The practice of emergency medicine (EM) is consistently challenging. At any given moment during a shift, emergency physicians are responsible for making numerous decisions about multiple patients. Many of these decisions are time-sensitive, some a matter of life or death. Physical, intellectual, and spiritual fatigue can set in during or after a shift. Our consultants, clinic physicians, or hospital administrators rarely understand the roller coaster we ride. Out of necessity, those of us practicing EM look for ways to navigate the peaks and valleys that make up the natural rhythm of the emergency department.
I was recently celebrated for more than 30 years practicing EM in the same ED. Following this virtual luncheon, one of my talented new colleagues (David Cisewski, MD) asked me to share my secrets for longevity and career success. I figured others might be interested as well, so I crystalized 20 tips for emergency physicians (and perhaps all physicians) looking to achieve more joy, professional satisfaction, and wellness throughout their careers. I’ve separated them into 3 categories: Attention to Self, Mastery of Skills, and Finding Joy and Purpose.
Attention to Self
- Change your attitude from “woe is me” to “WOW is me” (Pearls from the Practice of Life). Dr. Peter Rosen used to say “Nobody woke up this morning and decided to ruin your day. Don’t get angry at your patients… Happiness is your choice.”
- Be positive whenever possible. Bring a positive attitude to the ED every shift. Start each day (or at least each shift) by asking yourself “Will I make war or peace with this day?”
- Nurture your health. Focus on and improve your diet, exercise, sleep, and spiritual wellness. Avoid drugs, tobacco, alcohol, energy supplements, and soporifics. Protect your time off, and schedule time for activities such as reading or exercise. Make time to connect with family and friends, as social isolation and loneliness put your health at risk. Some people now refer to these as the “new smoking” (Together: The Healing Power of Human Connection in a Sometimes Lonely World, also Relationships #8).
- Practice mindfulness. Some form of daily meditation, yoga, relaxation, or self-reflection such as journaling (which does not mean posting on social media) is beneficial. The proper use of and participation in the right social media groups and networks can provide support for some physicians. The positive effects from these activities can be present throughout your shifts, and often contribute to wellness and better sleep.
- Know when you need help. When you need help, get it without feeling shame or guilt. Seeking help is a sign of strength, not weakness. This must be a cultural shift in EM (and the medical profession in general). The more normalized that seeking help becomes, the better for us, our patients, our colleagues, our friends, and our families. Despite being trained to act heroically, we are nevertheless human and need (and deserve) support.
Mastery of Skills
- Work to improve your technical, communication, leadership, efficiency, delegation, charting, and relationship skills. Embrace beginner’s mind – there is always something new to learn. Commit to developing emotional intelligence (EQ), which is as critical to your success, longevity, and mental well-being as are the technical skills you learned in residency.
- Learn continuously. Every patient, consultant, EM colleague, advanced practice provider, nurse, and staff member has something to offer. Learn from reading textbooks and the medical literature. Discover what leaders in our field or at your medical center think or believe. Attend lectures and conferences related to EM or other areas of interest (including non-medical topics) to develop your intellect. Grow your knowledge base. As a bonus, you will have more interesting things to discuss with others.
- Relationships matter. Nurturing and cherishing them will help you feel satisfied during your career and throughout life. Foster and maintain healthy professional relationships. Get to know your co-workers in the ED. In addition, network with people outside of the ED (physicians and non-physicians). Always make sure to strengthen and prioritize relationships with your family and friends. Disengage from and avoid toxic relationships.
- Show interest in others. Be curious about what’s important to them, their lives, their families, and their interests. This gives your mind and heart a needed break from all things EM. Plus, it is the right thing to do and the best way to live.
- Develop good listening skills and show empathy. Understanding empathy (and being good at using it) will not only help you in your practice, but also with your relationships.
- Connect with patients and their stories. See your patients as people with lives outside of the ED. Patients are not just the “abdominal or chest pain in room 10.” (A Piece of My Mind. Gomer, JAMA 2004 and The Name of the Dog, NEJM, 2018).
Finding Joy and Purpose
- Celebrate your successes (even small ones) and your good fortune. Consider changing how you “define” success if your current definition doesn’t make you happy.
- Take one day at a time and, when possible, one moment at a time. Look forward to the future but immerse yourself in the present.
- Take pride in your work, your training, and your skills. Don’t lose confidence when you make an error. Instead, assume responsibility for your errors and don’t blame others. There are no failures, only growth opportunities. Commit to learning from your mistakes and from the mistakes of others.
- Work hard with intentionality and purpose.
- Remind yourself of the privilege and honor to care for patients who neither choose you nor have a prior relationship with you. Patients and their families are often afraid or have problems that they simply can’t handle without help. Be humbled by their courage to seek help, and that they’ve placed their trust in and hopes with you.
- Mentorship. Seek mentoring early from experienced, trusted faculty who will commit to your success with passion, integrity, and confidentiality. Mentors do not all need to be from your discipline, of the same gender, or of similar training, cultural, or socioeconomic backgrounds. It is reasonable to have more than one mentor supporting your growth. Throughout your career, keep in touch with mentors, and add new ones as necessary. When you are ready, take on the responsibility of serving as a mentor to “give back” to a colleague. (Mentoring in Emergency Medicine, Ch. 4, in Practical Teaching in Emergency Medicine, 2nd ed).
