By Sophie Brock – Emergency Medicine Trainee
I was unsurprised to learn that recent studies have revealed that almost half of practicing physicians find medical practice very or extremely stressful1 and almost half are in the advanced stages of burnout2. What can we do to ensure that we as individuals do not fall prey to these statistics?
The Emergency Department (ED) has been my home these last eight years of my medical career. Originally qualifying and learning the ropes in the frenetic Accident and Emergency Departments of the NHS and now in Australia, the last three years have been spent as a trainee with ACEM. I have evolved from a fresh-faced enthusiast to a tired Mum of twin girls facing three more years of study, exams and advanced training.
I am not going to lie; sometimes the path ahead seems unsurpassable. During the most challenging of times, I find that my intrinsically extroverted and positive outlook stands me in good stead. Whilst on my long and convoluted cross-continental journey to find my calling, I found I was attracted to the personalities in Emergency Medicine. I find that my wider ‘Emergency Family’ are my buoyancy aid on days when the fatigue is real, the empathy is running dry and the tears are near.
In our arena we must recognise that certain aspects of our work are demanding and can negatively affect our wellbeing and therefore I feel that it is important for our ED to have a social portfolio. Emergency Medicine, despite typically involving an expansive team, can be paradoxically isolating. We are often perceived negatively by other departments and unfortunately regularly experience unsatisfactory interactions with other specialities, which can leave us feeling undervalued and anguished.
When physicians are twice more likely than the general population to report that their mental health is fair or poor3 we must seek support from our colleagues because they understand the grind of shift work, the winter pressures, postgraduate exams and missed family milestones. Our workplace with its burgeoning workload and increasing time pressure, is an environment at risk of anger and hostility. A beer with colleagues after a gruelling shift, perhaps as a segue to an informal debrief after a distressing case, may well have more value for our wellbeing than immediately seems apparent. We must be cognisant of the value of social support; it is an interpersonal coping resource where one person helps another and it often involves talking to someone who is supportive and understanding4.
Positive collegiate relationships, and indeed friendships, can thrive in the ED. Sometimes the only enjoyment during a wearying shift is the interaction with colleagues with whom we relish working. Our relationships with our colleagues only thrive if built on mutual respect, shared experiences and united ambition. We should make time to nurture these relationships, to build a positive environment for everyone, and to carry our colleagues if they are having a bad day.
Small gestures can provide great comfort and a sense of being valued by your team during a stressful shift. Often what gets you through the day is is that look of support across a harrowing resus, recognition of a job well done or being wordlessly given your strong flat white because your Boss has memorised how you take your coffee!
I believe that departmental social events can have great benefit to our overall contentment. Our ED Christmas party this year was an event of which I feel that the Department should be proud. It was a celebration of each other successes and of our new ED as a whole. Colleagues from every multi-disciplinary ‘spoke’ that makes up the wheel of our ED came together for one night to let our hair down, pose for silly photos, relax and dance. The immediate aftermath might have seen several staff nursing their sore heads but overall people seemed to feel rejuvenated after a night of connecting with friends and colleagues!
The Wellness team within our ED meet regularly to discuss key strategies to improve our morale and coping strategies at work, including the organisation of social and charity events. Despite the traditional hierarchy present in Medicine I can see that the Registrars have felt increasingly empowered by a growing feeling of camaraderie between them and their Consultant colleagues, with meetings both inside and outside of work. We share opinions as to how to improve aspects of patient care, patient safety, interpersonal and inter-departmental relations. Sometimes that occurs in a formal arena, such as our weekly Registrar Representative-led meetings, and other times over a meal and a glass of wine! Multidisciplinary team building activities, may be another powerful strategy to enhance communication and support amongst colleagues, which in turn surely leads to improved patient care. Physicians feel considerably less stressed when they feel they are part of a good team and this may be due to the support that team members offer one another5.
Making the effort to get to know a colleague, how they like their coffee and remembering the name of their partner or child, makes supporting them through a challenging time at work all the more meaningful for both of you. I think that it is this ‘Human Factor’, our opportunity to apply our emotional intelligence to our colleagues at work and outside of work, and strengthening the social network within our ED, that ultimately makes this job even more worthwhile.
References
- Henry, OMA membership survey results confirm overwhelming level of frustration among Ontario physicians Ontario Medical Review, 71 (2004), pp. 1-6
- Robertson, Alberta physician stress and burnout research study. Report prepared for the Alberta Physician and Family Support Program, Calgary Alberta.
- Shanafelt, Sloan, & Habermann, 2003 The well-being of physicians American Medical Journal, 114 (2003), pp. 513-517
- Cohen & Patten, Well-being in residency training: A survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta BMC Medical Education, 5 (2005), p. 21
- Ross & Mirowsky, Explaining the social patterns of depression: Control and problem solving—Or support and talking? Journal of Health and Social Behavior, 30 (1989), pp. 206-219
- Firth-Cozens Interventions to improve physicians’ well being and patient careSocial Science & Medicine, 52 (2001), pp. 215-222
WRaP EM 
Nice work Sophie. And it’s equally important to have activities and friendships outside the hospital. Otherwise work can become just too much of a pressure cooker.
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