2019 Resolutions

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Taking care of yourself is more than dieting and exercise.

Happy New Year!  Many of us struggle for an appropriate resolution for the New Year, so I’d like to offer a variety of options.  It’s important as a busy professional to reflect on opportunities to improve and grow in our careers, and having a resolution is one way to help achieve that.


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Personal

Every year, I briefly consider dieting and exercising more as my resolution.  Pretty boring.  Some years I’m more successful than others.  But the important part may not be the diet or exercise, but rather to have a resolution that focuses on taking care of ourselves.  This may mean eating better or exercising more, but could also mean spending more time with our family, taking that extra week of vacation or deciding to work fewer shifts. Dividing 14 shifts over a month feels a ton better than 17 shifts, so depending on your contract, you may be able to cut down a couple of shifts every few months and improve your sleep, mood and attitude.

Reach out to colleagues. Physician suicide is real.  At the ACEP Council session last fall, numerous docs got up to speak about having a colleague commit suicide during the discussion of a resolution on physician suicide.  I was overwhelmed at how common it was in the profession.  Each of us should find the time to reach out to colleagues to check on their well-being.  We all have bad cases and these can haunt us for along time, but it can be helpful to those feeling depressed to talk about the case and their feelings and to know that people care. Perhaps the conversation evolves to the point of referring someone to their Employee Assistance Plan or to a counseling.  You could save a life.  If you’re feeling depressed, reach out for help as well.  We have a really hard job and we need to be there to care for each other.


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Volunteer your clinical or administrative services somewhere for the greater good.

I’m sure there’s a free clinic or non-profit center where you could volunteer your expertise.  Many say that volunteering or going on a medical mission trip can be an antidote to compassion fatigue or burnout.  Imagine just practicing medicine to grateful patients without an EMR or CMS metrics to worry about.

On a very practical side, maybe this is the year you update your CV and your LinkedIn profile.  It’s tedious, but you never know when you might be looking for a job.  I also find it somewhat rewarding and fun when I look back to see what I’ve accomplished or how my life has changed since the last time I updated it.

I have a friend who’s a judge and he’s pretty sure he’ll work into his 70s.  I don’t know any ER docs looking to do that.  Since doctors are usually not recognized for their business prowess, every year we should be committing to spending time on financial planning. Whether it’s planning for retirement, paying off your student loans or saving for a mortgage, it’s critical to develop a plan (I highly recommend using a professional financial advisor), pay yourself first and commit to following the plan.  This will require research and commitment to spending the time to make sure you reach your financial goals and ultimately retire on your terms.


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My wife had her identity stolen and I’ve had social media accounts hacked.  Watching someone control your Instagram account is not fun and certainly raises questions from your friends.  This could (and should) be your year of helping to protect your identity by using a password manager.  One of the key advantages is that it ensures you have a completely different password for every site. It’s inevitable that some site you use gets hacked and your password stolen, but you want to make sure that if someone steals your password for one account, it doesn’t also give them access to your hospital account. It’s well documented that doctors and hospital employees are being particularly targeted with phishing attacks etc., as hackers are trying to extort money from hospitals. Your phone and your laptop can already do this for you, and there’s other free or very low cost apps available, giving you passwords that are difficult for the routine hacker to crack.

Clinical

Hospitals are dangerous places.  If you don’t believe me, go talk to your CMO and review the serious safety events over the past year at your hospital.  There will be some eye-opening errors, many of which could have been prevented with improved communication and more questioning of a doctor’s decisions. Be receptive and listen to nursing concerns.  Be approachable and when nurses come to you with questions and concerns, take the time to listen.  They can save us from ourselves.

Part of being approachable is being consistent friendly.  Learn all the ED staff’s names and something about them. You don’t have to do it all at once.  Give yourself a weekly goal.

