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Health and Jesus in the Emergency Department

Larry Cohen

Presenter

Larry Cohen

Emergency Physican in Colorado

Conference

Recorded

  • November 1, 2013
    3:15 PM
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him afternoon and got some handouts of the work were setting out right now my name is Larry Cohen it's an honor to be here at the amen conference is my first name and conference it's something that the IAF really am excited about amendments are not being a part of this this group when they opened up with this will repair first foreheads and if I thank you for this opportunity for us to be together for this weekend I pray that we can all get some information that will help us to serve our patients better and help us to lead them to you we assess and use for a name amen I guess I must like on a member emergency physician from Colorado Springs Colorado I work in the business words apartment in the states up until year ago where the city hospitals and now about a year ago were leased out to the University of Colorado health system were not teaching facility at this point we do has medical system rotate through our surgical department has residence at road rotating through the Lucy over hundred thousand people in our ED every every year were up in a post- of ten thousand this year were level two trauma center axis running at level one status for a chest pain center stroke center all they haul the stuff so we see a lot of patients we have about hundred and thirty hours into this physician covered today with thirty hours of the mid-level providers I am sickly clinician and I worked nights and I did about a hundred and sixty two hundred seventy hours of a month so I know emergency medicine I'm not not enacted an academic person of the death throughout in the letter trying to assist their ways the title of talk basically heart attacks alcohol mentally ill illness health and Jesus in the emergency department and I think it is Jesus really want to the people and he laid back very comfortable around my merge department with all the people that are sick and all-male illness and drunks that murderers them with their mark to seven when Jesus heard it he saith unto them they that are whole have no need for the physician but they that are sick I come not to call the righteous but sinners to repentance and my mers farm is full of them I have no financial disclosures although I was actually going to do the of the robust listings on-site physician had their engine to finger Doctor Carney was talking about open of Colorado as you have a car license hander minute the Colorado and do their thing the whole foods thing up with that Estes Park we got a little nervous about the altitude eighty five hundred feet away on your name so we may get a little bit about in a mountain sickness but found the exact spec much in the way of high-altitude polar edema or cerebral edema but they have to put up some protocols so a part of protocols for the worst-case scenario back to turn out the FSM the protocols with the Sedona Arizona so and it's a good thing because if they were to come there I think AI think that the fact with their dealing God is blessing them they would come the Estes Park they would have exactly halfway through because of the floods anyway so I do along with my wife June we do facilitate the via chip program which mostly apply familiar with corner complete health improving program at women's enough about eight years now and start by Doctor Hans Seo but the real leader of the program is this man Halliburton so the thing about chip and an health and preventive medicine in general as you know you want to help people and we get more people from the community than we do church members if any of you familiar with doing programs like this doesn't happen and that the inside of one of the guys from our church once our first program you with the pictures of me when I was on was two hundred pounds and had a little bit more hair brushed silver gray in he goes that's me I want to be there and that I never bypass valve undergoes I'll talk more about that tomorrow but that the program and sure enough areas about six months ago and a half left his heart attack as he felt the program that he started back on again but from Colorado this is just a few miles from our our home this is Garden of the gods of Pike's Peak in the background on things to do like to go hiking around if you like doing the stair climber this is the incline it's about nine tenths of a mile the sooner mile got a twenty one hundred foot game and it's that the average average or the greatest forty percent and generally Olympic athlete he can do it about eighteen and that my only two minutes Barton Redrock most of them this is in that manager sprinklers outside a car springs so is a visit from the fund of fund marked out most of them go down it is very state gunned down a couple times yet the incident user step and we get a lot of people numerous apartment from their having heart attacks it's a long extrication you know you have a heart attack in way out I know it's not referring to the hospital now yet I speak there's a summons my wife and daughter like new things the family especially hiking this is my son and I I type this up outside of the veil and I love the mountains with one think of a hike up the news is a big jump up to he did the next forty five minutes it down like look at her window we can see bears hosting Fox's received dear Lucy smoke sometimes fire sometimes so that we asked me if we had the record for about an hour out of for about a week from the fire last year about two miles more we live our fear homes got burnt down so we