Subscribe to The Podcast by KevinMD. Catch up on old episodes!

Join Rida Jawed, an emergency medicine resident in Pakistan. Rida shares her invaluable insights and experiences from her journey in the emergency department. We delve into essential rules for thriving in this demanding field, from self-care to continuous learning and effective communication.

Rida Jawed is an emergency medicine resident in Pakistan.

She discusses the KevinMD article, “From burnout to brilliance: How one doctor found balance.”

Careers by KevinMD is your gateway to health care success. We connect you with real-time, exclusive resources like job boards, news updates, and salary insights, all tailored for health care professionals. With expertise in uniting top talent and leading employers across the nation’s largest health care hiring network, we’re your partner in shaping health care’s future. Fulfill your health care journey at KevinMD.com/careers.

VISIT SPONSOR → https://kevinmd.com/careers

Discovering disability insurance? Pattern understands your concerns. Over 20,000 doctors trust us for straightforward, affordable coverage. We handle everything from quotes to paperwork. Say goodbye to insurance stress – visit Pattern today at KevinMD.com/pattern.

VISIT SPONSOR → https://kevinmd.com/pattern

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/3rr5Om

Powered by CMEfy.

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Rida Jawed. She’s an emergency medicine resident in Pakistan, and today’s KevinMD article is titled “From burnout to brilliance: How one doctor found balance.” Rida, welcome to the show.

Rida Jawed: Thank you so much for having me, Dr. Kevin. It’s very exciting to be here.

Kevin Pho: All right, well, thank you so much for joining me all the way from Pakistan. Before we get into your article, just briefly share your story and journey.

Rida Jawed: Right. I’m currently working as a third-year resident in the emergency medicine department, and I worked for about three more years as a medical officer before that, so I have six years of total experience in emergency medicine and have been through a lot of different scenarios. I’m also a mother of two kids, one four years old and one three years old, and I’m also the very proud wife of a man who’s currently at the end of his interventional cardiology fellowship. So there’s a lot going on on my side, as you can imagine. There are a lot of duties that have to be done, and a lot of micromanagement going on.

Fortunately for me, all of these things came up slowly and gradually, so I learned to cope with them. But over the years, because my roles have expanded, as a mother, as a wife, and in a residency where you’re more academically inclined, I have learned to adopt strategies that help me not burn out and perform to the best of my abilities.

Kevin Pho: So tell me a little bit about the emergency department you practice in. Are you in a large city? Do you work in more of a community setting? Tell us a little bit about your emergency department.

Rida Jawed: OK. I’m currently working at Aga Khan University Hospital, which is supposed to be one of the biggest hospitals in Pakistan. It’s a private setup, but there’s also welfare available there, because I come from a lower-income country, so that option is always available. We see all kinds of patients. We see really critical patients from lower economic settings who have often been mismanaged elsewhere and then show up at our private setup, and we also see higher-class people. So we see all kinds of presentations. I’ve seen groups of people from different socioeconomic classes, and they also present at different stages, so there are lots of different presentations.

Kevin Pho: All right, so I want to explore your different roles. Like you said, not only are you an emergency medicine resident, you’re also a mother to two young children, and you talk more about that in your KevinMD article, “From burnout to brilliance: How one doctor found balance.” Tell us how your article came together.

Rida Jawed: All right. Since I’ve been practicing emergency medicine for the past six years, I think I’ve gotten the gist of how you’re supposed to perform as an emergency medicine physician, because there’s this constant pressure and energy rush you go through when working in the emergency departments. It gets a bit overwhelming at times, and it can make you feel obliged to perform in a certain way. As I mentioned in my article, there are a few things I’ve learned over the years that have helped me cope in that stressful environment. So the article came about as a set of rules that I’ve made for myself, things I do to tackle all the chaos that is emergency medicine.

Kevin Pho: All right, well, why don’t we go into some of these rules? Tell us more about them.

Rida Jawed: OK. Rule number one: It always starts with yourself. The number one rule is that you have to prioritize yourself first. I know that in emergency, when all of these critical patients are coming in, you are so full of this adrenaline rush, and you just want to help, and a lot of times we forget ourselves: to eat, drink water or go to the bathroom. I have done that so many times. At the end of a 12-hour shift, I would recall that I hadn’t had even one glass of water or anything to eat. Sometimes there would be food for us, but it would just go cold, and none of the doctors would show up to eat it. At times our faculty would actually come and ask us to go into the room and just eat something, for God’s sake.

It can get very overwhelming, because in emergency medicine we have this strange drive to help everybody and tackle everything that walks in the door. It gets very, very difficult to control that urge and tell yourself to take a moment, think about yourself a little bit, be relaxed, shift gears to a more peaceful situation and care about yourself a little bit more. Initially it used to work out just fine. You had all these people around who used to motivate you, because everybody was working and nobody was taking breaks, so it seemed like working is what you should be doing. And the culture we have rewards this workaholism: The person who works extra is the better one, taking breaks is kind of frowned upon, and if somebody takes too long a break, that is also frowned upon.

