Rebecca Kornas, MD, FACEP
President CO ACEP
“To arrive early, is to be on time. To be on time, is to be late. To be late, is to be dead.” This is a maxim that my middle school coach shared with our team which resonates with me to this day. The way that you enter a shift as the attending emergency physician sets the tone for the day. If you come in after a poor night’s sleep, hitting the snooze button multiple times and leaving your house late, followed by getting stuck in traffic on your way to work, this sets you up for entering your shift with a near empty cup. This is quite a different tone than one where you go to bed early, wake up early with the motivation (and time) to get a bit of exercise, hit all green lights on your commute to work and then arrive promptly to your shift with a great mental attitude, ready to face the day. This is a day when you start with a full cup.
In life, we don’t always have 100% control, but we can engage in little habits as we prepare for the day ahead, which will set us up for success. Getting physical activity, eating healthy and nourishing food, having fulfilling conversations with family/friends, a wind down process that tells our body it is time to rest, good sleep hygiene (not allowing phones or work in bed) are all basic practices that facilitate our mind and body resting more effectively and prepare us to successfully face the following day. In this way we have more control than we might initially believe.
Even though you don’t have control over all the events that happen around you, you do have control over your response to these events. Your perspective and interpretation of events is your reality. Why not choose to live with a more generous perspective on the events that occur around you? It doesn’t cost anything. For example, when you have a conversation with a consultant where he/she asks several questions about the workup of the patient you could interpret that as him/her distrusting your clinical judgement and pushing back on the admission. Or more charitably you could consider these queries to represent curiosity into the patient’s presentation and clarifications on level of illness to ensure that the patient is appropriate for your requested level of care. Both versions of this interaction follow the exact same consultant conversation, but the latter is a more generous interpretation of the communication. The truth likely falls somewhere in the middle of these two thought experiments, but what mentality is going to raise your blood pressure, cortisol levels and lead to animosity between you and a colleague and which will lead to increased oxytocin, collaboration at work and ultimately improved patient care? (Loaded question, anyone?)
If you can’t tell, I just returned home from The Coalition for Physician Well-Being’s Joy and Wholeness Summit, in beautiful Santa Ana Pueblo, New Mexico. It was a needed recharge in a gorgeous locale with other physicians and health care team members presenting data driven practices toward improving our well-being, fulfillment and longevity in health care careers while practicing in an industry rife with burnout. Don’t worry, I have a plan and some new and old friends, who I will be working with in the coming months and years to help to share and expound upon these lessons learned with you.
One simple thing that I have resolved to resume practicing is journaling “3 Good Things” that I am grateful for, which occurred during that day and associate them with the positive emotions most closely tied to burnout (joy, gratitude, serenity, hope, pride, amusement, inspiration, awe, and love). A study out of Duke University1 followed health care workers keeping such a daily log for 2 weeks and it was associated with improvement in their symptoms of depression, emotional exhaustion and happiness extending up to 12 months.
Figure 1
Well-being metrics at baseline, 1, 6 and 12-month follow-up.
On your next shift, ask your team members to identify one thing they are grateful for lately.
Say thank you to one of your co-workers. Saying thanks is a win-win. You feel happier, more optimistic and hopeful after sharing your gratitude and the subject of your thanks is happier and potentially even more productive after your appreciation.
Little changes culminate in big changes. You have more control in your life at home and at work than you may realize. As the team leader, I challenge you give meaningful thanks to someone on your next shift and try out the “3 Good Things” journal. For 5 minutes at the end of each day instead of scrolling the news or social media, name what you are grateful for and the associated emotions. It pays dividends for your happiness and is a simple (partial) antidote to burnout.
I look forward to seeing you all on November 14th and 15th at Beaver Creek for Colorado ACEP’s 3rd Annual Leadership Symposium followed by our High Risk/Don’t Miss Educational Conference and Ultrasound Skills sessions.
- Sexton JB, Adair KC. Forty-five good things: a prospective pilot study of the Three Good Things well-being intervention in the USA for healthcare worker emotional exhaustion, depression, work-life balance and happiness. BMJ Open. 2019;9(3): e022695. Published 2019 Mar 20. doi:10.1136/bmjopen-2018-022695