were really lucky so blessed I would say I was going to this I mingle and talk about ways to identify identify arduous spiritual care in a busy emergency permit practice very different in private practice treatment in hospital practice I'll look at some clinical opportunities set maneuvers Carmen for introducing an intensive lifestyle change and they will look at them some burnouts in ways that improve us now how many emergency physicians there were numerous garment nurses but commanders at the picnic is nurses get complacent to big role I can hear this the typical night my emergency department to think it really cannot get under my skin is this kind of screening and fun baby screaming were also the Children's Hospital so I said that I worked nights and where I work this frivolous overnight so busy and worse different to carry units and the area that I take it that I work in that regular bed plus three trauma beds but I also than secure lockdown units which is another ten beds and that's where we put our art drawings are sides renowned than we had Jesus locked up in their cell in our so this is a citizen might my lockdown unit you can see MLC alkyl alcohol cocaine subsidies suicide alcohol ill and result want to limit this time I have these other on the site after your regular medical people short of breath chest pain altered mental status and trauma Henman this is difficult well acted as a talk screen still the positives amphetamine opiates cocaine THC this is not typical for my department use of his alcohol am bored to bring the Son of Man came not to be mentors ministered unto but to minister and to give his life a ransom for many I think the basically that's what we should be doing to as Christians as Christian physicians nurses allied health people we are there to help people to show them God God through us the preflight is not really typically part of what we do is emergency medicine and so Doctor Michael Beuerlein is an internist bioethicists acted at the University stated emergency medicines comprise a discipline practice of routines and guidelines under conditions of uncertainty pressure and time limits more than any other area emergency physicians learn to act automatically faster the speed of philosophical thinking and that's really it I would have a very different job compared to the primary care physician our patients come in by hand him police telling members bring in and have an acute change in their inner health we don't have the luxury of knowing the patients and their family their values they don't haven't built a trust in a legal department for the primary document and pick us and sometimes it's almost adversarial when first going to see a patient where the enemy at certain points we knew that we working very on open environment where I met evident as it comes in the primitive first down in LA and that we have very stressful work schedules work the private auditing cancels work schedules if you need to were four hours a day seven days a week I was Martha stated nothing in life is more wonderful than faith one great moving force which we can either wait in the balance worked of testing the crucible so addressing spiritual care in a busy emergency department especially in a place like mine you know I would not all of us have you know get to work out for work NAF and Adventist health system or any other religious health system where you noticeably comes in a guy like praying the so is it even feasible especially when you think about patient complaints of you know people 's rights but these surveys of the service of what they show is majority of people believe in God many of them out pray for their help ask others to pray for them many people read the Bible outside and pray outside of the church missed to study two thousand seven this is over thirty five thousand people in America US adult question Missouri people believe in God or a higher spirit was interesting to me I come up from a Jewish background can tell by my name eighty three percent but doesn't surprise me that wasn't half are absolutely certain that there is a God him and talk about more about that small to my testimony would take people that are cute with the people that are acutely terminal chronically terminal acutely ill or injured ex- illness mental health issues substance abuse issues we see it all unfortunately some it does a pretty devastating for everybody around so most of the research done for spiritual care looks at palliative care patients hospice patients elderly patient patient's turmoil cancer patients how you type how you take care of the spiritual history in your office practice or on the hospital floor nothing is no sweeter device found on emergency department spiritual care assessment and intervention which might be adjourned to research might be a good thing to do but said that the interviews and basic things and that thing is listen carefully and an empathetically you know clarify their patients concerned with talked about that this morning on there was a great great talk this morning how to how to approach this so there is a two thousand two JAMA article this discussing religious and spiritual issues at the end of life apart from that position it's not bad and I also have time to those that passed out but this is Gerhard read it in here and out of they do have a copy this over here but is basically tools like the hope tool that I could fool the spiritual I'm how to do it by history spiritual history will question asking how to ask so if you need some help that hopefully no using it it might be something we can use our job the numerous department is take your intermediate physical and summary comes in and on take care something they die you have