Prioritizing Wellbeing - #ACEM19 #HumanityInHealthCare
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A talk given to at the ACEM (Australasian College of Emergency Medicine) pre-congress workshop for the Annual Scientific Sessions in Hobart, Tasmania 2019. These are reflections and tips shared by Dr Bishan Rajapakse, an Integrative, Academic, Emergency Physician, along his towards "prioritizing wellbeing" in the first 12 months of working as an Emergency Medicine Specialist in NSW, Australia. Bishan is an EM Fellow with ACEM and a committee member of the Global Emergency Care committee (GECCo), as well an advocate fo Mental Health and researcher in doctor wellbeing.
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Prioritizing Wellbeing - #ACEM19 #HumanityInHealthCare
- 1. Prioritizing Wellbeing Sharing the journey towards “balance” during my first year consultanthood Dr Bishan Rajapakse MBChB, PhD, FACEM Staff Specialist Shellharbour ED, and VMO Liverpool ED ACEM ASM 2019, Hobart – New Fellows Forum; Saturday 16th November 2019
- 3. Prioritizing “Self-Care” Bio SocialPsycho Spiritual Emotional Prioritizing “Self-Care”Prioritizing “Self-Care” Bio SocialPsycho Spiritual Emotional Prioritizing “Self-Care”
- 6. Knowing Thy Self… Is knowing “who” you want to be
- 7. “so what’s next for you” = What kind of life do you want? • What kind of work do you want to do • What are your career aspirations • The specifics will evolve with time
- 10. Practice saying NO! Saying No = Saying “YES” to the things you really want to do
- 12. Mentors & FACEM Buddies.. are SO Important!
- 13. Be inspired, Inspire others & have some fun!
- 15. Empowering Culture Change Practicing “Kindness” on the floor in 2019 !
- 16. Education & Wellbeing go hand in hand!
- 18. Summary Wellbeing is essential to our Vitality! • Prioritize Self-Care • Know thyself • Practice saying NO • Overcome imposter syndrome • Be inspired, inspire others and have fun!
- 19. A small pitch for Shellharbour ED, NSW • SHH Provincial ED (30,000 presentations per year) • Great Leadership Culture • Education Focused • Diverse doctor background, Experienced nurses • Good for New FACEMs • Professional and personal development • Wellbeing culture/ Mentorship • Research, Education (UOW Medical students)
- 20. Questions?
Notas do Editor
- Thanks. It’s lovely to be talking to you all on a topic close to my heart. Wellbeing. I’m not an expert in Wellbeing, but I have a special interest in it, and I've done some research in the area (mainly looking at impact some of the "Wellbeing interventions for JMOs in our region" - because I don't think whats been thrown at at risk groups always makes a big difference) In fact, through this work, I've come to believe that the most interesting part of what I call "Wellbeing conundrum" is the gap between what we know we should be doing, and the reality of what we end up doing - especially with the rising pressures that we are perhaps all facing both in work and in life, not just in our sector, but in society at large. So to me, an Emergency Consultant who has recently finished training, 18 months ago, wellbeing is about continually finding the balance between, this crazyily stressful, yet simultaneously rewarding, and privileged, line of work (that we all do!) AND Life outside medicine (which for me is about Family, Friends and Hobbies that you find Joy in). The more that you have a passion for this life outside medicine - the harder it is to find that balance = so for me Wellbeing has some very personal qualities to it. However, I do believe there are some common obstacles to finding that balance, that we come across, and there are some that are particular to each stage of training. Also I believe that everyone has a story that is equally relevant and important. And perhaps it's not the specifics of the story that matter, but the conversation around it (So my main hope is to inspire you to at some stage in the future to talk more with your inner circles about your own strategies for prioritizing wellbeing, which could be quite different from mine). So with this talk I hoped to touch on just a few of the things that "I" have found helpful along my training way – particularly in the first year of consultant hood. The key message are: Prioritize Self-care Connecting with the "Why" - knowing what kind of EM physician you want to be Practicing saying NO Getting inspired, inspiring others, and having some fun!
