Finding the Joy: Emergency Physician Wellness and Resilience
Physicians are struggling with burnout, and emergency physicians are particularly at risk. Burnout is an insidious mix of emotional exhaustion, empathy fatigue, devaluing the importance of your work and worsening doubts about your own competence. The CMA reports that more than 25% of Canadian physicians show signs of burnout. We have a suicide rate three times that of the general population.
Can we avoid burnout by strengthening our own reserves? Yes... and no. The Institute for Healthcare Improvement outlined nine components necessary for a “happy, healthy, productive” workplace. These include not only individual level factors like development of wellness and resilience skills but also big-picture factors like safety, choice and autonomy, and alignment of daily work with organizational goals. Addressing burnout effectively means tackling both system and individual factors.
- Learn to accept failure. Don't do this alone. Dr. Gray has championed the idea of having a “failure friend”, someone you trust who you can talk to about how you feel when the inevitable happens and you've made a mistake.
- Remember that you're human. Don't forget the basics: eat, drink, sleep (!), exercise, and have a life outside of the hospital. Beyond the basics, the literature shows that we get a big bang for our buck in terms of happiness, work satisfaction and productivity with adopting daily practices in mindfulness, gratitude and random acts of kindness.
- Take care of each other. Few people understand the demands of emergency medicine as well as another emergency physician. You may be the first to notice that a colleague is struggling and be the first to offer them a compassionate ear. A colleague coping with a difficult patient outcome with gallows humour might be struggling more than they are letting on.
And what about the big picture? How can we focus on our own wellness when our patients are being seen in hallway beds or in the waiting room? How can we “find the joy” when our patients are dealing with the overwhelming burdens of poverty, substance abuse and systemic racism? The answer is that we have to be healthy enough to advocate for our patients. We have to be accepting of our own limitations in order to help our learners cope with sad outcomes and their own frustrations
Increasing physician wellness and resilience isn't the solution to burnout, but it is a step in the right direction, and will allow us to better advocate for those bigger changes we need to provide the excellent care our patients deserve. We've borrowed so much from aviation about decision-making, why not use another aviation analogy: when it comes to burnout, we need to put on our own oxygen mask first.
Resources
Perlo, J. et al. (2017). IHI framework for improving joy at work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement. Available from: www.ihi.org
Headspace Inc. Meditation made simple. Available from: https://www.headspace.com
Weisbaum, E. (2018) What is mindfulness? Available from: www.elliweisbaum.com
Ontario Medical Association (2011). Physician burnout: Understanding causes, symptoms and treatment. Available at: https://www.oma.org/wp-content/wp-private.php?filename=physicianburnout.pdf
The Ontario Medical Association Physician Health Program is a confidential resource if you, a colleague or a loved one are experiencing difficulties:
1-800-851-6606, http://php.oma.org