helped him obviously want to get the symptoms under control especially pain you know people that are dying you know I mean we give a lot of pain medications to recruit there currently dying around the if you get the payment control and get them relax with anxiety and control you might be able to open up and talk to find out get some shoes she is an open of their fear of dying there is spiritual choose you know there for it to die under anxious about it there are they are there felt hopeless I feel like they don't their useless nobody wants you don't these accuse hatred within there is a better way you don't and you can open up we can start talking to them unfortunately again our time is limited the big thing is patient you know focus Karen the patient and that's why they were to become compassionate and caring compassion made to suffer with so you know you want to be on a journey with them is not saying anything that you don't already know but against per customer department sometimes you have the luxury of being it it'll been fully attentive very hard sometimes you going to see a patient you can history your phone goes off of the bench to his blood pressure disrupt on seventy are with you twenty church opponents they are required to call us with every component I think it just impatient and seven eyes zero okay yeah or you know you know you think of irony at four five really bad patients going on our guy got it you that that that lacerations as the severe for two hours and have just to get to all this is going to your mind so I given four hundred percent to that patient it's hard it's very hard sometimes he wanted at the atmosphere trust focus on the whole person and he talked about the patient's story this morning that is so important and you can sometimes get from the family structure the patient can talk to you their story and each person is different we had a guy that was coming in at every night for a month practically for intoxicated you know that businesses in the junk take anymore of the drum with Rome in the ER because they don't want simulacrum that the goodness something so this guy and one night when the guys talking to a Missouri sobered up it didn't very delicate you know I'm from New York and when I'm around my family I don't drink a half so we all got a collection that you came in Sweden plan was you know one doesn't turn out to some of the morning say hey how elected the New York death so that I know of our partners don't muck to Denver Nebraska he said talking to the guy you would lose a hundred percent different was a nice guy he had you know he was fun to be with his enough we see these patients patients a microcosm of their life their dirtbags stumbles in our name we don't like similes patients and sometimes it's hard like them God loves in the so you know that's when when I'm really getting will talk about my burnout later but when you know getting stressed after think you know who was this person and every person at our care who it is I talked sometimes hard he know when it comes recently for medical clearances during the arrest they got a little bump on the head like the guy that that children murdered to young people and am I supposed the young bladder that the judge of some have we focus on the yell I'm inherently native people regardless of physical conditions or mental condition prior with patience I think it's so important it's we don't always have that time I've had patients out pamphlets with priority you he printed us innovate and when asked to a lot of partisan get asked as far as I know and yes you know sometimes all sale be praying for you cannot can I cover prayer with you right now most time is taking pretty positively we saw ninety two percent of Americans use adults believe and it's like she said earlier you know what is a hurt so but again we have to do this in loving nonthreatening on course of manners that we don't want to violate the patient's trust in us enough the first thing we do they think you don't set on the predator prey but you know I'm right every time I do a procedure pretty much out out of the better I pray that it goes well you know I don't think the patient want to see the family want to see please let me get the spiral pepper we limited the Central line enough I mean River Gahanna and may sell those a nice job figure out some I prayed to God that don't go well and I try not to take credit for any of those procedures and we do a lot of them in a art in we do foresee to make our economies and armored sperm relic Helen what Ellen White said the view held by some that spirituality is a detriment to health is a sophistry of Satan the religion of the Bible is not detrimental to the health of either body or mind the influence of the Spirit of God is the very best medicine for disease heaven is all health and all the more deeply heavily influences are realized more sure will be there covering into believing invalid the true principles of Christianity open open before all the source of an double happiness religion it is a continual wellspring from which the Christian Christian constraint that will and never exhaust the fountain the Christ method alone will get you success to the region the people he mingled the man is one who desired their good showed sympathy for them the minister to their needs he won their confidence many bathe and follow me that was from Ellen White Ministry of health healing creating a environment of compassion were patients feel their emotional and spiritual needs are met is the heart of holistic care humans are very vulnerable however because the intensity of the illnesses people have the dynamics of the department you know it's it's sometimes very difficult and we can't