Wellness, resilience and performance in emergency medicine

Essentials

1
Wellness is integral to performance and the ability to provide high-quality patient care.
2
Emergency physicians are at high risk of poor physical and mental health, including compassion fatigue and burnout.
3
Work-related distress is common. There is a need to move towards open discussion and encouragement of physicians to seek help when necessary.
4
Wellness interventions should include both individual and organizational strategies.
5
Peer support, mentoring, debriefing and access to trained counsellors can be of value.
6
Career longevity is identified as a significant issue for emergency physicians, and there is a need for ongoing research into workforce sustainability.

Acknowledgements

The authors acknowledge the contributions of Dr Allison Fifoot and Dr Shahina Braganza to this chapter and additionally to cofounders of WRaP-EM, Dr Una Harrington, Dr Ashwini Amaratunga, Dr Suneth Jayasekara, Dr Charley McNabb, Ms Tracy Churchill and Ms Kate Jurd for their work on this important topic.

Introduction

A career in emergency medicine can be both rewarding and challenging. The combination of relentless shift work, high clinical acuity, challenging patient presentations and a real or perceived lack of control over the work environment creates a perilous milieu predisposing to poor physical and mental health, compassion fatigue and burnout.

Although literature reveals that doctors usually enjoy better physical health than the general population, emergency physicians suffer the highest level of burnout of all specialties. The 2016 Australasian College for Emergency Medicine (ACEM) Workforce Sustainability Survey report revealed up to 75% of respondents had moderate to high degrees of the components of burnout (emotional fatigue, depersonalization and perceived lack of accomplishment). To ensure career longevity, focus needs to be placed on well-being and maintaining meaning and joy in medical practice.

There is strong evidence that links physician health to workplace performance, which then directly relates to quality patient care. Happy workplaces with engaged staff are more productive, with better patient outcomes. The converse is also true, because patients treated by physicians with poor health suffer greater morbidity and mortality.

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