Em consultants wellbeing talk Dr Bishan Rajapakse & Dr Hughes Makoni
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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.
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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
- 5. JMO Wellbeing in NSW – Strategy & it’s translation https://www.health.nsw.gov.au/workforce/culture/Publications/jmo-support-plan.pdf
- 6. High levels of psychological distress in Doctors Beyond Blue survey (2013)
- 7. 2017 JMO Wellbeing Forum – Key issues raised & Strategy Problems • Fatigue from long hours • Lack of senior support • Lack of mentoring /peers support • Bullying & harassment Consequences • Poor wellbeing • Burnout • Psychological distress/illness • Suicide
- 8. Wellbeing Research Identify Champions Creating Wellbeing Culture
- 12. Looking out for your Colleagues/ Fellow Humans #HumanityInHealthCare
- 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
- 15. My Mistakes… just a couple to talk about JMO in EM Surg Reg on Call
- 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)
- 17. Making Mistakes… https://bishansworld.wordpress.com/2012/06/20/making-mistakes-stress- management-and-leading/ “Medical Error: It never gets easier” “We just get more skilled in understanding and coping with error”
- 18. Medical Error: System vs Individual factors (Reason’s) Swiss Cheese Model of Error
- 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!!!
- 21. Medical Shame
- 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)
- 23. Mentorship How many of you currently have a mentor?
- 24. Mentorship J Standing on the shoulders of Legends!
- 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”
- 27. Wellbeing tips Hughes Makoni Difficulty of Shift Work Impact on Sleep Nutrition Exercise Relationship Developing Resilience
- 28. Shift work – Getting into Rhythm?
- 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)
- 34. Can we translate Meditation into real Medical practice? ?
- 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!