always be perfect you want to be perfect we can't always be an destitute of yourself to the attitude many tasks and not enough time sometimes it can be very discouraging patient satisfaction surveys are big on the hospital ministration wants to look at the consumer know the patient newspeak of importance of the partnership practitioners meeting their emotional and spiritual needs the actually bit there's been some studies show it patients pay a priority on your place a high priority on this on spirituality and so you have you not needed and she is not that of the faulted for doing that it makes patients happier than half the new possible scores go up and we get these press Gainey scores on how all you do it's amazing I think I give a lot of pain medicine and I never seem to make patients give them enough your pain is not controlled now I had a gentleman not too long ago comes in he says he got bad first phase of the tramadol and Doctor Gibson does not help it and I weigh four hundred and fifty pounds I said you know why they will guide you as I know he goes on but nothing that helps the Percocet of them I think you know you cannot know it was some way you know get a better health United States of the top of all the talk about doing a a gastric bypass potential mates that are not so bad I hardly anything in the pajama Percocets but so we deliver high-tech care for diagnosing treating and monitoring the people that the observer called evermore for humanistic approach to treat the whole person don't make them in there they're frightened they feel abandon their powerless that they are panicking over their whole life is coming before them or something they think that it is may not be of the everybody comes emergency room in its emergency for them and some are very sick and scary yet we so we don't want in the field of personalized we have to make them feel comfortable nuts were sometimes a nurse nurses do a great job some more than other with his word nurse can really step in and continue and really hold their hands I'm just touching somebody you can be a luxury member 's apartment treatment patient mind body and spirit but is it sentimentally happy willing to make I would have such an influence on John R patient's and they get to know you then understand what kind of person you are they like you to give them some trust and he can do a bit better Karen again got to listen confront their reality nobody felt younger couple of October Monger journey but you have to member it is privilege is the premise is part of the patient's care and when you start to get into the spiritual aspect in a very intimate that's that you got to take that and believe it is a privilege talk about some research there is research a lot of research in religion and health and this this study Mallozzi before before two thousand from nineteen centers are more than twelve hundred empirical studies have examined the relationship between religion and health since two thousand more than three thousand studies have shown and basically the board the majority of the studies are so large have to show us an overwhelming evidence that that indicators of religiosity 's spirituality faith hat are markers of personal and and population health most studies are cross-sectional so that we can't show between cause and effect however the prospectus that the trials to support the findings from the cross-sectional studies and a lot of studying maybe more more more this research because of the joint commission who basically said patients have a fun will write their spiritual values so that cannot when Teresa is in a white talk about related patient for the world to enhance joint commission says we should eat all day and I will do what we want to upset them so is stronger Joe did a twenty eight year perspective assessment of more than five thousand adults with they found was weekly attendance at religious services the decrease in relative risk of dying by twenty three percent the second way a man was approximate effect of not smoking itself how they got did a follow-up study they speak for nearly four thousand the community dwelling adults eight sixty four hundred one similar effect and again was strongest in women via national health interview survey of multiple cause of death was around serving done more than twenty thousand Americans what they found was that the whites who regularly attended that services with seven years Absalom and those who did not and was twice fourteen years longer for blacks after controlling for a multiple covariates and explanatory factors the dying during the eight-year follow-up was fifty percent higher in those who never never to religious services and those it can more than once a week and that is right once a week it's kind of and for this religious attendance associated with the adult mortality United States integrated fashion people never ten in exhibit one eight seven time the risk of death to follow and then those he never tended this translates into a seven-year difference in life expectancy it is a twenty this is a good essay by Ludendorff India and health psychology we did is looked at the five hundred fifty seven adults was a prospective study in religious attendance and serum interleukin six what they found was arrested that frequent attendance at reduced risk of dying in a secure follow-up by seventy eight percent and what should be mediated by low are decreased levels of serum interleukin six at high interleukin six levels are an indicator of immune system dysfunction in this microbiological mechanism why religious attendance that may influence health mean God knew what he was doing when he made money when he made us and then again religiously the influence