Speaking of having the nursing and tech staff view you positively, take time with patients to “manage up your staff.”  A positive word from you about staff can change the entire visit for the patient and staff.  Let them know how great or caring the nurse is or if you were having an IV placed, you would definitely want their tech, etc…

There’s CME and then there’s real CME. You know what I mean.  Some years I get my hours, and other years I challenge myself by picking a topic in which I am weak and book a course specifically in that topic.  Maybe its trauma, peds or bedside sono, but I am sure there is something that you’re afraid of taking care of at 2 a.m. Your chair could advise you as well. Along the same educational lines, mine the universe of emergency medicine podcasts.  They are getting better and better and technology makes them even easier to access.

You’re looking for the trifecta of documentation—the right amount to justify billing, communication of the visit for the next provider and CYA.  Don’t over document as it rarely adds to the CYA portion. It slows you down (or takes time after your shift), and clogs up the department.

Do patient follow up phone calls. These reduce risk, improves patient sat and makes you feel good since the patients are usually better and they’re generally really appreciative of your care and that you took the time to call them.

While some hospitals or departments may not be able to do this, if you want to feel good, regain some enthusiasm for medicine and contribute to the knowledge of future clinicians, consider taking on a clinical student (MD, PA, NP) as a mentee for a period of time. It might just be once a week or two as an intro to doing an H and P or it could be an entire ED rotation, students love coming to the ED.  Be prepared to spend time teaching and being less productive when it comes to metrics, but having a student can be great.

Administrative

Say thank you to your team.  Let them know you appreciate them.  As a clinician, thank the nurses, techs and support staff after a labor intensive case or at the end of your shift.  As an administrator, be sure to find ways to say thank you to everyone working in the department (including the providers). Hand written cards, emails and a pat on the back all work.  Saying thank you increases retention and makes for a more engaged team.

Just like we need CME for our clinical job, we also benefit by taking formal courses on professional development, on topics such as accounting, negotiation, finance, public speaking etc.  There’s plenty of conferences, online learning opportunities or through a local college.

We all know that burnout is real, but I’m not seeing enough leaders focused enough on reducing burnout.  This should be the year that you do something related to burnout for your providers.   This may be anonymously measuring burnout in the group using one of the standardized burnout assessment surveys or it may be doing some of the things that seem to provide protection against burnout such as building community via happy hours, group dinners or journal club.

Celebrate the saves.  Make sure you highlight the heroic work of your colleagues on a regular basis.  Incorporate this into your department meeting just like you incorporate analysis of the negative patient experience comments. Share the stories at the nurse staff meetings as well and be sure to give them credit for their contributions. There is great work being done everyday and this should be recognized.

Spend more administrative time managing the high performers.  The department moves better and it’s more enjoyable to manage high performers (it also increases their satisfaction and retention rates) and this group may have insights you can use on the low performers or areas of the ED. Too often we end up focusing on low performers (they need our help) but the time may prevent you from working on other projects that moves the department forward.  If one or two low performers are constantly making trouble for you and occupying your time, it may be time to move them out.

Pull someone up and mentor: Succession planning is one of the most important things we can do as leaders, and most of us have been fortunate to have at least one mentor.  Now it’s our turn to help pull someone up the career ladder. Part of our job is to develop the next generation of leaders as well as ensure a transition plan so that the ED mission is carried forward if we were to step aside.  This can be as simple as passing on good articles or data on a regular basis. You can also challenge them to do the work you know they are capable of if given the opportunity. I would additionally challenge you to mentor both genders as we know that women are underrepresented in hospital leadership positions and don’t typically get the mentoring that men get (particularly when the chair is male).

Conclusions

Resolutions are not meant to be easy.  But they are a way for each of us to identify an area we would like to make some improvement in and commit to doing it.  While no one needs this many resolutions, each of us can likely be a better person, clinician and administrator if we try choosing one resolution from each category.

ABOUT THE AUTHOR

EXECUTIVE EDITOR Dr. Silverman is Chairman of Emergency Medicine at the Virginia Hospital Center. He also serves as the Chief Performance Officer with Emergency Medicine Associates, a founding partner of Alteon Health. Dr. Silverman’s practical wisdom is available in an easy-to-use reference guide, available on Amazon. Follow on Twitter @drmikesilverman

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