WPW – Week 6 RPR

“For wood to burn and release its light, it must be given space.” Zen teaching

Any concerns I may have had about losing momentum were easily laid to rest this week. The ED registrars leading on different projects are moving forward with a core energy that is a privilege to nurture.

It feels like the time is right to set up a new page tracking progress more formally than these end of week blog entries. Work for the week ahead.

Closing this weekend with the personal nourishment of attending a Peaceful Hearts retreat and understanding more deeply the roots of compassion.

WPW – Week 5 RPR

This week’s surprise lesson for me was experiencing how it can be quite stressful to be kind to oneself. Might sound paradoxical, yet this was my direct experience.

Simple practices – like letting the computer screen hibernate for the 5-7 minutes I have lunch, finishing my shift on time, allowing myself to not eat the fast food brought in by a well wisher and instead have a salad pre-prepared for work… Simple practices of self compassion and self care that should feel easy – but didn’t. Similar to the initial discomfort that comes when (re)learning a skill.

A big positive for the week – recognising this week’s ‘pause’ provided the team with the kind of time and space that nurtures psychological safety. Will this be at the cost of losing project momentum ? Or will individual and team motivation be boosted instead ? We will find out as the new week dawns …

WPW- Week 4 RPR

“I saw the angel in the marble and carved until I set him free.” Michelangelo

The stand out moments for me this week have mostly been around 1:1 development time with different members of our wider ED clinical team. Letting them grow and spread their angel wings as I hopefully reinforce their sense of autonomy, authenticity and ways to engage.

The most precious encounter was with one of the registrars taking care of a patient who visits our ED frequently. This time though, the registrar was able to shift his focus to work with that part of the patient that keeps coming back to the ED for help – instead of the part of the patient that makes her relapse into destructive behaviours as soon as she leaves. This change in intention opened a whole new path for both the patient and the registrar (who had seen her several times before with the same problem.)

Compassion in practice, one patient at a time.

From a systems point of view, the ED older patient flow pathway we put forward last week has been accepted and the pilot starts tomorrow. A record breaker for getting stakeholder engagement (not to mention agreement !) so quickly.

For the week ahead, my intention is to prioritise some self care and self compassion. To remind myself of what I share so often with my team – when we pour for others, we must sometimes stop to fill our own cups too.

WPW – week 3 RPR

The external growth this week has mostly been in the intellectual and physical energy domains. Notably – delivering the first session of a training program I am offering to ED clinicians interested in quality and clinical audit. And upgrading a proposed ED geriatric referral pathway to a patient flow pathway – shifting the central focus back to the patient.

Diminishing psychological safety at the organisation-ED interface has been the challenge for a second week running. I find myself coming back and taking refuge in the spiritual domain of our work – a purpose and perspective that helps me acknowledge the suffering without it becoming overwhelming.

Serenity to accept what I can not change, courage to make the changes I can, and experiential insight to recognise the difference. Compassion in practice.

WPW – week 2 RPR

Positives this week – seeing leadership and new confidence express itself in an ED registrar’s board round. Plus nurturing the leadership wings in a member of an ED Frailty Intervention Team (that I am responsible for).

The monthly ED journal club continues to mature, in particular relationships and shared learning between the registrars. An opportunistic teaching moment this week – reinforcing the ethics/integrity that must be at the heart of everything we do as clinicians – research and beyond.

My most difficult moments this week – experiencing the physical symptoms and the hit to psychological safety that arise from management meetings without good governance. Observable changes in concentration, mood, energy levels, headache – not dissimilar to carbon monoxide poisoning!

Personal area to grow – allowing myself the self compassion to focus on what matters most and let go of career aspirations that necessitate carbon monoxide type toxidromes.

WPW – week 1 RPR

Feels like a good week. The Europe wide research study our department is participating in connects us with a bigger picture and higher purpose, nourishes social engagement and provides a channel for physical action.

Also protected some 1:1 time with ED Quality Improvement Project registrars. Helped them understand the difference between medical research and quality improvement. Reinforced the importance of a moral compass – looking deeply and understanding where our (project) volition comes from.

Personal positive – concentrated most of my time and energy on my sphere of influence. Action and agency.

Personal area to grow – meeting people where they are, and not where I want/expect them to be ! Balancing the real life time pressure of delivering on research and departmental change while still providing young minds a safe space to learn.

Compassion in practice.

WPW – Work Place Wellbeing

What does “human factors” mean in an Emergency Department world of Covid 19 and how can my ongoing training in it make a difference to where I work ?

As a first step, I am introducing Zoom based sessions on quality improvement methodologies, adapted to my local setting. Gently redirecting attention from our circle of concern to our sphere of influence – individually and collectively.

My belief – action and agency in these difficult times help relieve suffering and maybe even promote well being in the workplace. Compassion in practice.

Breakfast Rounds



Which comes first – my role as a doctor or my role as a human being ?

Recently, with clinical need exceeding inpatient bed availability, patients have been forced to spend the night boarded in their local Emergency Departments. Which brings me to my dilemma.

Imagine I come in at 8 am. I start with a “ward” round on these overnight patients. I come to patient number two and find a frail 81 year old lady who has been in ED for hours with very little to eat or drink. I look for a health care assistant or hospital volunteer who could bring my patient some breakfast. There isn’t anyone. I look for my patient’s nurse and find she is stretched between several other patients, about to start antibiotics on someone septic while simultaneously organising the urgent transfer of a patient she needs to take down to CT. (gone for another 30-40 minutes at least). So it comes down to me –  do I  stop the round and make tea and toast for this lady and other overnight stay patients myself ? Or do I delegate the task –  knowing it may be an hour or more before it gets done – and instead check whether the remaining boarded patients have serious medical problems to sort ?

I honestly don’t know. Like Australian Lieutenant General David Morrison, I believe the standard you walk past is the standard you accept. And this is a standard I can not accept.

My friend and colleague Damian Roland wrote about being the kind of consultant who answers the telephone.

Another friend (and fellow ED consultant) routinely pushes patients on trolleys to the CT scanner when a hospital porter isn’t available.

While noble and good for the individual patient concerned, I wonder if such actions might weaken the system further, putting future patients (and staff) at greater risk. (“We don’t need more reception staff / porters / health care assistants – the doctor can answer the phone / push the trolley / get breakfast…”)

I guess some of it depends on how we as doctors communicate these issues to hospital managers, and how hospital managers in turn respond.

Till then however, my dilemma remains …