“For the most part, we have a society that is overweight, overstressed, underexcercised, and lacks sleep, and the numbers are reaching epidemic proportions. They’re not doing the things they should be doing to take care of themselves, and this is being passed on to children. Our society focuses on sickness when it should be focusing on wellness.”
— Glenn D. Wollman, MD
For the past week you have been getting about four or five hours of sleep, you aren’t eating well, and you haven’t exercised in almost a month. Because of stresses at work and home, lately you feel like there isn’t enough time in the day for these things.
We have all had periods like these, in which everything seems to be out of balance. Chances are very good that in these times, we do not perform well at work. In my work as an executive coach for physician leaders, I have seen many instances in which leaders were held back not by weaknesses or poor communication styles, but rather by the fact that they were out of balance in their lives.
A balance in mind, body and spirit is essential to the effectiveness of leaders, and this is especially true in the high-stress world of the emergency department. Top clinicians in this environment always need to be in peak form in order to manage their highly responsible dual roles as clinicians and leaders. This means that they need to take the time and effort to combine proper nutrition, physical exercise, ample sleep and stress-reduction techniques to provide the necessary balance in their lives.
One veteran ED physician has launched a new career beyond the ED, helping people in health care achieve and maintain a healthy balance in their lives. Glenn D. Wollman, MD, CEO of Living Suite, knows firsthand about what life is like for clinicians in the ED. “I worked in emergency medicine for over 30 years, and was well aware of its stresses,” Dr. Wollman said. “However, the depth of the stress became apparent to me only after I was able to look at it from the outside. I also realized that I made it through that stress because of the things I did to balance my life. People need to work on this balance while they are in the profession, rather than repairing the damage later in life.”
Many emergency physicians go into their line of work because they do not want to deal with the issues of everyday practice. However, they take on a much different set of issues. Wollman says that balance in the emergency department can be looked at from two main points of view—the patients and their families, and the ED staff.
The ED presents clinicians with a unique patient environment. While emergency department physicians often derive great satisfaction from making a huge difference in people’s lives, and even saving them at times, they are often very limited in their ability to affect the long-term care and outcomes for patients. In my coaching practice, emergency physicians have told me that while the emergency department can be a fantastic, rewarding environment in which to both lead and practice medicine, there is also the frustration that more cannot be done for some patients. This frustration can be a source of stress for these clinical leaders.
The emergency department patient is different from the patient that the general practitioner normally sees. “Generally, these people do not have a great interest in their own health care,” Dr. Wollman says. “I don’t see them coming in for wellness checkups. I see them when the problem has either acutely happened or it has been chronic and they have avoided it up to that point.”
Emergency department physicians can cite many examples of their limited effectiveness in long-term care. Dr. Wollman gave the example of the heavy smoker who will seek antibiotics and other medicine for a persistent cough, but will not attempt to stop smoking. He also presented the case of the obese 9-year-old who comes in with an asthma attack so severe that he nearly needs to be intubated, and after the child is stabilized, his obese mother wants to bring in chips and a soda for him. Dr. Wollman said that ED patients are also often unable to provide information that is vital to patient safety and clinical decision making, such as which medications they are now taking, and what surgical procedures they have had and when they had them.
“For the most part, we have a society that is overweight, overstressed, underexcercised, and lacks sleep, and the numbers are reaching epidemic proportions,” Dr. Wollman said. “They’re not doing the things they should be doing to take care of themselves, and this is being passed on to children. Our society focuses on sickness when it should be focusing on wellness.”
The Job Affects Balance
The emergency department clinician also encounters situations that are unique to that environment. In one room, the clinician might be in the middle of a situation in which one family member has accidentally killed another, and is helping the family work through all of the associated dynamics of anger, grief and denial. In another room that same clinician might be dealing with a satisfaction issue with a patient, and then he may go to dealing with paperwork, and then on to an employee issue.
“All of these things cause wear and tear, and I don’t believe most physicians and nurses are aware of that,” Dr. Wollman said. Emergency physician leaders and other healthcare workers must have balance in order to deal effectively with the myriad situations they encounter at work. “You can’t have a patient yelling at you about a bill and you yelling back,” he said.
The “wear and tear” that these issues cause over time is very real. As Dr. Wollman asserts and I have found in my own coaching practice, emergency physicians are able—probably better than most clinicians—to “compartmentalize” stressful situations and move on to the next challenge, as in the example before of the ED physician going from room. However, if this person is out of balance in any area, whether it is in sleep patterns, stress management or other areas, the “wear and tear” will eventually catch up and manifest itself in negative ways in the workplace.
Though he consciously worked to balance his life during his career, Dr. Wollman himself said that the stresses of the job could intrude. He said he realized that despite all of his training and experience, that sometimes he would be driving to work fretting and feeling waves of nausea over the thought that today’s shift would present him with a clinical problem that he would not be able to handle. He said he experienced this anxiety despite the fact that he knew this would never happen because of his knowledge of the basics and the resources of the team around him.
At his Web site, Dr. Wollman introduces his “Balancing Your Life Program” with the following explanation of balance: “The body, mind and spirit are interconnected. If one is out of alignment all aspects are affected. Being out of balance is manifested in many ways, including: physical and mental illness, difficulty in personal relationships, career frustration and loss of general well-being.”
Many Aspects Are Involved in Balance
When considering balance, many aspects that affect mind, body and spirit are combined, including nutrition, physical exercise, general health, sleep patterns, stress management, behavior patterns, and relaxation and meditation. I have found that clinical leaders who pay attention to these life-balancing concepts are much more effective at work.
Dr. Wollman said all of these aspects must be addressed in achieving balance. He said that among medical staff, he has seen many people who are out of balance. “Healthcare staff understand health, and many of them try to do the right things, but it’s often not a complete balance,” he said. “For example, some may understand that exercise is important and may exercise well, but they may not combine that with eating well or sleeping well. Others may eat well, but they don’t exercise well or manage their stress well.”
When something is out of balance, it is manifested in ways that may be construed differently by the people around a clinical leader. Sleep patterns have a definite effect on behavior. Sleep deprivation can cause people to lash out at others for no reason, or cause a lack of attention that could lead to errors. My initial feedback assessments from the people around a coaching client may tell me that his staff consistently perceives him as being abrupt and overbearing. Some may even say that this leader needs anger-management counseling, when the real problem is that the physician has been sleeping only four hours per night. A change in that sleep pattern might be the remedy that would change this behavior and greatly improve this leader’s effectiveness in the ED.
This points out why it is important to work on this life balance and keep at it. The aforementioned physician may go and get a good night’s sleep or two and then apologize for his actions, but he will not be able to keep repeating this cycle and still be an effective leader.
The same thing is true for the over-achiever. The initial assessments may say that he is a hard worker, always in the ED, working long hours, and doing more to improve the department. Some label him a workaholic. The real underlying reason for his behavior may be a bad home life, and the physician leader may be “compartmentalizing” that part of his life and losing himself in his work. His balance suffers. This behavior may bring amazing results in the short term, but it will only be a matter of time before this kind of behavior wears this leader down.
We Need to do More
It is important for physicians and nurses to “do more” in maintaining a healthy balance. “In doing more, we set a better example for patients,” Dr. Wollman said. He added that people who work in the ED need to be more mindful of their physical health and fitness, and more aware of the stresses that are put on them in their work environment.
Dr. Wollman said that balance is especially important for leaders. When mind, body and spirit are in balance, an individual shows up at work as a clear-thinking, effective leader.