Wellness Issues for

Emergency Medicine
Residents
Jim Holliman, M.D., F.A.C.E.P.
Professor of Military and Emergency Medicine
Uniformed Services University of the Health Sciences
Clinical Professor of Emergency Medicine
George Washington University
National Naval Medical Center
Bethesda, Maryland, U.S.A.

Wellness Issues for E.M. Residents

Lecture Outline

General importance of wellness considerations

Work scheduling

Family interactions

Outside activities

Personal health

Support mechanisms

Wellness Issues for E.M. Residents

Lecture Goals

Familiarize E.M. residents with wellness
issues

Help individuals develop personal wellness
plans and programs

Promote discussion of wellness issues

What is "wellness" ?

Same as "well-being"

Person's state of being should be :
Pleasing
Desirable
Appropriate
Healthy

Cannot be taken for granted but must be

planned

Goal is to enable successful & comfortable
coping with stresses

Stress Factors in E.M.

Residency

Intense work environment

Patient demands & expectations

Risk of illness / injury

Long work hours

Limited time for family / recreation

Sleep deprivation

Criticism by other specialties

Perception of lack of knowledge or
confidence

Stress Factors on Residents from

the E.D. Work Environment

Time pressure to see patients quickly

Large numbers of patients

Must manage multiple simultaneous patients

Other concurrent work duties & demands
Answering referral phone calls
Answering paramedic radio calls
Informing relatives & other physicians

Unpredictability of patient presentations

Types of Patients that Cause Stress

for E.M. Residents

Severely injured, especially children

Disfigurement

Malodorous

Victims of deliberate harm

Hostile

Combative

Inappropriately demanding

Psychiatric

Coping with the Stress of Caring for

the Severely Injured

Focus on providing care for the patient

Involve other E.D. personnel as a team

Treat the patient's pain early

Try to see a mix of acute and minor cases
(don't just see a continuous stream of severe
cases only)

Coping with the Hostile Patient

Try to find out the real reason for their
hostility

Often is due to fear or anxiety which can be

addressed

Explain situation carefully & completely

Involve the attending early

If situation seems unsalvagable, then
transfer care of patient to another resident

Coping with the Inappropriately

Demanding Patient or Family

First : carefully explain the situation

Second : find out what is really concerning the
patient & address that

Third : have the attending speak to the patient

Fourth : have a nurse or other non-physician
re-explain things to the patient

Finally : don't allow yourself to do something
inappropriate just to satisfy the patient or
family

Coping with the Stress of Seeing

Psychotic Psychiatric Patients

See them only in a secure area or
accompanied by other E.D. staff

Utilize sedative medication early after
medical clearance

Have a plan in place for early involvement of
psychiatrist and admission or transfer

Don't spend fruitless time trying to reason
with the acutely psychotic patient

Coping Measures for General E.D.

Workload Stress

Take a couple of short breaks out of sight of
the patients

Don't skip meals

Enlist appropriate help of co-workers
Obtain extra personnel if needed
Call personnel in earlier

Measures for Dealing with the Stress

of Patients Dying in the E.D.

Residents should have training in "deathtelling" from faculty

Should involve counselor, chaplain, or nurse
to assist in talking to family

May help to have conference afterward of all
involved personnel to review case

Residents should have access to counselors
themselves if needed

Should quickly focus on caring for the next
patient

Coping with the Stress of Shift

Work

E.M. physicians spend more time at night at work
than most other physicians

But have less on-call time and fewer unexpected work

time demands

Should only have limited responsibilities for work or

conferences on day following night duty

Should have at least 24 hours off after night shift
before switching to day shift

Should ensure equitable distribution of night shifts
among residents & faculty

Should allow night residents to sleep if not busy

Home Aspects of Coping with

Night Shift Work

Don't drink too much coffee in the morning if
planning to sleep

Have "breakfast" before going to bed

Try to ensure quiet sleeping area (turn phone off)

Make sleeping area as dark as possible
(blackout curtains)

Sleep till afternoon if in a series of night shifts

Set alarm & wake by noon if finishing a single
or series of night shifts to allow return to
normal sleep schedule at night

Improving Relations with Coworkers in the E.D.

