This is a talk that given at the NSW Emergency Medicine Wellbeing day. I talked about the "importance of prioritising wellbeing" illustrated through the trials and tribulations of my lengthy, yet fruitful training journey - which included basic surgical training, international research, and emergency medicine specialist training.. plus a whole lot of adventure, fun and despair! The aim was to provide some hope, inspiration, and tips for those who are inclined to take the path less travelled!

1. The road less travelled…
Prioritising Wellbeing
Dr Bishan Rajapakse
MBChB, PhD, FACEM
Emergency Physician (VMO) – Liverpool Hospital
Honorary Clinical Lecturer – University of Wollongong
Emergency Medicine Wellbeing Day – Jan 15th 2019 - Clovelly, Sydney

2. Why Wellbeing?
Topic close to my heart..
• Personal experience of Burnout
• Suicide of Friends
• Student/Doctor representative
• Detrimental to entire Healthcare
community
– More wellbeing  better patient care
Vision - A kinder more compassionate
health care system

3. Overview
• Short Meditation exercise
• A short story of medical training (personal
journey through burnout and wellbeing,
toward balance)
• “Learned strategies” in Wellbeing

4. A short exercise/experiment

5. My educational Journey
– “the scenic route”
1997-2000 Exploring
the way (undecided)
2001-04 Completed
basic surgical training
2005-06 Transition to
Emergency Medicine
2006-10
Toxicology/Med
Education (Field work

6. PhD fieldwork - “Improving the emergency management of
OP poisoning through medical education & research” (2006
2010)

7. “Life is not a race.. But unfortunately
we live on a race course”
Always follow your dreams, as life is too
short to follow other peoples dreams

8. Part time ED
ACEM advanced training
2016 201820152010 2011
PhD
“Knowledge
translation”
Fellowship
FACEM
Sydney
POW
Swe
den
2013
Research: Part time Research
2012 2014
Full time ED
Part time ED
Wollongong - TWH
Full time
Research
Sydney
- Locuming in Aus
Liverpool
ED
Aubur
n

9. ….but what about the “back-story”
• Change of Specialty
• Relationships breakdowns
• Making Mistakes
• Exam Failures
• Bullying/bad behaviour
• Burnout/Crises; -
• Grief
– Family
– Friends
• Lots of travel
• Falling in Love
• Dance
• Music
• Community
balanced by many
sustaining positives

10. Key points of struggle
2004 End of surgical career
Asian Tsunami
2009 Field work stress
Publication, War-time,
Research, Time out
2010 Back to clinical work
Prince of Wales 2010 –EAP, time out for PhD
2012 Simultaneous EM training & PhD
Write up
Wollongong – (crisis) time out,
Dedicated year to completing thesis
2015 EM Training – Burnout post ICU
Wollongong, (urgent) time out
2017 Fellowship
Failed Written 2016.2, Failed OSCE 2017.2
2017/18 Broken ankle & faced ACEM dismissal
Proactive strategy, support, Wellbeing

11. Evolve your Wellbeing strategy!
Transforming “avoiding collapse”….
into
to “rest in order to do your best”

12. Crisis Management -practical steps..
• ED Department
– Consultant mentors
– Directors of Training/ Department
– Organised leave/ time out
• Hospital
– Employee Assistance Program (EAP)
• Psychologist
– Doctors health Advisory service (DHAS)
• External
– Good GP
– Family/Friends
– Community
– Coach
ED mentors
General
Practitioner

13. A few reflections on burnout
• It’s personal and
context specific
– Burnout is a continuum
• It’s common
– Subtle
– Under-recognized
Don’t buy into false
stigma
• Key Strategy
– Self-awareness: “Know
thyself”
– Self CARE
– Enlist help  take action
• Build up
strength/resilience
• Take time “out of the fire”

14. Personal Wellbeing Strategies
Lived experience tips…

15. Finding Purpose – know “your” Why?
• Take a break
• Gain inspiration
– Loved ones / mentors
• Know the “why”
– Re-visit it often
“Know thyself”

16. Platform for “Life”
Physical Health
- Rest
- Diet
- Excercise
Mental Health
- Healthy mindset
- Managing psycho
and emotional
trauma
Social Health
(relationships)
- with Self
- Partner
- Family
- Friends
- Community
CORE
• Purpose
• Inspiration
• Joy
LOVE
(unconditional)
Meditation
Physical Activity
Time in “nature”
“Time off”
Hobbies
Community
income
savings
invest-
ment

17. Build career – on top of “Life”
Images courtesy of Miranda Clark – Graphic design

18. Meditation / Mindfulness

19. Read/Write/Debrief

20. Exercise, Sport & Hobbies

21. Mentorship 
Standing on the shoulders of Legends!

22. “Inspiration for Perspiration..”

23. “The darkest hour is just before dawn”

24. Remember the highlights!

25. Coaching

26. Relationships: support for/from your
Inner circle

27. Community Involvement
Keeping an interest outside medicine (perpective)
Remember that I’m a Human being > Doctor > EM Physician

28. Fluro Friday
Mental Health Awareness

29. My key wellbeing practices
– Meditation
– Hobbies; surfing, music, dance, travel
– Relationship time: “Inner circle”
– Reading, writing, debriefing
– Mentorship / Coaching
– Community groups
& Healthy “ED Work life” –
Training/Education/Regular Debrief

30. Wellbeing Resources
• WRaPEM
– https://wrapem.org/
• ACEM
– Wellbeing Page
• LivoCast
– Episode 2 : Wellbeing & Mindfulness
• Literature - Tait Shanafelt
– https://bishansworld.wordpress.com/2017/04/21/the-rising-tide-of-
burnout-a-major-threat-to-our-healthcare-system/

31. Wellbeing: Summary
• Burnout is common & important
(Psychological/Emotional/Social/Physical impairment)
– Often under-recognized due to “Stigma”
– Prevention practice is often too little, too late
• Wellbeing Strategy  knowing thyself
– Personal needs/ limits
– Creating personal practices / strategies
• Enlisting Help
• Find what works & practice regularly
Prevention is better than the cure!

32. Last but not least….
Take a break –but never give up!

33. Reflections/Questions?
Any feedback /discussion / ideas about wellbeing
Please email; bishan.rajapakse@gmail.com
@trainthetrainer
www.bishansworld.wordpress.com

35. Processing mistakes in medicine…
https://bishansworld.wordpress.com/2012/06/20/making-mistakes-stress-
management-and-leading/

36. Self care- Remember to Rest!
Transforming “avoiding collapse”….
into
to “rest in order to do your best”

37. “Creating a Life Platform”
to support work
• Looking after ones
mental(emotional) /
physical and social health
• Compassionate Health
Education