Wellness and Resiliency during Residency: EM is a career with unresolved stories

2017-05-22T14:16:43+00:00

“We do make a difference, but not just in the setting of resuscitating critically ill or injured people, but in putting people on the pathway to health. We often get cheated out of the ending of the movie. We don’t see the romantic side of what we’ve helped facilitate. We certainly don’t get credit for it.” – Dr. Richard Cantor

wellness and resiliency think tankThere are lots of reasons why Emergency Medicine (EM) has one of the highest burnout rates compared to other medical specialties.1,2 We have long and erratic hours, difficult patients, and an increasing number of bureaucratic tasks such as clicking boxes in an electronic medical records system or ensuring high patient-satisfaction survey responses.2 These stresses are not unique to EM, but our high-volume and high-acuity patient loads do amplify those stresses compared to other fields.

Why does getting the rest of the story matter?

EM does have one unique problem though. We never get to see the end of the story. It’s like running out of battery when we’re watching a movie on a long plane flight. We can hope that eventually the good guys win, but rarely do we get the chance to find out for sure. This has real consequences for our job fulfillment. Other specialties get to see their patients walk again, talk again, and often get the thanks and gratitude from families that comes with recovery. We don’t even get to see the outcome of basic laceration repairs. It’s easy to start believing that nothing that we do matters. Thinking like this leads down a slippery slope toward burnout, job dissatisfaction, depression, and a desire to leave EM.

We need 3 things in life to feel fulfilled through the lens of self-determination theory: 3

  1. Autonomy
  2. Competence
  3. Social relatedness

In other words, we need to feel independent, we need to feel that our actions are effective and have consequence, and we need to feel connected to other people. It’s hard to feel competent when we’re not sure if our patient survived the night upstairs in the ICU. We can be the popular cowboy ED doc with all the independence and friends in the world, but it’s hard to feel fulfilled when we’re not sure if our medical decision-making actually made a difference for our patients.

What can I do to feel more fulfilled in EM?

The easiest solution is the simplest one. We need to go upstairs or pick up the phone. Come early to our next shift and visit our patients and their families in the ICU or on the medical floors. Call them the next day after we discharge them from the ED. Ask, how are you doing? Offer support, reassurance, and condolences. Celebrate small victories with them. The patient and us will benefit.

Not all of us will be as lucky as Dr. Cantor and get the chance to hug the small child whose life we saved, 2 decades later after she became a nurse. But we are all lucky in the sense that we save lives every shift. We resuscitate critically ill patients and snatch them back from the brink of death. We help people to stop abusing their bodies and give years back to their lives. And maybe one day, we’ll inspire that 10-year-old with the distal radius fracture to become a doctor who will then go on to heal hundreds of other people. Just like we do every day.

What you do makes a difference.

Featured podcast with Dr. Richard Cantor

Listen to Dr. Richard Cantor, one of the keynote speakers at the upcoming Essentials of Emergency Medicine Conference on May 16-18th, 2017, share what has helped to build his own resilience and sustain him through his long and fulfilling career as a master clinician and educator.

Help make a difference at Essentials of EM next week

If you’re an EM resident, join us on May 15th, 2017 at the 16th annual Essentials of Emergency Medicine (EEM) educational event where residents from all over the country will converge for the first-ever Resident Wellness Consensus Summit (RWCS) to innovate real-world solutions to physician wellness issues just like this one. The RWCS is jointly sponsored by EEM, Emergency Medicine Residents’ Association (EMRA), and ALiEM.

RWCS is an on-site only event for EM residents, included in your Essentials of EM 2017 Resident registration. Can’t make it to Vegas? You can still experience the rest of the Essentials education from home at the amazing rate of $249 as an EMRA member. Simply register at EMRA’s Hippo Education page.

1.
Shanafelt T, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385. [PubMed]
2.
Medscape Lifestyle Report 2017: Race and Ethnicity, Bias and Burnout. Medscape. http://www.medscape.com/features/slideshow/lifestyle/2017/overview#page=1. Published January 11, 2017. Accessed May 10, 2017.
3.
Ryan R, Deci E. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68-78. [PubMed]

Arlene Chung, MD

Arlene Chung, MD

Chief Strategy Officer,
2016-17 ALiEM Wellness Think Tank
Assistant Professor of Emergency Medicine
Assistant Program Director
Mount Sinai Emergency Medicine Residency
Editor, AKOSMED (EM wellness blog)