I would like to challenge the notion that physicians, especially us emergency physicians, are supposed to BE TOUGH and POWER THROUGH at all times.

How about instead we shift over to thinking of ourselves as the calm and focused leader who is constantly surrounded by chaos.

 

 

THIS notion is the definition of resilience. The resilient physician is one who thrives in a state of constant stress, change and hardship. That doesn’t mean just trudging through and doing the job at hand. It means knowing how to bend and move with our stressors, not against them.

So… How do we learn to become this force field that allows stress to bounce off us and not bring us down?

 

MINDFULNESS

Below are some basic meditation tips to help you refocus your thoughts and go back to feeling calm when you’re feeling overwhelmed and like you’re about to break at work. We have all been there. It’s not a sign of weakness it’s just a fact with our jobs.

PRACTICE THESE AT REST at home for a few seconds every few days. You can’t expect an intern who’s never intubated a live person to successfully intubate the crashing variceal bleeder the same way you can’t expect to magically relax while the ER is going crazy and about to implode.

 
-       Take a few breaths. Breathe slowly and focus only on your breath. Feel the cool air going in through your nose and the warm air coming out through your mouth. After a few breaths notice the way your body and mind suddenly feel a little more relaxed. Practice this and will be handy in the resus bays. This simple technique is taught and practiced rigorously amongst our own US military.
-       Stand, sit or lie down. For 10 seconds squeeze every muscle in your body and hold in your breath. Squeeze your forehead, your face, your shoulders, arms, abs, butt, legs and toes. After 10 seconds release. Notice the way your muscles feel relaxing and you can feel your blood flowing through them. That’s the feeling of full relaxation. With practice, you will be able to take a deep breath in, and breathe out and achieve relaxation on the spot when needed. This one is a common technique that originated in cognitive behavior therapy.
-       A popular saying amongst resuscitationists and taught to me by mentors in residency… Before checking the patient’s pulse check your own. Find your heart racing? Stop, take one breath, then go on to your task at hand. Remember the anxiety/performance bell curve? A little anxiety is good.. it helps us stay sharp during the chaos… But too much is detrimental and decreases our performance drastically.
-       And lastly and all time goodie. One you probably heard your mother tell you time and time again. Remember that most things in life can wait a few seconds for a response. Think before you speak and think before you act. Most people don’t have to be intubated at that very moment and most consultants don’t need an immediate response from you. 


ACEP created The “Emergency Medicine Wellness Week” in 2016 with a goal to remind us to take care of ourselves, and not just others. Hopefully the Wellness and Resiliency Curriculum at SIUH has helped introduce some ideas and topics over the year to help you do just that. Visit their website if interested for further discussion and articles https://www.acep.org/emwellnessweek/

 

Frosso Adamakos, MD
Emergency Medicine Attending Physician
SIUH Wellness and Resiliency Curriculum Director
 

References

  • ACEP; “The Resilient Emergency Physician Manuscript”
  • Building physician resilience; P. Jensen P, K. Trollope-Kumar, H. Waters, J. Everson; Can Fam Physician 2008;54:722-9
  • Physician Resilience: What It Means, Why It Matters, and How to Promote It”; R. Epstein, M. Krasner; Academic Medicine, Vol. 88, No. 3 / March 2013  
  • ACEP Wellness Week
  • USA Military Resiliency Training
  • Cognitive Behavior Therapy Basic Techniques