Thursday, August 27, 2015

Resident Rules of the Road: Chapter 11 Summary: "Wellness"

Originally Published: AAEM's Rules of the Road for Emergency Medicine Residents, 7th Ed. Chief Editors: Tom Scaletta, MD FAAEM; Michael Ybarra, MD FAAEM; Leana Wen, MD MSc. AAEM and AAEM/RSA. Milwaukee, WI. 2010.

Chapter Summary Edited By: Andrew W Phillips, MD MEd, Stanford/Kaiser Emergency Medicine Residency Program  

Summary Series Editors: Muhammad Alghanem, BS and Andrew W Phillips, MD MEd

Physician—heal thyself.

It is difficult to estimate exactly the burnout rate in emergency medicine (EM) since it is a relatively young specialty, but there is no denying that it is a stressful specialty prone to burnout. Here, we provide some tips for preventing burnout.

Shift Work/Sleep
Dealing with night shifts: If you move to a regular night schedule, keep that schedule even on days off whenever possible to keep your circadian rhythm. Be cautious that day sleepers often do not get as good of sleep as night sleepers and will lean toward using stimulants and sedatives. Scattered, single night shifts may be preferable. A third alternative is a forward-moving schedule: day to evening to night to break. Shorter shifts (8hr) and 30-45 minute power naps before night shifts are helpful to remain alert. Experts also recommend sleeping as soon as possible after a night shift.

Sleep environments: To improve sleeping during the daytime, fully darken the room and remove any extraneous sounds such as cell phones. Specific suggestions include blackout curtains, eye shades, ear plugs and sound machines. Avoid bright lights before going to sleep during the day, along with caffeine, nicotine and alcohol. Aerobic exercise can improve the adjustment to waking up at night.

Professional Environment
Work and play well with others — it’s as simple as that. Handle complaints from patients/families and criticism from consultants with professional integrity; do your best to not take them personally.

Malpractice Claims: It is an all too common hazard for the emergency physician to be sued. The cases can linger for years, and physicians will often go through stages of grief. A malpractice suit is not to say you are a failure as a physician. Do your best to intellectually separate yourself from the case.

Gender Issues: There can be a sense that society is expecting females to be both full time professionals and perfect partners and/or mothers. Be careful that this does not bring you to pit your personal life against your professional life.

Sexual harassment of female doctors occurs in many forms. The perpetrator should be told immediately to stop, whether verbally with a witness or in writing; a formal workplace grievance should be filed if the behavior continues if not done on the first offense.

Stress Reduction: “Take care of yourself so you can take care of others,” admonishes the Rules of the Road book. You must grow in your personal and professional life while recognizing signs of stress and burnout. Exercise and humor are two central components of stress relief. Base your self-esteem on things you can control which means efforts, not results.

Emergency physicians — any physicians for that matter — must guard against chemical dependency. Never take any medications that are not absolutely necessary, especially to treat stress. Seek help from peers, your personal physician, family, spiritual leaders, or close friends, to name a few.

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