is actually not the case!

Connectedness matters more than we may think. We underestimate the benefits of social connection, especially when connecting with strangers.

We may already have an understanding that keeping a social circle improves our wellbeing. Myers (2000) found that people with close social ties are less vulnerable to premature death and more likely to survive a fatal illness.

Diener and Seligman (2002) studied happy and unhappy people. Those who were very happy had more close friends and strong family ties than those who were unhappy.

Very unhappy people spend more time alone and happy people spend more time with their friends, family, lovers, etc.

Knowing this information, can we make an active effort to change our lives and improve our happiness?

Epley and Schroeder (2014) did a study on talking to strangers while taking public transport.

They found that people in the study who were instructed to make conversation with a stranger, and make a meaningful connection with them were happier than those who did not.

Most participants predicted they would be happier not connecting with others. However, the study found that the positivity was the lowest amongst those who did not connect and those who did connect with a stranger had a significant increase in their positivity.

Our brain’s intuition is sometimes wrong and we think the interactions may be awkward, because we assume strangers would be bothered by being interrupted. The researchers went further to study the strangers being spoken to – they found that their well-being improved as well. Both the person trying to connect with a stranger and the person being connected with – there is a statistically significant increase in the positivity for both people. In conclusion, not only would your positivity increase if you speak to a stranger, that stranger’s positivity will also increase.

In our field of work, we have the privilege of meeting new people every day. If we made an effort to connect with at least one stranger every day, we can not only improve our own wellbeing, but also that of the other person.

The science of well-being is a fascinating field of research. You can access a very easy to follow and very intriguing free course at https://www.coursera.org/learn/the-science-of-well-being. This course offers you more information about how our brains lie to us about what makes us happy, it explains the science and research behind what truly improves your wellbeing – a lot of the findings may surprise you! Further to this, Dr Laurie Santos, the creator of this free online course on the science of well-being has a podcast called The Happiness Lab (https://www.drlauriesantos.com/happiness-lab-podcast) where she shares her great knowledge on the subject.

References:

Myers (2000). The funds, friends, and faith of happy people. American psychologist, 55(1), 56.

This paper tells us that having strong social ties makes you healthier.

Diener & Seligman (2002). Very happy people.

Psychological science, 13(1), 81-84.

This paper tells us that being social/having strong social ties makes you happier.

Epley & Schroeder (2014). Mistakenly seeking solitude. Journal of Experimental Psychology: General, 143(5), 1980.

This paper tells us that talking to strangers makes us happy. Even if you are reluctant to talk to a stranger, you and the stranger get a happiness boost after talking to each other.

Dr. Huma Ali

Dr. Huma Ali is an Emergency Physician working in Calgary. She is passionate about culture change and physician wellness. She holds a Master of Arts in Healthcare Leadership, is a Schwartz Rounds facilitator, a Physician Collaborator with Well Doc Alberta where she helps lead Physician-to-Physician Peer Support Training and is a certified spin instructor.

Day 4 - Shifting the Culture of Medicine with Peer Support (Thursday, January 25)

Shifting the Culture of Medicine with Peer Support

We are working through some of the most difficult times the specialty of emergency medicine has ever seen. Post pandemic, the system cracks have become caverns, and it feels as if we are trying to hold everything together with shoestrings and best intentions. Boarding, long wait times, hallway medicine, news stories weekly about the ‘failure’ of emergency department X to provide timely care leading to a bad outcome; all this weighs on us as we walk into our next shift.

And yet, there is much to be proud of in our specialty: our rapid pattern recognition and ability to problem solve, save a life, care for the young and old, and provide a social safety net for individuals when all else has failed them. These are the things that keep us coming back despite the high stress levels associated with emergency medicine.

