Falling Back in Love with my Emergency Mind

In 2017, Annals of Emergency Medicine published my article, Falling Back in Love with Emergency Medicine. The essay focused on practical strategies for better shifts to decrease burnout. Fast forward to 2021, and nearly a year after the pandemic began, I was burned out again. It was the first time that I seriously considered leaving emergency medicine which sparked a transformative period of introspection and growth that changed the way I see our profession. As burnout reaches epic proportions, and COVID-19 persists, I aim to provide a glimmer of light and a path for my colleagues that are also at risk, experiencing and recovering from burnout:

1. You have a license to practice medicine. This license affords you many opportunities to do work that you likely did not train to do in residency. Yet, you are an intelligent human that has the capacity for endless learning. My first position outside the traditional ED involved doing telemedicine. While there are a lot of bread-and-butter complaints similar to what I saw in emergency medicine, there were different complaints, that I had little knowledge of how to work up and treat. I learned that my anxiety was not about treating non-emergent conditions, it was about not knowing, or the perception of not knowing in front of a patient. Most patients, even in the age of Dr. Google, are genuinely happy to have access to a physician. I am transparent about my educational background, and I suggest a path forward, which has universally been well received.
2. Emergency medicine residency is a mindset, not a place. Lately, mainly on social media, there is a lot of demonization and undercutting of our colleagues that work in non-traditional settings. This must stop. Every colleague that completed residency gained access to the expertise of emergency medicine, wherever we practice and whatever we do, we bring our emergency mind to that setting. When I was in the Navy, I trained small resuscitation teams to resuscitate and perform damage control surgery in tents and unusual locations such as hotel rooms. My surgeon colleague said, “Resuscitation is a mindset, not a location.” It’s time we recognize and celebrate that our training is a mindset that can inform all sorts of facets of medicine and other industries. We are excellent at prioritization, a skill that is vastly important in a complex world with new challenges every day that require re-prioritization and leading teams to tackle these problems. Let’s celebrate the EM physician that becomes the CEO of a hospital system, works in urgent care, public health, really anything. Everything we do is improved by our background in emergency medicine. This is vital as we prepare for the transformation in medicine that is alluded to by the EM workforce report. Part of the solution to the workforce report must be expanding our scope of practice beyond the traditional emergency department. We must provide opportunities for EM physicians in practice to learn and gain new skills to prepare for the changing landscape.
3. We are not superheroes; we are humans that deserve humane working conditions. Perhaps one of the most damaging, although well intentioned labels that came from the pandemic was healthcare heroes. This term had been weaponized to make us feel that working without the necessary PPE was heroic, seeing more patients than what is safe and reasonable is what we do, and taking time off for rest and illness is weak. This must stop. We are human. The time is now for a transformation in how we support each other to ensure adequate sleep, rest and safe working conditions.
4. Empathy is not enough. While empathy is a crucial component to meaningful patient interactions, it is only part of the equation. Empathy is the ability to understand and share the feelings of another. Compassion requires empathy and adds the action to help. There is emerging research that empathy can trigger our pain pathways in our brain, while compassion, linked to an action can trigger our reward pathways! Along with emphasizing compassion, emotional regulation is crucial. Boundaries that promote our well-being increase our capacity for emotionally regulation. High emotional regulation and high empathy promote protection from compassion fatigue.
5. Our identity is more than our profession. There is extreme risk when we inextricably link our personal identity with our professional identity. We have seen throughout the course of this pandemic, that even emergency medicine is not impervious to scarcity and the potential for reduced hours and pay. Our colleagues have died from COVID-19. Others have left due to physical or mental illnesses. We have lost colleagues to suicide. Physicians are at higher risk of suicide than other professions, and we lose the equivalent to a medical school class, approximately 300 physicians, to suicide each year. I can’t help but thinking that some of these suicides must be linked to an outsized emphasis on us as physicians instead of whole people. We must encourage and cultivate pursuits outside of medicine. We must support and encourage physicians to practice in various environments that allow them to thrive. We must stop providing narrow career paths that working in the busiest, hardest ED is the only “real,” path for “real EM docs.” To all my friends that have paved new roads inside or outside of medicine, I respect and support you. To paraphrase Maya Angelou, it was never about where you worked, it was about how you made those feel around you.

As I recover from this last episode of burnout, I return to a blended practice of telemedicine, simulation education, and, yes, some traditional emergency medicine. I return rested, a more wholehearted person, and more understanding of myself and my colleagues. As we navigate the pandemic and the challenges related to the EM workforce report, may we practice self-compassion and compassion for our colleagues. You are enough, wherever and whatever you’re doing.

Falling back in love with medicine is a journey. Coaching can be a powerful catalyst to begin and speed up your progress. Schedule a coaching strategy call today.

Acknowledgments: Inspiration for this article came through conversations with Dr. Linda Lawrence, https://www.peoplealwayshcc.com/, Dr. Naomi-Lawrence Reid, https://doctoringdifferently.com/, Dr. Dan Dworkis, https://www.emergencymind.com/ and Sharee Johnson, https://www.coachingfordoctors.net.au/.

References:

1. Austin AL. Falling Back in Love with Emergency Medicine. Ann Emerg Med. 2017;70(2):255-256. doi:10.1016/j.annemergmed.2017.01.025
2. Marco CA, Courtney DM, Ling LJ, et al. The Emergency Medicine Physician Workforce: Projections for 2030 [published online ahead of print, 2021 Aug 2]. Ann Emerg Med. 2021;S0196-0644(21)00439-X. doi:10.1016/j.annemergmed.2021.05.029
3. Xiong RC, Fu X, Wu LZ, et al. Brain pathways of pain empathy activated by pained facial expressions: a meta-analysis of fMRI using the activation likelihood estimation method. Neural Regen Res. 2019;14(1):172-178. doi:10.4103/1673-5374.243722
4. Kawamichi H, Tanabe HC, Takahashi HK, Sadato N. Activation of the reward system during sympathetic concern is mediated by two types of empathy in a familiarity-dependent manner. Soc Neurosci. 2013;8(1):90-100. doi:10.1080/17470919.2012.744349
5. Brown, B, David, S. The Dangers of Toxic Positivity. Dare to Lead. 2021. Available at https://brenebrown.com/podcast/brene-with-dr-susan-david-on-the-dangers-of-toxic-positivity-part-2-of-2/
6. Matheson, J. Physician Suicide. https://www.acep.org/life-as-a-physician/wellness/wellness/wellness-week-articles/physician-suicide/