Principles of Management

Common methods for overcoming professional fatigue use time management, support systems, debriefing/relaxation, administrative training, and physical self-care. Regardless of the validity of the need, one can not say yes to one commitment without saying no to something else. A process of value clarification helps identify those concepts one is willing to commit to and provides a starting point for determining personal priorities. One then should set life's major goals in all areas—physical, mental, financial, spiritual, social—according to the individual's most meaningful objectives.

Develop relationships with peers that go beyond the immediate clinical issues. Listen, and provide emotional support and challenge. Be the one to take the risk of talking about the things that are felt but ignored. Share the social reality of what living and practicing in current society is like, sharing thoughts, feelings, and strategies. The fear that someone may discover one's vulnerabilities needs to be resisted. This encourages low levels of trust in peers and tends to isolate one from the social supports needed in times of crisis.

Concern for the well-being of medical trainees must be constantly modeled in training. Many trainees do not have the advantage of mentors who share with them their mistakes, let down their guard, and demonstrate that a lack of perfection does not mean incompetence. Such mentors demonstrate that a mistake is compatible with excellence and compassionate care. Errors in problem solving can be used to improve learned behavior. A faculty that can mentor on personal/professional humility is the best prevention against medical arrogance.

Well-being committees within hospital or medical societies can provide education along with referral to other resources. Lines of communication are opened as physicians learn coping techniques that others have found effective. Topics to present to the medical staff include value clarification, goal setting, time management, grieving, and reframing. A well-being committee is different from professional assistance programs for impaired, disabled, or "troubled" physicians, though their work should complement one another.

The critical incident stress debriefing (CISD) team is an approach that attempts to reduce the severity of poststress disorders at the time of occurrence. Personnel who have experienced a critical or anxiety-provoking situation are debriefed as a group. The group is facilitated by experienced group leaders of similar professional background in conjunction with mental health professionals. This occurs within 72 h following the event. The goal is to intercede before unhealthy reactions have time to be fully incorporated. Each individual is asked to describe what he or she saw, heard, and felt. The incident becomes the setting to share feelings. Participants are given the message that the discomfort they are encountering is a normal reaction to an abnormal experience. It also allows the opportunity to identify those individuals who may need further assistance.

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