Over time it gets tiring, and you end up realizing that you have exhausted yourself, especially by the end of a 12-hour shift, and if you have back-to-back shifts, it gets pretty tiring pretty quickly. So if you’re not taking those breaks, if you’re not prioritizing yourself, if you’re not going to the bathroom, if you’re not keeping up your water intake, if you’re not making sure you’re eating properly, if you’re not making sure you have healthy relationships with your colleagues in your department and calling them at times to make sure everything’s all right, it’s going to take a toll on you eventually. So it’s very, very important to prioritize yourself first, and I think that’s rule number one that I’ve learned over the years, as a mother and as a doctor. I know you feel guilty for not putting other people first, but you have to, because you cannot pour from an empty cup.

Kevin Pho: Now, how long did it take you to realize that rule? Because, like you said, you’re a mother and a wife, you’re learning emergency medicine, and you’re being pulled in so many directions. How long did it take you to realize that you need to take care of yourself first?

Rida Jawed: In every role, I’ve had to relearn it over and over again. First I was working as a medical officer, where not that much was expected of me; I just had to see the patients. Then I had to realize that I should focus more on myself. Then I became a mother, and there was the whole guilt thing all over again: I have to keep up with the kids, so I have to sacrifice my sleep and my diet for them. Then I had to learn this lesson again. And then when I shifted to residency, it became more academic, so academics also started taking priority. I would not eat, I would not sleep, I would miss things. It’s very obvious that people pull all-nighters when they have exams, and that is your academics taking priority over your self-care. So I’ve had to relearn the same rule over and over again at different stages of my life, and I’m still learning.

Kevin Pho: All right, what’s rule number two?

Rida Jawed: Rule number two I would call “begin with a game plan.” This is something I learned after becoming a mother. Before becoming a mother, I was just answerable to myself, so I used to do whatever I wanted to do. Nobody was there to question me; it was just me. But when I became a mother, I started realizing that you have to take care of these little kids, and for that you have to plan ahead: what things I want to take, their breakfast, their meals, what I’m going to take if I want to go somewhere outside with them. So I brought that into my own job after I became a mother. This is something motherhood taught me: to plan ahead.

The way I plan ahead, because I’m usually short of time now with so many roles going on, is that I try to iron my clothes and set them apart on Sundays, or on the weekends, or whenever I get a day off, so I have them ready. That way I don’t have the anxiety every day of opening the cupboard and staring at it for a while; that anxiety is gone. Secondly, I have a designated bag that has my stethoscope, my pen and all the stationery I require on a day-to-day basis, and a separate wallet with money, so anytime I get an emergency call and have to go, I just pick up the bag and everything is in there. That gives me a lot of ease.

When it comes to my shifts, I use my transit time. We actually have a hospital application on our mobile phones that lets me see the list of patients, their investigations and their lab reports, so I usually go through that on my way. It gives me a good idea of what the diagnosis is and where the patient is going, and it also helps me make a priority list of which patient I’m going to see first and which is more critical. So it puts me in a comfortable position to start my shift, because I know which patients I’m going to see beforehand, in comparison to people who just come in and get the handover from the previous doctor. That preparation on my transit route helps me a lot. At times I also like to go through literature updates on the topics patients usually present with. That eases my entrance into the shift, and it helps me get comfortable in my surroundings much more quickly.

Kevin Pho: So it sounds like preparation is a key tool you use to handle all the commitments you have and all the anxiety that can come from being pulled in so many different ways.

Rida Jawed: That’s true. That’s a very good way to say it.

Kevin Pho: All right. I see rule number three here is to communicate effectively. How do you use that rule on a daily basis?

Rida Jawed: I would personally say that I put a lot of effort into communicating with the people around me, probably because I believe communication is a prime skill that everybody working in a hospital needs to learn. I’m usually friends with all of my staff. I wave at them and say, “Hello, how are you?” and put in a compliment here and there, like, “That looks nice. That’s a nice color you’re wearing.” That kind of eases the tension among everybody. Then I take the handover of the patients and go visit them, and I always connect with a personal touch, like meeting the family or someone close to the patient, and putting in a joke here and there. I think my juniors would really vouch for the fact that I’m a fun senior to be around, because I’m always joking around during the shift, and that eases the chaos and tension of whatever is going on in the emergency department. I tell my junior colleagues, “Just relax. We’ll work at our own pace, in our own comfort zone. Nobody’s going to rush anything. We’re just going to take it slow, one step at a time.”

So I communicate with all of my staff members, and I’m on good terms with them, and I think that’s very, very important, because the ER is teamwork. You’re supposed to be a team player. You cannot work in the ER without good team support; you really need people to back you up. There have been countless times when my juniors have not been scared to communicate with me. At times they’ve told me, “I’ve seen this patient, and they have something else going on,” or my staff comes and tells me, “I’ve been with the patient longer, and I think this patient is also showing these symptoms. Do you really want to go with that?” That really helps me change my plan, rectify it or alter whatever I’m doing, and that helps the patient in the end. So I think it’s very, very important to have a team that has confidence in you, is not scared of you and can communicate with you directly, because you have maintained that kind of relationship with them, a level of friendship, I would even say.

