This post is the final post of four covering my learning points and reflections from #FIX181. FIX – the FemInEM2 ideas exchange – took place in New York on Weds 17th and Thurs 18th October 2018. You can find my thoughts from the first half of day one here3, the latter half of day one here4, and the first half of day two here5.
Speaker self-nomination is open for #FIX19 NOW – take the plunge, submit your pitch and take the stage here: APPLY NOW! Applications close 31st December, so be quick!!
Arlene Chung6 spoke first in the afternoon, challenging us to “stop teaching doctors to be well.” She highlighted the 400 physician suicides/year in the US – this is not just a doctor problem, but an everybody problem. Burnout, she says, represents a failure of the system to provide the resources that we need to deliver good quality patient care.
Teaching wellness doesn’t work, she asserted – if it did, we would have solved the problem already. Collectively we’ve been trying to teach wellness for three decades – if it worked we would expect to see the results by now. Change is possible but the solution is bigger than us, our departments, our nations. Drivers of burnout and engagement are the same – it is the outcome that differs7. Systems change takes years – we can do individual level stuff in the meantime but real meaningful change has to come from top-level. We won’t get there just by teaching. Thought-provoking stuff, with parallels to some of the wisdom from our own expert on clinician wellness, Liz Crowe.
My good friend Swami8 (Anand Swaminathan) shared his experiences of trying to reconcile his own career with his wife’s and their childcare responsibilities, and the resistance he faced when he tried to step up to balance parental responsibilities. It was refreshing to hear frustration from the male perspective about how institutionalised misogyny does a disservice to families from both traditional gender roles.
His top tips were:
- Set your own priorities – don’t let others set them for you
- We can’t do everything – and we feel a lot of guilt about saying no to things
Melissa Parsons10 gave her moving story of fertility and infertility. IVF, she says, is a hurricane – your fertility team “jacks you up on lots of hormones, then gives you bad news every day.”
A really interesting point she raised was the increased infertility in EM – at 24.1% in the US, this is double the national average. The figures are partly explained by later age, but this is not the whole story. She calls for studies to be undertaken – is this another detrimental effect of shiftwork on our circadian rhythms?
Darria Gillespie11 gave us some “hacks for parents”, but there were a lot of transferable tips in her talk relating to keeping yourself healthy.
- Design your environment – put obstacles between you and the unhealthy. Don’t buy crap food; don’t even have it in the house! Put physical obstacles in place – you eat 33% of what you normally would if it’s harder to get to. Rearrange your pantry so you don’t see the unhealthy stuff but you do see the healthy stuff.
- Automate your habits – 45% of our decisions are habits. Cue – triggers and reminders. Routine – healthy behaviours. Reward – program/social reinforcement. Set a bedtime routine – even if it doesn’t happen at the same time, the routine will help prepare you. And don’t forget to breathe!
- Reframe – thoughts and intentions. “Your brain is like Velcro for negative experiences, but Teflon for positive ones.” – Rick Hanson
- Engage – your raft of bitches. We don’t make changes alone.
I really enjoyed Catherine Shari12‘s talk on research in EM in Tanzania. “I decided to do EM research when I realised the impact my research could have on my community,” she said. Her description of the working environment in Tanzania, with her 3hr trip to work and up to two days without electricity sounds very unfamiliar – but this is the environment she is conducting EM research in. “It seems as though my life is chaotic,” she says, “but it’s not.” Her keys to success are things we can all learn from:
- Find your passion and follow it. Passion brings happiness.
- Role models – find them, be one.
- Organisation – plan your days, respect your plans, learn to say no.
- Consistency – uniformity, constancy, steadiness, stability. If you do anything regularly you will see results – good or bad.
- Persistence – continue despite existing difficulties and opposition
- Mentorship – choose them wisely and learn from them
- Make it worthwhile – many people sacrifice to support us. Don’t let them down. Be good at your job, look after yourself. And when you are present with your friends and family, really be present.
Megan Ranney13 & Torree McGowan14 talked about gun violence. This talk is hard for me to completely fathom, as I have only lived and worked in countries with tight gun control. I have seen and treated victims of gun violence in the ED – but I can literally count the number on one hand (they both died). It’s a cultural clash for me, and for many of my Australian and UK colleagues. I actually try not to talk about gun ownership with my US colleagues, because it is so alien to me that I don’t really have a framework to process their responses. I could really relate to this tweet from fellow conference-goer and FOAM contributor Justin Morgenstern15 (side note: if you want to know what it looks like to be a genuine, open, curious, FOAM community #HeForShe, Justin is doing a sterling job):
Megan and Torree challenged some preconceptions. 80% of homicides (and the majority of suicides) from guns are perpetrated by handguns. Statistically, then, handguns are more dangerous than the AR15 which is responsible for <1% of deaths. Hmmm.
Not all gun owners are good or bad – that one I can agree with. The role of legislation is murky too – specifically banning assault rifles will make only a small dent in deaths from gun violence, but tighter controls on who can own a gun will have a bigger impact. This was a polite, balanced and respectful conversation about responsible gun ownership. Refreshing to know that this can happen!
Nikita Joshi16 called us to volunteer at polling stations; to sustain the backbone of democracy by helping voting happen. In Australia these positions are actually paid although you have to be registered to vote (and voting is compulsory!) – if you live in the UK you might be able to sign up to work at a polling station, earning a flat fee from counting votes or registering voters (students – you should definitely try to do this!). Being part of democracy matters, Nikita argues.
Hilary Fairbrother17 spoke about her passion for advocacy in health. If we don’t advocate for health, she challenged us, not only will we be silenced but we probably won’t like the outcome: a world in which the focus is not on patient-centred outcomes. Advocacy comes in different shapes and sizes – and there’s a way for you to advocate from wherever you are with whatever you have. My friend, colleague and (s)hero Nat Thurtle18 made this point eloquently with her talk at DFTB17, which you can find below.
Sheryl Heron19 challenged us to stop talking about diversity and to start talking about equity – giving people what they need, when they need it. The way we see the world and the way we present ourselves to the world affects how we see our patients. Diversity is already here, she says, but if we don’t take action then equity will never be.
Finally, Jen Gunter20 spoke on pseudoscience and the patriarchy. Jen has taken on pseudoscience in her blog and writing but has found lots of crossover with patriarchal values. Medical misinformation around women’s health has existed for centuries, along with a history of vaginal shame – something that persists today as a barrier between women and good healthcare. She points out that misinformation helps no-one – we can respectfully redirect people (particularly our patients) to better sources.
And with that it was done! And I left feeling empowered and proud, exhausted and exhilarated, and above all inspired. I hope I can make it to #FIX19 – you should too, whatever your gender. And remember that nominations for speakers are open, so get thinking! I’ve already got three amazing women in mind, all of whom I’m hoping will make it to the FIX stage…
Want to find an awesome woman speaker? Check out the FEMinEM Speaker Bureau here.
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