You’ve noticed that a colleague has been under stress and isn’t her usual self. You’re concerned, but how can you approach in a productive, constructive way that doesn’t prompt a backlash or shutdown?

It doesn’t come naturally for most people, physicians included, who were raised in an American culture.

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“A respectful check is really one of the more difficult and challenging steps for individuals, in part, because we learn socially in the United States that if somebody is having a bad day, give them their space or leave them alone. So, we have very little skill in our society of respectfully engaging somebody who is in distress,” said Richard Westphal, PhD, co-director of the Wisdom and Wellbeing Program at the University of Virginia School of Nursing in Charlottesville.

Westphal co-created the AMA STEPS Forward™ toolkit, “Stress First Aid for Health Care Professionals,” which helps you learn how to use the OSCAR communication strategy to check in respectfully with a co-worker who is showing signs of a stress injury. This kind of injury goes beyond burnout and is any severe and persistent distress or loss of ability to function caused by damage to the brain, mind or spirt after being exposed to overwhelming stressors such as fatigue, trauma, loss or moral injury.

The toolkit also outlines the stress first aid framework and helps physicians and others in health care recognize and respond early to stress injuries, and manage them as one would any other injury. The peer-support and self-care model that health systems can provide to improve self-care is based on years of research. It is practical, flexible and tailored to specific styles and needs of those involved in recuperating from stress injury.

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The OSCAR communication strategy is one tool that can help you preform the first step of stress first aid: Checking in with someone.

“It doesn’t lay blame or shame. We call attention to the behavior. We say: Help me understand what is going on,” Westphal said. “Why that is so powerful is that if I say, ‘Help me understand as a peer,’ I am putting right up front that I’m ignorant in some way so I can’t pass judgment.”

Here’s how to use OSCAR, which is acronym for each of five key steps to follow.

Observe. Watch the colleague’s behaviors and look for patterns. Ask yourself if your colleague is more sullen, withdrawn, frustrated or irritable than usual.

State your observations. Summarize the facts without interpretations or judgments. For example, you can say, “I have noticed over the past few days that you seem ...” lost in thought, quiet, frustrated or irritated—as befitting what you are noticing.

Clarify your role. State why you are concerned about the behaviors and validate why you are addressing the issue. “As a [co-worker, friend, supervisor], I am concerned.”

Ask why. Seek clarification and try to understand the other person’s perception of their behaviors. “Help me understand what’s going on. I would like to help if I can.”

Respond. Clarify concern, if necessary, and discuss desired behaviors. State options in behavioral terms. For example, you can say, “Thank you for trusting me enough to share that [state the issue]. I really do want for you to be comfortable working together. I respect your privacy and that you have a lot going on. If not me, would you be willing to talk with [names of two trusted resources?]”

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Once you’ve talked with a co-worker, connecting them with additional support is critical.

“Doing nothing tends not to work with stress injuries,” Westphal said. “The solution for stress injuries is getting connected to additional resources. It’s not always mental health. Sometimes we just need a little help in the moment. It may be financial ... it may be finding a concierge service to come clean your car while you’re in the clinic after your child was sick … because you just don’t have time.”

The AMA STEPS Forward open-access toolkits are part of the AMA Ed Hub™️, an online platform that brings together all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards.

Learn more about AMA CME accreditation

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