Should have regular meetings where all
personnel are invited to discuss problems

Critical Incident Stress Debriefing may be
useful for groups involved in major incident

Helpful to have social events outside the
hospital for staff several times per year

Interactive problems should initially be
addressed in private

Improving Relations with Your

Family or Significant Others

Most Important Principle : DON'T NEGLECT
YOUR FAMILY !

Must allocate sufficient dedicated time to
family

Have family tour the E.D. so they know some of
the work stresses you face

Resident families should get to know each
other, communicate regularly, and agree to
help each other out regularly

Methods for Residents' Families or

Significant Others to Interact Supportively

Set up rotating baby-sitting service

Rotating evening "pot-luck" dinners

Regular group meetings for support

Attend hospital or department social
functions

Importance of Personal Health

and Well-Being

Maintaining one's personal health ensures greater
enjoyment & efficiency at work

Maintain balanced diet
Consider bringing food pre-prepared at home when on
work duty
Try to stick to regular meal schedule

Regular exercise

Avoid drugs, tobacco, & excessive alcohol

Sufficient sleep

Extra rest or limit activity if infectious illness occurs

Key Method to Help Ensure Wellness :

Make a Personal Schedule

VERY IMPORTANT to write out a general
long term schedule & a more detailed short
term (one month) schedule

THEN STICK TO THE SCHEDULE !

Important to plan time for :
Family
Exercise
Recreation / hobbies
Social events
Vacation
Academic pursuits

Recommended Considerations
for Your Personal Schedule

Consult your family or significant other for
events significant for them

Be flexible with your fellow residents to cover
work duty to allow them to attend their
important events so they will do the same for
you

Schedule specific times for exercise

Importance of Developing
Hobbies

Don't center your life around medicine only

Should develop interests outside medicine

I recommend pursuing at least one "indoor" and
one "outdoor" hobby

So if the weather happens to be bad on one's

day off, the indoor hobby can be enjoyed

Best hobby choices are ones that can be shared

by spouse, significant other, or family members

Hobbies that create something can be the most
rewarding

Indoor Hobbies to Consider

Painting / drawing / drafting

Music

Sewing

Indoor gardening

Woodworking

Model building

Toy making

Other crafts

Board games / computer games

Film developing

Cooking

Wine or beer making

Note that
watching TV
or reading
do not count
as hobbies

Outdoor Hobbies to Consider

Sports

Gardening / landscaping

Photography

Hiking

Camping

Swimming

Outdoor toy building

Bicycling

Boating / canoeing

Target shooting / hunting

Archery

Paint ball

Other Activities to Consider

Outside the Hospital

Must be careful with these to not interfere
with time for family
Youth counseling
Sports team supervision
Lecturing to students or the public
Career advising for students
Volunteer work with elders
Political activism

Importance of Career Planning

Should establish & prioritize career goals

Make sure family or significant other has
input into & understands your career goals

Must integrate financial planning

Discuss with E.M. faculty

Set realistic goals

Update or change as needed

Establish a Personal Support

System

Prearrange a "confidante" person to whom
you can talk about any problem

A person who understands stresses of

medical career is best, but does not
necessarily have to be a person in the medical
field

E.M. faculty should arrange availability of

other counselors as needed

Make sure confidentiality is assured

Helping Your Fellow E.M.

Residents

Should have regular meetings of all the residents to
discuss problems

Should maintain cooperative, rather than
competitive, atmosphere in the residency

If a resident shows signs of stress or work
decompensation, other residents should encourage
counseling and be extra supportive

All residents should maintain willingness to make
schedule changes and cover for times of illness for
other residents

Options to Deal With Major

Unresolved Stresses

Discuss carefully with counselor first

Take a vacation

Switch rotations with another resident

E.M. Program Director may grant a
temporary reduced work schedule

Take on a new "distracting" project such as
an academic project

Wellness Issues for E.M. Residents

Summary

Stick to a prearranged personal schedule

Maintain healthy lifestyle

Devote sufficient time to family

Set career goals

Maintain flexibility & helpfulness for other
residents

Utilize personal support structure early for
any major problems