In the chaotic environment of the ED, we are required to make quick decisions, we bear witness to other peoples’ trauma, and we do it all within the framework of being human (a fact we sometimes forget). Medical training indoctrinates a culture of perfectionism: a good doctor is expected to ‘bat 1000’ while good baseball players bat 300 (and they do it with coaching and better sleep). ‘Good doctors’ put aside their own needs to serve others. This culture has always been put forward as good for patient care (who doesn’t want a doctor who is putting in their best effort?) The other side of the coin unfortunately, is that this same culture can also cause harm to those practicing within this framework. It is not unusual for a doctor to believe that they have failed, and sometimes, that they are a failure, when a decision they make results in a bad outcome. Known as the second victim phenomenon, guilt and shame can become part of our ethos. For far too long, we have kept this inside and suffered alone. Left unchecked, years of this type of thinking fosters isolation and physician burnout. In the Stanford WellMD course, they discuss an interesting analogy. Construction workers are provided with hard hats and noise protection because of the occupational hazards of their job. Similarly, burnout is the occupational hazard of a career as a physician. What is the equivalent ‘protective gear’ we are providing to protect physicians from experiencing this work-related injury so they can stay productive, engaged, and compassionate in the care they provide? Our health care system and most organizations have not yet fully embraced thinking about this problem from an occupational health lens. Medical culture needs to shift to include the wellbeing of physicians as much as it cares about what ails patients.

The zeitgeist about trauma informed care has typically been focused on the patient. However, our nervous systems also deserve this lens applied to clinical providers. Witnessing other peoples’ trauma, working against our circadian rhythms, making rapid decisions with missing or imprecise information; all of this puts our nervous system in a state of sympathetic arousal: fight or flight. We need regular doses of the parasympathetic system, the ‘rest and digest’ system, to keep our bodies in optimal physical and mental health. Authentic connection with others permits downregulation of cortisol and sympathetic activation.

Peer support provides a relational space of confidentiality and psychological safety that fosters a conversation between colleagues where a person feels heard and that they matter. It reminds them of their strengths (often difficult to remember when we feel we have failed). Most importantly, it reminds them that they are not alone. While we are good at being compassionate towards others, we often lack self-compassion. For too long, the profession of medicine has been about putting the patient above all else, including ourselves. A good peer support conversation reminds us that we are doing our best in a system that is not optimized for either the patient or the physician. The shift to thinking about physician wellbeing hand in hand with patient outcomes is the key to our healthcare system being able to continue providing care in the decades to come.

A 2023 study published by a peer support program offered in a paediatric medical centre in the USA, found that 72% agreed that the peer support program was valuable and 81% of survey respondents recommended peer support be offered to those involved in adverse and stressful events.1

As paediatrician and author, Rachel Naomi Remen so eloquently stated: “the most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention…A loving silence often has more power to heal and to connect than the most well-intentioned words.” Our authentic presence can help a colleague feel connected to and supported, at a time when they may be doubting their care and their abilities as a physician. These conversations can mitigate burnout by turning what feels like a career ending event in the moment, to an expected ripple in the ups and downs of a long career in emergency medicine.

As the pressures on our system are likely to continue, it is my hope that the culture of medicine will evolve to understand that excellence in patient care will happen not in spite of, but because of, prioritizing a healthy physician work force. Connection and empathic listening via peer support is one way we can encourage this culture shift to mitigate burnout and foster longevity in a career in emergency medicine.

References:

Simpson et al 2023

Implementation of a peer-to-peer support program in a quaternary paediatric medical centre https://pubmed.ncbi.nlm.nih.gov/37482296/

Dr. Deepa Soni

Dr. Deepa Soni practices emergency medicine in Mississauga and is an assistant professor in the Department of Community and Family Medicine at the University of Toronto. She is the peer support lead at Trillium Health Partners and has helped create a new GTA wide EM peer support program. A recent graduate of the Stanford WellMD course she loves to learn about and discuss, the art and science of wellbeing both in our personal and professional lives.

Day 5 - Connect to What Matters: Wrapping up Wellness Week 2024! (Friday, January 26)

Connect to What Matters: Wrapping up Wellness Week 2024!

