Wellness

EM Resident Wellness is an extremely important topic. Rates of burn out, depression, anxiety are highest among PGY 1 residents. It does not get easier as you become attendings. EM specialty has the highest rate of burn out when compared to all specialities. Despite efforts to improve wellness on individual scales, the rates of physician suicide & burn out have been increasing and EM ranks as one of the highest specialties for this. Taking care of yourself is just as important as taking care of your patients.

Our job as EM physicians is NOT normal. It is okay to have a normal reaction to abnormal situations. Most people go to work and if they make a mistake in the office, yeah they might get yelled at or have to fix something, but someone’s life isn’t on the line. As EM Physicians, we deal with fast-pace, high acuity, make decisions on the fly without all the data everyday all day long. Its stressful. But it is OK to get upset or process these stresses like a normal person. That doesn’t make you weak or a bad physician, it make you human. Everyone at some point in residency experiences fatigue, burn out, depression and anxiety. Recent studies show that 65% of EM residents experience burn out.

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Factors Related to Burn Out

  • Having a significant other or spouse
  • Poor global job satisfaction
  • Lack of administrative autonomy
  • Lack of clinical autonomy
  • Stereotype Threat
  • Intolerance of uncertainty
    • Its OK not to know everything, but the goal is to improve knowledge and clinical gaps during residency. Ignoring it will only make burn out & anxiety worse.

Fatigue: Its more than just being tired

  • Impairs cognition and performance
  • As little as 2 hours less sleep has an impact
  • After 1 night of no sleep, cognitive performance decreases by 25%
  • Multiple studies show sleep deprivation leads to:
    • Increased errors
    • Increase time to perform procedures
    • Propensity toward accidents
Businessman feeling tired and low battery.

Clinical Signs of Fatigue

  • Moodiness, irritability
  • Impoverished speech or flat affect
  • Impaired problem solving
  • Sedentary nodding off (e.g. during conference)
  • Medical errors
  • Micro-sleeps (5-10 second lapses in attention)
  • Repeatedly checking work
  • Difficulty focusing on tasks

How to mitigate Fatigue

  • Get a full period of rest before any shift
  • If you are on nights, you must sleep during the day
  • Expose yourself to bright light before starting your shift
  • If using caffeine, use it only when working and feeling sleepy
  • Nap during the call/shift
    • Shorter, more frequent naps help avoid sleep inertia
  • DO NOT DRIVE IF YOU ARE FATIGUED
    • Take an UBER/LYFT, call a friend, sleep in the call room
    • Let a faculty member or chief know
    • Residents have been held liable in legal suits for fatigue!
    • Residents have been injured or died from fatigue!

Sleep Hygiene

  • Develop a relaxing routine
  • Limit exposure to bright light
  • Avoid exercise or computer use before bed
  • Avoid caffeine, nicotine, and alcohol before bed
  • Make the room dark- get black out curtains or a good sleep mask or both
  • Insure it is quiet
  • Have it cool
  • Avoid a heavy meal before bed

Time Management

  • Make Goals
  • Prioritize Goals/Tasks
  • Re-evaluate
  • Use a planner or electronic organizer/To Do List
  • LEARN TO SAY NO
  • Resources

Physician Impairment:

Impairment is more than just substance abuse; it encompasses mental and physical health as well. It is our duty to our patients and our profession to report colleagues with suspected impairment. Seek help before this happens.

Signs of Physician Impairment

  • Isolation, withdrawal
  • Diminished clinical performance
  • Erratic behavior
  • Recurrent lateness or absences
  • Deterioration in personal hygiene or dress
  • Smell of alcohol on breath
  • Writing prescriptions for stimulants or narcotics for self

Depression

  • Rate of Major Depression in general population is 10-20 %
  • Residents have a higher rate – EM Residents even higher
    • 4-10 residents in this room may have depression
  • Treatment is very effective

Addiction

  • Addiction in the general public: 14% alcohol and 6% for illicit substances
  • Emergency physicians have higher rate
  • Top four for physicians:
    • Alcohol
    • Marijuana
    • Opioids (usually prescription)
    • Stimulants (Ritalin, amphetamines)

As your leadership, we are here for you no matter what. If you are ever experiencing any of this or want to talk about anything please do not hesitate to reach out to us, your classmates or your chiefs. The sooner you come the sooner we can help!

  1. Chiefs
  2. Residency Leadership
  3. Assigned mentor families

Helpful Resources: