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I completed my medical school and background EM training from India (Christian Medical College, Vellore and Apollo Hospitals, Hyderabad) where I worked for 4 years. Following this, I devoted (with all my heart) about 1.5 years to do US Medical Licensing Exams. My stint towards an EM Residency in States did not work but it took me to places and it has been quite a journey. I then relocated to London, England to work as a Registrar (Non-Trainee) in A&E. This gave me an opportunity to better understand NHS, EM training pathways and more importantly the EM Mindsets in the United Kingdom. 

Currently, I am pursuing Higher Specialist Training in Emergency Medicine at South East Scotland Deanery where I have the honour and privilege of training under some of the most innovative brains in the field of Emergency Medicine. Over the past few years, I have realised that LEARNING and UNLEARNING (which can be challenging!) is equally important to deliver cutting edge care to our patients.And through this blog, I aspire to disseminate knowledge, assist trainees with exams and stay up to date with contemporary EM literature. I have always been an avid FOAMed supporter because FOAMed has always played an indispensable role during my training. 

Lakshay Chanana
ST4 EM Trainee 
Edinburgh, Scotland

Monday, July 4, 2016

Fostering a culture of appreciation in the ED

The deepest principle of human nature is the desire to be appreciated. Whether it is the CEO of an institute or the housekeeping staff, everyone seeks appreciation for the work that they do. Knowing that our efforts have been recognized and appreciated makes us feel valued. Conversely, without appreciation we can feel taken advantage of, leading to negative reactions. Research suggests that people who feel appreciated are more productive, have greater levels of job satisfaction. Other benefits include more fulfillment, more positive attitudes, decreased stress and burnout.

While teaching children, preceptors make encouraging comments frequently, to make children feel appreciated, reinforce the good behavior and expedite the learning process. Parents praise their children for every effort but this is not done with colleagues at our workplace. Why not? Adults are no different. Self-esteem in kids as well as in adults contains a large component of internalized appreciation. A pat on the back makes individuals feel good and content about themselves and pushes them to achieve more.

This is something that we need incorporate in Medicine (esp. Emergency Medicine). Getting appreciation from colleagues is a rare sight due to a multitude of reasons. But a few words of appreciation can make our day. Also, lack of appreciation is the number-one reason for burn-out and people changing jobs. 

Feeling appreciated is an extremely strong emotion that makes a tremendous difference to relationships. For instance, your rapport with the consulting physician matters a lot when you ask for a consult in the ED. Healthy relationships are in fact build on appreciation. A personalized recognition of someone’s efforts, in a meaningful way to that individual, can make them feel encouraged. It lifts the morale and is a motivation tool that inspires to take that extra effort striving for praise once again. 

Components of Effective Appreciation

  • Expressive Action (What you do to express gratitude)
  • Inner Attitude (How you felt by a person's actions)

This needs to be done consciously at least in the beginning. People can easily make out the difference between a truly "heartfelt thank you" and an "insincere thank you".

Ways of showing appreciation

1. Saying Thank You - Using words like Please, Sorry and Thank You is important to be courteous towards individuals. But, get rid of the NAKED Thank You. Whenever you express gratitude, tell people about the resulting benefit they created for you and make it more meaningful. Make an extra effort to complete this statement. Don’t just say “THANK YOU”, instead, add the emotion about how you felt and how their act changed things for you. For instance, when you request a colleague to relieve you from work an hour before. Rather than saying an insincere Thank you, consider this

It is very kind of you for being so considerate and showing up early even after working last night. I truly appreciate that. This is going to make things very easy for me today. 

If an attending/ consultant teaches you about a topic following a hectic shift, he just gave you a few minutes of his lifetime. Be thankful to him for doing that.

2. Gifts - The price of the gift is not important here, it is all about the THOUGHT. Everyone likes to enjoy good food. So it is one good way of doing this. You know how it feels, when someone shows up with a box of doughnuts in the midst of a HANGRY (Hungry + Angry) shift! 

3. Publicly acknowledge people for what their work - This makes people feel recognized and also shows others what to aspire to. For instance, if a resident performs a difficult airway, taking 30 seconds and praising him during the next didactic session is going to  make him feel worthy and boost up his confidence. 

This works on the principal of mutuality i.e. the exchanging of actions.  In regard to commendation, that person would be pushed to do more for the former person and aspire for more.

4. Make your appreciation personal - Be specific as it makes people feel being heard, lifted up and understood. Rather than making cliche statements, be clear and candid. Tell them how they impacted your life, what you admire about them. It tells them that you actually spent some time thinking about them.

5. Appreciate yourself - If you have difficulty in praising others then I recommend you to start doing it with yourself first. Perform at least one good deed every day to make you feel appreciated and think what could you do better tomorrow.

6. See what others are doing RIGHT - Rather than focusing on the negative in a person, look at the positive habits. Start acknowledging people regardless of the outcome of the task but recognize the efforts that have put in. 

7. Make “I” statements - It is about how they made you feel, it is not about the other person. So focus on "I" statements. Rather than saying "YOU are awesome", say "I always enjoyed working with you as you constantly checked on my work making me feel secure". Just saying YOU ARE AWESOME is pretty non-specific and meaningless. Using "YOU" statements might make people feel being judged, which is another reason to avoid it.

Further Reading:
Attitude of Gratitude – Showing Some Love in the ED


     Lakshay Chanana



  1. Excellent!!! we all budding ED physicians should adapt this couture to make our specialty more attractive and likeable.