many medical decisions like DNR end-of-life care death directives and physical health benefits makes sense given what's known about the effects of negative emotions on health outcomes and the quality of the life particular people with heart disease and cancer I mean science is great for showing this but don't like that also stated that the relation which exists between the mind and the body is very intimate when one is affected the other sympathizes the condition the mind affects the health of the physical system if the mind is free and happy from a consciousness of right doing and a sense of satisfaction and causing happiness to others the traits of cheerfulness that will react upon the whole system causing a freer circulation of the blood in the strong and atoning up of the entire body the blessing of God is a healing power and those who are abundant and benefit benefiting other others will realize a wondrous blessing in both heart and life is out it benefits them it benefits us so how do we address spiritual camera department in our times of illness no people really start question about life and death like that we see patients from every different specialty if you know how at times we see a miscarriage you know we might sit for five hundred night note if the same routine for us it's so emotional I mean I forget you know every now and then a woman Antichrist this is Mister not visit a fifteen -year-old but can I forget these people want have these babies and this is hard on them you know sometimes the commute calendar there are the pregnant percent well I will get myself an abortion reserved these are big spiritual and philosophical and ethical things we have to do I think about every shift is a potentially mass casualty CO situation and sometimes get overwhelmed flu season is a great example that you should have a plan as you can whenever we have protocols very think how to plan how you can approach spiritual issues and your patience time is very precious emergency department deputy nonjudgmental you understand that there scared when the comment were very comfortable emerge permits our home you know it very better monitor going off you know I mean how times is the bluntly unmonitored alarm go off on the monitors and we moved around in our developments going on up there but your blood pressure is one fifty it's okay I wanted to sit in the one God and let me know okay we wanted just a physical problems first okay invited like me and wife said you know that within the acid malignancy let's talk about God so I don't course our views and be compassionate with the door open for discussion here yet to find the best way to your personality and for your practice no matter what I mean I'm that guy that I go boom boom boom boom boom nicely anywhere from twenty five to thirty five patients in nine hour shift granted by drunks don't think so long but I think and what can I do for these guys their unconscious all they know is get a little track or little steps to Christ from their pocket you know they may board at the two consoles warm and I hadn't know you're there but maybe not you never know who to have the bachelor found the Bible McCain can look what happened you don't know we're going to affect how about people that are dying because of my friends say will lure the coach got good reports and communal Google voice vote alike enough if I say get your ear they may still here and still except Jesus it can be her Savior Matthew twenty one to sixteen yeah workers in the vineyard glasses first doesn't matter when you accept them so my brother was a Christian long before I was in my father was dying of cancer and he told me I'd have told that it would you just are talking about Jesus you know and no anti- didn't accept Christ and enough knowledge of the American Christian but they can more I got mad at him for doing the really needed is that while he's on his deathbed this data will be accepted this book back to both Hamilton religion and health first and second edition by Harold Koenig these are books that he takes all the literature last note really hundred and some years one to two thousand first division is before two thousand looks in all literature ghostly critiques help how well done they are how good and it is just as just fantastic book the second edition came out in two thousand twelve and that's really all the studies from two thousand on so and then be Christlike I mean love these people believe the best you can go on the ballot talk about the lifestyle massacres at the scientific assembly up in Denver from that a super dog it was our welcome breakfast now they do have a 3-D type talk about well as for us but that I think we didn't make our ER patients what happened if we put that out and waiting them to that's a change things up with the over hundred thousand a year way our hundred thousand patients a year with hardly ever have a waiting time over two hours maybe they don't have been filled most people I have that kind of volume may have residents and staff that we don't have resin spreads which some things something that not some not so good that we don't have super long legs anymore usually I spend that night and nuclear four five six hours know now almost never which is nice so interesting health intense in-flight cell chamber department we all know that the healthy lifestyle right diet Ryan Wright exercise and I would prevent the arrest and reverse disease medical literature is daily coming out with you know besides approves it you know and what to do in confirming the Bible that is handled through some some case study that argues a real patients in my merge department more that I started over the years trying to introduce them to a healthy