Thank you for connecting with us for this important week. The Wellness Committee finds strength in sending important messages to our profession and others in order to promote career fulfilment and longevity. Such amazing messages and information this week. This week carries forth the momentum from November 2023, when we collaborated with the stop the stigma EM campaign. Click on the image below to view the the important Grand Rounds Dr. Dawn Lim presented!

For our last day of CAEP Wellness Week 2024, we’d like to collate some of the key messages that have been shared!

On the first day, we got a lay of the land by Dr. Gray. We reminded ourselves about the joys of emergency medicine — the capability of delivering lifesaving interventions in one’s greatest time of need, the novelty of cases within the profession, the honing of one’s ability to think on their feet, and more. We were also reminded of its less glamorous aspects, from physical and emotional burnout to resource constraints. But to deal with those challenges and continue practising the beautiful, essential profession of emergency medicine, it is vital to connect to what matters — our well-being, our patients, and our passion for saving lives.

On day two, Dr. Rang explored the connections within our lives. In the ED, we depend on our teammates to make sure the department runs smoothly; it is no different in life. The anchor, a special person in your life that knows you, listens to you, and grounds you — they can always make your day better; the failure friend, that someone who is there for your lows, who will hear out your struggles and help reframe your thinking; the life smoothers, those specialists in other areas who can handle the financials, the groceries, and the gardening; and let’s not forget about the dog! It is said we are the average of the five individuals we spend the most time with. These people enrich our lives and fuel our drive to do good. Consider reaching out to those connections and telling them how much they mean to you.

It may be intuitive that connections with the people we hold dear are crucial. But what about the importance of connecting with strangers? Dr. Ali delved into this topic on day three. Studies have shown that having a strong social circle enhances health outcomes and happiness. One in particular had participants try to connect with strangers by conversing with them on public transport. Results showed that both the participants and strangers that ended up chatting displayed a statistically significant increase in positivity. In the ED, we never know who to expect, and come upon strangers every day. To connect with their stories is a privilege that can enrich our happiness. For references to those research articles and links to a podcast and free course on well-being by Dr. Laurie Santos, revisit that day three post.

In a career with wholly unique hardships to overcome, Dr. Soni covered the importance of support from those who experience and understand those exact challenges: our peers. Post-pandemic times have left us scrambling to weave an even larger safety net to aid our patients, with minimal resources. This has exacerbated already-present issues, such as increased wait times, hallway medicine, decision-making under duress, and the second victim phenomenon from bad patient outcomes, all contributing to maladaptive sympathetic activation and the breakdown of resilience in EM physicians. Research shows that peer support programs can be useful in combating these stressors. Oftentimes we just need a colleague to provide a loving silence, to remind us of our strengths, to let us know we are not alone. Only when the wellbeing of physicians is accounted for can they in turn devote themselves fully to the wellbeing of patients.

We thank you for connecting with us and being a part of CAEP Wellness Week 2024! With high rates of burnout and workforce retention issues ever prevalent, medical culture is recognizing and addressing the importance of physician wellness. It is more important than ever to leverage the connections in our life.

Dr. Rod Lim

Dr. Rodrick Lim is a Professor of Paediatrics at the University of Western Ontario. He is the Medical Director & Section Chief of the Paediatric Emergency Department at the Children’s Hospital and the Chair of the Wellness Committee, and the co-chair of the Leadership Committee at CAEP. He could not be more thrilled to be involved with a diverse group of passionate, capable and dynamic individuals in the wellness community.

Si-Cheng Dai

Si-Cheng Dai is a medical student at McMaster University aspiring toward a career in Emergency Medicine. He completed his Bachelor of Medical Sciences at Western University. As a member of the Wellness Committee, he is thrilled to be working with leaders in the field of Emergency Medicine and learning how to contribute to the longevity of the profession.

Interested in joining the CAEP Wellness Committee? Email jgale@caep.ca to get involved.

Wellness Committee

Wellness Resources

Wellness Week – January 22-26, 2024