It’s also important to have that kind of relationship with your patients, where they can really ask you things and raise their queries. In the ER, the first thing we’re taught is to ask the patient, “What brought you here today?” The patient may have all sorts of problems, but they may be there because they want to feel reassured about something, and if you don’t reassure them, the patient does not feel satisfied whatsoever. So I think the main, important thing is to really communicate with the patient: “What do you want? What do you want out of this visit? Why have you come to my hospital? How can I help you?” Having that kind of clear communication about their goals helps you provide better care and increases their satisfaction with you. Clear communication is the major key overall, both in your team dynamics and with your patients. I think that’s rule number one of teamwork: good communication.

Kevin Pho: Now, physicians in the United States, and I’m sure in Pakistan, are so busy. You have so many patients to see and so many things to keep track of, and sometimes a lack of time interferes with the communication you said was so important. So how do you manage to slow down and give yourself time to communicate with both your team and your patients, when so many things are pushing you on to the next thing? Physicians may feel so rushed. How do you take a moment, take a breath and really ensure strong communication?

Rida Jawed: There are a couple of things I have learned, and there’s some research I have read. Some researchers found that if you sit down with the patient, they feel that the time has passed more slowly, versus standing up and talking to them; sitting down for five minutes can feel like more than 15 minutes standing. Also, good physical gestures help: You touch the patient, come down to their eye level and talk to them.

Personally, how I like to communicate is to go for something personal. That really opens patients up and makes them feel more connected to me, so I reach whatever I’m going for sooner, compared with just talking at them and never really getting to the point. Sometimes I just say, “Yeah, OK, I also do that,” or “Yes, I know how you feel. That must feel very bad. I understand. I hope I can get you something for the pain, and just let me know if it doesn’t help, and I’m going to give you something stronger.” Talking to them in a personal way shortens the time I have to take with the patient, and it helps them open up a bit more.

I also have to keep reminding myself to calm down and not rush into it, because whoever is coming in is probably having the worst day of their life. So I really need to be a sense of comfort to them, a person of comfort, and help them process whatever they’re going through. I have to keep reminding myself not to rush, and at times it’s not really possible, of course, because there are so many patients coming in. So I try to delegate the task to somebody else, like, “OK, fine, you start with that patient. I’m going to finish with this person, and then I’m going to come back to you.” That reduces the time I need to spend with each one.

Kevin Pho: I think that last point you made was very powerful: No matter how busy you are and no matter how many patients you’ve seen that day, for that patient it’s often the worst day of their life, especially in the emergency department. Now, you have three other rules here, and if you want to read all the rules, go to the link to your article; we’ll put that in the show notes. But take one of the last few rules and talk about it.

Rida Jawed: The last rule, which is very, very important, and I think it’s the perfect ending to the article, is that you have to reflect on what you’ve been through during the shift. I think self-reflection is very, very important for your growth. At the end of the shift, I usually like to tell myself verbally what I did well and what I could have done better, and I also try to jot it down. At times I get feedback from other people, and at times my patient outcomes tell me what the results were. So I do take my time to really connect with that and see the errors and where I can improve, because if you’re not reflecting, it’s like starting from point zero every day, and that’s not going to benefit you or your patients. So self-reflection is crucial to growing and improving.

At the end of the day, obviously, you just need time for yourself, the self-care part, but you also need self-reflection. You really need to take a pause and reflect, and journal if you want to; I do a lot of times. That’s very important so you don’t repeat the same mistakes, and so you improve on the things you’re already good at. I think that over time, a person becomes a really good judge of their own character. They know what they’re doing right. If you really go inside yourself, you will hear that voice. You’ll know what you did right and what you did wrong, because at times when you do something wrong, that voice corrects you itself, immediately: “Oops, that was a bit harsh,” or “That was not right.” Over time, you become a better judge of your own character by watching other people and yourself, and you realize your own strengths and your own weaknesses and what you need to work on. So I think self-reflection is super crucial to ending your shift and making sure you’re improving over time.

Kevin Pho: We’re talking to Rida Jawed. She’s an emergency medicine resident in Pakistan, and her KevinMD article is titled “From burnout to brilliance: How one doctor found balance.” Rida, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Rida Jawed: All right. My take-home messages are these points. Number one is that you have to prioritize yourself. Number two is that you have to start your shift with a game plan. Number three is that you have to really communicate effectively with your team members and your patients; that’s the key goal in maintaining good relationships. You have to keep learning and keep growing: You have to teach your juniors, and you have to learn from your seniors. It’s a give-and-take process. You have to take breaks and take care of yourself, and you have to delegate tasks. Don’t try to be a hero. You’re just a human being, so embrace your humanity and work with it. And at the end, make sure you reflect, and take time to know what you did right and what you did wrong, so you can continue to improve and be a really good doctor.

Kevin Pho: Rida, thank you so much for sharing your time and insight, and thanks again for coming on the show.

Rida Jawed: Thank you so much for having me.