lifestyle marriage the sixty eight -year-old lady brought in by her daughter is about not allowing house blood pressure was a hundred sixty over ninety rushes of beer no pickles ablaze medical history was negative physical exam only posited that the blood pressure one sixty two over ninety two with limitless multivitamins fish oil supplements vitamin B complex of Ms. Koepke ten by the calcium vitamin A asked about her diet a at least five times a week did not cook foods yourself basically packaged foods issued to hook up so I talked to about ten minutes had some time well worth it you don't really need to be put on medicine only does it give you medicine now to bring blood pressure down is not dangerously high but I do like maybe make things worse and get off I thought what well and they even sent a letter to the hospital all adopted in this talk about diet and an address or treat my mother dangerously high blood pressure rises twenty nine -year-old guy comes in had I woke one morning have nice big dead receipt dinner with the threat of aquatic epigastric pain going to his right going to the flank and that he is happy for never left this long is pretty sick I nauseated that like to enter generous outside not out of whack little overweight vendor rep replied upon Murphy sign white count sixteen thousand LF is bilirubin up little bit normal lipase ultrasound is positive for stones in cholecystitis glucose is two ninety I told Nick that young you may have diabetes what might parents had diabetes well enough before I took about three four minutes talk to them they listen you have to happen you know you can possibly possibly prevent going on medicine or get off the medicine was given a start on medicine lay in a hospital you know and maybe you'll have to let me know how you go on a low-fat plant -based diet and exercise that's what he said to me I'd rather take the pill okay so that one was a thirty two -year-old guy theoretical paper couple days nor the complaint best of the history is negative review system is a poly polydipsia as of roundest for a walk for some time mother had type two diabetes a lot of complications of MI she hadn't right knee right leg amputation from it so his committee was he was familiar with diabetes and its outcome so what he did give I'll find like that had the febrile and enough of them record up her collapses and here was his lambs like I'm eighteen thousand sugar was vice city five yes okay what it was a busy busy night when I go out and what happened last time I took Friedman 's talk this got my sit down for fifteen twenty minutes of him and his wife his wife is also two hundred fifty plus pounds two beautiful kids one four one six nice family just want to help I start talking you don't have to do that you know you can go on a easy health program that would just very simple you know legumes vegetables fruit and some nuts whole grains and you can really youngest matricide you can lose this weight you can get healthy you may not happen this and probably muttered and it will quickly get excited about and why skin excited your height this video this is to be be up for us and then he sent me this but I like my meat and of the set and I love that is why as like you plunged the knife into her chest you like your meat or the like are for your family so last one was the fetal guy comes in just they had RPG program wasn't Bob from FL by my production broke this held this was basically reproducible not release the unknown radiating non- pleuritic of the test of history the PD high cholesterol of a pelvic fracture and a TIA is on two men who can take statins to the side effects and undiagnosed with chest wall pain many admit there an Internet I want is announced quite nice guy but I know he rode bike I ride bikes of the triathlons of the back and talk to them and want for them he goes is you know when the person you came and we laugh until my wife on the orders that Doctor talks about diet but we just were just about the startup this Leica early Sunday morning about the star first request for that in order to earn first-ever trip last that that season so that was out on Monday so tell me over the data subordinates health programs for weeks with the little bit about it and goes he shows up they think the class so what what all this has caused one from to succeed on one twenty is that on that on that assessment never went down that far anything that's what he had to come talk to history on not on health and things like that he's our new health programs of their so what are some opportunities we have no what the ones I find that listen the most right dancing the most excited arm IQ for outpatient special guy having Stanley the adopt a minor heart attack you know of enough new guys coming fifty years old you know you get EKG and I chosen have acute MI via you know the wife will usually say it is in such good condition so healthy nothing yes mantle ten seconds ago at this sudden act of that happen overnight I go but there is heaven then this is where I was blessed of my bypass until you know I have my past eleven years ago and I didn't have been had I known then that the honeymoon them I know now I would not have the bypass so whenever heart attack I just had sent word that I tell me off without the triathlon the marathons in ugly look amazing Harry looked fit enough and so yeah so I usually go to those of the ones are really listening but every patients every patients an opportunity whether obese hypertensive have diabetes have autoimmune disease cancer you know we could talk we can help everyone and what I usually do is have page print out a changeup periodically the top I have our websites Mister programs as local Colorado Springs