Emergency Medicine Wellness Bill of Rights
Issue: May/June 2019
Author: Andy Mayer, MD FAAEM
Editor-in-Chief, Common Sense
Sitting in an airport after leaving the latest AAEM Scientific Assembly is a place for me to reflect upon the last several days of lectures, meetings, social events, and personal interactions. Attending the Scientific Assembly, as I have mentioned in previous articles, is a “wellness event” for me. The meeting allows me to charge my emergency medicine batteries. Listening to one of the many rock star lecturers like Amal Mattu or Peter Deblieux or a new young academic at an open mic session allows me to feel like I am part of the broader emergency medicine community. You can hear new opinions and approaches to problems we face in our practice every day. These are all great, but to me, the real magic occurs standing with a cup of coffee hearing how the rest of the country is holding up.
The tales of success and failure and how different practitioners deal with the various common stressors allow me to realize that my issues and concerns are not unique. In fact, we in the end really share most of the same issues just in different forms. Speaking to doctors in different practice settings, whether it be a huge inner city hospital to a small rural hospital, lets you consider the same problem from many perspectives. The tales of success, failure, or stress allows you to see the various emotional, intellectual, and other responses to these issues. Sometimes there is a flash of genius when you hear how someone solved what to you seemed an insurmountable task. These interactions give encouragement to those having troubles. You can hear the range of situations from great success while flourishing in a career to others who are just barely hanging on by their fingertips.
What is the difference between these two groups? This brings me to “wellness” and what it means to different people and what it should mean to you and AAEM. Wellness has many forms and strategies. Interacting with fellow emergency physicians makes me ponder what I as a colleague, partner, friend, or whoever could and should do in this regard. What is your responsibility to yourself and your emergency medicine community? The more I think about it the more I realize that whether you work for a CMG, an independent group, academic setting, locums, military, or wherever the stressors are intertwined. Your fellow emergency physicians can be feeling burned out for various reasons whether they are related to the insanity which is now modern medicine or some personal issue. Certainly, there are unique individualized causes for burnout but in my experience, they usually boil down to a lack of control at work and/or personal issues related to relationships, family, money, or substance issues.
I was raised in a household where I was taught that success in life was “10% what happened to you and 90% what you do about it.” This may seem simplistic but there is real truth in the phrase. Being a World War II buff, I have been fortunate to live in the city where the National World War II Museum is located. I have attended many lecturers and tours and met many Holocaust survivors or other survivors of incredible ordeals. I was fortunate several years ago to be able to sit and speak with Lester Tenney who survived the Bataan Death March and was a prisoner-of war in the Philippines and then in Japan for years. My Hitch in Hell, his book based on his experience is not an easy read. After surviving years of torture, he returned home to find that he had been declared dead and his wife had remarried and had a child. Somehow, he rebuilt his life, married, became a college professor, and lived until the age of 96. This type of experience makes me wonder what is the difference between these survivors. What makes one survivor of unspeakable horrors succeed and be content while another’s spirit is broken for life. Consider reading Victor Frankl’s book titled Man’s Search for Meaning. He was a psychiatrist who survived Auschwitz. It gives one perspective on this issue and in the end, it relates to wellness and resiliency. How does one person become self-actualized while another cannot overcome these events?
There is no intention by me to compare the challenges we face in America’s emergency departments to the Holocaust or the Bataan Death March, but there are lessons to be learned and food for thought. Each emergency physician’s path to wellness is different but there should be shared tools and resources which can help in this regard. We all see and hear examples of burnout in our emergency departments. When I listen to the tirade from a doctor about seeing yet another fully dressed patient with knee pain what I hear is frustration. Burnout is in the end the opposite of resiliency and is often caused by a lack of autonomy in our practice. We are daily being held responsible for things which we do not control. This is a formula for frustration and burnout.
So, what can AAEM do in this regard? I was fortunate to be able to attend several wellness events at the Scientific Assembly. The Wellness Committee is active and interested in you and helping our members with these challenges. AAEM is very fortunate to have such an incredible group of emergency physicians who are championing this cause. This group is exploring the common issues and concerns facing all of us in our practices. Certainly, AAEM cannot wave a wand and make the practice of emergency medicine self-actualizing and carefree. The violent psychiatric patient, stroke protocols, EMR, nursing shortages, and boarding issues will still be there on your next shift.
During one of the Wellness Committee’s events, I attended a small group session where these groups sat around and brainstormed about ideas and solutions. This is definitely not a one solution issue which can be fixed in a quick and easy way. Sitting back, listening to those in my group I was struck by the depth of talent in this group of emergency physicians. Sadly, I do not remember the individual who made mention of the idea which is the title of this article. What about writing an Emergency Medicine Wellness Bill of Rights? Could this organization with input from any interested stakeholder put together some core rights which we could promulgate and try and honor? What might these be? Could you list ten things which you feel are inalienable rights on a shift?
Low hanging fruit in this line would simply involve having time to go to the restroom, time to have a cup of coffee, maybe be able to walk outside and see the sunshine or moonshine for a minute. I don’t know about you but working in a room with no windows can be a real downer. What would you put on the list? I know that making this list will not solve the problem but maybe they would provide insight into what our profession is missing and be a place to start. I challenge you to send in your ideas or join the Wellness Committee. Contact firstname.lastname@example.org.