- Look forward to each patient and each shift as an opportunity to “cure sometimes, treat often, and comfort always” (Hippocrates).
- Express gratitude and offer sincere thanks. Think about thanking at least one person each hour. This doesn’t have to only be for major things; it can be for simple things and can be directed to anyone – patients, families, nurses, consultants, staff, colleagues, EMS personnel, and environmental services who clean up after us. Be sincere and specific with your gratitude. Even better, use people’s names as a show of respect.
- Keep a happy folder on your computer and establish a happy “area” in your office or home that has patient cards, gifts, perhaps your diploma, any recognition or important mementos, family items, and inspiring photos, quotes, or books. These items will likely make you smile, so refer to them regularly or as often as needed. Honor the impact you’ve had on others.
I hope these pearls help readers enjoy long and productive careers. I recommend reviewing the modern version of the Hippocratic Oath from time to time to remind yourself of medicine’s greater purpose. I also suggest Viktor Frankl’s book Man’s Search for Meaning. Although somber at times, Frankl beautifully relays the significance of finding meaning during life’s most challenging experiences. Our work in EM and healthcare in general is demanding, difficult beyond description, yet remarkable. As such, it has the potential to transform us in meaningful and lasting ways. I wouldn’t trade my last 30+ years in EM for any other profession despite the exceptional focus and effort it requires. Only by challenging ourselves do we learn the depth and breadth of what’s in our hearts. I hope that everyone reading this is fortunate to feel similarly about their career choices and clinical practices.
Good luck with your careers!
(special thanks to Laura)
As we submit our responses to the daily health screen for the thousandth time; realize, after having removed a mountain of PPE and sanitized our hands, that we left our phone in the patient’s room and would need to re-don everything; repeatedly observe the inevitable struggle with mute/unmute on Zoom; with all of these regular tasks and activities enveloping our lives these days, it’s hard to feel creative. Is the practice of emergency medicine a creative endeavor? How can we increase not just our creative or scholarly output, but also our internal sense of artistry and creation?
Podcast Preview of the Book
Brief Summary of Book
In Keep Going: 10 Ways to Stay Creative in Good Times and Bad, Austin Kleon attempts to answer this question (somewhat prophetically, given the book’s 2019 publication)– how can we, even in trying times, continue to nurture our creativity? Throughout the engaging, full-of-art book, Kleon outlines his argument for how, regardless of occupation, each of us can thrive in our creation of new, meaningful output:
- Every day is groundhog day.
- Build a bliss station.
- Forget the noun, do the verb.
- Make gifts.
- The Ordinary + Extra Attention = Extraordinary
- Slay the art monsters.
- You are allowed to change your mind.
- When in doubt, tidy up.
- Demons hate fresh air.
- Plant your garden.
Although Kleon himself writes and draws for a living, his suggestions are also applicable to the practice of emergency medicine, especially for those of us who are in academic, educational, and leadership positions and who need to constantly be creating to stay afloat. The book has an almost Zen quality to it, centering around mindfulness and reframing how we experience the life in front of us, rather than focusing ourselves on chasing an unachievable ideal or becoming absorbed by the mundane. For example, when we’re feeling a creative block, Kleon suggests that we set aside time to draw, like a child does, applying instrument to medium simply to enjoy the process and without an end product in mind– he writes:
“Drawing is simply another way of seeing, which we don’t really do as adults… we’re all going around in a cloud of remembrance and anxiety… and the act of drawing helps us live in the moment and concentrate on what’s really in front of us.”
A cloud of remembrance and anxiety! Yes! That is what the past year has felt like.
If you’re looking to rise out of your personal cloud of remembrance and anxiety, and explore how to infuse your career with creativity to just Keep Going, come join us for the next version of The Leader’s Library! All leaders (past, current, and future) in emergency medicine, of all professions and all locations, are welcome to participate. The book is short and full of drawings, so don’t worry that you won’t have time to read. This will be the most playful and fun iteration of TLL yet! Can’t wait to create with you!
Book Discussion Group
When: May 25-27, 2021*
Platform: Slack app
Size: 40 registrants
* The Leader’s Library runs asynchronously on the Slack app– jump in whenever you have time!
Deadline to sign up: May 9, 2021
- Submit your interest form with your contact information.
- We will inform you if you’re selected by May 10, 2021.
We would absolutely love to learn and grow with you. Sign up now to secure your spot!
- Felix Ankel, MD: Emergency Physician, Regions Hospital. Medical Director, Education, HealthPartners Institute, Professor of Emergency Medicine, University of Minnesota Medical School (@felixankel)
- Nikita Joshi, MD: Emergency Department medical director, Alameda County Medical Center, Oakland, California (@njoshi8)
- Peter Tomaselli, MD: Assistant Residency Program Director, Emergency Medicine, Thomas Jefferson University Hospital/Sidney Kimmel Medical College, Philadelphia, Pennsylvania (@pjtomaselli)
- Victoria Brazil, MD, MBA: Medical Director of Goal Coast Simulation Service; Co-Producer of Simulcast and Harvard Macy Institute podcasts, Emergency Physician, Bond University (@SocraticEM)
- Dina Wallin, MD: Assistant Medical Director of PEM, San Francisco General Hospital; Director of Didactics, UCSF-SFGH EM residency, San Francisco, California
Learn more about the other Leader’s Library book clubs.
Listen to all of The Leader’s Library podcasts
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