it makes a local altar in town and with that though cited the town that he was not that that my wife and I not facilitated but we don't make any money from infected I will come across us by we have to pour money into due to our church and notes that it's a ministry that we do I give you new start website Google 's website is in books like I did my diabetes by Wes Youngberg prevent reverse heart disease by as a stand this and then into guidebook Angela and get a lot of feedback from there a lot of positive feedback need even letters to the hospital saying that his doctor really cared about me more so than the heaving to my pain medicine and in my partners and I all get out get find notes my boss called this guy 's existing health program the other that they know what I do I've got a couple of hot card cardiologist that them that come exit talk we believe it may come and talk to my their graduation and that goes hunting for a bit cardiologist and you and you walk in his feminine leaving for work women of leaving work notes healthy look slim and trim and newspaper tailoring in the neighborhood of engine two diet that's what I'm doing now you have heard of the NSF stem in Arizona with the main example to start tell people you know it healthy and not doing yourself humming we have to be honest with ourselves there but first let's go until not burn out with nothing to twenty five four twenty ten okay and that a passive family talked about this this morning which I think that was great lots of it what is burnout is loss of enthusiasm for work or an emotional exhaustion feeling the sin of schism with the personalization and will sense of personal accomplishment and it is in this morning it's a bit of burnout among the problems of it among US physicians is is alarming and related positions in specialties and frontline in Madison Pacific league emergency medicine are at the highest risk we were long hours and we have greater struggles of their worklife integration and an Nikes of this morning afternoon just for hours worked per week and level of H education higher degrees seem to reduce the risk of burnout outside the field of medicine or medical degree increases the risk so it's not mirroring societal trends when they had more common go for it what's interesting is an pedophilia magistrate nearly one out of two physicians report at least one symptom of burnout and what is it really also interesting is what slow and preventative medicine is has one of the lowest rates of burnout and if you know if you get really struggling please help program it's amazing I tell the people wept there after I'm done after four with a member the very first chip program we did at the end of the programmers I told him I got more satisfaction out of doing that from the night working to put forth just to get crack open a chest because people are happy he anything is known to know them admit Netscape in a similar survey this past March and again to medicine that were number one for burnout and what it does is admit it the world professionalism isn't it influences the quality of care increase was for medical errors promotes early retirement infects our private lives with that of broken relationships problematic use with alcohol and drugs I mean I believe it can even happen to an Adventist and suicide ideation I think job stress poor for it in active treatment for male illness is probably one reason why physicians such a higher than average rate of suicide in the last four years we've had five physicians in our town commits suicide what was the first physician and one of the Air Force at the Air Force we were we were committed as part made the Air Force Academy 's medical director you never see the guy without a smile happy-go-lucky but there is also the resistant he knows how to kill himself he took down the two hundred Ativan when the garage on the car and and it worked so and was lead to lost interest in working on the attractive we once had in all of a sudden no we want to avoid it that it is only because we load almost load going to work angry much of time or something that would normally when by the ACLU's is deflected you know really to set you off unable to find joy in life things that once were fine no longer find enjoyable corner vacation is a chore to come back to no more refreshing when you left so when we do we make a good living with my toys nearly try to buy that piece and wind up doing is hope not sure I have the wartime no retirement with so we can know spend ourselves into into Russian debt then of course the physical and emotional problems and anxiety depression headaches loss of appetite loss of the six interest we can become isolated which can lead to depression and even worse you know the young leases alcohol is abused knowing with right now we get the script was written for drugs we get poor physician-patient communication which can lead to poor decision-making increased malpractice risk than I would read it denial you know even when it's floor and you know say Lyman be okay no it's no different than patient with chest pain the testing is his heart only approved note deny it and a delay treatment that would be beneficial in itself what was coming up at eighteen hours after them I know difference for our program so why we risk monthly medicine monopolizes our time might be my success is basically my job which will become over responsible we we exist in a fishbowl and every patient we say something is sick and some other doctors can review it and you know of we get the worst feedback from people that never stepped foot member department who have a poor sense of community the hospital based practice we don't have much control over nursing tech things like that