Before we delve into this, we would like to point out that we’re fortunate to have Dr. Paul Pageau (ER Physician and current CAEP president) and Dr. Lorne Wiesenfeld (ER Physician and current Vice-Dean for the PGME) guest writing our final post for wellness week. These two have an wealth of wisdom between them; with insights on how to maintain a strong career, promote wellness and avoid burnout. We want to thank you for spending this time immersing yourselves in wellness week with us, and hope that you have gained some useful tools and valuable lessons to reinvest in your own wellness!


1980: “If you can’t handle the heat, get out of the kitchen”

1990: “You’re interested in Emergency Medicine? you must be an adrenaline junky. What is your plan B career for when you burnout?

2000: “We must address physician burnout because we are losing doctors”

2010: “Compassionate care depends on well physicians and a self-awareness of burnout” 

2018: “Our institutions, hospitals and national organizations should prioritize and support physician wellness”

Weakness, burnout, wellness. The conversation has slowly changed over the past few decades. Our work culture and attitudes about self care have changed, and for the better. It seems that perhaps it is time to take off the cowboy hat and get out the yoga mat..

As my thoughtful colleagues have so eloquently written over this past week, we are now much more aware of the benefits of wellness, gratitude and mindfulness. On an individual level, many Emergency Physicians are becoming more mindful and striving to create a balanced life. They’re beginning to take time to be grateful for meaningful jobs, family and friends. What, however, can be done at an institutional level to ensure that ER physicians prioritize self care and wellness? How do we ensure that our physicians in training are equipped to succeed personally and professionally in what can often be a merciless speciality?

Clearly it is not an easy task, and the very nature of our specialty creates some hurdles. The wellness literature tells us that good quality, regularly timed sleep and balanced, regular meals are essential. Shiftwork is no friend to either of these good habits. In terms of heightened stress; on a regular basis, ER physicians deal with individuals experiencing their worst day. We are constantly multitasking, thinking ahead and anticipating the worst – not exactly a zen like state.

An institutional approach to burnout

It almost goes without saying that individual wellness is enhanced by a positive work environment. Not only do patients suffer in a system plagued by access block, but the degradation of physician wellness only further exacerbates the problem. Organizations such as CAEP (Canadian Association for Emergency Physicians) will continue to advocate for improved wait times and increased certified Emergency Physicians, for the benefit of our patients as well as ourselves. Institutions can also step up to support MDs at different stages (mentoring, sabbaticals, addiction support, parental leave, etc.). We can all contribute to a healthy institutional environment through a code of respect, effective listening and collaboration.

The wellness literature also tells us that connections are important. CAEP; our national specialty society, connects ER physicians from across the country who are all dealing with similar issues – limited resources, access block and sometimes difficult consultants. CAEP provides a forum for sharing and developing solutions. There is comfort in meeting and talking with colleagues and knowing you are not alone in your ED struggles.

At the CAEP 2016 conference, Richard Fleet and Marcel Emond put physician wellness onto the national stage with Joie de Vivre. They demonstrated how creativity and discovery are important aspects of wellness. As is often the case, the residents have lead the way by developing a CAEP position statement on resident wellness. Due for publication soon, this excellent document gives clear guidelines on what residency training programs should be doing to start the next generation of Emergency Physician on the right wellness path.

If you want a long career in what can be a very rewarding, exciting specialty, then as individuals, institutions and as a national organization we need to prioritize wellness. We need to continue to connect with colleagues both locally and nationally to make personal and system wide changes for the benefit of all of us.

Connection and Community in Emergency Medicine

Multiple studies have demonstrated that face-to-face contact is important for wellness, resilience and happiness. This is highlighted in ‘The Village Effect’; a book by Susan Pinker detailing the importance of these interactions.

In the Emergency Department, we have ubiquitous face-to-face contact with our colleagues and are rarely alone. This may help camaraderie and perhaps an espirt de corps, but does it help our wellness? Departments are continuously expanding, so while we may know our colleagues as they are at work, do we know them as more than just colleagues? With the importance of wellness coming to the forefront, the nurturing of a community of our colleagues outside of the usual work environment is more essential than ever.

At the Ottawa Hospital, the female members of our department have pioneered this connectivity though a “girls night out”. Their male departmental counterparts, have been (perhaps as always in history), a little late to the table – but it is clearly evident that having departmental events helps to foster a sense of community amongst the group.

Departmental events (and we don’t just mean the annual Christmas party), help to foster a sense of community and organizational pride, and enhance the overall sense of wellness. Further to this, it is an undeniably more enjoyable experience to work alongside those whom you know well.

In February, the “gentlemen” of the department have organized an Barbecue class, where they will be taught the essentials of cooking and smoking meat over open flame followed by consumption of their work and of course accompanied by fermented malt/hops and grape beverages. Ultimately, we hope to further enhance a sense of community, essential to our wellness.  No T-shirt has been made yet but with the plausible deniability of a certain Dr. Jason Frank, a logo has been specially created for this event:

 

Conclusions

Wellness is not an solo activity, nor is it something that only applies to a specific set of individuals. Wellness is something that we need to approach as a speciality, because it is something so fundamental that affects all of us. Departmental activities are also so important because they foster a sense of community and belonging. Perhaps it was said best by Robert Fulghum:

“When you go out in the world, watch out for traffic, hold hands and stick together”. 

Paul Pageau

Paul Pageau

Dr. Pageau is an Emergency Physician at the Ottawa Hospital, and current present of the Canadian Association of Emergency Physicians. He has a special clinical interest in ultrasound, global health and protocolized care. His personal search of wellness involves; family, friends and time in the Gatineau hills.
Lorne Wiesenfeld

Lorne Wiesenfeld

Dr. Lorne Wiesenfeld is an Emergency Physician at the Ottawa Hospital, and current Vice-Dean of Postgraduate Medical Education at the University of Ottawa, with an very evident interest in medical education. His concept of wellness includes engaging in the social aspects of life, and making time to enjoy his cottage.
Shahbaz Syed
Dr. Syed is an staff Emergency physician at the Ottawa Hospital, with an fellowship in Digital Scholarship and special interests in rational resource utilization.