Earlier this year, I traveled to Tokyo, Japan for an electrophysiology conference and was struck by the sense of honor, work ethic and politeness displayed by everyone I met. It was humbling to have strangers frequently greet me with a bow and everywhere I went was sparkling clean. The people there clearly cared deeply about the well-being of others, and this experience left a memorable impression on me as I was forced to reflect and contrast my everyday environment.

As cardiology Fellows in Training (FITs), we spend an inordinate amount of our lives at work. Therefore, its influence on our well-being can be dramatic. On top of this, we may have experienced an insensitive boss or co-worker that makes our work lives feel like hell. We may have also experienced a patient, open, supportive and empathic leader or colleague who makes us feel like anything is possible. I imagine most would prefer the latter.

Christine Porath, PhD, associate professor at the McDonough School of Business at Georgetown University, and Christine Pearson, PhD, professor of global leadership at the Thunderbird School of Global Management, researched the cost of incivility in the workplace. They conducted a poll of 800 managers and employees from 17 industries and found that of those subject to uncivil behavior:

• 48 percent intentionally decreased their work efforts
• 47 percent intentionally decreased the time spent at work
• 38 percent intentionally decreased the quality of their work
• 80 percent lost work time worrying about the incident
• 63 percent lost work time avoiding the offender
• 66 percent said that their performance declined
• 78 percent said that their commitment to the organization declined
• 12 percent said that they left their job because of the uncivil treatment
• 25 percent admitted to taking their frustration out on customers

Furthermore, they found that survey results and interviews indicate that simply witnessing incivility has negative consequences. Witnesses to incivility were found to be less likely than others to help out, even when the person they would be helping had no apparent connection to the uncivil person; only 25 percent of the subjects who witnessed incivility volunteered to help, whereas 51 percent of those who had not witnessed it helped out.

These numbers are astounding! In our very demanding careers as FITs, having a toxic work environment makes success even more challenging. So how do we maintain our sense of well-being and purpose-driven work that thrives in this type of environment? Unfortunately, many times we may not be able to change our external environment but rather adapt internally, which may be extremely difficult. Also as FITs, we do not always have the authority to make significant changes within our work place. Yes – we always have a voice and we are encouraged to use it. However, systemic change sometimes takes a long time to happen. In the meantime, I believe there are four tools that may help alleviate some of the challenges involved in this process:

1. Patience: This may seem like the last thing we want to do when placed in a highly-charged and demanding field such as cardiology. However, I have found that when faced with difficult situations at work, simply having the patience to actively wait it through has produced invaluable positive results both personally and collectively. Sometimes my greatest learning opportunities have been accomplished through this process. On the flip side, I have seen where a lack of patience achieves the opposite results desired, leaving things worse than they began. For example, I have been in intense interventional and electrophysiology cases where tempers may be understandably short while dealing with potential complications. Funny enough, being patient in these types of circumstances has enhanced my learning and actually made such procedures smoother. Of course, an urgent temperament is required for acute situations, but somehow keeping a "cool head" seems to make things work better, safer and faster.
   
   
2. Openness: Cardiology may be considered by some to be an egocentric field where vulnerability may not always be seen as a strong quality. However, it may actually improve trust in relationships and help build rapport with peers and colleagues. Being open can make for better teams that work efficiently towards a common worthwhile goal. For instance, I am usually fortunate to have a great inpatient telemetry team with superb interns, residents, co-fellows and attending cardiologists. We maintain professionalism at work, but at the same time we are open to sharing a good laugh from our private lives. Sometimes we buy a good meal and share together or meet up for events such as celebrating birthdays. We are also honest with each other regarding patient care and admit when we do not know something and need help. This relationship makes our rotation a pleasant and productive one, despite the large workload.
   
   
3. Support: This not only means support from family and friends but also from those at our workplace, where we spend so much of our lives. How does this look practically? It starts with first being a support to others. Generosity may sometimes be underplayed due to fear of being taken advantage of. Of course, we should always have our personal boundaries. Nonetheless, I believe in the age-old adage that states, "Give and it will be given back to you..." Not that the purpose of our giving is to receive, but instead there is the potential for great joy and fulfilment in doing it! This may also be the reason many of us chose to serve as cardiologists. I have found that the more generous I am, the more support I receive, creating a positive reinforcing cycle – the gift that keeps on giving.
   
   
4. Empathy: For me, empathy is viewing others through non-judgmental eyes – accepting others around me for who they are and then trying to imagine why they act and think the way they do. There are behaviors that are never acceptable despite how understanding you are of the person conducting them. In general, however, being empathetic may help distil fears regarding another person's actions and make you more favorable towards them. This sometimes helps to build camaraderie at work in a way that make tasks run all the more smooth and efficient.

With these tools in hand and those provided by the ACC, we will help create and maintain the type of nurturing environment in which our careers may flourish both individually and collectively. Most importantly, it may translate in the end to better care for our patients who suffer from cardiovascular diseases.

This article was written by Edinrin Obasare, MD, Fellow in Training (FIT) at Albert Einstein Medical Center in Philadelphia, PA.