Image 1: Prepping for a shift!

This month on our “How I stay Healthy” series, we’re featuring Dr. Keith Henry, director of medical student education at Regions Hospital in St. Paul, Minnesota. Dr. Henry tells us about his pre-shift rituals, his on-shift prioritization schema, and his new favorite exercise tool!

Words of Wisdom:

Life comes at most of us fairly hard and fast these days. Whether it’s balancing work, teaching, family, or general chaos, it’s easy to take what we do in the continuum of medicine for granted. It has become increasingly important for me to center and reflect on the honor and privilege bestowed upon us by our culture and society. To center before a shift, I take a brief moment (on the drive in, walking down the stairwell to the department, logging into the work terminal) to recall that feeling of “awe” I think we all had well before medical school or residency training – the feeling of how incredible it would be to care for patients, to provide a sense of hope, compassion, and empathy in the role of a physician. And to be able to provide something of value to patients and family by way of knowledge and skill to promote wellness, to heal, and to save. That spark reminds me of why I do what I do. All of the other white noise and distraction fades into the periphery so that I’m dialed into providing the best care and experience for patients, families, colleagues, and department staff.

A word of wisdom and inspiration that has had a profound impact on my personal and professional life is as follows:

“People won’t remember what you did for them, but they’ll remember how you made them feel.”

A Day in the Life:

My typical day starts fairly early.  I’m usually up around 5 am, peruse CNN and NPR online, and enjoy a half cup of coffee – the methylxanthines are a great bronchodilator and the caffeine is a welcome bonus.  Then, it’s off to the bike.

As I’ve become older and wiser, I’ve become a firm believer in the power of frequent exercise (even after a busy night shift).  Prior to the pandemic, I would work out several times per week at a local Crossfit gym.  Lately, I’ve become a huge fan of the Peloton home exercise bike and recently hit a 19-week streak!  A 30 to 45-minute session on the bike augmented with a 2-mile family walk with Sam, our mixed Shepherd rescue, is usually enough to ensure I start (or end) the day with a great frame of mind.

Keith Henry

Image 2: Sam, our mixed Shepherd rescue

I’m way more productive when I generate lists and prioritize tasks at work and home.   Admittingly, I’m nowhere nearly as refined as my colleague and friend Michael Paddock (featured previously on this blog segment).  I have, however, tried several checklist type apps but they just don’t seem to hold a candle to good old fashioned pen and paper.  Listing, prioritizing, and checking tasks off early on helps me to generate momentum that powers me into the bigger tasks of the day.

To keep up with med-ed, I’m a frequent listener of the EM:RAP, EM Abstracts, and EMCRIT podcasts.  Annals of Emergency Medicine and The Journal of Emergency Medicine round out my weekly reading lists.  To wind down on the flip side, I’m a frequent viewer of all things Netflix, Amazon Prime Video, and Apple TV (Minnesota gets really, really cold in the winter).

Keith Henry

Image 3: Visiting a brewery is a great way to stay healthy!

Wellness Work Hacks:

More words of wisdom: You can run the shift, or the shift can run you”. The more I’m able to manage a department on my terms, the better care I provide, the better teaching I disseminate to learners, and the more gratified I feel for performing and practicing my profession. How do I “run the shift?” There are a few concepts and fundamental principles I follow that help make this possible:

The first concept to consider is knowing and understanding your role as an Emergency Medicine Physician, and why that role is fundamentally different than that of our non-EM colleagues. Our focus and objectives during a patient encounter are to provide care to many patients seeking care in the safest and most efficient way possible. If you haven’t spent time defining your role as an Emergency Physician, the people you come into contact with on a typical shift will have no problem defining that role for you – be it the patient, their family,  consultants, nursing staff, etc. The most skilled and efficient Emergency Physicians know and understand who they are as specialists, what their fundamental mission and roll is, and why they do what they do in the way that they do it.

The second concept is using a structured approach to my priorities during a shift. In times of high acuity surge in the department (managing cardiac arrests, level I trauma activations, agitated mental health emergencies, etc.) knowing how to “get back on the horse” is a common question asked by trainees. I observe 3 priorities in shift management in sequential order. This prevents me from ever walking out of a resuscitation room wondering “where do I start now.”

Priority One: Initiate care! Until you are able to initiate care, the patient may sit in a treatment room, in a hallway, or in the waiting room with the clock ticking away. Initiating contact and care with the patient will move their care forward exponentially. If the patient has been roomed, they’re taking up a very precious and finite resource that may be better suited for your next high acuity patient. Initiate care and get folks moving safely and efficiently.

Priority Two: Disposition! After fulfilling priority one, move to priority two. This requires constant maintenance of situational awareness. Where is the patient on their workup continuum in terms of labs, imaging, and treatment? Are there delays in lab or imaging return? If so, look into it. Is the workup complete?  If so, call for the admission, consult the consultant, or discharge the patient with clear and explicit follow-up and return to ED instructions.

Priority Three: Busy work! Stapling the scalp laceration, sedating the patient for hip reduction, eating/bathroom breaks, and documentation. Quick work on documentation – consider it part of the patient encounter. And when your care of the patient is complete so too should be the documentation. Plain and simple, that’s just good patient care! You are nowhere near as accurate with important and specific detailed information as you are when you are caring for the patient at the time the care was provided. How does one become more efficient with documentation?  Figure it out. This will be vastly different for everyone and will be based on personality and available resources (scribes, dragon, phone dictation, sandscript, etc). There are abundant resources in departments and online for appropriate and timely documentation – use them!

Keith Henry

Image 4: Celebrating with one of my residents after a busy evening after “running the shift.”

More Wellness

Any and all feedback is welcome as we continue this series! We would be happy to hear from you, especially if you have specific wellness resources to share, would like to be featured, or are interested in hearing from any particular EM rockstars. And if you missed them, check out our other “How I Stay Healthy” posts.

Keith Henry, MD

Keith Henry, MD

Director of Medical Student Education
Department of Emergency Medicine
Regions Hospital
St. Paul, MN
Keith Henry, MD

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