This post is the third 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 and the latter half of day one here4.
Day two started with a sobering talk by Dmitri Papagnou5 on his reflections on being bullied. Dmitri spoke about his experiences of childhood bullying and homophobia and the power of the validation of being told “you are normal.”
He reminded us of the startling statistics around LGBTQIA youth – and that seeing young people in the ED gives us a unique opportunity to provide much-needed support and understanding. Here’s a quick reminder of the HEADSSS tool, designed to help healthcare professionals connect with young people around significant factors that can determine health and social outcomes. You might also like to listen to this excellent talk6 by Aidan Baron from #DFTB17.
Dmitri gave us three actionable outcomes to help support one another.
- Find your voice and speak up – don’t give people the power to silence you
- Recognise your influence – you all have influence and you may never know exactly when you are using it
- Be a transformative leader – leverage your power as a clinician and a teacher to speak out for those who have no voice
His talk was followed by Marina Del Rios7, who spoke about the impact of Hurricane Maria hitting Puerto Rico and running directly through her hometown. She spoke of the tense emotional burden of waiting for news from her family, but also of the positivity and hope that emerged as the community pulled together to support friends, neighbours and total strangers.
Teresa Smith8 talked about her experiences of significant illness and how it has shaped her career and her interactions with mentees and patients.
▶️ #FIX18 / @feminemtweets— Bernadette Keefe MD (@nxtstop1) October 19, 2018
More…@docteresayvonne /TYSmith MD
Our patients are scared – it IS an emergency to them even if it may not be to you.”
I will never forget the terror of the moment of reading my own CT scan."
"Support your patients, tell them "You Can Do It" ~#EM pic.twitter.com/eU20DejC6T
Regina Royan9 went on to challenge access to medicine – the disparities across races and socioeconomic status in the US reflect those in the UK with the majority of medical students coming from affluent families. She challenged us that, as with all other elements of inclusion and diversity, those of us who are privileged have a responsibility to use our privilege to address this – “holding the door open for the people who are coming after us.”
Cori Poffenberger10 shared her insights on the way we interact with and judge people who have disabilities. It reminded me strongly of Rachel Callendar’s SuperPower Baby Project from #DFTB17. Cori points out that there is a big issue with the medical model of disability – that medicine expects that we should change people to fit in better with “normal” society. This contrasts with the social model, which seeks to remove barriers for those with disabilities in order for the world to adapt to them. She called out our everyday ableism – a real eye opener.
More examples of how words matter:— Megan Ranney MD MPH 🌻 (@meganranney) October 18, 2018
🔹️ It's a *person*, with a disability, not a "disabled person"
🔹️It's a "wheelchair user," not someone "wheelchair bound"#AbleismExists #fix18 @coripoff pic.twitter.com/sWVk7LeIof
#ableismexists and these quotes are striking!— Julia Hellman, MD, MPH (@DrHellman) October 18, 2018
Thank you @coripoff for helping me to examine my assumptions and implicit biases. Quality of life is defined in the home, not in the hospital. @feminemtweets @slappybogoch. #fix18 pic.twitter.com/nbKqQmIJy6
I also spoke in the first half of the morning – my talk has its own blog post (with accompanying video!) – you can find it here.
The legendary Ashley Shreves started the second half of the morning of day 2. Ashley is a powerhouse of palliative care and once again she spoke with equal amounts of humour and sensitivity on the topic of end-of-life care in ED. You can find her smacc back catalogue here: How to Diagnose Dying and What is a Good Death?11
Karen Kuehl12 spoke about the impact of her experiences taking a job “no-one else wanted” and owning it. She has made amazing differences, particularly for patients presenting with mental health problems, by showing them respect and addressing their needs (earning her the title “the psych whisperer”). She encouraged us to recognise our talents, to look around our EDs and to see what our patients need – and to focus our energies there for tremendous rewards.
Dr. @KarenKuehl, the founder of the Carilion Approach to caring for our patients with psych emergencies— many of whom are forgotten after their “medical clearance” but deserve quality care during their hours and days of ED boarding #FIX18 @feminemtweets pic.twitter.com/GvhlJFQ89K— Dana Im, M.D. (@DanaImMD) October 18, 2018
Jennifer Tang13 shared her experiences as a Canadian coroner, where she sees her role as being to speak for the dead and to protect the living. Her work as a coroner, she believes, has made her a more empathetic individual. She draws upon one of our frustrations in EM – the fact that we can’t always find out what happened to our patients. Her work gives her these answers for families and she helps them understand the end of the story. Coronial work is a route some EM physicians have taken in the UK – it does require legal experience14 but the work is certainly interesting.
Michael VanRooyen15 spoke about family leave policies. Family leave tends to be pretty standardised in the UK and is contractually determined in Australia too – but there are definitely things we can do better. What happens with night shifts, pre and post delivery? Do you make your staff “pay them back” in due course? What about staff who are breastfeeding? What facilities are available to them and how suitable are they? Michael’s talk outlined his role as a departmental leader and a #HeForShe in making our working environment better for staff who have young children.
Janelle Bludhorn16 shed some light on her role as a physician assistant. While well established in the US, the role of the PA is a little more controversial in the UK and in the early stages of development – and I don’t think it exists in Australia at all. Janelle planted herself firmly in the ED team, describing how PAs can offer diversity of background to our departments and support – both emotional and clinical – to us in our challenging work environments.
Prior @MassGeneralEM PA @JanelleRBlu highlighting at #FIX18 that #physicianassistants are our teammates and colleagues.— Renee N Salas, MD, MPH (@ReneeNSalas_MD) October 18, 2018
Personally, our #ED would not operate without them.
Make sure you access their expertise. They help us save lives and will improve our EDs. Thank you, PAs! pic.twitter.com/6v6cs3McR9
Carolyn McClanahan17 is a physician-turned-financial planner. Her talk was a call to change the culture of medicine. She points out that in medicine WE ARE TOO MEAN TO EACH OTHER! Many of our issues are mistakes in systems rather than by people, but we take it out on people. Medicine is a hyper-masculinised environment; from admission to medical school, there is significant jostling and one-upmanship. She makes the point that even in bad cultures, most people are good people. She has used a workplace behaviour contract (“engagement standard”) that employees sign, review regularly and commit to. And when they come up against a tricky issue, they bring in outside help to work it out. She highlighted these keys to effective engagement standards:
- Not platitudes
- Created by team
- Have an empowered culture-keeper
- Review and update regularly
- Used to hire new employees
▶️#FIX18 via @feminemtweets— Bernadette Keefe MD (@nxtstop1) October 21, 2018
Our energy must be devoted to delivering the best care for our patients. It is counter productive to fight with one another
To wit, conserve energy for constructive ends!
Pointers by @CarolynMcC on how to craft a great workplace culture in the ED👇 pic.twitter.com/wO3PvjuVRQ
Then it was time for lunch – but still another half a day of goodness to come, which I’ll capture in post four of four. Until then…!
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