the intent to the work by case types by volume and the unpredictability of both and we have to make rapid decisions and sometimes easily with little information hero ships work circadian rhythms are often hourly losses sleep or lack of sleep and this can affect us over mentally and physically there's rare precision for a work by both patients and colleagues perfect example that comes in dislocated ankle I reduce get back investments in orthopedist orthopedists dealt me know your later Hamer that direct you reduce his ankle yet goes out and has beautiful cabin up in the of the mountains and just needs a time thank you so much for fixing his ankle he is owing to this but a cast on you revisit your stuff that's kind typical for us but were not in it for the accolades I guess you unexpectedly the unrealistic expectations but after a spike young patient the family hospital staff administration as well as unrealistically low once we set for ourselves and with little margin for ourselves personally with all we do any little thing and illness the unplanned personal problem just put us over the edge and we also can have problems with this dumb healthy boundaries sometimes it's hard for us to say no idea got a committee sure can you do that accident sure you were we our profession becomes more important than our personal lives and there's a organizational contribution on the fast workload I mean you can only do so much at once lucky controlled work-study were breakdown can workplace a supportive community reward system fairness and scheduling remember your family get all the bits yesterday Melvin is poor shifts and value set on us by your buyout are different to die between us and the administration of the department Doctor Cohen I mean I got letter nine months ago artist may CAT scans are met with the cartel will Doctor only works are currently here he theses on sick patients all the trauma he orders market skins as you know as opposed to the people who work within our inner less acute areas nothing like itself in I just laugh at them that that's a problem though that can put stress on your side we don't burn out understanding admit that your risk the title M.D. should not mean malignant denial now where do you know we need to do we need to really feel educate yourself about it base of .org website has a wellness book from its position that you can download pretty good book thousands of his summits cow qubits is not bad enough and understand that you have it it's eerily sake can severely size yourself but how can you see some media partner being burnt out he said anything to them I say be proactive one pray the main document the select and remember to go back to where you are you know we used to be like this job and there's a reason we like this job and get to know the patients I mean one might really in a feel down about it I start thinking about that I said I like this patient I talked to them and I pray with them and all of a sudden this fund on the work get a burnout buddy either whether it's your wife your husband a coworker a good friend to hate if you see me start to go off what me know and at that point gets professional help is needed you know learned that I felt most alive to hear the talking bout ill cry no a bad situation then you know you may have to have a yellow some sort of the mass casualty debriefing with with everybody we had a kid come in mission abroad many was dead three years old as uncle stabbed and killed six months old and nearly decapitated kid that came in and into the trait that the slasher dead Young is a terrible terrible thing one of the first of seven years big Roy guy that let them offer week you can handle it so the breakers get so have to develop us that balance in the physical balance and healthy eating right exercise emotional balance spiritual balance so sort go to church pray read the Bible read online is so important relationship balance work and career balance never remember why he went emergency medicine you know this humanity this reconnection with a young we want to beat me up when you're born you know little Doctor areas know the doctors know all of our lives just than get into the title to a graduate medical school note if you conference possibly a group faces issues you be proactive and if you really are having a problem take time off so what's my definition for the day what really makes me flip a day without a registered letter got ahead in fact that this was the deposition of a lawsuit because this guy they before saw patient with TIA referred the TIA clinic the next day from the stroke I mean he got the CAT scan of Boomer me there was a massive stroke while I'm getting sued because I'd like my dictation said Ari J Doctor so-and-so 's record while understood as a supervisor that I reviewed your so and I go tent at the large changes as a hay keeping it up he diagnosed he admitted him know that there do try to get you scared to face and that another so there is need of coming close to people by personal effort if less time or staff sermonizing more time was spent impersonal ministry greater results of the same purport to be relieve the sick care for the sorrowing and breathed comforting to ignore instructed inexperienced counsel we are to weep with those who weep and rejoice of those that rejoice accompanied by the power of persuasion the power of prayer the power of the love of God this will will not come without fruit Ellen White Mister Giuliani in this media with God audio players a website dedicated to spreading God 's word reading seven audio and for I know more about how he was on his mind this is more so than please visit www. .com universe .org

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