I asked Dr. Walter Himmel to give a talk at EM Cases Summit 2021 on what he has learned in 40 years of practice. Herein lies his profoundly thoughtful answer, that is especially relevant during the COVID pandemic –  a special edition EM Cases video podcast of his live presentation at The Summit…

Podcast production, sound design & editing by Anton Helman

Written Summary and blog post by Walter Himmel, edited by Anton Helman November, 2021

Cite this podcast as: Himmel, W. Helman, A. Managing Adversity with Walter Himmel. Emergency Medicine Cases. November, 2021. https://emergencymedicinecases.com/managing-adversity-walter-himmelAccessed [date]

Do not underestimate your power to help or to harm

What you do matters deeply. As a health care professional, every interaction you have with a living being has the power to improve or to harm. At times in a small way and, more often than realized, in a profoundly life-altering manner.

7 Habits of Highly Effective People. Stephen Covey

Emotional Intelligence. Daniel Goleman

Truth has many faces that must be understood in order to manage adversity

Opposites can be concurrently true.

The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.

– F. Scott Fitzgerald.

There are two essential fundamental truths in EM and in life:

(i) Intellectual: look at the facts and consider the truths that they bear out.

(ii) Moral: love is wise and hatred is foolish. We must learn to live together or we shall certainly die together (I suggest option one).

Bertrand Russell Message to Future Generations

Think probabilistically in medicine and life. Diagnostic decision-making is not a simple binary yes or no.

Emergency Medicine Decision Making: Critical Choices in Chaotic Environments. 2006. Weingart, Scott and Wyer, Peter

Everyone tells you what they expect but no one tells you how to fulfill those expectations

CanMEDS 2015 expectations for physicians in Canada

There are similar expectations for all health care workers, that you should be all of the following: professional, communicator, collaborator, leader, health advocate, scholar, and expert. Exactly how to measure and do all of this is not fully detailed.

How to fulfill the expectations placed on you

Two skills are required for a meaningful and satisfying 40-year career: empathy and curiosity.

Empathy so you don’t get angry and curiosity so you don’t get bored to death.

The fifth habit of the 7 Habits of Highly Effective People is “Seek first to understand, then be understood.”

“People need love the most when they deserve it the least.”

– Lou Holtz, football coach

Life satisfaction comes about through managing adversity rather than chasing happiness

Happiness is a momentary state and easily evaporates. A meaningful life and a life of satisfaction (a life of self-respect) is the product of managing adversity. Developing a high adversity quotient takes practice and planning and a philosophy that adversity produces growth. I tell my residents that they learn little or nothing when things go well. Failure is more likely to produce growth.

Antifragility is a more useful concept than resilience

Antifragile: Things That Gain From Disorder, Nassim Nicholas Taleb 2012

Adversity Quotient: Turning Obstacles into Opportunities, Paul G. Stoltz 1999

Empathy requires the ability to suspend one’s feelings while under attack. Practice and preparation are necessary.

System 1 and System 2 Thinking is applicable to more than decision making in the ED:

System 1 thinking is pattern recognition. System one is used most of the time, is efficient and usually correct but occasionally dead wrong.

System 2 is methodical, rational, and logical. This takes work and preparation. It only occurs in a clear mind. Such a mind only exists when one suspends one’s feelings and is intellectually humble. Intellectual humility is the ability to consider that you could be wrong and totally so. Then by suspending one’s certainty, one can begin to think more clearly and in a manner free from pre-existing beliefs and assumptions.

Thinking Fast and Slow. Daniel Kahneman
Peak Mind. Amishi Jha How to focus and protect your working memory.

Seeking knowledge mandates reading and exposing oneself to completely opposing views and opposing sources of information. Partially because of the internet and social media, one is at risk of being exposed to biased and monolithic views. Seeking and studying inputs you don’t like is becoming a necessary skill to developing a more balanced concept of the world.

Cynefin framework to help manage adversity and complexity

Life and Emergency Medicine present eclectic problems. Some issues are simple, some complicated, some complex, and some chaotic. The inability to recognize the difference produces clouded thinking and polarized relationships.

Cynefin Framework Wiki

A leader’s framework for decision making, Harvard Business Review (2007) Volume 85, Number 11.

Preparation and practice, empathy and logic, and the capacity to suspend one’s assumptions and feelings are the powerful tools for a good career and life. However, it takes practice on a daily basis and considerable planning and learning in advance.

For streaming access to all the talks, procedural videos and rants from EM Cases Summit 2021 from Nov 2021-Feb 2022 visit emcasessummmit.com

Drs. Helman and Himmel have no conflicts of interest to declare