- I have a special interest in Wellbeing I was the class rep at my medical school I remember being on a special task force looking at suicide in junior doctors. I remember at the time , I didn’t have a problem in the world – I loved medicine, pathologically so, so it was clear to me that If I could struggle with burnout, anyone could. Liking something, and being capable were not protective factors. For me it was only later on in training , after facing road blocks, that I struggled with burnout . My specialisation training started off in Surgery (Orthopaedics at that) Then around PGY 7 or 8 changed to EM, a few weeks later in Dec 2004 the Asian Tsumnami hit. I went to Sri Lanka That’s how I got into GEC Coming back after a big break in the flow of clinical work and training was really hard I felt like I couldn't tell anyone, nobody seemed to understand, I was in charge of a tertiary hospital ED at night , I felt repeatedly overwhelmed, I burnt out , sought help - saw EAP and realised I was juggling too many balls, and priortiazed my relationship (which was long distance one) - I first went and lived over seas and with my girlfriend, who is now my partner, and she came back with me (for me I had sorted out the most important thing for me which was relationship) Then I got back into training and had (second phase of Roadblocks ) - I was behind in my training time with the college, And I was also getting pressure from the University to finish my PhD thesis write up, as well to as hold together a very important relationship Again was trying to do too much, juggling too many balls. I And I met now a recongised friend - called "burnout" again, But this time it was a bigger encounter. I had to take some time off work to recover, 3 months. that’s when I looked at a range of strategies – including journaling, meditation (did a 10 day vipassnana retreat – which helped me so miuch to heal and new persepective on life) and enlisted a professional coach to help me navigate the thesis and training pressures I decided to risk my EM training and finished the Thesis I had strarted on 4 years prior. And went back to EM training with newfound lustre. doing well However, I met my old friend burn out again during the fellowship period. However, this I knew how to navigate him - I had recognised the signs in advances, talked with the people around me, and already started a prevention strategy– it was so different, I never stopped prioritizing self-care (or if I did I would be aware of it, and do something), which included regular time with self and nature (for me surfing was so important, and community group – I support a mental health awareness group called Fluro Friday , weekly authentic chats about life – that’s why I don’t mind speaking from the heart like this – I’m well rehearsed, Also I kept remembering "why" I was doing this rigorous training, And I continually used to get inspired in order to face the challenges of training So when I failed my Fellowship written, (the first significant exam I've ever failed, quite a late stage in l ife to learn about exam failure )- whilst it hit me super hard, I didn’t burn out I was ready to cope with it. "Failure was an event - not a person" I took me a year of study and got it the second time, and when I failed the OSCE which I needed to pass to avoid being dissmissed from ACEM training, despite doing all this extra work in medical education and Global Emergency Care, AND I broke my ankle whilst hiking in the few days that I had in the post exam period - it felt like one huge road block. A recipie for burn out. But again I had support from my inner circle and we created a strategy. That involved the same principles - self-care, rest, heal, Remember the Why, and get inspired and continue forward. I successfully appealed the proposal of dismissal, studied hard, and got my fellowship But one thing did rock me, during that fellowship that I want to mention -it was the news of the sudden and unexpected death of an inspirational friend and colleague in EM, I later founding out that it was a death by suicide. He was one of the main inspirations for me staying in EM to try and make a difference, and to not be able to help him in his period of need, in the same way that helped me a few times during my period of need, still wears down heavily on me. And this is one of the reasons I do this advocacy - which is very hard - to share the most difficult parts of one training journey or life . But I do it for because burnout, depression and suicide are real things in our profession. Burnout is reported to affect 60-80% of us at some stage, and this is the point of this slide and talk it can and will affect us if we don't "prioritize wellbeing" n
- Putting ones’ one But how to do that What are the obstacles? What do so many EM physicians struggle with, including myself = Switching off, or Resetting For me Surfing does that So there is a little thing that
- What kind of Emergency Physician do you want be? And more importantly what kind of life can you envisage for yourself? Who do you want to be – rather than who do you need to be.
- For me I remember being here one year ago and it was stressful being asked by so many colleagues, “So whats next!?” But for me it wasn’t about the job – I just told people for me the next 12 months are all about spending time with my patner, and reclaiming my life. She had really been through a lot , especially with the failing of the OSCE and the The question of “What kind of job do you want , to me stats with. What kind of Life do you want. For me it was one where I had a life – time with self., time for family and also leisure. Remember ho you hang out with Luckily before coming to ACEM I had spent some time talking over For me it was clear that I didn’t want to work a fulltime job Also I had the benefit of talking to my two study buddies who had passed 6 months before me - and one of them got a SS job straight away, the other did VMO work , and locumed. And the one who locumed reassured me to not “Believe the hype” it’s okay Also th Remember everyones circumstances are different Thought research was important , later realized it wasn’t
- Two things GEC work - Paramedic training in Sri Lanka Wellbeing research Yes Having a family Having time to relax guilt fre NB what stopped me is a hang up of a need to prove myself Difficulty switiching off
- Imposter syndrome is when you feel like you are some kind of fraud, and don’t deserve to be here. Sure you got your fellowshop but.. But how? Was is a fluke? Everyone else is legit..b ut you!? Remember working with my study buddy Angelo who was just 6 months ahead of us - he seemed to know what he was doing better than I, more comfortable and fluent I felt like an outsider, like maybe I didn’t belong, like I got here by fluke . I was worried about what people thought of me (I am It was tough at the beginning, not knowing how to things, not clinical stuff, but the non clinical stuff, clinical governance, or going to meetings, talking with exec But now 6 months on I feel much better, and part of the team We are all equivalent in knowledge and skills, different areas of strengths and weakness, and different amounts of time in the job And this is the key “Time in the job”, and the Role of consultant
- So the antidote to Imposter syndrome is “talking about it” - and any stigma for that matter - Brene brown says – shame So the antidote to Imposter Syndrome in my book is “Reflective Practice” – ie talking to trusted ones – most trusted is self – ie write a journal , check in with self Then talk to your director or other trusted senior FACEM - and develop a mentorly relationship. Explore the “Expectations!” and help them give you guidance and feedback . I learned this through my research career – it was about forming a supervisory relationship with you . In this case it’s forming a mentorly relationship Pick a trusted colleague and talk about these things. Just as I teach registrars, the value of having a failure friend – the same benefit goes for FACEMs, Failure friend scenarios are - where you have agreed safe space to talk about perceived or actual errors (our mind does a diservice here and we suffer far more with imagined scenarios and consequences than real scenarios and consequences) You may have good study buddies from the Fellowship journey, make use of the trust that has been built in this relationship (after all you saw each others knowledge gaps, and flaws and you worked through them – make use this We Just met up with my two groups of study buddies
- For that You need Prioritize Self care Know who you want to be And get inspired often Quote from Peter smith – ne of my many Mentors ; - Medicine is a big part of my life , but it doesn’t define you I feel the same way
- Downside No 24 hours surgical services Not ACEM accredited…Yet (process underway for 6 months accreditation for ATs) Personal reflections - was cautious initially (May 2018), but realise this is the best job I could have dreamt of! (Nov 2018) Who we are looking for; Those who fit our culture Collaborative Team Players Mainstream and ”Fridge Dwellers” welcome Proactive, patient and staff centered individuals Those who prioritize wellbeing so they can provide good care, leadership and education to their patients Female Role models in Medicine and EM