This is a talk given for the ISLHD Wellbeing week for JMOs on 16th September 2019 - Two emergency Physicians sharing their experiences and tips with maintaining wellbeing whilst working in medicine.
Em consultants wellbeing talk Dr Bishan Rajapakse & Dr Hughes Makoni
1. Strategies for Wellbeing –
Reflections from two EM
consultants
Dr Bishan Rajapakse
MBChB, PhD, FACEM
Staff specialist Emergency Physician
Shellharbour Hospital
VMO Liverpool Hospital
Dr Hughes Makoni
MBChB, FACEM
Staff Specialist Emergency Physician
Wollongong Hospital and Shellharbour
Hospital
“Welltember” wellbeing week for JMOs– ISLHD
September 16th
2019
2. Overview
• Introductions – why wellbeing?
• Bishan
• Making mistakes in Medicine
• Power of debrief and mentorship
• Hughes
• Coping with Shift work
• Developing resilience
• Mindfulness excercise
4. Why Wellbeing?
Topic close to my heart..
• Student & ACEM representative
• Suicide of friends
• Researcher in wellbeing
• Friends who left medicine
• Past experience of burnout
• Impact on Healthcare
community
Vision
• A kinder more compassionate
health care system
• Healthier teaching , patients,
and communities
• Raising consciousness/peace
globally
14. Making
Mistakes,
Debrief &
Mentorship
• Why Medical Mistakes are a source of
great distress
• Stigma
• High stakes
• High achieving doctors
• Moral injury
• Medico Legal implications
16. Consider surgical mishaps;- “a general surgeon left a
large metal instrument in a patient’s abdomen, where
it tore through the bowel and the wall of the bladder.”
“A cancer surgeon biopsied the wrong part of a
woman’s breast and thereby delayed her diagnosis of
cancer for months”
“A cardiac surgeon skipped a small but key step
during a heart valve operation, thereby killing the
Consider these cases, I gathered them simply by
asking respected surgeons I know – surgeons at top
medical schools – telling me about mistakes they had
made in the last year. (Gawande 2002 p55-56)
19. Coping with Medical Error
Reflective practice
Writing (eg Journal)
Talking
• Friend
• Mentor
M&M meeting
The “Re-Frame”
changing one’s perspective
• Focus on what you Did do
well
• Consider Systems/Teams
• Learn and Improve & teach
BE KIND!!!
22. Stigma Busting - Interactive
• How comfort are you talking about
medical error (of others, or in
general)
• (1) Very uncomfortable or
uncomfortable
• (2) Ok
• (3) Comfortable or very comfortable
• How about when talking about your
own errors?
• Turn to your left and your right , and
discuss something to do with medical
error (2-3mins)
25. A “Support Crew” to survive/thrive?
• Mentor
• Senior Mentor
• Co-Mentor
• “Failure Friend”
• Someone in your Community & Inner Support crew
• Prepare for Failure, Breakdown, Meltdown….IN ADVANCE
26. JMO
Mentorship/Debrief
reflections
“I definitely found the feedback useful.
It was my first week and I was just completely lost and felt
like every patient was this huge challenge and went home
exhausted from the 10 hours of constant thinking.
You sent me like a 10 minute voice memo on whatsapp
which was so handy. You mentioned writing down the
patients you see helped you and I started a little journal.
Even now on ward jobs I have a ‘stalk’ list of patients I’ve
seen on after hours shifts and keep an eye on.
I think it’s having that senior feedback that even though it
all feels like you suck, it’s a pretty normal experience.
It would be handy for JMOs, especially in ED to have that
kind of feedback.
The first few weeks of ED were easily the hardest of this
year so far. I hope that’s helpful”
33. What is meditation about?
What meditation is not about
• Religion
• Goal directed action
• About being “good at”
or “achieving”
• Being competitive
What meditation is about
• Curiosity
• Noticing
• Mind
• Body
• Letting go
(momentarily)
Meditation is simple
… but not always “easy”
And invariably beneficial (try
and make your own mind up)
35. A short Exercise
• 2 mins
• Attention on our
breath
• Notice how you
feel
36. Take home
Reflections…
We can all be
champions of
Wellbeing?
Lets be part of the
change, we want to see!
Mistakes are normal
Reflective Practice is a
good strategy
Debrief, Mentorship
Meditation
Shift work is Tough – but can decreased
negative impact
The system is strained – but developing
resilience will help!